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| Section | Objectives |
|---|---|
| Topic 1: Insurance Basics | - Insurance Contracts
|
| Topic 2: Producer Duties and Ethics | - Ethical Responsibilities
|
| Topic 3: General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
| Topic 4: Government Health Insurance Programs | - Medicaid and Other Programs
|
| Topic 5: Accident and Health Insurance Fundamentals | - Disability Income Insurance
|
| Topic 6: Health Insurance Policy Provisions | - Claims and Benefits
|
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NEW QUESTION # 128
A producer receives a phone call from an insured who already has health insurance and now wants to buy an Accidental Death and Dismemberment (AD & D) policy. In this situation, the producer should take which of the following actions?
Answer: B
Explanation:
The application is a material underwriting document, so the producer must use a process that obtains accurate information and a valid applicant signature before submission. Choice D is correct because the producer should meet with the prospect, have the prospect complete the application, and obtain the prospect's signature. This confirms that the answers are the applicant's statements and that the applicant has reviewed the information before the insurer relies upon it. The producer may explain questions and assist with completion, but should not answer questions on the prospect's behalf. Choice B is improper because the applicant's signature should not be postponed until after insurer approval. Choice C is improper because the producer should not independently answer application questions; the applicant provides the information.
Choice A is less appropriate because it bypasses the producer's opportunity to review the application for completeness, explain disclosures, and verify that required signatures are obtained. The existing health coverage does not eliminate the need for a complete AD & D application. Study Guide References/Topics:
Completing the Application, Underwriting, and Delivering the Policy; Producer Responsibilities; Application Completion.
NEW QUESTION # 129
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:
Answer: A
Explanation:
For insured women age 40 or older, Nevada requires group health insurance coverage for an annual mammogram to screen for breast cancer. The required benefit must be available through an in-network provider, and the insurer generally may not impose a deductible, copayment, coinsurance, or another form of cost sharing for that mandated screening.
Mammography is preventive screening. It is intended to detect breast cancer early, often before symptoms appear. This differs from diagnostic imaging, which may be ordered after an abnormal screening result, a finding on examination, or another clinical concern. Nevada law also addresses medically necessary imaging and diagnostic testing when the insured's provider recommends them based on medical history, family history, risk factors, or an observed abnormality.
A family history of breast cancer does not eliminate coverage; instead, it may support the need for additional screening or imaging. The benefit is not restricted only to plans that voluntarily choose to offer mammography. It is a required coverage provision for applicable group health policies.
Study Guide references/topics: preventive care; breast-cancer screening; mandated benefits; deductibles and coinsurance; NRS 689B.0374 .
NEW QUESTION # 130
Which of the following BEST describes Medicare Advantage Plans?
Answer: A
Explanation:
Medicare Advantage Plans are best described as government-subsidized private insurance. Medicare Advantage, also called Medicare Part C, is offered by private companies that contract with Medicare and must follow Medicare rules. Eligible beneficiaries receive their Medicare-covered benefits through the private plan instead of receiving benefits through Original Medicare directly.
The federal Medicare program pays private Medicare Advantage organizations to provide covered services to enrolled beneficiaries. The plans must provide all medically necessary services covered by Original Medicare, except hospice care, which remains covered under Original Medicare. Many Medicare Advantage plans also include prescription drug coverage and may provide additional benefits such as dental, vision, hearing, wellness, or transportation benefits.
The plans are private, but they are not privately subsidized government insurance. They are federally regulated Medicare arrangements supported by Medicare payments. They are not long-term care riders and are not welfare benefit plans. Enrollees generally continue paying their Medicare Part B premium and may also pay a plan premium, although some plans have a $0 additional premium.
Study Guide references/topics: Medicare Part C; Medicare Advantage; private insurers; federal Medicare program; Medicare Advantage overview .
NEW QUESTION # 131
A group health insurance policy MUST include coverage for which of the following expenses?
Answer: D
Explanation:
A group health insurance policy in Nevada must include coverage for expenses arising from hospice care.
Hospice care is intended for patients with terminal illness and emphasizes comfort, pain control, symptom management, supportive services, and assistance for the patient and family rather than curative treatment.
Nevada's group-policy required-provisions statute specifically identifies benefits for expenses arising from hospice care. This makes hospice the correct answer. Adult dental and adult vision benefits may be offered by separate policies, riders, employer plans, or benefit arrangements, but they are not universally required in every group health policy. Over-the-counter dietary supplements are not a standard mandated group health benefit and are generally covered only when specifically provided by a policy or health plan.
Hospice coverage should be distinguished from ordinary inpatient hospital coverage. Hospice care may be delivered in a home, residential setting, hospice facility, or other appropriate location, depending on the patient's needs and the terms of coverage. It frequently involves an interdisciplinary team and includes both patient care and family-support services.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; supportive services; NRS 689B.030 .
NEW QUESTION # 132
A Major Medical policy insured is injured in an auto collision during a police chase. The occupants in the police car are killed. The insured is convicted of reckless driving and manslaughter. If the insured files a claim, the insurance company will MOST likely take which of the following actions?
Answer: A
Explanation:
Major medical coverage pays covered medical expenses resulting from accidental injury or sickness, subject to the policy's stated exclusions and limitations. The facts establish reckless and criminal conduct, but they do not establish an intentional self-inflicted injury or identify a policy exclusion that removes coverage.
Therefore, choice A is the best answer: the insurer will pay the covered benefits according to the policy.
Insurance examination questions require careful separation of criminal conduct from intentional injury.
Reckless driving and a resulting conviction do not automatically mean that the insured intended to injure himself. A health insurer may deny a claim only when a valid policy exclusion, limitation, misrepresentation defense, or other contract basis applies. The insurer does not reduce benefits merely to "partial benefits" because of the conviction, and it does not return all premiums after denying a properly covered accidental- injury claim. The controlling analysis is the policy language, including exclusions for intentional self-inflicted injury, war, occupational losses, or other listed circumstances. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Major Medical Insurance; Exclusions and Limitations.
NEW QUESTION # 133
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