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2026 Statistics

Key Facts: IC-38 Insurance Agent Exam - Health Exam

50 MCQs

Official exam length with a 60-minute time limit

IRDAI / III guidelines

35%

Passing mark (minimum 17/50 correct answers)

III regulations

₹590

Exam fee including GST per the III schedule

Insurance Institute of India

50 hours

Mandatory training requirement for single category health agents

IRDAI Agent Regulations

₹50 lakh

Ombudsman compensation limit after November 2023 amendment

Insurance Ombudsman Rules

12th Pass

Minimum education requirement to register as an agent

IRDAI regulations

The IC-38 Health Agent exam has 50 MCQs, a 60-minute time limit, and a 35% (17/50) pass mark. Sponsoring insurer registration requires ₹500 + GST exam fee and ₹750 + GST online training fee. The syllabus is split into 6 topics covering basics, principles, underwriting, customer service, regulations, and health products.

Sample IC-38 Insurance Agent Exam - Health Practice Questions

Try these sample questions to test your IC-38 Insurance Agent Exam - Health exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which of the following best defines the concept of 'risk' in health insurance?

A.The certainty of an adverse financial loss occurring due to illness

B.The uncertainty regarding the occurrence of a physical or financial loss due to health issues

C.The total expenditure incurred by a policyholder on medical treatments

D.The maximum limit of compensation offered by an insurance policy

Explanation: Risk is fundamentally defined as the uncertainty regarding the occurrence of a loss. In health insurance, it refers to the unpredictable chance of falling ill and incurring medical expenses. Certainty of loss is not insurable, and expenditure or policy limits refer to costs and benefits, not the risk itself.

2How does risk pooling benefit health insurance policyholders?

A.By eliminating the occurrence of diseases among the insured population

B.By spreading the financial loss of a few individuals across a large group of similar risk exposures

C.By ensuring that healthy individuals are paid cash bonuses if they do not file claims

D.By allowing policyholders to trade their policy benefits with other pool participants

Explanation: Risk pooling is the core mechanism of insurance where the losses of a few are spread across a large pool of individuals with similar risk exposures, making the financial impact manageable for everyone. It does not prevent or eliminate the physical occurrence of disease, nor does it allow policy trading or mandate cash payouts to healthy members.

3Which of the following represents a 'peril' in the context of health and accident insurance?

A.An oily floor that increases the chance of slipping

B.A disease or accident that directly causes bodily injury or hospitalization

C.The deliberate neglect of one's physical health

D.The high cost of prescription medications in private hospitals

Explanation: A peril is the direct cause of loss. In health and accident insurance, the peril is the disease, sickness, or accident that causes bodily injury or hospitalization. An oily floor is a hazard (an condition that increases the probability of loss), deliberate neglect is a moral/morale hazard, and medication cost is the consequence of the loss.

4What is the primary role of the Law of Large Numbers in the pricing of health insurance?

A.It limits the maximum number of family members that can be covered under a floater plan

B.It enables insurers to predict future loss ratios more accurately by observing a larger group of risk units

C.It guarantees that insurers will never suffer underwriting losses in any given financial year

D.It mandates that premium rates must decrease automatically as the insurer's customer base grows

Explanation: The Law of Large Numbers states that as the number of similar exposure units increases, the actual loss experience will more closely approach the expected loss experience. This mathematical principle allows insurers to predict claims and price premiums accurately. It does not limit family size, guarantee profits, or require automatic premium cuts.

5Which of the following is categorized as a moral hazard in health insurance?

A.A family history of hereditary cardiovascular illnesses

B.Exposing oneself to cold weather resulting in seasonal influenza

C.A policyholder inflating a hospital bill in collusion with a clinic to claim more money

D.The proximity of the insured's residence to a high-pollution industrial zone

Explanation: Moral hazard arises from the dishonesty or character defects of an individual that increase the frequency or severity of a loss. Colluding with a clinic to inflate hospital bills is a clear example of moral hazard. Family history and geographic location are physical hazards, while simple exposure to weather is often a morale hazard (carelessness).

6Which risk management technique involves an individual keeping money aside to pay for future minor medical treatments instead of buying insurance?

A.Risk Transfer

B.Risk Retention

C.Risk Avoidance

D.Risk Reduction

Explanation: Risk retention (or self-insurance) occurs when an individual or firm decides to bear the financial consequences of a risk. Setting aside money to cover minor medical costs rather than paying premiums is risk retention. Transfer involves buying insurance, avoidance means eliminating the activity, and reduction means minimizing the chance of illness through healthy habits.

7Which of the following is a physical hazard that an underwriter evaluates for a health insurance policy?

A.The applicant's tendency to exaggerate minor symptoms during clinical checkups

B.The applicant's occupation as an underground coal mine worker

C.An applicant's belief that health insurance makes healthy lifestyle habits unnecessary

D.A plan to migrate to a country with a tropical climate in the future

Explanation: A physical hazard is a physical condition that increases the likelihood or severity of a loss. Working in an underground coal mine exposes the applicant to dust and hazardous working conditions, which is a physical hazard. Exaggerating symptoms and ignoring healthy habits represent morale or moral hazards.

8In risk management, taking regular vaccinations and maintaining a balanced diet to prevent illness is an example of:

A.Risk Transfer

B.Risk Avoidance

C.Risk Reduction

D.Risk Retention

Explanation: Risk reduction involves taking proactive measures to decrease the probability or impact of a loss. Getting vaccinated and eating a balanced diet are active methods of reducing the frequency and severity of health ailments. Risk avoidance would require eliminating the risk completely, which is impossible with health.

9Why is 'speculative risk' generally considered uninsurable by commercial health insurers?

A.Because speculative risks only result in catastrophic losses that ruin insurers

B.Because speculative risk involves the possibility of either a gain or a loss, violating the principle of indemnity

C.Because speculative risks are too small in value to justify administrative expenses

D.Because there are no statistical methods available to track speculative risk occurrences

Explanation: Speculative risk involves situations where there is a possibility of gain as well as loss (like gambling or business ventures). Insurance is designed for pure risks (loss or no-loss situations) to restore the insured to their original position. Insuring speculative risk would violate the principle of indemnity by allowing individuals to profit.

10Which of the following describes the social benefit of health insurance in India?

A.It eliminates the need for government-funded public health programs

B.It reduces out-of-pocket medical expenditures, preventing families from falling into poverty due to medical emergencies

C.It guarantees that private hospitals will provide free treatment to all citizens

D.It increases the profitability of pharmaceutical manufacturing corporations

Explanation: Health insurance provides a massive social benefit by reducing catastrophic out-of-pocket medical expenses, which are a major cause of debt and poverty in India. It does not replace public health initiatives, guarantee free private care to non-policyholders, or focus on drug manufacturer profits.

About the IC-38 Insurance Agent Exam - Health Exam

The IC-38 Insurance Agent Exam - Health is the official qualification exam for health insurance agents in India, conducted by the Insurance Institute of India (III) under the authority of IRDAI. The syllabus covers the fundamentals of risk management, core legal principles of insurance contracts, underwriting and medical rating processes, documentation (proposals, policy documents), claim procedures (TPA, cashless, reimbursement), customer service, and the IRDAI code of conduct. Candidates must complete a mandatory 50-hour training course and score at least 35% (17 correct out of 50 questions) to pass.

Assessment

50 one-mark MCQs in 60 minutes; no negative marking.

Time Limit

60 minutes

Passing Score

35% (18/50)

Exam Fee

₹500 + GST (₹590 total) exam fee per III table; online training fee ₹750 + GST (₹886 total) (Insurance Institute of India (III) on behalf of IRDAI)

IC-38 Insurance Agent Exam - Health Exam Content Outline

15%

Introduction & Core Elements of Insurance

Concepts of risk, peril, hazard, risk transfer, pooling, law of large numbers, and historical evolution of insurance.

15%

Principles & Insurance Contracts

Crucial legal principles: Utmost Good Faith (Uberrima Fides), Insurable Interest, Indemnity, Subrogation, Contribution, Proximate Cause, and standard contract clauses.

20%

Underwriting, Documentation & Claims

Proposal form details, KYC/AML documents, policy documents, medical underwriting, TPA functions, cashless/reimbursement claim steps, and repudiation.

15%

Customer Service & Grievance Redressal

Ethical selling, Bima Bharosa portal, grievance redressal rules, and the post-Nov 2023 updated ₹50 lakh compensation limit for the Insurance Ombudsman.

15%

Regulatory Aspects of Insurance Agents

IRDAI (Appointment of Insurance Agents) Regulations, code of conduct, agent duties, prohibited practices, and licensing rules.

20%

Health Insurance Products

Indemnity policies (family floaters, group health), fixed benefit covers (critical illness, hospital cash), personal accident, and travel insurance.

How to Pass the IC-38 Insurance Agent Exam - Health Exam

What You Need to Know

Passing score: 35% (18/50)
Assessment: 50 one-mark MCQs in 60 minutes; no negative marking.
Time limit: 60 minutes
Exam fee: ₹500 + GST (₹590 total) exam fee per III table; online training fee ₹750 + GST (₹886 total)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

IC-38 Insurance Agent Exam - Health Study Tips from Top Performers

1Study the concept of Utmost Good Faith and the difference between non-disclosure and active misrepresentation, as these form the basis of many contract questions.

2Understand the Ombudsman rules thoroughly, noting that the compensation limit has been amended to ₹50 lakh (effective post-November 2023), and learn the 30-day turnaround rules.

3Memorize the standard waiting periods in health insurance: the 30-day initial waiting period (except for accidents), specific 2-year exclusions, and pre-existing disease (PED) caps.

4Contrast indemnity policies (where claims match actual medical costs up to the sum insured) with fixed benefit policies like critical illness (which pay a lump sum upon diagnosis).

5Do timed practice tests of 50 questions under a 60-minute constraint. Because there is no negative marking, never leave a question blank on the actual exam.

Frequently Asked Questions

What is the IC-38 Health Insurance Agent Exam?

The IC-38 Health Insurance Agent Exam is a qualifying test conducted by the Insurance Institute of India (III) on behalf of the Insurance Regulatory and Development Authority of India (IRDAI). It is required for individuals wishing to become licensed health insurance agents in India.

How many questions are on the exam, and what is the time limit?

The official examination consists of 50 multiple-choice questions (MCQs) for a total of 50 marks, to be completed in 60 minutes. There is no negative marking, so candidates should attempt all questions.

What is the passing score for the health agent exam?

The passing score is 35%. Candidates must correctly answer at least 17 out of 50 questions to pass the exam.

What is the fee structure for training and registration?

Standard fees set by III include an exam registration fee of ₹500 + GST (₹590 total) and a mandatory online pre-licensing training portal fee of ₹750 + GST (₹886 total).

What are the education and training prerequisites?

Candidates must have completed at least a 10+2 (12th class) education or equivalent. Additionally, they must complete a mandatory 50-hour health insurance training course (or 75 hours for composite licensing) from an IRDAI-approved training institute before scheduling the exam.

What topics are covered in the IC-38 Health Insurance Agent syllabus?

The syllabus includes six key topics: Introduction & Core Elements of Insurance (15%), Principles & Insurance Contracts (15%), Underwriting, Documentation & Claims (20%), Customer Service & Grievance Redressal (15%), Regulatory Aspects of Insurance Agents (15%), and Health Insurance Products (20%).