UPSC Prelims Practice Questions — Health insurance sector records Strong growth momentum with premiums exceeding ₹1.2 lakh crore in 2024-25
Q1. The Insurance Regulatory and Development Authority of India (IRDAI), which regulates health insurance, functions administratively under which one of the following?
- A. Department of Financial Services, Ministry of Finance
- B. Department of Health and Family Welfare, Ministry of Health and Family Welfare
- C. Ministry of Corporate Affairs
- D. Department of Commerce, Ministry of Commerce and Industry
Q2. With reference to the statutory and institutional basis of insurance regulation in India, consider the following statements:
1. IRDAI was constituted as a statutory body under the IRDA Act, 1999.
2. The principal legislation governing the business of insurance in India remains the Insurance Act, 1938.
3. The headquarters of IRDAI is located in Mumbai.
Which of the statements given above is/are correct?
- IRDAI was constituted as a statutory body under the IRDA Act, 1999.
- The principal legislation governing the business of insurance in India remains the Insurance Act, 1938.
- The headquarters of IRDAI is located in Mumbai.
- A. 1 only
- B. 1 and 2 only
- C. 2 and 3 only
- D. 1, 2 and 3
Q3. The IRDAI Master Circular on Health Insurance Business issued on 29 May 2024 consolidated the regulatory framework by repealing how many earlier circulars?
Q4. Consider the following changes and identify those that are correctly attributed to the IRDAI Master Circular on Health Insurance (29 May 2024):
1. Reduction of the pre-existing disease waiting period to 36 months.
2. Reduction of the moratorium period to 60 months (five years).
3. A standard free-look period of 30 days for policies of a term of one year or more.
4. Final authorisation of a cashless claim at discharge within six hours of request.
Which of the statements given above is/are correctly identified?
- Reduction of the pre-existing disease waiting period to 36 months.
- Reduction of the moratorium period to 60 months (five years).
- A standard free-look period of 30 days for policies of a term of one year or more.
- Final authorisation of a cashless claim at discharge within six hours of request.
- A. 1, 2 and 3
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 3 and 4
Q5. With reference to the cashless claim timelines prescribed by IRDAI, consider the following statements:
1. An insurer must grant cashless pre-authorisation within one hour of receiving the request.
2. Final authorisation at the time of discharge must be granted within three hours of the hospital's request.
3. Where final authorisation is delayed beyond three hours, the additional hospital charges are to be borne by the policyholder.
Which of the statements given above is/are correct?
- An insurer must grant cashless pre-authorisation within one hour of receiving the request.
- Final authorisation at the time of discharge must be granted within three hours of the hospital's request.
- Where final authorisation is delayed beyond three hours, the additional hospital charges are to be borne by the policyholder.
- A. 1 only
- B. 1 and 2 only
- C. 2 and 3 only
- D. 1, 2 and 3
Q6. In the context of IRDAI's cashless health insurance norms, the prescribed 'one-hour' timeline refers to the maximum time within which an insurer must do which one of the following?
- A. Decide on a request for cashless authorisation made at the time of admission
- B. Grant final authorisation at the time of the patient's discharge
- C. Disburse the settled claim amount to the hospital's account
- D. Acknowledge receipt of a reimbursement claim filed by the policyholder
Q7. The National Health Claims Exchange (NHCX) is best described as which one of the following?
- A. A digital gateway under the Ayushman Bharat Digital Mission for interoperable exchange of health insurance claims data
- B. A government-funded assurance scheme providing health cover of ₹5 lakh per family per year
- C. A statutory authority that regulates the settlement of health insurance claims
- D. A registry of all hospitals empanelled under PM-JAY
Q8. Under the Ayushman Bharat Digital Mission, certain components are designated as 'gateways'. Consider the following and identify those correctly classified as gateways:
1. National Health Claims Exchange (NHCX)
2. Unified Health Interface (UHI)
3. Health Information Exchange–Consent Manager (HIE-CM)
4. Ayushman Bharat Health Account (ABHA)
Which of the above is/are correctly identified?
- National Health Claims Exchange (NHCX)
- Unified Health Interface (UHI)
- Health Information Exchange–Consent Manager (HIE-CM)
- Ayushman Bharat Health Account (ABHA)
- A. 1, 2 and 3
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 3 and 4
Q9. With reference to the health insurance sector in FY 2024-25, consider the following statements:
1. The health insurance premium volume crossed ₹1.2 lakh crore.
2. This reflected a year-on-year growth of about 9%.
3. Health insurance is regulated in India as a distinct line of life insurance business.
Which of the statements given above is/are correct?
- The health insurance premium volume crossed ₹1.2 lakh crore.
- This reflected a year-on-year growth of about 9%.
- Health insurance is regulated in India as a distinct line of life insurance business.
- A. 1 only
- B. 1 and 2 only
- C. 2 and 3 only
- D. 1, 2 and 3
Q10. With reference to the entities that underwrite health insurance in India, consider the following statements:
1. Standalone Health Insurers (SAHIs) are licensed to transact health, personal accident and travel insurance.
2. General (non-life) insurers are permitted to offer health insurance products.
3. Life insurers may offer benefit-based health insurance products.
4. Health insurance in India can be underwritten exclusively by standalone health insurers.
Which of the statements given above is/are NOT correct?
- Standalone Health Insurers (SAHIs) are licensed to transact health, personal accident and travel insurance.
- General (non-life) insurers are permitted to offer health insurance products.
- Life insurers may offer benefit-based health insurance products.
- Health insurance in India can be underwritten exclusively by standalone health insurers.
- A. 1 and 3
- B. 2 and 4
- C. 4 only
- D. 1, 2 and 4
Q11. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the government-sponsored health assurance scheme, is implemented by which one of the following?
- A. National Health Authority under the Ministry of Health and Family Welfare
- B. Insurance Regulatory and Development Authority of India under the Ministry of Finance
- C. National Health Mission under NITI Aayog
- D. Directorate General of Health Services under the Ministry of Home Affairs
Q12. With reference to the policyholder-protection framework for health insurance in India, consider the following statements:
1. A policyholder has the right to port the policy to another insurer carrying forward accrued credits.
2. Health insurance is recognised as a distinct line of non-life insurance business.
3. A moratorium period is provided, after which a claim cannot be contested except on grounds of established fraud.
4. Health insurance policies can never cover pre-existing diseases under any circumstances.
Which of the statements given above is/are NOT correct?
- A policyholder has the right to port the policy to another insurer carrying forward accrued credits.
- Health insurance is recognised as a distinct line of non-life insurance business.
- A moratorium period is provided, after which a claim cannot be contested except on grounds of established fraud.
- Health insurance policies can never cover pre-existing diseases under any circumstances.
- A. 1 and 2
- B. 3 only
- C. 4 only
- D. 2 and 4