Testking InsNV_Health02 Exam Questions - InsNV_Health02 Free Test Questions

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Coverage for reconstructive surgery
- Mandatory policy clauses and provisions
  • 1. Coverage for newborn children
    • 2. Coverage for preventive healthcare services
      • 3. Coverage for physical handicap or intellectual disability for dependent children
        - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
        - Medicare
        • 1. Medicare Advantage Plans
          • 2. Medicare supplement regulation
            • 3. Prescription Drug Plan
              - Hospice care
              - Long Term Care
              Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Group life and health insurance
              • 1. Required provisions
                • 2. Eligible groups
                  - Credit life and health insurance
                  - Advertising
                  Accident & Health – General Knowledge50%- Policy Provisions, Clauses, and Riders
                  • 1. 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
                  • 2. 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
                  • 3. Rights of renewability
                    • Noncancelable
                    • Cancelable
                    • Guaranteed renewable
                  • 4. Riders
                    • Impairment and exclusions
                    • Guaranteed insurability
                    • Future increase option
                  - Other Insurance Concepts
                  • 1. Total, partial, recurrent, and residual disability
                    • 2. Subrogation
                      • 3. Occupational vs. non-occupational
                        • 4. Cost containment
                          • 5. Primary and contingent beneficiaries
                            • 6. Owner's rights
                              • 7. Managed care
                                • 8. Tax treatment of premiums and proceeds of insurance contracts
                                  • 9. Nonduplication and coordination of benefits
                                    • 10. Workers Compensation
                                      • 11. Modes of premium payments
                                        • 12. Dependent children benefits
                                          - Field Underwriting Procedures
                                          • 1. Completing the application
                                            • 2. Sources of insurability and HIPAA privacy information
                                              • 3. Replacement
                                                • 4. Initial premium payment and receipt
                                                  • 5. Contract law
                                                    • Elements of a contract
                                                    • Insurable interest
                                                    • Warranties and representations
                                                    • Unique aspects of the insurance contract
                                                  • 6. Submitting application and initial premium to company for underwriting
                                                    • 7. Explaining policy provisions, riders, exclusions, and ratings
                                                      • 8. Policy delivery
                                                        - Social Insurance
                                                        • 1. Medicaid
                                                          • 2. Social Security benefits
                                                            • 3. Medicare Parts A, B, C, and D
                                                              - Types of Policies
                                                              • 1. Other policies
                                                                • Dental
                                                                • Vision
                                                                • Cancer
                                                                • Critical illness or specified disease
                                                                • Worksite employer-sponsored
                                                                • Hospital indemnity
                                                                • Short-term medical
                                                                • Accident
                                                              • 2. Medicare supplement policies
                                                                • 3. Group insurance
                                                                  • Differences between individual and group contracts
                                                                  • General characteristics
                                                                  • COBRA
                                                                • 4. Individual and Group Long Term Care
                                                                  • Eligibility
                                                                  • Levels of care
                                                                • 5. Accidental death and dismemberment
                                                                  • 6. Disability income
                                                                    • Individual disability income policy
                                                                    • Business overhead expense policy
                                                                    • Business disability buyout policy
                                                                    • Group disability income policy
                                                                    • Key employee policy
                                                                  • 7. 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
                                                                  Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Marketing Practices
                                                                  • 1. Unfair practices
                                                                    • Unfair claims methods and practices and settlement of claims
                                                                    • Rebating and inducement
                                                                    • Twisting
                                                                    • Misrepresentation
                                                                    • Fraud
                                                                    • Unfair discrimination
                                                                    • Defamation
                                                                  • 2. Silver State Health Insurance Exchange
                                                                    • 3. Fiduciary responsibilities
                                                                      • 4. Affordable Care Act
                                                                        • 5. Commissions and payment restrictions
                                                                          • 6. Required records and record retention
                                                                            - Definitions
                                                                            • 1. Authorized and unauthorized
                                                                              • 2. Insurer
                                                                                • 3. Cost-sharing
                                                                                  • 4. Transacting insurance
                                                                                    • 5. Domestic, foreign, and alien
                                                                                      • 6. Premiums
                                                                                        • 7. Certificate of authority
                                                                                          - Insurance Commissioner
                                                                                          • 1. General powers and duties
                                                                                            • 2. Examinations
                                                                                              • 3. Notice and hearings and penalties
                                                                                                - Licensing
                                                                                                • 1. Suspension, revocation, and refusal of license
                                                                                                  • 2. Termination of license
                                                                                                    • 3. Persons required to be licensed
                                                                                                      • 4. Obtaining a license
                                                                                                        • 5. Name of licensee
                                                                                                          • 6. Renewal and continuing education
                                                                                                            - Nevada Life and Health Insurance Guaranty Association

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q22-Q27):

                                                                                                            NEW QUESTION # 22
                                                                                                            Which statement is true of a variable life insurance policy?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            Variable life insurance is permanent life insurance with cash values invested in separate-account investment options. Because the value of those investments can rise or fall, the policyowner bears the investment risk.
                                                                                                            The policy's cash value may fluctuate based on market performance, and the death benefit may vary above a guaranteed minimum amount, subject to policy provisions. The insurer does not guarantee the investment performance of the separate account.
                                                                                                            Variable life insurance differs from whole life, where the insurer's general account supports guaranteed cash values and fixed premiums. It also differs from universal life, which emphasizes flexible premiums and adjustable death-benefit structures. Variable universal life combines flexible-premium features with separate- account investment options. All such products must be described accurately because the potential for growth is accompanied by potential loss.
                                                                                                            Because variable life is a security as well as an insurance product, a producer generally needs appropriate securities registration and authorization in addition to life insurance licensing. Suitability is especially important. The product may be appropriate only for a consumer with a long time horizon, tolerance for market volatility, and a need for permanent life insurance. It should not be sold as a guaranteed investment or as equivalent to a fixed life policy.
                                                                                                            References/topics from the Study Guide: Variable Life Insurance; Separate Accounts; General Accounts; Securities Registration; Investment Risk; Suitability.


                                                                                                            NEW QUESTION # 23
                                                                                                            An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            Nevada group-life law protects an insured person during the conversion interval. If a person covered under a group life policy dies during the period in which the person was entitled to obtain an individual conversion policy-and before that individual policy becomes effective-the amount of life insurance the person could have converted is payable as a claim under the group policy. This protection applies whether or not the person submitted the individual-policy application or paid the first premium before death.
                                                                                                            The conversion privilege is important because group coverage is usually tied to employment or membership.
                                                                                                            When eligibility ends, the individual may lose the group policy's protection. Conversion gives the former insured an opportunity to obtain individual life insurance without new evidence of insurability, subject to the statute and policy terms. The converted amount may be limited by the group policy and applicable law, and the individual policy's premium is based on the insurer's conversion rates.
                                                                                                            This rule should not be confused with portability. Portability allows continuation of group-style coverage under certain conditions, whereas conversion replaces group coverage with an individual policy. The producer should explain notice requirements, the available conversion amount, deadlines, and premium differences whenever group coverage terminates.
                                                                                                            References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Termination of Employment; NRS 688B.120-688B.130.


                                                                                                            NEW QUESTION # 24
                                                                                                            Under a Medicare Supplement policy that is issued in response to a direct solicitation, a policyowner may return the policy to the insurance company for a full premium refund within a MAXIMUM of how many days?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            A Medicare Supplement policy issued in response to direct solicitation may be returned for a full premium refund within 30 days. This is commonly called a free-look or right-to-return period. It gives the policyowner time to examine the policy after delivery and decide whether the coverage is suitable.
                                                                                                            Direct solicitation presents a heightened consumer-protection concern because the purchaser may not have received the same personal explanation and comparison assistance available in a face-to-face sale. The 30-day period allows the consumer to review benefits, exclusions, premiums, Medicare coordination, replacement implications, and suitability without financial penalty.
                                                                                                            The policyowner should return the policy within the required period and follow the insurer's return instructions. Once timely returned, the insurer must refund the premium in accordance with the applicable rule. The free-look right does not mean that every policy can be cancelled at any time for a complete refund; it is a specific statutory or regulatory rescission period following delivery.
                                                                                                            Ten, 45, and 60 days are common distractors because various insurance rules use different deadlines. For Medicare Supplement direct-solicitation policies, the tested maximum period is 30 days.
                                                                                                            Study Guide references/topics: Medicare Supplement insurance; direct solicitation; free-look period; consumer protections; Nevada Medicare Supplement regulations .


                                                                                                            NEW QUESTION # 25
                                                                                                            An insured who wants to guarantee that an Accident and Health policy will remain in force even in the event of being disabled should purchase which of the following riders?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            The Waiver of Premium rider is designed to prevent a disability from causing the insured to lose coverage because premiums cannot be paid. When the rider's qualifying disability conditions are met, the insurer waives future premiums after the applicable waiting period while the disability continues. The policy therefore remains in force without premium payment during the qualifying period. Choice C is correct because it directly addresses continuation of coverage during disability. AD & D pays a benefit for accidental death or specified accidental losses; it does not waive premiums. Double indemnity generally increases the death benefit for a qualifying accidental death and likewise does not preserve health coverage during disability. Guaranteed insurability permits the future purchase of additional coverage without new evidence of insurability, but it does not relieve the policyowner of the duty to pay premiums on existing coverage. The rider's exact definition of disability, elimination period, age limitation, and proof-of-disability requirements are controlled by the policy. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Waiver of Premium.


                                                                                                            NEW QUESTION # 26
                                                                                                            A policy pays a stated dollar amount for each day an insured is confined to a hospital, regardless of the actual hospital bill. What type of coverage is this?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            Hospital indemnity insurance pays a fixed benefit for a covered hospital confinement, often expressed as a stated dollar amount per day. The payment is not based on the actual amount of the hospital bill. The insured may use the benefit for deductibles, transportation, household expenses, lost income, or other needs, subject to the policy terms. Because it pays a predetermined amount rather than reimbursing actual expenses, hospital indemnity coverage is generally considered limited-benefit or supplemental coverage.
                                                                                                            Major medical insurance operates differently. It is designed to cover a broad range of medical expenses, subject to deductibles, coinsurance, network provisions, and out-of-pocket maximums. Major medical coverage generally reimburses or pays eligible expenses rather than merely paying a fixed daily hospital amount. The existence of hospital indemnity coverage does not replace the need for comprehensive health insurance.
                                                                                                            The producer must clearly explain the limitations of indemnity products. It would be misleading to present a
                                                                                                            $200-per-day hospital indemnity benefit as if it pays all hospital charges. Consumers should understand whether the policy is supplemental, what events trigger payment, whether preexisting-condition or waiting- period provisions apply, and whether benefits are payable in addition to other coverage.
                                                                                                            References/topics from the Study Guide: Hospital Indemnity Insurance; Limited-Benefit Coverage; Supplemental Health Insurance; Major Medical; Fixed Indemnity Benefits.


                                                                                                            NEW QUESTION # 27
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