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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health — General Knowledge | ~68% | - Social Insurance / Government Plans
|
| Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
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NEW QUESTION # 130
A person insured under a policy of Long Term Care insurance issued pursuant to a direct response solicitation has how many days after delivery to return the policy for a full refund?
Answer: A
Explanation:
A long-term care insurance policy may be returned within 30 days after delivery for a full premium refund if the applicant is dissatisfied for any reason. This is known as a free-look or right-to-return provision. It gives the insured time to examine the contract after delivery and determine whether the coverage is appropriate.
The right is especially important in a direct-response sale, where the consumer may not have met face-to-face with a producer. Long-term care policies can contain detailed provisions concerning benefit triggers, elimination periods, activities of daily living, cognitive impairment, benefit periods, inflation protection, exclusions, premium changes, and nonforfeiture benefits. The 30-day review period allows a buyer to examine those terms without forfeiting premium.
The policy must prominently disclose the right to return the contract and receive a refund. The insurer must make the refund within the required period after the policy is returned. This rule differs from other health- insurance free-look, cancellation, grace-period, and reinstatement provisions, which can use different deadlines.
Study Guide references/topics: long-term care insurance; direct response solicitation; free-look provision; return of policy; NAC 687B.060 .
NEW QUESTION # 131
In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:
Answer: D
Explanation:
A person may not concurrently hold a Nevada producer license and an Exchange Enrollment Facilitator certificate. Therefore, a health insurance producer who wishes to become an EEF must surrender the producer authority and apply for certification as an Exchange Enrollment Facilitator.
An EEF assists consumers with enrollment in qualified health plans offered through the Exchange. The role is designed to provide objective enrollment help, application assistance, and general information. An EEF may not sell, solicit, or negotiate insurance. The EEF also may not receive consideration from a health insurance issuer or insurer in connection with enrollment and may not receive remuneration arising from EEF activities from a licensed producer, insurance consultant, surplus lines broker, or insurer.
For that reason, a producer cannot receive commissions while acting as an EEF, cannot collect both commission and EEF compensation in the manner described, and cannot steer a consumer toward a particular coverage choice. Producers and EEFs have different legal roles, compensation structures, and consumer- protection limitations.
Study Guide references/topics: Exchange Enrollment Facilitators; producer licensing; prohibited acts; compensation; NRS 695J.210 .
NEW QUESTION # 132
Group health policies MUST provide which of the following benefits?
Answer: A
Explanation:
Nevada requires group health insurance policies to include benefits for expenses arising from hospice care.
Hospice care is designed for individuals facing terminal illness and focuses on comfort, pain and symptom management, emotional support, and assistance for the patient and family rather than curative treatment.
The group-policy required-provisions statute specifically includes hospice-care benefits. It also recognizes benefits for care at home or health supportive services when prescribed by a physician and otherwise covered if provided in a medical facility. This reflects the policy goal of allowing appropriate end-of-life care in a setting suited to the patient's needs.
Adult vision care and adult dental care are not universally required benefits under every group health policy.
They may be offered through separate policies, riders, employer benefit arrangements, or plan designs.
Cosmetic surgery is generally not a mandatory health insurance benefit and may be excluded unless medically necessary or required because of injury, congenital condition, reconstruction, or another covered circumstance.
The key examination point is that hospice care is a specifically required group-policy benefit in Nevada, while the other choices may be optional, limited, or excluded depending on the plan.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; NRS 689B.
030 .
NEW QUESTION # 133
The Nevada Life and Health Insurance Guaranty Association is financed by which of the following methods?
Answer: A
Explanation:
The Nevada Life and Health Insurance Guaranty Association is financed through assessments on member insurance companies. Insurers authorized to transact covered life, health, or annuity business in Nevada are members of the Association as a condition of their authority to operate in the state. When an assessment is necessary, the Association assesses member insurers according to the statutory assessment system.
The Association exists to provide limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not financed by direct assessments against insureds, policyowners, agents, or association members. It is also not simply funded through a general premium tax imposed on consumers.
Nevada law establishes assessment classes, including assessments for administrative and legal expenses and assessments needed to carry out the Association's obligations regarding an impaired or insolvent insurer.
Member insurers may consider the cost of assessments when establishing rates and dividends, but that does not change the source of the Association's direct funding: the member insurers themselves.
The Guaranty Association is a safety mechanism with statutory limits. It is not a substitute for evaluating an insurer's financial strength, and insurers and producers may not use its existence as a sales inducement.
Study Guide references/topics: insurer insolvency; guaranty associations; member insurer assessments; NRS Chapter 686C .
NEW QUESTION # 134
The maximum cost share for preventive screening from an in-network provider is:
Answer: B
Explanation:
The maximum cost share for a covered preventive screening received from an in-network provider is 0%. In practical terms, the insured generally pays no deductible, copayment, or coinsurance for qualifying preventive services delivered in-network. This rule is intended to encourage early detection of illness and promote preventive care before conditions become more serious and costly.
Examples of qualifying preventive care can include certain screenings, immunizations, counseling, and wellness services. The precise covered service and frequency may depend on age, sex, medical circumstances, and the applicable preventive-service recommendations. The in-network condition is important because services received outside the plan's network may be subject to different cost-sharing rules, except where other law or plan provisions apply.
The choices of 10%, 20%, and 30% reflect ordinary coinsurance levels that may apply to nonpreventive treatment or to services that do not qualify for first-dollar preventive coverage. They do not apply to an eligible preventive screening under the in-network preventive-care rule.
Always distinguish preventive screening from diagnostic care. A screening is generally performed when no symptom or suspected condition is being evaluated; a diagnostic service may generate cost sharing depending on the circumstances and plan terms.
Study Guide references/topics: preventive services; in-network providers; deductibles; copayments; coinsurance; HealthCare.gov preventive-care guidance .
NEW QUESTION # 135
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