CIIN Certificate CF7 - Healthcare Insurance Products (Nigeria)

In Nigeria's healthcare insurance market, which body promotes, regulates and integrates health insurance schemes under the NHIA Act 2022?

• ANational Health Insurance Authority (NHIA)
• BNational Insurance Commission (NAICOM)
• CNigerian Insurers Association (NIA)
• DNational Social Insurance Trust Fund (NSITF)

Which organisation is the apex regulator of insurance companies operating health and general insurance business in Nigeria?

• ANational Insurance Commission (NAICOM)
• BNational Health Insurance Authority (NHIA)
• CChartered Insurance Institute of Nigeria (CIIN)
• DHealth Maintenance Organisation Association of Nigeria

A Health Maintenance Organisation (HMO) in Nigeria primarily acts as a:

• AThird-party administrator managing enrolment, premium collection and provider networks fo…
• BReinsurer accepting surplus healthcare risks from life insurers only
• CCourt-appointed liquidator for failed hospitals
• DTax authority collecting VAT on medical devices

Under the NHIA Act 2022, which entities may be registered as third-party administrators alongside HMOs?

• AMutual Health Associations and other TPAs accredited by the Authority
• BOnly commercial banks licensed by the CBN
• CPharmaceutical manufacturers exclusively
• DForeign reinsurers without local incorporation

Private healthcare providers that reinvest surplus into better facilities and care, rather than distributing profits to external shareholders, are often structured as:

• AProprietary insurers
• BProvident associations or mutual organisations
• CReinsurance pools
• DCaptive finance companies

Which market segment describes employer-sponsored private medical schemes administered for staff groups?

• ACorporate or group medical insurance
• BIndividual retail travel insurance only
• CMicro-insurance crop cover
• DMarine cargo health riders

Reinsurance support to the healthcare insurance market typically includes:

• ACapital relief, stop-loss protection and assistance with product design and claims analyt…
• BDirect treatment of patients in NHIA-accredited PHC centres
• CIssuing of NHIA enrollee identity cards
• DSetting hospital consultation fees for public sector doctors

An employer healthcare trust in the UK market is best described as:

• AA vehicle where the employer funds employee healthcare benefits under trust rules, someti…
• BA mandatory NHIA state scheme for civil servants
• CA NAICOM capital adequacy calculation method
• DA dental capitation plan sold directly by dentists

Which distribution channel is commonly used for growing employer-sponsored private medical arrangements?

• AThird-party administrators and employee benefits consultants
• BCustoms clearing agents at seaports
• CMotor vehicle inspection officers
• DCrop loss assessors

In comparing Nigeria and UK healthcare insurance structures, CIIN F08 candidates should understand that:

• ANigeria combines NHIA-regulated social health insurance with NAICOM-regulated private hea…
• BBoth countries fund all healthcare solely through private PMI with no public system
• CNAICOM operates the NHS on behalf of the UK government
• DNHIA underwrites aviation insurance for Nigerian airlines

The UK National Health Service (NHS) was founded on the principle that treatment would be:

• AFree at the point of use and funded mainly through taxation
• BPaid directly by patients before any consultation
• CFunded exclusively by private medical insurance premiums
• DAvailable only to employees in the organised private sector

Which is typically a principal difference between public and private healthcare sectors?

• AWaiting times, choice of facility and availability of private accommodation
• BPrivate hospitals always provide full accident and emergency services for all trauma
• CPublic hospitals never employ specialist consultants
• DPrivate treatment is always subsidised by the State in Nigeria and the UK

Acupuncture and homeopathy are examples of:

• AComplementary or alternative medicine
• BEmergency trauma surgery
• CIntensive care ventilation
• DCosmetic surgery

Ghana is often cited in global health policy discussions because it:

• AHas made notable progress toward universal health coverage through the National Health In…
• BHas abolished all public hospitals in favour of PMI only
• CDoes not permit any private healthcare providers
• DFunds healthcare entirely through employer 1% NSITF-style contributions

When comparing countries' healthcare systems, which indicator is commonly used?

• AInfant mortality and life expectancy
• BAverage motor insurance premium
• CNumber of marine cargo policies in force
• DFire loss ratio for commercial property

Private medical insurance (PMI) is primarily designed to pay for:

• APrivate acute medical treatment, often excluding chronic maintenance and cosmetic procedu…
• BRoutine motor third-party liability claims
• CCommercial building fire damage
• DMarine hull total loss

Which treatment cost would PMI policies typically cover?

• AAcute treatable conditions such as typhoid or malaria requiring curative care
• BNormal pregnancy and childbirth as standard unlimited benefit
• CLong-term maintenance of stabilised chronic asthma without acute flare-up
• DElective cosmetic surgery for appearance change

A patient admitted to hospital overnight for supervised recovery is classified as:

• AAn in-patient
• BA day patient
• CAn out-patient
• DA chronic patient

A patient who attends a clinic, receives treatment and goes home the same day without overnight admission is:

• AA day patient or out-patient depending on context
• BAlways classified as an in-patient
• CDefined as a chronic patient only
• DExcluded from any PMI cover automatically

Hospital bands (or hospital lists) in PMI policies classify providers according to:

• AAccommodation standard and treatment costs, affecting premium and claim limits
• BThe patient's occupation only
• CWhether the hospital is located in a rural ward
• DThe insurer's motor fleet size

A health cash plan typically provides:

• AFixed cash benefits towards everyday health costs such as dental, optical and physiothera…
• BUnlimited private in-patient surgical cover worldwide
• CIncome replacement until retirement after any illness
• DLump-sum payment on diagnosis of any cancer without survival period

Which benefit would a standard health cash plan NOT typically provide?

• AFull cost of major complex surgery
• BOptical and dental cash benefits
• CMaternity or paternity grants
• DChiropody or physiotherapy cash benefits

Comprehensive PMI policies generally offer:

• AThe widest scope of in-patient, day-patient and out-patient cover among personal PMI prod…
• BCover for motor third-party injury only
• CNo hospital accommodation options
• DAutomatic cover for all cosmetic procedures

Blood and urine laboratory testing in a hospital setting is classified under:

• APathology
• BRadiology
• CPhysiotherapy
• DConsultation only

Body scans such as MRI and CT imaging are classified under:

• ARadiology
• BPathology
• CPhysiotherapy
• DCapitation dentistry

A table of benefits in a PMI policy lists:

• ACovered medical services and maximum benefit amounts per day, week or procedure
• BOnly the broker's commission schedule
• CThe insured's motor no-claims discount history
• DReinsurance treaty retention percentages

Policy excess in healthcare insurance is:

• AThe amount the insured bears before the insurer pays eligible medical benefits
• BThe maximum lifetime benefit the insurer will ever pay
• CThe broker's fee for placing the policy
• DThe NHIA registration number of the HMO

An affinity discount on healthcare insurance is offered when:

• AThe member belongs to a recognised group such as an employer, association or sports club
• BThe member has never visited a doctor
• CThe member cancels cover mid-term
• DThe member switches hospitals without notifying the HMO

Dental capitation plans typically work by:

• AThe dentist receiving a fixed periodic payment per enrolled patient for agreed routine ca…
• BPaying unlimited inpatient surgical fees for any hospital worldwide
• CReplacing all NHIA mandatory contributions
• DGuaranteeing a lump sum on critical illness diagnosis

International medical insurance for expatriates commonly adds benefits such as:

• AEvacuation, repatriation and treatment in multiple countries subject to geographic limits
• BMandatory cover for commercial cargo theft only
• CUnlimited cosmetic surgery worldwide as standard
• DExclusion of all GP and primary care costs

Choosing treatment in a lower-cost country offering comparable quality is sometimes called:

• AMedical tourism or healthcare arbitrage
• BStop-loss reinsurance
• CMoratorium underwriting
• DUtmost good faith disclosure

Critical illness insurance typically pays:

• AA predetermined lump sum if the insured survives a specified period after diagnosis of a…
• BThe exact hospital invoice for every GP visit
• CWeekly income until the deferred period ends only
• DNothing unless the insured dies within 24 hours

Long-term care insurance is designed to fund:

• APersonal care and nursing home or home-care costs when the insured cannot perform daily a…
• BEmergency appendectomy in a private hospital
• CRoutine dental check-ups only
• DShort-term travel medical expenses abroad

Travel insurance medical sections typically consider rating factors such as:

• ATrip duration, destination, age and whether pre-existing conditions are covered
• BThe insured's household building sum insured
• CCommercial fleet no-claims bonus
• DCrop yield forecasts

Self-funded employer healthcare schemes differ from insured PMI because the employer:

• APays treatment costs as they arise, sometimes using stop-loss insurance to cap large loss…
• BNever bears any healthcare cost risk
• CMust always use NHIA as the sole underwriter
• DCannot access any third-party administration services

The primary role of an insurance broker in healthcare insurance is to:

• AAct for the client in placing cover, advising on product choice and negotiating terms wit…
• BUnderwrite medical risks on behalf of NAICOM
• CPerform surgical procedures at accredited hospitals
• DIssue NHIA enrollee cards directly without insurer involvement

Healthcare providers in a managed care network are responsible for:

• ADelivering agreed clinical services to enrolled members under contract with the insurer o…
• BSetting NAICOM minimum capital requirements for insurers
• CConducting CIIN professional examinations
• DCollecting VAT on imported pharmaceuticals for FIRS exclusively

Which party is NOT typically classified as an independent intermediary in healthcare insurance?

• AHealthcare provider treating the patient
• BInsurance broker
• CEmployee benefits consultant
• DFinancial adviser placing PMI

A stated strength of third-party administrators in healthcare is:

• AIndependence and specialist expertise in claims administration and provider management
• BImmunity from all regulatory oversight
• CGuaranteed profit on every health policy regardless of claims
• DAuthority to amend NHIA Act provisions

When an enrollee requests a change of primary healthcare provider through their HMO, the HMO will typically consider:

• ANetwork adequacy, plan benefit level and whether the requested hospital tier matches cover
• BThe member's motor insurance renewal date
• CThe broker's professional indemnity limit only
• DWhether the member holds a marine cargo policy

Employee benefits consultants add value to corporate healthcare programmes by:

• ADesigning benefit structures, benchmarking insurers and ensuring regulatory compliance
• BPerforming clinical surgery on employees
• CReplacing NHIA as scheme regulator
• DSetting hospital drug formulary prices unilaterally

Insurers in the healthcare market may employ medical professionals to:

• ADevelop clinical guidelines, review treatment necessity and manage claims costs
• BAudit NAICOM annual returns exclusively
• CConduct civil service recruitment examinations
• DLicense new pharmaceutical manufacturing plants

Managed care is best described as:

• AA generic term for systems coordinating financing and delivery to control cost and quality
• BA specific NAICOM penalty for late premium payment
• CA type of life assurance endowment policy
• DAn NHIA tax on imported medical equipment only

Under formal sector NHIA programmes, contributions typically cover:

• AThe employee, spouse and up to four biological children with optional additional dependan…
• BOnly the employer with no dependant benefits
• CMotor vehicle third-party injury exclusively
• DCommercial fire and special perils on office buildings

The employer contribution rate under Nigeria's formal sector social health insurance is typically:

• A10% of emolument with the employee contributing 5%
• B1% of total monthly payroll under NSITF rules
• C50% paid entirely by the employee
• DZero contribution because NHIA is fully tax-funded

Morbidity statistics in healthcare underwriting measure:

• AThe incidence and prevalence of illness and disability in a population
• BOnly the number of motor accidents per thousand vehicles
• CFire frequency in commercial warehouses
• DMarine piracy events off West Africa

Which factor is commonly used when rating individual private medical insurance?

• AAge, location and smoking status
• BThe insured's favourite sport team
• CNumber of previous household burglary claims
• DCommercial fleet vehicle count only