InsNV_Health02 Online Prüfungen, InsNV_Health02 Fragen Antworten

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Topic 1: Accident & Health – General Knowledge	50%	- Field Underwriting Procedures 1. Completing the application 2. Sources of insurability and HIPAA privacy information 3. Submitting application and initial premium to company for underwriting 4. Policy delivery 5. Explaining policy provisions, riders, exclusions, and ratings 6. Initial premium payment and receipt 7. Replacement 8. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract - Policy Provisions, Clauses, and Riders 1. Riders Impairment and exclusions Guaranteed insurability Future increase option 2. Rights of renewability Noncancelable Cancelable Guaranteed renewable 3. 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 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 - Social Insurance 1. Medicaid 2. Social Security benefits 3. Medicare Parts A, B, C, and D - Types of Policies 1. Accidental death and dismemberment 2. Medicare supplement policies 3. Group insurance Differences between individual and group contracts General characteristics COBRA 4. 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 5. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy 6. Individual and Group Long Term Care Eligibility Levels of care 7. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident - Other Insurance Concepts 1. Modes of premium payments 2. Tax treatment of premiums and proceeds of insurance contracts 3. Workers Compensation 4. Subrogation 5. Dependent children benefits 6. Nonduplication and coordination of benefits 7. Occupational vs. non-occupational 8. Total, partial, recurrent, and residual disability 9. Cost containment 10. Primary and contingent beneficiaries 11. Owner's rights 12. Managed care
Topic 2: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Insurance Commissioner 1. Notice and hearings and penalties 2. Examinations 3. General powers and duties - Definitions 1. Cost-sharing 2. Transacting insurance 3. Insurer 4. Authorized and unauthorized 5. Premiums 6. Domestic, foreign, and alien 7. Certificate of authority - Nevada Life and Health Insurance Guaranty Association - Licensing 1. Obtaining a license 2. Suspension, revocation, and refusal of license 3. Name of licensee 4. Termination of license 5. Renewal and continuing education 6. Persons required to be licensed - Marketing Practices 1. Fiduciary responsibilities 2. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation 3. Required records and record retention 4. Commissions and payment restrictions 5. Silver State Health Insurance Exchange 6. Affordable Care Act
Topic 3: Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Hospice care - Coverage for reconstructive surgery - Mandatory policy clauses and provisions 1. Coverage for newborn children 2. Coverage for physical handicap or intellectual disability for dependent children 3. Coverage for preventive healthcare services - Long Term Care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Medicare 1. Medicare supplement regulation 2. Prescription Drug Plan 3. Medicare Advantage Plans
Topic 4: Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Group life and health insurance 1. Required provisions 2. Eligible groups - Advertising - Credit life and health insurance

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InsNV_Health02 Übungsfragen: NV Accident and Health & InsNV_Health02 Dateien Prüfungsunterlagen

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Insurance Licensing NV Accident and Health InsNV_Health02 Prüfungsfragen mit Lösungen (Q21-Q26):

21. Frage
Which of the following statements is CORRECT about Medicare?

A. It is a hospital and medical expense insurance program.
B. It provides benefits to totally disabled persons only.
C. It is a medical assistance program.
D. Its Part A provides payment for physicians ' bills.

Antwort: A

Begründung:
Medicare is a federal social insurance program that provides hospital and medical expense coverage to eligible persons. Therefore, choice B is correct. Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services.
Medicare Part B primarily covers physician services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Choice A describes Medicaid, which is a needs-based medical assistance program jointly administered by federal and state governments. Choice C is incorrect because Medicare also serves people age 65 or older and individuals with qualifying end-stage renal disease or ALS; it is not limited to totally disabled persons. Choice D is incorrect because physician bills are generally associated with Part B, not Part A. Medicare beneficiaries may also choose Medicare Advantage plans, which provide Medicare-covered benefits through private plans, and may obtain prescription drug coverage under Part D. Study Guide References/Topics: Social Insurance Programs; Medicare Parts A and B; Federal Health Programs.

22. Frage
A life policy has been in force during the insured's lifetime for more than two years. Which circumstance may still permit the insurer to deny a claim under the policy's incontestability provision?

A. A material misrepresentation unrelated to the policy
B. Nonpayment of premium
C. An innocent misstatement on the original application
D. A change in the insured's occupation after issue

Antwort: B

Begründung:
The incontestability provision limits the insurer's ability to contest the validity of a life insurance policy after it has been in force during the insured's lifetime for the stated period, which Nevada law permits to be no longer than two years from issue. Once that period has passed, an insurer ordinarily cannot avoid the policy because of misstatements in the application, except as provided by the policy and law. The rule promotes certainty for beneficiaries and prevents an insurer from indefinitely reopening underwriting issues after accepting premiums for years.
Nonpayment of premiums remains an exception. Incontestability does not require an insurer to pay a claim on a policy that lapsed because required premiums were not paid. A policy can also contain provisions concerning total and permanent disability benefits or additional accidental-death benefits that are treated separately under the applicable statutory rule. In addition, an incontestability clause concerns contesting the policy's validity; it does not automatically override every policy exclusion or restriction on coverage.
The producer should distinguish contestability from the grace period, reinstatement, and exclusions. Each provision serves a different function. For test purposes, the durable rule is that incontestability does not eliminate the insurer's defense of nonpayment of premium.
References/topics from the Study Guide: Incontestability Clause; Premium Payment; Policy Lapse; NRS
688A.080.

23. Frage
Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?

A. 30 days
B. 45 days
C. 15 days
D. 31 days

Antwort: D

Begründung:
A group health policy that terminates dependent-child coverage at a stated limiting age must continue coverage for an eligible dependent child who remains incapable of self-sustaining employment because of a qualifying disability and who remains dependent on the insured group member for support and maintenance.
To preserve that continuation right, the required proof must be furnished within 31 days after the child reaches the policy's limiting age.
This is a time-sensitive protection. The purpose is to prevent automatic termination of coverage solely because a dependent reaches the normal age limit when the child remains disabled and financially dependent.
After initial proof is provided, the insurer may require continuing proof of incapacity and dependency, but it may not demand that proof more often than permitted by law.
The 31-day rule should be distinguished from notice periods for newborn coverage, conversion rights, premium grace periods, and claim notices. Each insurance provision may use a different time period, so examination questions often test the exact statutory deadline.
Study Guide references/topics: group health dependents; limiting age; continuation of coverage; NRS 689B.
035 .

24. Frage
Which statement best describes Medicare Part B?

A. It is Medicaid coverage for low-income individuals.
B. It is automatic for every person at age 55.
C. It provides only outpatient prescription-drug benefits.
D. It is medical insurance and generally requires enrollment and a monthly premium.

Antwort: D

Begründung:
Medicare Part B is the medical-insurance portion of Original Medicare. It generally helps cover physician services, outpatient care, diagnostic services, preventive care, durable medical equipment, and other covered medical services. Enrollment is generally voluntary, although it may be automatic for certain people who are already receiving Social Security benefits. Most individuals pay a monthly Part B premium, and higher- income beneficiaries may pay an income-related additional amount.
Part B should not be confused with Medicare Part D, which provides outpatient prescription-drug coverage, or with Medicaid, which is a joint federal-state program for eligible individuals with limited income and resources. Part B also differs from Part A, which is primarily hospital insurance. Delaying Part B enrollment without qualifying employer coverage can result in late-enrollment penalties and gaps in coverage, so producers should avoid casual advice and instead direct consumers to current Medicare enrollment guidance.
When discussing Medicare-related products, producers must accurately identify whether a client has Original Medicare, a Medicare Advantage plan, a Medicare supplement policy, and/or a Part D prescription-drug plan.
These arrangements have different rules, premiums, provider networks, and cost-sharing structures.
References/topics from the Study Guide: Medicare Part B; Original Medicare; Enrollment Periods; Medicare Premiums; Medicare Supplement Products.

25. Frage
As a condition to granting a loan, a creditor can:

A. assess a higher interest rate if insurance is not purchased
B. accept assignment from an existing policy
C. require insurance in an amount greater than the debt
D. require insurance coverage through a specific insurer

Antwort: B

Begründung:
A creditor may accept an assignment from an existing policy as security for a loan. When consumer credit insurance is required as additional security for debt, Nevada law allows the debtor to furnish the required insurance through existing policies owned or controlled by the debtor, or through any insurer authorized to transact insurance in Nevada.
A creditor may not require the borrower to purchase insurance from a particular insurer. That would improperly limit the borrower's freedom of choice. The creditor also may not require coverage in an amount greater than the debt being secured. Credit insurance is intended to protect the creditor against the unpaid obligation, not to create excess insurance for the creditor's benefit.
Similarly, a creditor may not impose a higher interest rate merely because the borrower declines to purchase credit insurance. Credit insurance must not be represented as a mandatory condition of loan approval when it is optional.
Assignment allows the borrower's existing coverage to be used as collateral or security without forcing the borrower to buy duplicative insurance. The creditor may require proof that the existing insurance is adequate for the risk and debt involved.
Study Guide references/topics: credit insurance; creditor-debtor relationship; assignment; consumer protections; NRS 690A.140 .

26. Frage
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