PGDHIM SEM 2 ASSIGNMENT 2

 

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Post Graduate Diploma in Health Insurance Management (PGDHIM)

 

4^th SET OF ASSIGNMENT

PRN No.:_________________                                                                  

Student Name:____________

Answer the following questions:

 

Course 4: Health Insurance Claims Management

 

Question : What is Reinsurance? Enlist the functions.  (2 Marks)

 

Answer : Reinsurance is a way for insurers to transfer risk to other parties to reduce the likelihood of having to pay a large claim in the future. An insurance company, for example, may sell home insurance covering many households in one area. If a natural disaster, like a flood, were to hit that area, the insurance company would be obligated to pay many claims. If the insurance company gets nervous about that risk, and the extent of claims they may need to pay, then they will enter a contract with another insurance company (

 

 

 

Question : What is an Ombudsman?           (3 Marks)

 

Answer : An ombudsman is an authority, appointed by the government and even private bodies to investigate complaints against an authority. Essentially, the ombudsman is an intermediate person who tries to resolve the complaints which one party has raised against the other. Their task is to look into the complaint and resolve the

 

 

 

 

Course 5: Legal Aspects in Health Insurance

 

 

Question : Protection of policy holders interest as per regulations 2017                       (5 Marks)

 

Answer : Protection of Policyholders’ Interests Regulations, 2017

 

OBJECTIVE:

1. To ensure that interests of insurance policyholders’ are protected.

2. To ensure that insurers, distribution channels and other regulated entities fulfill their obligations towards policyholders and have in place standard procedures and best practices in sale and service of

 

 

 

Question : What is fraud? What are the industry interventions to manage fraud ? (10 Marks)

 

Answer : In simple parlance, insurance fraud can be defined as: The act of making a statement known to be false and used to induce another party to issue a contract or pay a claim. This act must be wilful and deliberate, involve financial gain, done under false pretences and is illegal.

Healthcare fraud as defined by the National Health Care Anti-Fraud Association (USA): "The deliberate submittal of false claims to private health insurance plans and/or tax-funded public health insurance programs." "Intentional deception or

 

 

 

Course 6: Final project report: As a part of term end assessment                (35 Mark)

 

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