Health Insurance Strictly For Internal Use Only

HEALTH INSURANCE
(6th Edition)
Supplementary Notes Version 1.1

Mock Exam

Prudential Assurance Company Singapore (Pte) Limited 1

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Health Insurance Mock Exam 1 Strictly For Internal Use Only

Mock Exam 1
C1/2.3
1. Ministry of Health has put together a "Healthcare 2020" Masterplan to improve healthcare
services for Singaporeans. Which of the following is not a strategic objective of this plan?

A. It is to ensure affordability of healthcare. • accessibility;

B. It is to enhance quality of healthcare. • quality;
C. It is to enhance accessibility of services. • affordability
D. It is to ensure transfer of healthcare costs to the insurers.

C1/4.3
2. Which of the following is not true regarding universal coverage provided by the Singapore
Government?.

A. Do not provide 100% subsidy to avoid over-consumption.

B. Compulsory healthcare savings through Medisave.
C. Risk Pooling via MediShield Life and Medifund.
D. Endowment fund set up for needy Singaporeans.

C2/2.9(a)
3. Daily Room and Board Charges are covered under Inpatient Expenses of a Medical
Expense Insurance Policy. Which of the following is NOT covered under Daily Room and
Board Charges?.

A. Accommodation
B. Meals
C. General Nursing Services
D. Medicines and drugs

C2/2.9(d)
4. Under the Medical Expense Insurance, Hospital Miscellaneous Expenses refers to the
services and supplies (other than room and board and general nursing care) furnished during
a hospital stay, and will usually include :

A. Short-stay ward
B. Operating room expenses
C. Intensive care unit
D. Surgical implant and prosthesis charges

C2/2.22
5. Mr. Tan is 45 years old and works as a bus driver. He lives in a one-room flat. Recently he got
into an accident and was hospitalised for 5 days in a "C" class ward of a government hospital.
The total hospital bill of $3000 as charged by the hospital is fully reimbursed by the insurer.
Which of the following insurance policy is most likely the one that he has purchased?

A. Disability Income Insurance

B. Hospital Cash Insurance
C. Medical Expense Insurance.
D. Critical Illness Insurance

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Health Insurance Mock Exam 1 Strictly For Internal Use Only

C2/3.6
6. Mr. Lim is buying a policy for himself and his wife and 2 children of the same premium each.
What is the premium payable given the following?.

Mr. Ang’s premium $182.31

Mrs. Ang’s premium $227.89
1 child’s premium $102.50

A. $512.70
B. $584.44
C. $615.20
D. $487

C2/6.1
7. The coverage for an insured person will terminate under Medical Expense Insurance
when____________.

A. the total amount of claims has reached the annual limit.

B. when the insured attains the maximum age of entry.
C. when the insured enters full time military service.
D. when the insured enters National Service Reservist Training.

C2/3.39
8. Paul has purchased a Medical Expense Insurance from Lion Insurance Company with the
following features:

Waiting Period: 90 days

Minimum Hospital Confinement Period : 72 hours

Which of the following scenarios would enable him to make the claim?

A. His right eye was injured and was confined for 24 hours at the hospital.
B. He was hospitalized for high fever 15 days after inception of the policy.
C. He fractured his ankle 12 days after the policy inception and was hospitalised for five
days subsequently.
D. He was diagnosed with cancer 2 months after policy inception.

C3/3.3
9. One advantage of contributory Group insurance plan is that the employer _________.

A. has greater control of the benefit structures and provisions.

B. has lower administrative work involved.
C. pays only part of the costs to provide the benefits.
D. does not need to monitor payroll deduction.

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C3/3.4 (table)
10. The most important factor for the underwriter when underwriting Group Insurance is
_____________.

A. Gender & age.

B. Health & financial status.
C. Smoking habit and family history.
D. All of the above .

C3/4.12
11. Which of the following is NOT TRUE of the employer to qualify for Transferable Medical
Insurance Scheme (TMIS)?

A. must have a group size of 11 or more employees.

B. to take up a Group Medical Expense Insurance Plan.
C. insure at least 50% of its local employees.
D. pay 50% of the premium for the Group Medical Expense Insurance coverage. 100%

C4/3.2 , Table 4.1

12. Which of the following characteristics of Disability Income Insurance is/are True?.

A. Maximum sum assured is based on the salary.

B. Choice of deferred period.
C. Partial disability is not covered.
D. Incorporated into life policies.

C4/4.1, Eg 4.3
13. Andrew , an engineer became disabled and unable to go to work. Compute his total Disability
Income Benefit. Given the following details:
Escalation Benefit : 3%
Monthly Income : $5,000
Monthly Expense : $3,000 $5000 x 75% = $3750
$3750 X 12 x *47.5754 = $2,140,893
No of years : 30 years * 47.5754 (factor from Table A1 – 3%; 30 years)

A. $1,141,809
B. $1,712,714
C. $2,140,893
D. $2,854,524

C4/6.16
14. In the event of a claim under Disability Income Insurance, Limitation of Benefit Clause will
not affect which type of payment?.

A. Rental Income.
B. Salary from ex-employer.
C. Workman Compensation.
D. TPD benefits under Life Insurance Policies.

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C4/8.5
15. In underwriting a Disability Income Insurance policy, which of the following factor is not a
underwriting decision?.

A. Benefit amount
B. Occupation
C. Deferred or elimination period
D. Limitation of disability benefit.

C5/2.3
16. Which of the following regarding Long Term Care Insurance (LTCI) is true?

A. LTCI is meant to meet costs of care to a special group of elderly who is physically
impaired and unable to function independently.
B. The young and healthy need not buy LTCI.
C. It is not governed by the Over Insurance Provision Clause.
D. Premiums are based on age band basis.

C5/3.1(a)
17. “Service Based” Long Term Care Insurance Policy describes________________.

A. Indemnity Method.
B. Pays if meet benefit trigger.
C. Pays 100% if unable to perform 4 out of 6 ADLs.
D. Level Premium basis.

C5/3.5 (c)
18. Which of the following is NOT an Activity of Daily Living?

A. Continence 尿
B. Morbidity
C. Dressing
D. Transferring

C5/3.1(a)
19. Long Term Care Insurance that pays a benefit when the insured incurs costs for home care
and satisfies the benefit trigger is the ____________ policy.

A. fee-based
B. service-based
C. disability based
D. benefit-based

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C6/5.8 (g)
20. Mr. Tan is covered under his company's Group Dental Insurance. Which of the following
benefits, Mr. Tan cannot claim from this policy?.

假牙坏了不理赔
A. Scaling and polishing of teeth.
B. Wisdom tooth extraction.
C. Pre-existing dental conditions.
D. Replacement of broken dentures.

C6/2.9(m)
21. Under what situations will Critical Illness Insurance cover not be terminated?.

A. Policy is converted into an Extended Term Policy.

B. A critical illness claim has been made.
C. Policy owner exercises Paid Up Option under the non forfeiture options.
D. Policy lapses due to non-payment of premium.

C6/3.2
22. Richard bought a Hospital Cash Income Insurance Policy, with these policy details:

Daily Benefit : $100

Max of 180 days per hospitalization
Lifetime Limit : 1000 days

He was hospitalized for a total 185 days for car accident injury. Calculate the total maximum
amount Richard can claim from this policy.

A. $100,000
B. $18,500
C. $18,000
D. $180,000

C6/3.11(f)
23. Which of the following regarding Standalone Hospital Cash Insurance is false?.

A. Free death benefit

B Triple payment if hospitalized overseas due to accident
C. Double payment if in Intensive Care Unit
D. Get well benefit

C7/3.2
24. Which of the following is NOT a component of Managed Healthcare?.

A. Accessibility
B. Cost
C. Quality of care
D. Capitalization

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C7/3.8(a)
25. Which of these method, the Managed Healthcare Organization pre-pay the providers a
fixed amount for each member’s medical care usually on a monthly basis?.

A. Capitation
B. Discounted-fee-for-service
C. Salary
D. Fee schedule

C7/4.10,4.11
26. In this HMO Model, the doctors and healthcare providers are not hired directly. A large
group of medical practice will provide medical care and the group is responsible for obtaining
the physicians necessary to provide the contracted services and compensating its physicians.
Which Model is this?.

A. Staff Model HMO

B. Group Model HMO
C. Independent Practitioners Association (IPA) HMO
D. Network Model HMO

C7/6.2
27. Managed Healthcare Insurance offers some benefits, which of the following is Not True?

A. Primary Care Primary Care

B. Preventive Care Specialist Care
C. Emergency Care Hospital Care
D. Inpatient Care Emergency Care
Preventive Care

C8/2.5
28. In January 2009, means testing in public hospitals was introduced to better target the
subsidies . Which of the following regarding means-testing is false?.

A. Subsidy received depends on class ward and income of the patient.

B. It is used to target B2 & C class wards in a public hospital.
C. Medical benefits received are based on the monthly income of the patient.
D. It is not used for day surgery and Accidental & Emergency (A & E) services.

C8/3.3
29. Medisave can be used to pay for medical expenses for all CPF members except
________unless they are Singapore Citizen or Singapore Permanent Resident.

A. Grandparents
B. Children
C. Parents
D. Non of the above

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C8/4.1
30. Which of the following regarding Medisave and MediShield Life is/are true?

A. Medisave is a saving scheme and MediShield Life is a basic healthcare insurance

scheme that covers all Singaporeans Citizens and Singapore PRs for life.
B. Both schemes are opt out scheme.
C. Both are low cost basic healthcare medical insurance schemes.
D. Both have deductibles.

C8/5.5
31. Policyowner is covered under an Integrated Shield Plan(IP) with exclusions on his entire IP,
when MediShield Life is launched. Which of the following statements is true?.

A. He will retain the exclusions on the entire IP .

B. He will be fully covered without exclusions for his entire IP.
C. He will be fully covered up to MediShield Life benefits, and the exclusions will only apply
to the Additional Private Insurance component of his IP.
D. Depending on the type of medical condition his exclusion is on, he may or may not be
fully covered up to the MediShield Life benefits. The exclusion will still apply to the
Additional Private Insurance component of his IP.

C8/5.16
32. Bob is 50 years of age this year. He wishes to calculate the amount of premiums that he
must pay by cash. Given that he has bought the following:

MediShield Life: $450

Integrated Shield Plan: $150
Co-insurance and deductibles riders: $500
ElderShield400: $100
ElderShield Supplements: $750

The Additional Withdrawal Limit for IP premiums are as follows:

MediShield Life: No limit
Integrated Shield Plan
Age Next Birthday
40 years and below : $300
41 to 70 years : $600
71 years and above : $900
ElderShield 400: No limit
ElderShield Supplements: $600

How much premiums must Bob pay by cash?

A. $400
B. $500
C. $650
D. $750

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C8/5.16
33. Richard, 55 years old, wishes to use his CPF Medisave to finance his Integrated Shield plan
with an annual premium of $2,500; ElderShield with an annual premium of $300; and
ElderShield Supplements with an annual premium of $1,000.

Assuming the applicable withdrawal limits (per person per year) for the following Medisave
Approved Medical Insurance plans are:
MediShield Life : No limit
Integrated Shield Plan : $600 (age 41 to 70 years old)
ElderShield: No limit
ElderShield Supplements: 600

Calculate the total amount Richard will have to pay in cash after withdrawing the maximum
amount from his Medisave?.

A. $0
B. $1,200
C. $2,300
D. $2,900

C8/7.10
34. Interim Disability Assistance Program For The Elderly was launched by the Government to
take care of needy Singaporeans who were not eligible to join ElderShield Scheme because
of reasons of ____________.

A. their age
B. health
C. age and pre-existing disability
D. All of the above.

C8/5.32
35. John has a MediShield Life and an Integrated Shield Policy (IP). He is hospitalized , his
payout based on MediShield Life is $5,000, and his payout based on the full IP benefits is
$8,000. What is eventual payout that John will receive?

A. $5,000 or $8,000 whichever is lower

B. $5,000 or $8,000 whichever is higher
C. $13,000 ($5000+ $8,000), pay first, claim later.
D. $3000

C9/3.3
36. Which of the following section in a Health Insurance Contract must the adviser goes through
with the client to ensure no typographical error?.

A. Policy Schedule
B. Insuring Clause
C. Entire Contract Clause
D. Benefit Provision

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C9/5.36
37. Under the Change of Occupation provision, the insurer is permitted to change which of the
following when the insured changes to a less hazardous occupation:-

A. increase the maximum benefit amount

B. reduce the premium rate
C. decline the insurance coverage
D. cancel the policy

C9/9.4
38. What are examples of endorsements found in a Health Insurance Policy Contract?

A. Promise to pay by insurer

B. Restrict the scope of coverage 附加条款
C. Actively At Work
D. Legal actions which insured can take against insurer

C10/2.3
39. When pricing Health Insurance products, insurers will charge females a ________rate than
males because _____________.

A. lower; women statistically have a higher longevity rate than men.

B. lower; the medical costs for women are statistically lower than men.
C. higher; women statistically have a lower longevity rate than men.
D. higher; the medical costs for women are statistically higher than men.

C10/3.15
40. The participation by employees in the plan is an important parameter in premium rates. If the
participation is _________, there will be a greater chance that a _________ than normal
proportion of unhealthy lives seeking coverage.

A. low; lower
B. high; higher
C. low; higher
D. good; greater

C11/2.1
41. Underwriters help the insurer assess the risk and determine whether or not to accept an
application, and if so, on what terms it will offer. Hence the role of underwriters are to
______________.

A. help to protect the insurer against anti-selection and in the preservation of the insurer’s
reserves.
B. ensure that the premium charged corresponds with the risk involved.
C. ensure the re-insurance limits will not be exceeded.
D. ensure that the premium charge is fair.

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C11/3.19
42. Underwriters look particularly for applicant’s earning and overall financial situation in
underwriting:

A. Long Term Care Insurance

B. Disability Income Insurance
C. Critical Illness
D. Managed Health Care

C11/3.20
43. Cognitive assessment is normally required during the underwriting stage for which plan?

A. Long Term Care Insurance.

B. Basic Medical Expense Insurance.
C. MediShield Life.
D. Disability Income Insurance.

C11/3.21
44. Which of the following factor is most important for underwriting Critical Illness Insurance?

A. Family history.
B. Overall financial condition.
C. Cognitive impairment.
D. Age and gender.

C12/2.1
45. MAS Notice No: MAS 120 comprises both mandatory requirements and best practice
standards on the disclosure of information and provision of advice to policy owners for:

A. life policies only

B. accident and health (A&H) policies only
C. A&H policies and life policies that provides A&H benefits
D. A&H policies, Investment- Linked policies and Universal Life policies

C12/41
46. Under MAS Notice No: MAS 120, if a prospective client does not want to accept an Accident
and Health (A&H) product recommended by the A&H intermediary but request to buy another
type of A&H product instead, the A&H intermediary should, _________________.

A. get the client to sign the disclaimer form, before going ahead with the request.
B. ignore the client's request and file a report with the insurer.
C. go ahead with the client's request but document client's decision and inform him that he
is responsible to ensure that the product selected is suitable.
D. proceed with client's request but A&H intermediary must ensure the product is
suitable.

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C13/3
47. An insurance representative is marketing a Health Insurance product to her friend, John.
Which of the following best illustrates needs selling by the representative?.

A. Representative offers a rebate of 50% on the commission earned if John buys the
product.
B. Representative explains how this product addresses the concern of John as stated
from his fact-find form.
C. Representative focuses on the features of the product, explaining clearly to John, if he
should be hospitalized and details on how to claim.
D. Representative discloses for the John's benefit that the discount for the product will end
in a week's time.

C13/3.3(b)
48. Mrs. Tan is keen to purchase Medical Insurance Product. She knows the product well and
the coverage needed. In this case, she comes under _________of the Fact-Find Document.

A. Application Type 1
B. Application Type 2
C. Application Type 3
D. Application Type 4

C13/4.13 Eg 13.3
49. Calculate Maintenance Cost given these assumptions:

Monthly income needed = $1,500

No. of years income needed = 21
Rate of return = 5% $1500 X 12 = $18,000
Inflation rate = 2% $18,000 X 15.8775 (table A2– 21 yrs; 3%) = $$285,794
Existing Life Insurance = $150,000 $285,794 – $150,000 (life insurance )= $135,794

A. $350,139
B. $285,795
C. $135,794
D. $87,705

C14/2.5
50. The most suitable product for meeting maintenance cost is _____________.

A. Disability Income Insurance

B. Dread Disease
C. Hospital Cash Insurance
D. Managed Healthcare Insurance

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Mock Exam 1 Answers

Question Answer Question Answer

1. D 26. B
2. C 27. D
3. D 28. C
4. B 29. A
5. C 30. A
6. B 31. C
7. C 32. C
8. C 33. C
9. C 34. C
10. A 35. B
11. D 36. A
12. B 37. B
13. C 38. B
14. D 39. D
15. B 40 C
16. C 41. B
17. A 42. B
18. B 43. A
19. B 44. A
20. D 45. C
21. C 46. C
22. A 47. B
23. A 48. C
24. D 49. C
25. A 50. A

Workings
Qn 6
Ans:
$182.31 + $227.89 + $102.5 + $102.5 X 95% (enjoy family discount of 5%) = $584.44

Qn 13
Ans :
$5000 x 75% = $3750
$3750 X 12 x *47.5754 = $2,140,893
* 47.5754 (factor from Table A1 – 3%; 30 years)

Qn 22
Ans: Lifetime limit of 1000 days X $100 per day = $100,000

Qn 49
Ans:
$1500 X 12 = $18,000
$18,000 X 15.8775 (table A2– 21 yrs; 3%) = $$285,794
$285,794 – $150,000 (life insurance )= $135,794

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Health Insurance Mock Exam 2 Strictly For Internal Use Only

Mock Exam 2
C1/2.3
1. Ministry of Health (MOH) has put together a "Healthcare 2020" Masterplan to improve
healthcare services for Singaporeans. The focus is on 3 strategic objectives, namely
_______________.

A. enhancing accessibility, quality and wide network for healthcare.

B. promoting health, prevent and reduce illness.
C. providing good, affordable and quality healthcare.
D. enhancing accessibility, quality and affordability of healthcare.

C1/3.1
2. Healthcare system in Singapore consists of namely:

A. Primary Healthcare Services, Hospital Services, Traditional Chinese Medicine.

B. Western Medical Science and also Traditional Chinese Medicine.
C. Primary Healthcare Services, Hospital Services, Intermediate and Long Term Care
Services.
D. Traditional Chinese Medicine, Primary Healthcare Services and Intermediate and Long
Term Care Services.

C2/3.25
3. Mr. Chen has a medical expense insurance policy that is subject to deductible, co-insurance
and pro-ration factor. He was hospitalized and the net claimable amount is $3,000.
However he was only able to claim $2,400 from the insurer. What is the possible reason?.

A. He has to pay a pro – ration factor of 20%

B. He has to pay a deductible of $600
C. He has to pay a co – insurance of 20%
D. He was unable to enjoy a family discount of $600.

C2/3.14
4. The three expense participation methods used by insurers does not include____________.

A. Deductibles.
B. Co-insurance
C. Pro- ration factor
D. Co-ordination of benefits

C2/3.14
5. Insurer may not give full reimbursements of medical expenses because of:

A. Underwriting limitations
B. Deductible & Co-insurance
C. Co- Ordination of Benefit Clause
D. Different subsidy level

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C2/3.19
6. Deductible is a flat dollar amount of medical expenses that a policy owner must pay out of his
own pocket, before insurer will make any payment. Which of the following statement is
most TRUE?.

A. per disability/per year deductible is more restrictive as compared to per disability/per

claim deductible.
B. the same sickness or injury within the same policy year applies to “per disability/per
claim deductible”.
C. per annum deductible includes a variety of covered sickness or injuries within a policy
year.
D. under per disability/per year deductible, the insured will have to bear the deductible each
time he makes a claim regardless of the number claims made within the same year.

C2/3.22
7. Nelson Tan has a medical expense insurance policy which has a deductible of $2000
per policy year from 1st Jan to 31st Dec 2013. He was warded for high fever in 1st Apr
and incurred a bill of $1200 for a two day stay in the hospital. Four months later, he was
treated in hospital due to a fracture of the leg and incurred a hospital bill of $2100. How much
can Nelson claim from the insurer under per annum deductible?

A. $$100
B. $1300
C. $2000
D. $3300

C2/3.28
8. Policyowner who pays a lower premium on a lower MEI plan should be encouraged to use the
services on the selected plan, otherwise the benefit payable is reduced. This is the working
of:
Pro- ration factor : when insured is admitted to a ward
A. Limitation Clause higher than the plan's entitlement, a percentage is
B. Deductible applied on the actual charges incurred and covered
C. Co-Insurance under the policy, hence benefit is reduced. In this way it
D. Pro-ration factor ensures fairness such that a policy owner who pays a
lower premium for a lower plan should be encouraged to
use the services available only on the selected plan.

C3/2.2(b)
9. Which of the following is NOT a feature of Group Medical Insurance Policy?.

A. Policy continues after one employee makes a claim.

B. Underwriting requirements are not waived.
C. There are many life insureds in one master contract.
D. The policy covers all employees below the statutory retirement age.

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C3/3.2, Table 3.1

10. Mr. Tan would like his wife to be included under his company’s Group Medical Insurance
Policy. What would the commencement date of cover for Mrs. Tan be?.

A. Anytime within 30 days after marriage.

B. Anytime within 15 days after marriage.
C. Anytime within the half year after marriage.
D. Anytime as and when Mr. Tan apply for her to be included and cover approved by
underwriting.

C3/4.5
11. Which of the following describes Portable Medical Benefit Scheme (PMBS)?.
employer
A. It rides on Medisave/ Medishield framework , as employees makes an additional
monthly contribution to his medisave account to buy medical insurance.
B. Employees are medically insured even though he may be unemployed or is in between
jobs.
C. To be eligible for the tax deduction, the scheme must cover 100% of all local employees,
as at the first day of financial year being assessed. 20%
D. For part- time employees, the monthly Medisave contribution should be based on 2% of
their actual salary. 1%

C4/5.6
12. “The insured’s inability to perform any gainful occupation or a similar occupation for which he
is reasonably suited by reason of education, training or experience” refers to:

A. Any Occupation .
B. Own Occupation
C. Specific Occupation
D. Modified Own Occupation

C4/6.12, Eg 4.3
13. David has a monthly income of $6,000 and has bought a Disability Income policy at 75% of
his monthly income with a 3% escalation benefit. He is disabled and made a claim
successfully on 1-1-2000. What is the amount that he will receive on the 1-3-2001?.

A. $4,500
B. $6,000
C. $4,635
D. $4,770

C4/6.9
14. Rehabilitation Expense Benefit under Disability Income Policy does not refer to payment for:

A. Medical Aids
B. Training Courses
C. Workplace Modifications
D. Partial Disability Benefit

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C4/8.11
15. The deferred period for Disability Income is an important factor to the underwriter in that it:

A. assesses any moral hazard involved.

B. meets medical requirements.
C. complies with the limitation of benefits clause.
D. determines the occupational risk of the insured.

C5/3.1(a)
16. If you know that your client has Long Term Care Insurance, you should also find out whether,

A. he has other sources of disability income.

B. the deferred period is right for him.
C. the benefits payable are on a serviced-based basis.
D. the policy has deductible and co-insurance features.

C5/3.2(b)
17. Which of the following is by far the most common type of Long Term Care Insurance Plan
found in Singapore ?.

A. Monthly Benefit Policy

B. Annually Benefit Policy
C. Quarterly Benefit Policy
D. Daily Benefit Policy

C5/4.2(c)
18. When a person requires an assistive rehabilitation device, which of the following benefits
available under a Long Term Care plan could provide it?.

A. Rehabilitation Expense Benefit

B. Extended Care Benefit
C. Surgical and Prosthesis Device
D. Financial Assistance with Adaptation

C5/9.1(e)
19. The following are exclusions under Long Term Care Insurance Policies EXCEPT:

A. All pre-existing conditions, which were not fully declared and described by the insured at
the time of application.
B. Alcoholism and drug abuse.
C. Any form of Acquired Immune Deficiency Syndrome (AIDS) or infection
by any Human Immunodeficiency Virus (HIV).
D. Self inflicted injury.

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C6/2.33(d)
20. Which event by the policy owner will cause critical illness cover to be terminated under a
Critical Illness Insurance Policy?.

A. When the policyowner exercise paid up option under Non forfeiture option.
B. When the policy is converted into an Extended Term Insurance Policy.
C. When the insured is diagnosed with a critical illness.
D. When an invalid critical illness claim has been made.

C6/2.13, 2.14
21. 100% Acceleration Dread Disease Policy is MOST suitable for clients who:

A. has dependents.
B. has sufficient life insurance.
C. disability income insurance.
D. wish to stay in A class or B1 class wards when hospitalized.

C6/5.11(d)
22. Cover for each individual insured employee under a Group Dental Care Insurance Policy will
automatically terminate under which event?.

A. Insured enters full time military service.

B. Insured exercises one of the non forfeiture options.
C. Insured could claim from other sources like Workmen Compensation.
D. Insured reaches age 60.

C6/3.7(a)
23. Larry bought a Hospital Cash Insurance Policy on 1 Jan 2016, with a waiting period of 30
days. He was hospitalized on 28 Jan 2016 . Upon the happening of which of the following
situations can he claim from the insurance company?.

A. Kidney failure
B. Miscarriage
C. hip fracture
D. None of the above as he was unable to claim

C7/3.2
24. Which component of managed healthcare is not used to contain and control healthcare
expenditure?

A. Accessibility
B. Cost
C. Quality of Care
D. Wide healthcare coverage

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C7/3.4,3.5
25. Primary care physician in Managed Healthcare Plan is NOT known as _____________.

A. Backbone of Managed Healthcare plans

B. Gatekeepers
C. Personal Physician
D. Specialist

C7/3.8
26. To control increasing medical costs, which of the following is not used by Managed
Healthcare Organization?.

A. Capitation
B. Salary
C. Profit Sharing
D. Fee Schedule

C7/4.21
27. Which of the following best describes Preferred Provider Organisations(PPOs) under
Managed Healthcare Plans?.

A. PPOs are gatekeepers.

B. PPOs allow clients to see specialist with referrals.
C. PPOs require greater “out of pocket” payments from members.
D. PPOs allow clients to choose to stay in the network or outside the network at point of
service.

C8/3.5
28. Contributions to the Medisave account are subject to a maximum amount, known as Basic
Healthcare Sum (BHS). Which of the following regarding BHS is most true?.

A. BHS is formerly known as Medisave Minimum Sum.

B. Amount above BHS can be withdrawn.
C. At the age of 55, if the CPF member has already met his full Retirement Sum, any
excess cannot be withdrawn as cash.
D. Amount in the Medisave account up to the BHS cannot be withdrawn as cash.

C8/3.13e(iv)
29. Medisave can be used to pay for which expenses under Chronic Disease Management
Programme?.

A. Wheelchairs
B. Prostheses
C. Drugs and Medications (including non-standard drugs)
D. All of the above

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C8/4.22
30. For families needing assistance with their premiums even after all subsidies are given and
Medisave use are not sufficient, which subsidy can be tapped further?.

A. Transitional Subsidies
B. Pioneer Generation Subsidies
C. Premium Subsidies
D. Additional Premium Support Subsidies

C8/4.24
31. MediShield Life Schemes pays on a _____________, subject to _______________.

A. as charged basis ; deductibles and co-insurance.

B. as charged basis ; deductibles , co -insurance and pro-ration factors.
C. reimbursement basis; deductibles, co-insurance and pro-ration factors.
D. reimbursements basis ; deductibles and co-insurance but no pro-ration factors.

C8/4.27
32. Mary a Singapore Citizen is covered under MediShield Life for stay in B2 class ward in a
public hospital. Upon her hospitalisation she chose to stay in a Class A ward in a private
hospital. Which factor(s) will particularly caused Mary to pay out more from her own pocket?.

A. Deductible
B. Co-insurance
C. Pro-ration
D. All of the above

C8/4.28, Eg 8.1
33. Mr. Wong , 60 years old, hospitalised in a C Class Ward. Details as follows:

• Bill after government subsidies = $8,000

• All expenses within MediShield Life claim limits.
• Deductible = $1,500
• Co-insurance applies on the following rates:
From $0 to $5000 - 10%
From $5,001 to $10,000 - 5%
More than $10,000 - 3%

Calculate the co-insurance payable under MediShield Life.

A. $325
B. $575
C. $500
D. $975

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C8/5.13
34. The government has worked with IP insurers to develop the Standard IP. Which of the
following is true of the Standard IP?.

A. It is a "no-frills" product targeted at covering B2 ward hospital bills and selected

outpatient treatments.
B. From 1 May 2016, all insurers are required to sell the Standard IP.
C. The benefits are identical across all IP insurers, and they are regulated under the
Insurance Act (Cap 142) under the Scheme.
D. It has co-insurance and deductible components.

C8/5.19
35. Which of the following statements about riders in Integrated Shield Plans (IP) is True?.

A. IP rider premiums can be paid for using Medisave and/or cash.

B. IP riders may cover the co-insurance and /or deductible portions that IPs do not cover.
C. IP riders are part of IPs and is approved by the Ministry of Health.
D. IP riders premiums are the same across all age groups.

C9/4.1
36. Which of the following section in a Health Insurance Policy contract is often viewed
as the insurer’s promises to pay under the conditions specified in the policy?.

A. Operative clause The insuring clause also known as the operative clause
B. Policy schedule states the purpose of
C. Generation conditions the policy and outlines the conditions under which the
D. Endorsements policy will pay.

C9/5.2
37. All insurance contracts have an "Entire Contract Clause”. In a Health Insurance Contract,
which of the following make up the entire contract between the insured and the insurer?.

A. Policy Document and Proposal Form.

B. Policy Document and Fact Find Form.
C. Policy Document and Insuring clause.
D. Policy Document and Schedule of Benefits.

C9/5.15
38. The Renewal Provision in a Health Insurance Contract describes:

A. Insurer’s right to increase premium on policy.

B. Insured’s right to renew his policy under certain conditions.
C. Circumstances which the insurer has the right to offer a change in plan.
D. Insured’s right to renew at certain dates.

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C10/2.3
39. What is the key factor for Health Insurance Pricing?

A. Age
B. Morbidity
C. Mortality
D. Gender

C10/3.13
40. The following statement about parameters in pricing of Health insurance is true?

A. Increase in proportion of females in a group will reduce the premiums.

B. Increase in morbidity experience will reduce premiums.
C. Increase in persistency will decrease premiums.
D. Increase in participation rate will increase premiums.

C11/3.9
41. Medical Aspects of Underwriting requires the consideration of___________.

A. Financial Factors
B. Current Physical Condition
C. Occupational Factors
D. Age Factors

C11/3.34
42. Moratorium Underwriting offers the proposers a few advantages except ____________.

A. Insured will have the certainty as to what is covered at the point of joining, rather than at
claim.
B. Insured need only provide basic information about himself.
C. Need not disclose the details of medical history.
D. Pre-existing conditions is covered after a few years, should it recur later, subject to
conditions.

C11/6.5
43. John, a proposed insured declared in the proposal form that he is going for a surgery. The
underwriter will likely _________________.

A. decline the proposal

B. postpone the proposal
C. charge more premium
D. apply specific exclusions

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C11/6.4(ii)
44. For which of the following is ‘extra premiums’ NOT commonly used for sub-standard risks?

A. Disability Income.
B. Medical Expense Insurance.
C. Long Term Care Insurance.
D. Dread Disease Insurance.

C12/15
45. Under the Disclosure Requirements an A&H Insurance Intermediary shall upon request of the
insured, disclose in writing which of the following?.

A. All remuneration
B. Commission
C. Fee and other benefits it has received or will be receiving
D. All of the above

C13/3.3(f)
46. What serves as a starting or reference point for the advisers to recommend further A & H
insurance recommendations to their clients?.

A. Client’s existing Health Insurance Policies

B. Client’s pay increase
C. Client’s promotion
D. Client’s affordability

C13/4.2
47 Why is an emergency fund important for the client?.

A. act as a safeguard against retrenchment

B. act as a fund to invest in future speculative assets for retirement
C. to help purchase big ticket items such as down payment for a house.
D. to help purchase more expensive policies to invest for future retirement.

C13/4.13 Eg 13.3
48. Mr. Tan is aged 30. He has income and expenditure of $5,500 and $2,500 respectively. He
wants to maintain his income to age 60 should he be disabled. Assuming that the interest
rate is 4% and inflation is 2%, what is the maintenance cost?.

A. $1,507,732 $2500 x 12 = $30,000 X 22.8444 (table A2– 2%, 30yrs)

B. $822,399 = $685,332.
C. $685,332
D. $529,135

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C14/3.5
49. For a prospective client buying a Group Term Life Insurance for the first time, which method
does not take into account the length of service of the employees?.

A. Number of times of the employee's basic salary.

B. According to rank. Determine Sum assured for Group Term Life Insurance in 2 ways:
C. Both A & B • According to Rank
D. None of the above Advantage: Easy to manage as it goes according to rank of the employee.
• Number Of Times Of Employee Basic Salary.
This method is takes into account the length of service, as the salary of a more
experienced staff is likely to be higher than a new staff.
Advantage: More equitable

C14/2.7
50. Mrs. Tang is a housewife. Which of the following policy is MOST suitable for meeting the
maintenance costs for Mrs. Tang ?.

A. Personal Accident Insurance Policy

B. Critical Illness Insurance
C. Long Term Care Insurance
D. Disability Income Insurance

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Mock Exam 2 Answers

Question Answer Question Answer

1. D 26. C
2. C 27. C
3. C 28. D
4. D 29. C
5. B 30. D
6. C 31. C
7. B 32. C
8. D 33. C
9. B 34. D
10. A 35. B
11. B 36. A
12. D 37. A
13. C 38. A
14. D 39. B
15. A 40 C
16. C 41. B
17. A 42. A
18. D 43. B
19. C 44. B
20. B 45. D
21. B 46. A
22. A 47. A
23. C 48. C
24. D 49. B
25. D 50. A

Workings

Qn 7
Ans: $1200 + $2100 - $2000 = $1,300

Q13
Ans: $6000 X 75% = $4500
$4500 + (3% X$4500 ) = $4635

Qn 33
Ans
Total Bill = $8000
less deducible = $1,500
Claimable amount = $6,500

Co- insurance is the percentage of claimable amount ($6,500) which she must pay on top of the
deductible.
$1,501 to $5,000 - 10% x $3,500 = $350
$5,001 to $8,000 - 5% x $3,000 = $150
Co - insurance payable = $350 + $150 = $500

Qn 48
Ans: $2500 x 12 = $30,000 X 22.8444 (table A2– 2%, 30yrs)
= $685,332.

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Health Insurance Mock Exam 3 Strictly For Internal Use Only

Mock Exam 3
C1/2.7
1. Ministry of Health move to enhance and strengthen primary healthcare providers such as
polyclinics and general practitioners (GPs) and constructing new polyclinics is an example
of______________.

A. enhancing accessibility
B. enhancing quality of care
C. ensuring healthcare remains affordable.
D. ensuring wide healthcare network.

C1/3.11
2. Intermediate and Long Term Care (ILTC) services are for those who need further care and
treatment after discharge from the hospital, who may need assistance with their activities of
daily living. This can be through :

A. Home based services.

B. Centre-based services.
C. Residential ILTC services
D. All of the above

C2/2.11(a)
3. Catastrophic Outpatient Expenses in Medical Expense Insurance Policy covers _________.

A. Outpatient liver treatment charges Outpatient Kidney Treatment Charges

B. Outpatient kidney treatment charges Outpatient Cancer Treatment Charges
C. Major organ transplant Major Organ Transplant Approved Immunosuppressant
D. Outpatient assisted conception procedures Drugs

C2/2.15
4. Medical Expense Insurance Policy covers miscarriage. Which of the following is true?.

A. Only per policy year limits are stated.

B. Miscarriage due to ectopic pregnancy is covered. 宫外孕
C. Payment is on a per charged benefits basis.
D. Policy will not cease if it reaches the lifetime limit.

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C2/3.6
5. If Mr Tan is enquiring about buying a policy for himself, his wife and 2 sons.
Premium is as follows:
Himself = $500
His wife = $700
1 son = $300
After considering he would like to cover only himself and his wife. How much family discount
did he enjoy?

A. $0
B. $60
C. $75
D. $90

C2/3.14
6. Mr. Tan who is self-employed is looking to buy a Medical Expense Insurance Policy. Which of
the following would be MOST suitable for him?.

A. Policy with no deductible

B. Policy with no co-insurance
C. Policy with no deductible and co-insurance
D. Policy with both deductible and co-insurance

C2/3.24
7. Mr. Tan and his family were injured while on holiday. They were covered under MEI, with a
deductible of $3000 and a co-insurance of 10%. Determine the total amount payable to Mr.
Tan, given hospital bills as follows: 一个一个算
Mr. Tan - $15,000
Mrs. Tan - $20,000 Mr. Tan : $15,000 - $3000 = $12,000 - $1,200 (coinsurance
Son - $2,500 10%) = $10,800
Daughter – $3,200 Mrs. Tan : $20,000 - $3000 = $17,000 - $1,700 (coinsurance
10%) = $15,300
A. $26,280 Son : cannot claim as expense is below deductible
B. $31,680 Daughter : $3,200 - $3000 = $200 - $20 (coinsurance 10%) =
C. $33,630 $180
D. $36,630 Hence total payable = $10,800 + $15,300 + $180 = $26,280

C2/3.47
8. Which of the following exclusions and limitations under Medical Expense Insurance is
FALSE?.

A. To avoid the insurer selecting against the insured.

B. To make premium more affordable.
C. To avoid policyowner receiving reimbursement twice and making a profit.
D. To define more clearly the necessary medical care and treatment.

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C3/2.2(c)
9. Which of the following characteristics of group insurance is important to the underwriter in
determining the “feel” of future claim experience?.

A. Minimal Underwriting Requirements.

B. Experience-rating.
C. Cost effectiveness.
D. Plan continuation

C3/3.3, A2(b)
10. Which of the following must be disclosed to the participants for Group Voluntary A & H
Policies?.

A. Premium is fully paid by the employer.

B. They have a say in the type of coverage that they want.
C. Contractual rights of the insurer.
D. Duration of coverage is until age 62.

C3/4.13(a)
11. How does the “continuation benefits” under the TMIS benefits the employee?.

A. To continue enjoying hospitalization coverage from the termination for 12 months.

B. To enjoy automatic coverage under the New Employer Group Medical Expense Plan.
C. Waiver of exclusion on pre existing medical conditions when joining his new employer.
D. Enjoy a lower entitlement of either the new employer TMIS plan or prior employer TMIS
plan.

C4/5.8
12. Which of the following is most stringent in the definition of Total Disability under Disability
Income Insurance?

A. Own Occupation
B. Any Occupation
C. Modified Occupation
D. Similar Occupation

C4/5.18
13. Mr. Sim has requested for a Disability Income Policy with a short benefit period. Hence
insurer will:

A. Charge a lower premium.

B. Charge a higher premium.
C. Reduce the payouts.
D. Increase the payouts.

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C4/6.7, Eg 4.2
14. Mr Tan, who is an accountant, used to earn $4,000 per month before he was disabled. After
partial recovery from his disability, he found a suitable job as a clerk, which pays him $1,500
per month. What would Mr Tan’s disability income benefit be?.

A. $3,000 per month

B. $2,500 per month
C. $1,875 per month
D. $4,000 per month

C4/8.8
15. An insured is covered under a Deferred Disability Income policy. 3 years later, he decides to
change to a more risky occupation and informs the insurance company. The underwriter is
likely to:

A. Exclude all disabilities as a result of the new application.

B. Reduce the monthly benefit payments without increasing the premiums.
C. Not change any of the policy terms as it is for more than 2 years old and is guaranteed
renewable.
D. Repudiate any claim.

C5/3.2
16. Which of the following least describes Long Term Care Insurance payment?.

A. Monthly Basis
B. Daily Basis
C. Disability Based Basis
D. Yearly Basis

C5/3.5 (a)
17. Which factor is the most important factor affecting premiums for LTCI Plans?.

A. Renewability
B. Number of exclusions
C. Number of Activities of Daily Living
D. Insured’s choice of distribution channels

C5/4.2(c)
18. In Long Term Care Insurance, Financial Assistance with Adaptation Benefit is:

A. An extra specified amount paid daily.

B. An extra monthly benefit.
C. A specified amount, 2 times the monthly benefit.
D. A specified sum more than the sum assured payable in special interval time.

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C5/9.1(g)
19. Which of these exclusion(s) is/are True of Long term Care Insurance?.

A. All forms of AIDS.

B. Participation in a felony, riot or insurrection.
C. Flying other than a fare paying passenger.
D. Convalescent & special nursing care, general medical checkup.

C6/2.9 (r)
20. Which of the following features is MOST TRUE of Critical Illness Insurance?

A. Sublimit
B. Event Limit
C. Minimum and Maximum Limit
D. Lifetime Limit

C6/2.14
21. Which of the following type of CI Cover you may not need to attached a Critical Illness
Waiver of Premium Rider?

A. Acceleration Type
B. Additional Type
C. Both types
D. None of the types

C6/3.11(e)
22. Hospital Cash Income Insurance when issued on a stand-alone policy is more attractive
compared to a rider. Why is that so?.

A. There is a double payment if insured is hospitalized overseas due to accident.

B. It includes a Free death benefit.
C. It includes Rehabilitation income.
D. All of the above.

C6/5.13
23. Andrew is covered by his company's Group Dental Care Insurance Policy. Should Andrew
wishes to claim under this policy, which of the following is TRUE ?.

A. Insured can only use insurer's panel of dentists.

B. Insured have to make payment first and file a claim with insurer for reimbursement if
he uses his own dentists.
C. Insured has to make payment first whether or not he uses his own or insurer’s panel of
dentists.
D. The dental clinic will bill the insurer directly for bills incurred.

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C7/3.2
24. Managed Healthcare Organizations work through which components to manage healthcare
expenditure?.

A. Quality of Care.
B. Premiums.
C. Enrolment fee for non usage.
D. Number of members eligible for enrolment.

C7/3.6,3.7
25. Which of the following is not a feature of the cost management under Managed Healthcare
Organisations?.

A. Large member enrolment

B. Consumer choices for healthcare services
C. Negotiated Provider Fees
D. Government subsidies on hospitals

C7/4.5
26. Which of the following type is the most restrictive under Managed Healthcare Plans?.

A. Point of Service Plans

B. Preferred Provider Organisations
C. Health Maintenance Organisations
D. Traditional Medical Expense Insurance

C7/5.1
27. Which of the following model, under Managed Healthcare Plans offers the lowest degree of
choice?.

A. Group Model HMO

B. Point Of Service Plan
C. Preferred Provider Organization
D. Traditional Medical Expense Insurance

C8/ 3.10
28. What changes regarding Medisave Minimum Sum is most true with effect 1 Jan 2016?.

A. CPF member will need to set aside at least the Medisave Minimum Sum in his
Medisave account before he can withdraw his CPF Savings at or after the age of 55.
B. At the age of 55, if he did not have enough in his Medisave account at withdrawal, he
need to use excess balances from his Ordinary and Special account (OA & SA) to top
up his Medisave account to the Medisave Minimum Sum.
C. CPF members can withdraw his CPF savings beyond the Medisave Minimum Sum at
the age of 55.
D. CPF members can withdraw his CPF savings from his OA and SA upon reaching the
age of 55 years, without the need to top up his Medisave account to the Medisave
Minimum Sum . This provides more certainty to the CPF Members after the age of 55
years.

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C8/3.13e(v)
29. Medisave cannot be used to pay for which expenses under Chronic Disease
Management Programme?.

A. Laboratory Tests
B. Prostheses
C. Consultations
D. Allied health services

C8/4.7
30. Which of the following is NOT one of the reasons why MediShield Life premiums (before
subsidies) are higher than MediShield premiums?.

A. MediShield Life has better benefits than MediShield.

B. Only MediShield Life pays for visits to the polyclinics and GP Clinics.
C. MediShield Life premiums include a small portion of the additional costs of universal
coverage.
D. Premiums are distributed more evenly over our lifetime in MediShield Life.

C8/4.25
31. MediShield Life Claim payouts are computed subject to deductible. "Deductible" in MediShield
Life ______________________.

A. is a fixed amount payable by the insured only once every policy year.
B. is a fixed amount payable by the insured each time he makes a claim.
C. is a fixed amount payable by the insurer upon insured's hospitalisation.
D. is a fixed amount payable by the insurer in the form of cash payouts upon
hospitalisation.

C8/4.28, Eg 8.1
32. Miss Tan, a Singaporean was hospitalised in a government hospital for 10 days in a Class C
Ward. Calculate how much will MediShield Life pays, given the following details:

Total hospital bills = $5,850

Deductible = $1,500
Co-insurance applies on the following rates:
From $0- $5000 - 10%
From $5,001 to $10,000 - 5%
More than $10,000 - 3%

A. $3,958
B. $3,915
C. $4,350
D. $4,133

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C8/4.33(b)
33. The MediShield Life Scheme Act provides for the implementation and administration of the
MediShield Life Scheme. Which is NOT a key features of the Act?.

A. Providing for access to information to facilitate the extension of MediShield Life

premium subsidies to all eligible households.
B. To recover premiums from willful defaulters to ensure premiums are paid in a timely
manner.
C. Section 73 of the Conveyancing and Law of Property Act (Cap 61) apply to the
policy issued under the Scheme.
D. Lifelong universal coverage for all Singapore Citizens and SPRs.

C8/ 5.5
34. John has pre-existing conditions and is thinking of buying an Integrated Shield Plans (IPs).
Which is true with regard to his pre-existing conditions?.

A. He may be excluded by both his IP Policy and MediShield Life.

B. He will be covered by his IP Policy if he is covered by MediShield Life.
C. Should he be excluded by his IP Policy, MediShield life will pro-rate the benefits
payable.
D. Should he be excluded by his IP Policy, MediShield life will cover him for life.

C8/7.13
35. Mr. Tan is 65 years old in the year 2014, and is unable to pay his hospital bill. He can seek
assistance from:

A. Interim Disability Programme for the Elderly (IDAPE)

B. ElderShield
C. Medifund
D. Pioneer Generation Disability Assistance Scheme

C9/3.2
36. The Policy Schedule in a Health Insurance Policy gives the specific details of the policy
contract. Which of these details are found in the Policy Schedule?.

A. Name, NRIC of Insured

B. Name, NRIC of Beneficiary
C. Claim procedures
D. Insurer’s contractual rights

C9/5.22
37. An Optionally Renewable Health Insurance Policy gives the insurer the right to terminate the
policy :

A. At anytime, for any reason

B. When the insured reaches a certain age
C. When the insured changes his employment status
D. At the policy anniversary date or any premium due date

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C9/8.5
38. Physical examination provision is included in Disability Income Polices to enable insurer to;

A. have the insured examined by the insurer’s doctor at the insured’s expense.
B. have the insured examined by the insured’s doctor at the insurer’s expense.
C. have the insured examined by the insurer’s doctor at the insurer’s expense.
D. have the insured examined by the insured’s choice of doctors on a contributory basis.

C10/2.2
39. Which of the following key factors is NOT used in computing premium for Health Insurance
Products?

A. Investment Income
B. Mode of Premium
C. Operating expenses
D. Occupation

C10/3.13
40. Which of the following will decrease premium?

A. Decrease in investment income.

B. Increase in persistency.
C. Increase in morbidity.
D. Increase in benefits covered.

C11/3.20
41. The detection of any early cognitive impairment is essential when underwriting:

A. Dread Disease Insurance.

B. Disability Income Insurance.
C. Long Term Care Insurance.
D. Managed Healthcare Insurance.

C11/3.44
42. Employees classes has effects of over-representation. Over-representation by a class in
which the employees earn low incomes can result in _______________.

A. Higher-than-desired rate of turnover.

B. Lower-than-average medical claims.
C. Higher-than-average medical claims.
D. Lower-than-desired rate of turnover.

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C11/4.15
43. To get a better insight to insured’s medical history, not available from medical examinations,
underwriter request for:

A. Agent’s Statement.
B. Supplementary Questionnaires.
C. Medical Examination/Test.
D. Attending Physician Statement.

C11/5.3
44. An adviser can expedite the underwriting process by:

A. Sending the insured for medical examination.

B. Extracting as much detail as possible from the insured if he is seeing a doctor for his
diabetes.
C. Calling for an Attending Physician’s Statement on behalf of the underwriters.
D. Getting the profit / loss statement if the insured is a self employed.

C12/33
45. Notice No: MAS 120 - Division 4 on Requirements on Provision of Advice Relating to Accident
and Health Insurance Policies shall not apply to:

A. ElderShield Policy
B. Long Term Care Insurance
C. Hospital Cash (Income) Insurance
D. Disability Insurance

C12/52(h)
46. Which of these offences under MAS Notice 120 is not considered a criminal offence and
does not attract any penalties?.

A. Failure to disclose the conditions under which payment of policy moneys will not be
made to insured.
B. Failure by the A&H representative to use only marketing materials that has been
approved by the insurance intermediary.
C. Documents given to the insured are kept up to date.
D. Opinions expressed and facts are not differentiated.

C13/3.3(b)
47. "Application Type 2" under the Fact-Find Document means _______________________.

A. the client do not wish to receive any advice from adviser.

B. the client already knows the product and coverage they want to purchase.
C. the client wishes to receive product advise only.
D. the client wishes to disclose all information requested in this form.

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C13/4.13 Eg 13.3
48. Mr. Lim has recently bought Dread Disease Insurance. He is concerned about Mrs. Lim, who
is a housewife, his son who is a newborn and their future daily expenses should anything
happen to him. Given that his family’s monthly expenses amount to $3,000, with existing
inflation rate of 2% and investment return of 7%, how much would Mrs. Lim require in the
event that Mr. Lim is not around, assuming number of years income needed is 21.

A. $630,775
B. $47,632
C. $484,639
D. $554,940

C13/4.20(a)
49. Calculation of how much Critical Illness Insurance the client needs is more of an art than a
science as there are many uncertainties. Which of these factors would be most important?

A. Whether the client has the means to pay the premium.

B. Need to know the client’s family medical history to determine which disease the client is
most susceptible.
C. Obtain the latest attending physician statement as an indication of his current physical
condition.
D. Occupational risk classification of the client.

C14/3.6
50. Which of the following method is fairer in determining the sum assured for group health
insurance?

A. Employee’s Salary X Performance Factor

B. Employee’s Salary X Standard Factor
C. According to Rank
D. Lower position; higher sum assured.

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Mock Exam 3 Answers

Question Answer Question Answer

1. B 26. C
2. D 27. A
3. B 28. D
4. B 29. B
5. B 30. B
6. C 31. A
7. A 32. A
8. A 33. C
9. B 34. D
10. B 35. C
11. A 36. A
12. B 37. D
13. A 38. C
14. C 39. D
15. B 40 B
16. D 41. C
17. C 42. A
18. C 43. D
19. B 44. B
20. C 45. A
21. A 46. C
22. C 47. C
23. B 48. C
24. A 49. B
25. D 50. B

Workings

Qn 5
Ans:
($500 + $700) X 5% = $60

Qn 7
Ans:
Mr. Tan : $15,000 - $3000 = $12,000 - $1,200 (coinsurance 10%) = $10,800
Mrs. Tan : $20,000 - $3000 = $17,000 - $1,700 (coinsurance 10%) = $15,300
Son : cannot claim as expense is below deductible
Daughter : $3,200 - $3000 = $200 - $20 (coinsurance 10%) = $180
Hence total payable = $10,800 + $15,300 + $180 = $26,280

Qn 14
Ans:
$4000 - $1500 / $4000 x $3000 = $1875

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Qn 32
Ans:
Total bills = $5,850
less deductible =$1,500
Claimable amount = $4,350
*less co-insurance = $392.5
MediShield Life pays =$3,957.5

Calculate co-insurance
$1,501 to $5,000 - 10% x $3,500 = $350
$5,001 to $10,000 - 5% x $850 = $42.5
Co - insurance payable = $350 + $42.5 = $392.5

Qn 48
Ans:
$3000 x 12 =$36,000 x 13.4622(table A2– 5%, 21 years)
= $484,639

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Health Insurance Mock Exam 4 Strictly For Internal Use Only

Mock Exam 4
C1/2.9(c)
1. To ensure healthcare remains affordable, how does the government enhanced support for
Singaporeans?.

A. Expand Medisave to cover all types of outpatient treatments.

B. Enhancing collective responsibility of healthcare through MediShield Life.
C. Reduce Government healthcare expenditure through MediShield Life.
D. Increase Government share of national healthcare expenditure by providing more
choices of hospitals and polyclinics.

C1/4.1
2. Singapore healthcare financing framework comprises of which of the following?.

A. MediShield Life, Medifund & ElderShield

B. Medisave, Medifund and Interim Assistance Programme for the Elderly (IDAPE).
C. Government subsidies, Medisave and individual savings.
D. Government subsidies, individual savings and insurance.

C2/2.11(b)
3. Which of the following is covered under Catastrophic Outpatient Treatment in a Medical
Expense Insurance Policy?.

A. Outpatient liver treatment charges

B. Outpatient heart treatment charges
C. Outpatient cancer treatment charges
D. Outpatient tuberculosis treatment charges

C2/2.15
4. Miscarriage Benefit in a Medical Expense Policy provides for:

A. The reimbursement of expenses in a willful termination to a pregnancy.

B. The reimbursement of Assisted Conception Procedure treatments.
C. The reimbursement of charges incurred for the consultation of a specialist
within a number of days before termination.
D. The reimbursement of medical expenses in an ectopic pregnancy.

C2/3.19
5. Which deductible under Medical Expense Insurance is the most common one used by
insurers in Singapore?

A. Per Annum
B. Per Disability/ Per Year
C. Per Disability/Per Claim
D. Per Disability

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C2/3.22
6. Mr. Tan has a basic Medical Expense Insurance policy, which has a $500 deductible from 1
January to 31 December 2013. At the beginning of the year, he was hospitalised and the
charges amounted to $200. Recently, he was warded and the charges amounted to $600.
What are the total benefits payable by the insurer, assuming per disability/per claim
deductible is used?

A. $300
B. $100
C. $500
D. $800

C2/3.23
7. Which of the following is NOT true of Medical Expense Insurance?

A. Pro ration factor and co-insurance.

B. Deductibles apply for all treatments.
C. Impose Sub- Limits.
D. Can be issued as a rider or stand-alone.

C2/2.9(p)
8. Under Inpatient Expenses of Medical Expense Insurance, when the Insured Person is a
recipient, Major Organ Transplant Benefit covers:

A. Cost of immunosuppressant drugs

B. Cost of Surgeries
C. Acquisition of Organ
D. Recipient Costs

C3/2.3
9. Group Polices often have an “actively at work” clause. In order to be eligible for the cover,
this clause requires:

A. The employee to be under a compulsory scheme.

B. The employee to be full time employed on the day the insurance coverage takes effect.
C. The employee to be at work on the day the insurance coverage takes effect.
D. The employee to obtain official Medical Certificate if he is unwell on the day the
insurance coverage takes effect.

C3/3.3, A2(b)
10. Which type of Group Medical Expense Insurance Plans gives the employees some control
over the plan?

A. Voluntary Plan
B. Compulsory Plan
C. Compulsory Plan and Voluntary Plan
D. None

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C3/3.4 Table
11. What is the key difference between an Individual and Group Insurance?

A. Premium bought under Group Insurance is unit related.

B. Many contracts are issued in Group Insurance.
C. All members of Group Insurance have to go for medical check-up.
D. Individual members’ health is evaluated for Group Insurance.

C3/4.29
12. Which of the following regarding ad-hoc contributions to employees' Medisave Account is
false?.

A. An employer cannot make ad-hoc contributions to the employees' Medisave Account

unless it is adopting the Portable Medical Benefit Options.
B. An employer can make ad-hoc contributions to the employees' Medisave Account.
C. An employer can make ad-hoc contributions to the employees' Medisave Account and
the employer can get an additional tax deduction beyond the 1% limit for the amount of
ad-hoc Medisave contribution made.
D. The overall tax deduction for medical expenses will be subject to the overall cap of 2%.

C4/6.6 & 6.9

13. What is true of the difference between “Rehabilitation Benefit” and Rehabilitation Expense
Benefit?.

A. Rehabilitation Benefit is for payment if insured is unable to go to work.

B. Rehabilitation Benefit is for reimbursement of medical aids eg. Wheelchair.
C. Rehabilitation Expense Benefit is for payment of reduce benefit.
D. Rehabilitation Expense Benefit is reimbursements that includes workplace
modifications.

C4/6.12
14. The following data is to be used for this question and Qn. 14,15 and 16
Mary, a lecturer bought a DI Policy, became disabled on 30/6/08. Her details as follows:

Salary : $8000 per month ;

Her expenses: $3000 per month;
Annual Escalation Benefit : 3% ;
6 Month Deferred Period chosen

When will she received the first payment from the insurer and for how much?.

A. 1/1/2009 for $8000

B. 1/1/2009 for $6000
C. 31/12/2008 for $6180
D. 31/12/2008 for $2250

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15. When will the escalation benefit kicked in and how much will she get?.

A. 30/6/2009 for $8240

B. 31/12/2008 for $5150
C. 1/2/2009 for $6080
D. 1/1/2010 for $6180

16. Mary subsequently on 1/2/2010 found a job as a tutor which pays her $2000 a month.
Calculate partial disability benefit payable on 1/2/2010.

A. $3,090
B. $4,500
C. $4,635
D. $4,180

C5/3.5 (c)
17. The ability to move indoors from room to room on level surfaces describes which Activities of
Daily Living?

A. Transferring
B. Mortality
C. Mobility
D. Morbidity

C5/3.7
18. In Long Term Care insurance, the deferred period is defined as a period of time:

A. after the insured is certified by a medical practitioner that he is unable to perform

specified numbers of ADLs.
B. from the inception of the policy or any reinstatement of the policy
C. from the commencement date of the policy.
D. from the time the insured is hospitalized.

C5/8, C8/6.22(i)
19. In which area is Long Term Care Insurance different from ElderShield?.

A. Free look Period.

B. The definition of Activity of Daily Livings (ADLs).
C. Purpose of the plans.
D. On how the plan is issued, eg guaranteed renewable basis.

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C5/8 (a)
20. Long Term Care Insurance is similar to Group Dental Care in that they_____________.

A. do not cover pre-existing dental and other pre-existing conditions.

B. can be issued on standalone or rider basis.
C. do not pay in addition to other insurance.
D. covers only those who are actively at work.

C6/5.8(d)
21. Like all other insurance covers, Group Dental Care Insurance Policies also impose certain
exclusions. Which is most true of such exclusions?.

A. Pre-existing dental conditions.

B. Medicine given.
C. Wisdom tooth extraction.
D. Scaling, polishing and root canal treatment.

C6/2.13
22. Mr. Tan has a Critical Illness Policy with a 50% acceleration benefit. The policy also has a
Critical illness waiver of premium rider attached to it. After a dread disease claim by Mr. Tan,
which of the following statement(s) regarding the premium is most true?.

A. remain unchanged
B. premium is waived for the full sum assured
C. premium reduced in proportion to how the basic sum assured is reduced.
D. premium will be reduced by 50%.

C6/2.20
23. Amy bought a Critical Illness Insurance with a sum assured of $200,000. She also bought an
additional benefit CI rider of $150,000. Which of the following statements is TRUE?.

A. Upon accidental death, insurer will pay $350,000.

B. In the event of an accident that caused her to be total permanently disabled, insurer
will pay $350,000.
C. She was diagnosed with skin cancer and subsequently died 4 months later. Insurer will
pay a total sum of $350,000.
D. In the event she was diagnosed with one of Critical Illness, insurer with pay a sum
assured of $350,000.

C6/2.15
24. Adviser is proposing a 50% Acceleration Dread Disease Policy to his client John , to cover
John's wife who is a homemaker. In this case, adviser should also propose to attach which
of the following riders?.

A. Waiver of Premium Rider to the policy.

B. Disability Income Insurance Rider to the policy.
C. Critical Illness Waiver of Premium Rider to the policy.
D. Total and Permanent Disability Benefit Rider to the policy.

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C7/4.19
25. Which of the following offers the broadest consumer choice of physicians and clinical
settings?.

A. Staff Model
B. Group Model
C. Network Model
D. Mixed Model HMO

C7/5.1
26. Which of the following Managed Healthcare plans is the most expensive?.

A. Staff Model HMO

B. Group Model HMO
C. Network Model HMO
D. Traditional Medical Expense Insurance

C7/6.2
27. Which of the following is not a benefit of Managed HealthCare Plans?.

A. Preventive Care
B. Specialist Care
C. Intensive Care
D. Emergency Care

C7/6.5
28. Which of the following is NOT true of Managed Healthcare Insurance?.

A. It excludes pre-existing conditions.

B. Payments are reduced by reimbursements from Work Injury Compensation and other
forms of insurance.
C. Deductibles and Co-insurance do not apply in Managed Healthcare Insurance.
D. Members have a choice of in-network or out-network providers.

C8/4.18
29. To ease the shift to MediShield Life, those whose net premium still increase in comparison to
MediShield, despite subsidies, will receive further subsidies for the first 4 years of MediShield
Life. This subsidy is ___________________.

A. Transitional Subsidies
B. Pioneer Generation Subsidies
C. Premium Subsidies
D. Additional Premium Support Subsidies

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C8/4.25
30. Which of the following is FALSE regarding how MediShield Life works?.

A. Allows members to insure their spouse, children, parents and grandparents.

B. MediShield Life is sized for class B2/C wards and subsidized treatments in public
hospitals.
C. Deductible is applicable once every policy year.
D. Deductibles apply for covered outpatient treatments.

C8/4.26
31. Co-insurance is a feature of MediShield Life. It is describe as____________.

A. a percentage of the claimable amount, which insured have to pay before deductible.
B. a percentage of the claimable amount, which insured have to pay on top of deductible.
C. a fixed amount payable by the insured.
D. a fixed amount that will decrease the amount payable from the insurer.

C8/4.28, Eg 8.1
32. Melvin, a Singapore Citizen was hospitalised for an operation and he stayed in a Class A
ward for 18 days, his total hospital bill amounted to $16,500. Calculate for this bill, how
much will MediShield Life claim computation will be based on ?.

Given:
Pro-ration - 35%
Deductible = $2,000
Co-insurance applies on the following rates:
From $0 - $5000 - 10%
From $5,001 to $10,000 - 5%
More than $10,000 - 3%

A. $5,775
B. $5,075
C. $4,776
D. $4,765

C8/4.34(2)
33. Section 10 of the The MediShield Life Scheme Act 2015 states that :

A. Rights of the insured person arising from the insurance cover under the Scheme are
transferable.
B. The Insurance Act will apply to the Scheme.
C. A policy of insurance issued under the Scheme does not create any legal or equitable
trust.
D. Section 73 of the Conveyancing & Law Property Act (Cap 61) will have an effect on the
policy issued under the Scheme.

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C8/5.13, 5.14
34. Which is false with regard to the Standard IP?.

A. The benefits and the premiums of the Standard IP are identical across all IP insurers.
B. It is meant to target Class B1 ward hospital bills.
C. Premiums and underwriting decisions for the plan are determined by the insurers.
D. It is a viable option to allow those who want to switch from their Class A and Private
Hospital IPs to a more affordable plan.

C8/5.22
35. Any policy holder who switches from his IP from one insurer to another , _______________.

A. does not have the option to go back to the previous insurer.

B. will have the option to go back to the previous insurer within 30 days from the date of
notification of termination from the previous insurer.
C. will have the option to go back to the previous insurer, subject to underwriting by the
previous insurer.
D. does not have the option to go back to the previous insurer unless he does not make a
claim within 30 days with the new insurer.

C8/7.9(b), 6.2
36. Wally bought an ElderShield 400 Plan at the age of 60. His premiums was $789. Five years
later, in the year 2014, he was unable to perform at least 3 ADLs under the plan, how much
benefits will he received in total on the first month?.

A. $S400
B. S$500
C. S$4800
D. S$6000

C9/3.1
37. The Policy Schedule in a Health Insurance Policy contains ____________.

A. The details of the policy owner, insured as well as insurance coverage.

B. The conditions under which the benefits will be paid.
C. That the present contract, together with any stipulated attachments, makes up
the entire contract.
D. That the policy will terminate if an insured resides outside Singapore for more
than a specified period of time.

C9/4.2
38. Which of the following sections in a Health Insurance Policy contract represents the
“foundation” of a Health Insurance Policy?.

A. Policy Schedule
B. General Conditions
C. Insuring Clause
D. Benefits Provisions

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C9/9.1
39. An endorsement attaching to an insurance policy :

A. has no legal effect

B. modifies the policy provision
C. is independent of the policy
D. provides additional benefits at no extra cost

C10/2.6
40. An increase in which of the following factor will NOT increase premium computation?

A. Investment income
B. Scope of benefits
C. Insurer’s expenses
D. Medical inflation

C11/4.9
41. Agent’s statement is needed to:

A. Let underwriter knows why that product is recommended.

B. Indicate applicant’s approximate net worth.
C. Clarify situations that is unquestionable.
D. Indicate information that is important to the applicant.

C11/4.15
42. An underwriter needs to know more about a client’s medical history which the medical
examination was not able to reveal. What form does he need?

A. Agent’s Statement
B. Attending Physician’s Statement
C. Supplementary Questionnaires
D. Fact Find Form

C11/6.4(i)
43. Which of the following plan will exclusions most likely be used for sub standard risks?.

A. Disability Income Insurance.

B. Critical Illness.
C. Medical Expense Insurance.
D. Personal Accident.

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C11/6.4 (ii)
44. Which of the following helps to reduce insurer’s risk?

A. Shorter deferred period.

B. Longer benefit period.
C. Extra premium.
D. Increase benefits.

C12/54
45. To facilitate the monitoring of switching for Long-Term accident and health policies, that may
be detrimental to an policy owner's interest by an A&H rep, the A&H insurance intermediary
should ensure ____________________.

A. the A&H rep has declared in writing that the policy owner agreed to the switch.
B. the policy owner has declared in writing whether he has been advised by the A&H rep to
switch.
C. Both are correct
D. Both are incorrect

C12/57
46. An A&H insurance intermediary should institute controls, process and procedures to
effectively monitor and track switching of long-term accident and health plans. Which is true
of such process?

A. Track the volume of switches so as to identify any A&H insurance reps with an unusually
high volume of switching transactions.
B. Ensure supervisor reviewed the each switch.
C. Identify any unusual trends in switching transactions.
D. All of the above.

C13/4.2
47. Mr. Lim the prospective client does not have an emergency fund, you should:

A. still recommend suitable products.

B. ensure he ticks Type 1 of the application type.
C. not recommend any policies as it may affect his ability to service the policies.
D. recommend disability income insurance.

C13/4.20
48. During need analysis, when recommending a Critical Illness Insurance, what must an advisor
advise a client?

A. Claims procedures.
B. Underwriting considerations.
C. Mode of Payment.
D. Coverage.

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C13/4.13, Eg 13.3
49. Miss X’s monthly income and expenses are $4,000 and $3,000 respectively. She is 32 yrs
old, single and would like to provide for herself till retirement (55 yrs old) in the event of
disability. She has an existing $100,000 Whole Life Insurance. Given an inflation rate of 2%
and interest rate of 4%, calculate the maintenance cost needed.

A. $795,586
B. $571,688
C. $671,688
D. $445,530

C14/2.12
50. Calculate for Tommy, the level of Medical Expense needed, given the following:

Basic average medical expenses needed for 1 hospitalisation in a year = $24,000

Benefits paying under his Group policy = $18,240
Amount payable under his IncomeShield Plan = $7,335

A. $5,760
B. $16,665
C. $1,575
D. No Shortage of medical expense protection

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Mock Exam 4 Answers

Question Answer Question Answer

1. B 26. D
2. D 27. C
3. C 28. C
4. D 29. A
5. A 30. D
6. B 31. B
7. B 32. A
8. B 33. C
9. C 34. A
10. A 35. B
11. A 36. B
12. A 37. A
13. D 38. C
14. B 39. B
15. D 40 A
16. C 41. B
17. C 42. B
18. A 43. C
19. A 44. C
20. B 45. B
21. B 46. D
22. C 47. C
23. C 48. D
24. C 49. B
25. D 50. D

Workings

Qn 6
Ans:
$600 - $500 = $100 (per disability/per claim)

Qn14
Ans:
Deferred period 6 months from 30/6/08, hence payable on 1/1/09.
Payments = $8000 x 75% = $6000

Qn 15
Ans:
Escalation will be effective on the 2nd year ie 1.1.2010 at $6180. ($6000 + $6000 x3%)

Qn 16
Ans:
($8000 - $2000)/$8000 x $6180 = $4635

Qn 32
Ans:
Total bill = $16,500
35% of $16,500 = $5,775

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Qn 36
Ans : $500 ($400 from ElderShield, $100 from Pioneer Generation Disability Assistance Scheme).

Qn 49
Ans:
$3000 x 12 = $36,000 x 18.6580 (table A2– 2%; 23 yrs)
$671,688 - $100,000 = $571,688

Qn 50
Ans:
$24,000 – ($18,240 +$7335) = ($1,575); no shortage

Prudential Assurance Company Singapore (Pte) Limited 51

Produced in collaboration with Julia Sim. Based on 6th Edition Text.(Version 1.1)(12/6/17)