Important Points for IC 27 - Health Insurance Exam
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Hard fraud is a deliberate attempt either to stage an event or an accident, which requires hospitalisation or other tpe of loss that would be covered under a medical insurance policy.
Soft fraud, which is sometimes called opportunity fraud, occurs when a policyholder or claimant exaggerates a legitimate claim. Soft fraud may also occur when people purposely provide false information with regard to the pre-existing illness or other relevant information to influence the underwriting process in favour of the applicant.
Fraud can be committed by both the insured member or the provider and at times are a concerted effort of agents, brokers, insurance employees, insured member and the provider of services and other stakeholders of the healthcare system.
Reinsurance is the acceptance by one or more Insurers, called reinsurers, of a portion of the risk underwritten by another insurer that has contracted with an insured person for the coverage.
As the name suggest- "Re-insurance" is, at its simplest level, -"Insurance for insurers".
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