The Insurance Licensing InsNV_Health02 certification verifies that you have a basic understanding of NV Accident and Health concepts and virtualization. Success in the InsNV_Health02 exam of the Insurance Licensing InsNV_Health02 certificate also proves your knowledge of basic troubleshooting concepts and data center technology. When you earn the InsNV_Health02 Certification you will get reliable exam guide materials.
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
| Topic 2: Accident and Health — General Knowledge | ~68% | - Policy Provisions, Clauses & Riders
|
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NEW QUESTION # 113
Which feature most clearly distinguishes a health maintenance organization (HMO) from a traditional indemnity health insurance plan?
Answer: C
Explanation:
An HMO is a managed-care arrangement that commonly delivers and finances health-care services through a defined network of providers. Covered persons typically select or are assigned a primary care provider who coordinates routine care and, depending on the plan design, provides referrals for specialist services. Services received outside the network may be limited or not covered except for emergencies or specifically authorized care.
Traditional indemnity insurance operates differently. It generally reimburses covered medical expenses subject to policy limits, deductibles, coinsurance, and usual-and-customary or other payment standards. The insured may have broader provider choice, but that flexibility is often paired with less managed coordination and potentially greater out-of-pocket exposure. A preferred provider organization, or PPO, also uses a network but typically allows nonnetwork care at reduced benefit levels rather than requiring the same referral structure associated with many HMOs.
The exam distinction is based on delivery of care and network control, not merely on whether a policy has a deductible. Managed-care plans seek to control cost and improve coordination by negotiating with providers and establishing coverage procedures. Nevada recognizes network plans as policies in which financing and delivery of medical care are provided, at least in part, through defined providers under contract with the insurer.
References/topics from the Study Guide: Managed Care; HMO; PPO; Network Plans; NRS 689A-Network Plan Definition.
NEW QUESTION # 114
Under a Gold health insurance plan, an insurer would be expected to pay which percentage of medical costs?
Answer: B
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 # 115
An insured has a $1,000 deductible and then pays 20% of covered medical expenses, while the insurer pays
80%. What is the insured's 20% share called?
Answer: D
Explanation:
Coinsurance is the percentage of covered expenses that the insured shares with the insurer after the deductible has been satisfied. In this question, the insured pays 20% and the insurer pays 80%; this is commonly described as 80/20 coinsurance. The deductible is separate. It is the amount the insured must pay before the insurer begins sharing covered expenses, subject to any services that the policy covers before the deductible.
A copayment is a fixed dollar amount paid for a covered service, such as a stated amount for a physician visit or prescription. It is not normally expressed as a percentage. An elimination period is a waiting period in disability-income insurance before benefits begin. A stop-loss feature, also called an out-of-pocket maximum in many plans, limits the insured's covered cost sharing after a stated maximum has been reached, subject to plan rules.
Understanding these terms is essential when comparing health plans. A plan may have a lower premium but a higher deductible, greater coinsurance, or a larger out-of-pocket maximum. Producers must clearly explain the consumer's potential financial responsibility and must not imply that the insurer pays every medical expense once a policy is issued.
References/topics from the Study Guide: Major Medical Insurance; Deductibles; Coinsurance; Copayments; Out-of-Pocket Maximums.
NEW QUESTION # 116
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: C
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 # 117
When a criminal violation of the insurance code has occurred, the Nevada Insurance Commissioner is required to report the violation to the:
Answer: C
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 # 118
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