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Health Insurance Claim Quiz: Cashless vs Reimbursement

Written by the Quizzeela team · Reviewed by Utsav Raj
Last checked · 10 questions · Medium

Most health insurance trouble happens at claim time. Learn how claims work before you need to make one.

Play as a timed quiz and earn coins

1A cashless claim means:

  1. You pay the hospital and claim later
  2. The hospital is free for everyone
  3. The insurer pays the network hospital directly
  4. You get cash from the insurer before treatment
Show answer
Answer: C. The insurer pays the network hospital directly. At a network hospital, the insurer settles approved bills directly with the hospital.

2In a reimbursement claim:

  1. Only the agent can claim
  2. The hospital pays you
  3. No documents are needed
  4. You pay first, then the insurer pays you back after checking the bills
Show answer
Answer: D. You pay first, then the insurer pays you back after checking the bills. Reimbursement is used at non-network hospitals or when cashless is not approved.

3A "network hospital" is one that:

  1. Is run by the government only
  2. Treats only emergencies
  3. Has Wi-Fi
  4. Has an agreement with your insurer for cashless treatment
Show answer
Answer: D. Has an agreement with your insurer for cashless treatment. Network hospitals have tie-ups with the insurer, making cashless claims possible.

4TPA stands for:

  1. Third Party Administrator
  2. Tax Paid Assessment
  3. Treatment Payment Account
  4. Total Policy Amount
Show answer
Answer: A. Third Party Administrator. A TPA processes claims on behalf of many insurers.

5For a planned hospital stay, you should get cashless approval:

  1. Before admission (pre-authorisation)
  2. Never
  3. Only after a month
  4. After discharge
Show answer
Answer: A. Before admission (pre-authorisation). Pre-authorisation before a planned admission avoids surprises at discharge.

6Under IRDAI's 2024 rules, insurers should decide on a cashless request within about:

  1. 3 months
  2. 1 hour
  3. 1 month
  4. 1 week
Show answer
Answer: B. 1 hour. IRDAI asked insurers to decide on cashless authorisation within one hour, and on final discharge within three hours.

7A "room rent limit" in a policy can lead to:

  1. Nothing
  2. Other bills being cut in proportion if you choose a costlier room
  3. A free upgrade
  4. Lower premium every year
Show answer
Answer: B. Other bills being cut in proportion if you choose a costlier room. If you pick a room above the limit, many policies reduce related charges in the same ratio.

8A "co-payment" of 10% means:

  1. The premium rises 10%
  2. The insurer pays 10%
  3. You get 10% cashback
  4. You pay 10% of each approved claim yourself
Show answer
Answer: D. You pay 10% of each approved claim yourself. With co-payment you share a fixed part of every claim.

9A common reason for a claim being rejected is:

  1. Having a nominee
  2. Using a network hospital
  3. Not disclosing a pre-existing illness
  4. Paying the premium on time
Show answer
Answer: C. Not disclosing a pre-existing illness. Hiding a known illness is one of the main reasons claims are rejected.

10If you disagree with the insurer's claim decision and its grievance team does not help, you can go to:

  1. Your employer
  2. The traffic police
  3. The Insurance Ombudsman
  4. The Election Commission
Show answer
Answer: C. The Insurance Ombudsman. The Insurance Ombudsman settles complaints against insurers free of charge. You can also use IRDAI's Bima Bharosa portal.
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Sources: IRDAI master circular on health insurance (2024) and policyholder guides. For learning only, not financial, tax or insurance advice. Found a mistake? Use "Report a mistake" in the timed quiz.