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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
| Topic 2: Accident and Health — General Knowledge | ~68% | - Types of Health Insurance Policies
|
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NEW QUESTION # 74
A Long-Term Care policy provides coverage for:
Answer: B
Explanation:
Long-term care insurance is designed primarily to cover services required when an insured cannot perform activities of daily living independently or has a severe cognitive impairment. Custodial care in a nursing home is a core example of long-term care coverage. Custodial care involves assistance with everyday personal needs, such as bathing, dressing, eating, transferring, toileting, and continence, rather than acute medical treatment.
Long-term care benefits may be provided in a nursing home, assisted-living setting, adult day-care setting, or the insured's home, depending on the policy. Coverage can include skilled nursing care, intermediate care, custodial care, home health care, hospice care, respite care, and care-management services, subject to policy conditions and benefit triggers.
Hospital-expense and medical-expense policies generally focus on acute treatment, physician services, surgery, hospitalization, and related medical costs. Medicare Supplement insurance is designed to help pay certain Medicare deductibles, coinsurance, and copayments; it is not long-term care insurance.
The distinction is crucial: long-term care insurance addresses prolonged assistance and supervision resulting from chronic illness, disability, frailty, or cognitive impairment, whereas major medical insurance focuses principally on acute medical treatment.
Study Guide references/topics: long-term care insurance; custodial care; skilled care; activities of daily living; nursing-home benefits; Nevada long-term-care regulations .
NEW QUESTION # 75
In a contributory group health insurance plan, which statement is correct?
Answer: D
Explanation:
A contributory group health plan is one in which covered employees pay a portion of the premium. Because employees must elect coverage and contribute financially, insurers commonly require a minimum percentage of eligible employees to participate. The participation requirement reduces adverse selection by helping ensure that enrollment includes a broad cross-section of the eligible group rather than only individuals who expect immediate medical expenses.
A noncontributory plan is one in which the employer pays the full premium for eligible employees. Because employees are not required to contribute, participation is generally expected to be much higher and may be mandatory for eligible employees under the employer's plan rules. The distinction is based on premium contribution, not on whether the coverage includes dependents, dental benefits, or a network.
Group insurance is characterized by a master policy issued to the policyholder, commonly an employer or association. Individual insureds receive certificates of coverage that describe the benefits and rights under the group contract. The employer's role, employee eligibility rules, waiting periods, and contribution structure must all be disclosed accurately.
On an examination question, remember the primary rule: contributory means employees contribute toward premium; noncontributory means the employer pays the entire premium for the covered employees.
References/topics from the Study Guide: Group Health Insurance; Contributory Plans; Noncontributory Plans; Participation Requirements; Certificates of Coverage.
NEW QUESTION # 76
Medicaid is best described as:
Answer: D
Explanation:
Medicaid is a joint federal-state medical-assistance program serving eligible individuals and families under income, resource, categorical, residency, and other program rules. The federal government establishes broad requirements and provides funding, while each state administers its program within federal parameters.
Nevada administers Medicaid through its state health and human-services structure and contracted delivery systems. Eligibility and benefits can vary by category and may change with law and program administration.
Medicaid is not the same as Medicare. Medicare is principally a federal social-insurance program associated with age 65 or older, certain disabilities, and end-stage renal disease or other qualifying conditions. Medicaid is generally means tested, although eligibility is determined by detailed program standards and should never be assumed from income alone. Some people may qualify for both Medicare and Medicaid; these individuals are often referred to as dual-eligible beneficiaries.
A producer should avoid giving legal or public-benefit eligibility advice beyond the scope of insurance licensing. The proper role is to identify the program accurately, explain how private coverage may coordinate where applicable, and direct a consumer to the appropriate state agency or benefits specialist for an eligibility determination.
References/topics from the Study Guide: Medicaid; Medicare; Dual Eligibility; Government-Sponsored Health Programs; Nevada Public Health Benefits.
NEW QUESTION # 77
The Nevada Life and Health Insurance Guaranty Association becomes involved in an insurance company ' s affairs when the company:
Answer: B
Explanation:
The Nevada Life and Health Insurance Guaranty Association becomes involved when a covered member insurer becomes impaired or insolvent. Its statutory purpose is to provide limited protection to eligible policyowners, certificate holders, enrollees, beneficiaries, and other covered persons when a member insurer cannot perform its contractual obligations because of financial failure.
An ordinary lawsuit, claim denial, or membership withdrawal does not by itself trigger Guaranty Association protection. Claim disputes are normally handled through the insurer's claims process, internal appeals, administrative complaint procedures, or litigation. The Guaranty Association is not a general claims-review agency.
When a member insurer is impaired or insolvent, the Association may guarantee, assume, reissue, or reinsure covered policies and contracts, or provide other support necessary to meet covered obligations. Coverage is subject to statutory limits, eligibility requirements, exclusions, and residency rules. It does not protect every type of policy or every amount of loss.
Insurers must not use the Association as a sales inducement. Consumers should evaluate an insurer's financial strength and coverage terms rather than assume that all benefits are fully guaranteed.
Study Guide references/topics: insurer insolvency; impaired insurer; Guaranty Association; member insurers; NRS Chapter 686C .
NEW QUESTION # 78
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:
Answer: A
Explanation:
The correct answer is C, Proof of Loss. Proof of loss is the written documentation supplied to the insurer to establish that a covered loss occurred and to provide the facts needed to evaluate the claim. It may include claim forms, medical records, bills, physician statements, dates of treatment, disability information, and other evidence required under the policy. Notice of claim is different: it simply informs the insurer that a loss has occurred or that a claim may be made. After receiving notice, the insurer ordinarily provides claim forms or instructions. A loss form may be one document used in the proof-of-loss process, but it is not the complete legal concept. An inspection report may be used by an insurer in some lines of insurance but is not the insured' s required statement establishing a health or disability claim. Timely proof of loss is important because it triggers the insurer's claim-review duties and helps determine when payment is due. Policy provisions specify the timing and form of proof required. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Notice of Claim; Proof of Loss; Claim Procedures.
NEW QUESTION # 79
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