Page 293 - Ebook health insurance IC27
P. 293
Sashi Publications
CHAPTER - 7 : Regulatory and Legal Aspects of Health Insurance
1. What are the various types of risks which a health insurer is required to manage in
addition to insurance risks?
2. Why a failed health insurer has major repercussions?
3. Write a note on need for Regulation of Health Insurance Sector.
4. Discuss the role of regulators in respect of following :
a) Policy holder protection regulation and grievance redressal.
b) Health insurance for senior citizens and rural / informal sector workers.
c) Standardization initiatives
d) Pre-existing diseases (PED's)
e) Renew ability of health insurance policy.
CHAPTER - 8 : Customer Service in Health Insurance
1. How consumer protection or policy holder protection can be achieved in health
insurance?
2. Write a note on claims - servicing?
3. What is cashless - claims, discuss its types?
4. Write a note on Grievance redressal in health insurance.
CHAPTER - 9 : Health Insurance Fraud
1. Why there is a need to focus on eliminating or reducing fraudulent claims?
2. Classify frauds. Explain the types of frauds.
3. Distinguish between health insurance and general insurance frauds.
4. What are the triggers to fraud claims?
5. What type of fraud may be committed by a consumer?
6. What are the different stages of insurance frauds?
7. What methods can be adopted to combat insurance frauds?
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