Exam InsNV_Health02 Exercise - Exam InsNV_Health02 Topic

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Accident & Health – General Knowledge50%- Social Insurance
  • 1. Medicaid
    • 2. Medicare Parts A, B, C, and D
      • 3. Social Security benefits
        - Types of Policies
        • 1. Group insurance
          • Differences between individual and group contracts
          • General characteristics
          • COBRA
        • 2. Other policies
          • Dental
          • Vision
          • Cancer
          • Critical illness or specified disease
          • Worksite employer-sponsored
          • Hospital indemnity
          • Short-term medical
          • Accident
        • 3. Medical expense insurance
          • Basic hospital, medical, and surgical policies
          • Major medical policies
          • Health Maintenance Organizations
          • Preferred Provider Organizations
          • Point of Service plans
          • Flexible Spending Accounts
          • High Deductible Health Plans and Health Savings Accounts
          • Health Reimbursement Accounts
        • 4. Individual and Group Long Term Care
          • Eligibility
          • Levels of care
        • 5. Disability income
          • Individual disability income policy
          • Business overhead expense policy
          • Business disability buyout policy
          • Group disability income policy
          • Key employee policy
        • 6. Medicare supplement policies
          • 7. Accidental death and dismemberment
            - Field Underwriting Procedures
            • 1. Replacement
              • 2. Sources of insurability and HIPAA privacy information
                • 3. Contract law
                  • Elements of a contract
                  • Insurable interest
                  • Warranties and representations
                  • Unique aspects of the insurance contract
                • 4. Policy delivery
                  • 5. Explaining policy provisions, riders, exclusions, and ratings
                    • 6. Initial premium payment and receipt
                      • 7. Submitting application and initial premium to company for underwriting
                        • 8. Completing the application
                          - Other Insurance Concepts
                          • 1. Owner's rights
                            • 2. Dependent children benefits
                              • 3. Managed care
                                • 4. Tax treatment of premiums and proceeds of insurance contracts
                                  • 5. Subrogation
                                    • 6. Occupational vs. non-occupational
                                      • 7. Workers Compensation
                                        • 8. Modes of premium payments
                                          • 9. Nonduplication and coordination of benefits
                                            • 10. Primary and contingent beneficiaries
                                              • 11. Total, partial, recurrent, and residual disability
                                                • 12. Cost containment
                                                  - Policy Provisions, Clauses, and Riders
                                                  • 1. Riders
                                                    • Impairment and exclusions
                                                    • Guaranteed insurability
                                                    • Future increase option
                                                  • 2. Other provisions and clauses
                                                    • Insuring clause
                                                    • Free look
                                                    • Consideration clause
                                                    • Probationary period
                                                    • Elimination period
                                                    • Waiver of premium
                                                    • Exclusions and limitations
                                                    • Preexisting conditions
                                                    • Coinsurance
                                                    • Deductibles
                                                    • Eligible expenses
                                                    • Copayments
                                                    • Pre-authorizations and prior approval requirements
                                                    • Usual, reasonable, and customary charges
                                                    • Lifetime, annual, or per cause maximum benefit limits
                                                  • 3. Rights of renewability
                                                    • Noncancelable
                                                    • Cancelable
                                                    • Guaranteed renewable
                                                  • 4. Mandatory and optional provisions
                                                    • Entire contract
                                                    • Time limit on certain defenses
                                                    • Grace period
                                                    • Reinstatement
                                                    • Notice of claim
                                                    • Claim forms
                                                    • Proof of loss
                                                    • Time of payment of claims
                                                    • Payment of claims
                                                    • Physical examination and autopsy
                                                    • Legal actions
                                                    • Change of beneficiary
                                                    • Misstatement of age or gender
                                                    • Change of occupation
                                                    • Illegal occupation
                                                    • Relation of earnings to insurance
                                                  Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Advertising
                                                  - Group life and health insurance
                                                  • 1. Eligible groups
                                                    • 2. Required provisions
                                                      - Credit life and health insurance
                                                      Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Nevada Life and Health Insurance Guaranty Association
                                                      - Insurance Commissioner
                                                      • 1. Notice and hearings and penalties
                                                        • 2. Examinations
                                                          • 3. General powers and duties
                                                            - Marketing Practices
                                                            • 1. Silver State Health Insurance Exchange
                                                              • 2. Commissions and payment restrictions
                                                                • 3. Required records and record retention
                                                                  • 4. Fiduciary responsibilities
                                                                    • 5. Unfair practices
                                                                      • Unfair claims methods and practices and settlement of claims
                                                                      • Rebating and inducement
                                                                      • Twisting
                                                                      • Misrepresentation
                                                                      • Fraud
                                                                      • Unfair discrimination
                                                                      • Defamation
                                                                    • 6. Affordable Care Act
                                                                      - Licensing
                                                                      • 1. Renewal and continuing education
                                                                        • 2. Termination of license
                                                                          • 3. Name of licensee
                                                                            • 4. Persons required to be licensed
                                                                              • 5. Obtaining a license
                                                                                • 6. Suspension, revocation, and refusal of license
                                                                                  - Definitions
                                                                                  • 1. Cost-sharing
                                                                                    • 2. Insurer
                                                                                      • 3. Transacting insurance
                                                                                        • 4. Certificate of authority
                                                                                          • 5. Domestic, foreign, and alien
                                                                                            • 6. Premiums
                                                                                              • 7. Authorized and unauthorized
                                                                                                Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Medicare
                                                                                                • 1. Prescription Drug Plan
                                                                                                  • 2. Medicare Advantage Plans
                                                                                                    • 3. Medicare supplement regulation
                                                                                                      - Mandatory policy clauses and provisions
                                                                                                      • 1. Coverage for physical handicap or intellectual disability for dependent children
                                                                                                        • 2. Coverage for preventive healthcare services
                                                                                                          • 3. Coverage for newborn children
                                                                                                            - Coverage for reconstructive surgery
                                                                                                            - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
                                                                                                            - Long Term Care
                                                                                                            - Hospice care

                                                                                                            >> Exam InsNV_Health02 Exercise <<

                                                                                                            Insurance Licensing InsNV_Health02 Questions - Latest Approved Exam Dumps

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q94-Q99):

                                                                                                            NEW QUESTION # 94
                                                                                                            Under a group health policy, which of the following coverages MUST be provided for newborn children?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            Nevada requires qualifying group health policies that cover family members to provide coverage for a newborn child from the moment of birth. Required newborn coverage includes injury or sickness and specifically includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Therefore, congenital health defects are the required coverage identified in this question.
                                                                                                            The rule is important because congenital defects may be present at birth and can require immediate diagnostic, surgical, medical, or hospital treatment. Nevada law prevents a policy from excluding this necessary care simply because the condition existed at birth. The statute also prohibits exclusion of premature births under the applicable coverage requirement.
                                                                                                            The transportation option is incorrect because the law addresses necessary transportation from the place of birth to the nearest specialized treatment center, within policy limits; it does not mandate transportation from the hospital to the child's residence. Routine eye examinations and genetic testing may be covered under a particular policy or health plan, but they are not the specific newborn mandate tested here. Continued coverage beyond the initial period may depend on timely notice and payment of required premium within 31 days.
                                                                                                            Study Guide references/topics: group health insurance; newborn coverage; mandated benefits; NRS 689B.033
                                                                                                            .


                                                                                                            NEW QUESTION # 95
                                                                                                            When a criminal violation of the insurance code has occurred, the Nevada Insurance Commissioner is required to report the violation to the:

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            When the Nevada Insurance Commissioner has reason to believe that a person has violated the Insurance Code or another law applicable to insurance operations and criminal prosecution appears appropriate, the Commissioner must provide the relevant information to the appropriate district attorney or to the Attorney General. Of the choices given, District Attorney is the correct answer.
                                                                                                            The Commissioner administers and enforces Nevada insurance laws, investigates potential violations, conducts examinations, and may impose administrative sanctions where authorized. Criminal prosecution, however, is handled by the appropriate prosecutorial authority rather than by the Commissioner personally.
                                                                                                            This division of responsibility preserves due process and ensures that criminal cases are evaluated and prosecuted by officials with criminal-law authority.
                                                                                                            The Secretary of State, Lieutenant Governor, and State Police may have governmental roles that occasionally relate to business records, executive functions, or investigations, but they are not the statutory prosecutorial recipients identified in Nevada's insurance law. The examination point is that an insurance violation can produce both administrative consequences, such as a fine or license action, and criminal referral when the conduct warrants prosecution.
                                                                                                            Study Guide references/topics: powers and duties of the Commissioner; insurance-code enforcement; criminal violations; NRS 679B.150 .


                                                                                                            NEW QUESTION # 96
                                                                                                            Which of the following policies provides a specified income benefit when the insured person becomes unable to work because of illness or accident?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            Disability Income insurance is designed to replace a portion of an insured's earned income when illness or accidental injury prevents the insured from working. Choice D is correct. Unlike medical expense insurance, which pays for covered health-care costs, disability income coverage pays a stated periodic benefit- commonly monthly-to help the insured meet ordinary financial obligations during disability. Benefits are subject to the policy definition of disability, elimination period, benefit period, maximum monthly benefit, and any offsets or residual-disability provisions. "Emergency Income," "Supplemental Income," and
                                                                                                            "Temporary Income" are not standard policy classifications that describe the core income-replacement product tested here. Disability policies may be written on an own-occupation, modified-own-occupation, or any-occupation basis, and that definition materially affects when benefits are payable. Individual disability income is commonly purchased by self-employed persons, professionals, and others who want income protection beyond employer-sponsored benefits. Group disability plans often provide short-term and long- term benefits, while individual policies can offer more customized benefit levels, riders, and noncancellable or guaranteed-renewable features. Study Guide References/Topics: Types of Health Insurance Policies; Disability Income Insurance; Income Replacement.


                                                                                                            NEW QUESTION # 97
                                                                                                            Under a Gold health insurance plan, an insurer would be expected to pay which percentage of medical costs?

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            A Gold Marketplace health plan has an actuarial value of approximately 80%. Therefore, the insurer is expected to pay about 80% of covered medical costs for a standard population, while enrollees as a group pay approximately 20% through deductibles, copayments, and coinsurance.
                                                                                                            Actuarial value does not mean that the insurer pays exactly 80% of every individual's bills. A particular insured may pay more or less than 20% in a year depending on the services used, the plan's deductible, copayment structure, provider network, prescription-drug costs, and whether the annual out-of-pocket maximum has been reached. It is an overall measure of expected cost sharing for covered benefits.
                                                                                                            The standard metal levels are Bronze at 60%, Silver at 70%, Gold at 80%, and Platinum at 90%. Gold plans generally have higher monthly premiums than Bronze or Silver plans but lower cost sharing when health care is received. Platinum plans generally have the highest premiums and the lowest cost sharing.
                                                                                                            Study Guide references/topics: Affordable Care Act; Marketplace plans; metal levels; actuarial value; deductibles; copayments; HealthCare.gov plan categories .


                                                                                                            NEW QUESTION # 98
                                                                                                            The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured ' s age on the policy application?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.


                                                                                                            NEW QUESTION # 99
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                                                                                                            The evergreen field of Insurance Licensing is so attractive that it provides non-stop possibilities for the one who passes the Insurance Licensing InsNV_Health02 exam. So, to be there on top of the Insurance Licensing sector, earning the NV Accident and Health (InsNV_Health02) certification is essential. Because of using outdated InsNV_Health02 study material, many candidates don't get success in the NV Accident and Health (InsNV_Health02) exam and lose their resources.

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