Insurance Licensing InsNV_Health02 Prüfung Übungen und Antworten

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health InsNV_Health02 Prüfungsfragen mit Lösungen (Q115-Q120):

115. Frage
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?

A. No benefit is payable because the employee did not submit an application.
B. The employer must personally pay the former employee's beneficiary.
C. The amount that could have been converted is payable under the group policy.
D. Only any accumulated cash value is payable.

Antwort: C

Begründung:
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.

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

Antwort: C

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.

117. Frage
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?

A. Sue the insurance company for not paying a claim within 30 days after submission of Proof of Loss
B. Demand binding arbitration if there is disagreement over a claim
C. Reinstate the policy within 3 years after it lapses
D. Add a newborn child to the policy without providing proof of insurability

Antwort: D

Begründung:
Choice D is correct. A family health policy must provide coverage for a newborn child without requiring evidence of insurability at birth, subject to the policy's notice and premium requirements for continuation of coverage. This protects the child during the period when medical needs can arise immediately after birth and prevents underwriting from becoming a barrier to initial coverage. Nevada law recognizes family coverage for dependent children from birth and establishes rules governing newborn coverage. The policy may require notice and any additional premium within the specified period to continue coverage beyond the initial statutory protection. The other choices do not state standard rights under an individual major medical policy.
Arbitration is not automatically available merely because an insured disagrees with a claim decision. A proof of loss does not create an automatic right to sue precisely 30 days after submission. Reinstatement rights also operate under the policy's reinstatement provision and are not a universal three-year right. Nevada's statutory framework specifically addresses dependent and newborn coverage under individual health insurance. See NRS Chapter 689A . Study Guide References/Topics: Nevada-Specific Health Insurance Mandates and Rules; Individual Major Medical; Newborn Coverage.

118. Frage
An Outline of Coverage for Medicare Supplement policies must be provided to a prospective insured at which of the following times?

A. At the time a claim is submitted
B. When the policy is delivered
C. When the premium is paid
D. At the time of application

Antwort: D

Begründung:
A Medicare Supplement insurer must provide an Outline of Coverage to the applicant at the time the application is presented. The outline is a consumer-disclosure document designed to summarize the policy's principal benefits, premiums, limitations, exclusions, and other important features before the applicant makes a final purchasing decision.
The outline is not the insurance contract itself. The policy contains the full contractual rights and obligations, but the outline allows an applicant to compare Medicare Supplement plans in a clear and standardized format.
It helps the consumer understand how the policy works with Original Medicare and whether it duplicates other existing coverage.
If the issued policy differs from the coverage described in the original outline, the insurer must provide a substitute outline describing the policy actually issued when delivering it. That later document does not change the initial requirement: the first outline is provided at application.
The premium-payment date and claim-submission date occur too late to serve the purpose of pre- sale disclosure. The key examination concept is timing: applicants receive the Outline of Coverage before purchasing the Medicare Supplement policy.
Study Guide references/topics: Medicare Supplement insurance; consumer disclosures; Outline of Coverage; NAC 687B.250 .

119. Frage
When a criminal violation of the insurance code has occurred, the Nevada Insurance Commissioner is required to report the violation to the:

A. Secretary of State
B. Lieutenant Governor
C. District Attorney
D. State Police

Antwort: C

Begründung:
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 .

120. Frage
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