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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident & Health โ General Knowledge | 50% | - Other Insurance Concepts
|
| Topic 2: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Group life and health insurance
- Credit life and health insurance |
| Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Nevada Life and Health Insurance Guaranty Association - Insurance Commissioner
|
| Topic 4: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Hospice care - Long Term Care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Coverage for reconstructive surgery - Mandatory policy clauses and provisions
|
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NEW QUESTION # 115
Group vision insurance plans typically provide insurance benefits that cover the cost of:
Answer: C
Explanation:
Group vision coverage is an ancillary group health benefit designed primarily for routine vision care and corrective eyewear. Its usual covered services include periodic eye examinations, lenses, frames, and-in plans that provide the option-contact lenses. The key distinction is between routine vision expenses and medical or surgical eye treatment. Choice C contains the customary routine vision benefits and is therefore correct. Laser refractive surgery is commonly elective and is not a standard core group vision benefit. Cataract removal and retinal corrective surgery are medical or surgical procedures ordinarily addressed through medical expense coverage, subject to that policy's provisions, rather than through a routine vision plan.
Vision plans often apply a stated allowance, benefit schedule, copayment, provider-network requirement, or frequency limit to exams, frames, lenses, and contacts. The insured should therefore recognize that the plan does not provide unlimited eye-care coverage; it covers specified routine corrective services under the contract's schedule of benefits. Study Guide References/Topics: Group Health Insurance; Types of Health Insurance Policies; Limited-Coverage Health Plans.
NEW QUESTION # 116
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: D
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 # 117
A life policy lapses because a premium was not paid. To reinstate the policy, the insurer will generally require all of the following EXCEPT:
Answer: D
Explanation:
Reinstatement restores a lapsed life insurance policy to active status if the policyowner satisfies the policy's requirements. Those requirements generally include applying for reinstatement within the permitted period, providing evidence of insurability satisfactory to the insurer, and paying overdue premiums plus interest. The exact reinstatement period and underwriting requirements are controlled by the policy and applicable law.
A new medical examination is not required in every case. The insurer may request medical information or an examination when needed to evaluate the applicant's current insurability, but it is not an automatic universal requirement. The key examination principle is that evidence of insurability is required, not that a physical examination must always occur. Reinstatement is often preferable to purchasing a new policy because the existing policy may have more favorable premium rates, accumulated cash value, or a prior issue age.
However, the policyowner must understand that contestability and certain exclusions may begin again with respect to the reinstatement.
A producer should explain the difference between reinstatement and renewal. Reinstatement restores a policy that lapsed; renewal continues or extends a policy under its existing terms. Neither should be assumed available without reviewing the contract.
References/topics from the Study Guide: Reinstatement Provision; Policy Lapse; Evidence of Insurability; Premium Payment; NRS 688A.130.
NEW QUESTION # 118
Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member:
Answer: A
Explanation:
The correct answer is D. A guaranteed renewable provision protects an insured against termination based solely on health deterioration or disability, provided the premium is paid and the insured continues to meet the policy's stated conditions. Therefore, the insurer may not terminate coverage merely because the member becomes disabled. The insurer may, however, terminate or end coverage when a member no longer meets an eligibility requirement, such as leaving the eligible occupational classification, ceasing active employment, or reaching a policy-specified terminating age. Those conditions concern the member's contractual eligibility for the group coverage rather than the member's health status. Guaranteed renewable does not necessarily mean that premiums can never change. The insurer may generally change premiums on a class basis, but it cannot single out one insured for an individual premium increase or cancellation because that person became ill or disabled. This concept should be distinguished from noncancellable coverage, which provides stronger protection by preventing the insurer from changing either premiums or benefits during the stated period.
Study Guide References/Topics: Group Health Insurance; Renewability Provisions; Guaranteed Renewable Coverage.
NEW QUESTION # 119
The maximum cost share for preventive screening from an in-network provider is:
Answer: C
Explanation:
The maximum cost share for a covered preventive screening received from an in-network provider is 0%. In practical terms, the insured generally pays no deductible, copayment, or coinsurance for qualifying preventive services delivered in-network. This rule is intended to encourage early detection of illness and promote preventive care before conditions become more serious and costly.
Examples of qualifying preventive care can include certain screenings, immunizations, counseling, and wellness services. The precise covered service and frequency may depend on age, sex, medical circumstances, and the applicable preventive-service recommendations. The in-network condition is important because services received outside the plan's network may be subject to different cost-sharing rules, except where other law or plan provisions apply.
The choices of 10%, 20%, and 30% reflect ordinary coinsurance levels that may apply to nonpreventive treatment or to services that do not qualify for first-dollar preventive coverage. They do not apply to an eligible preventive screening under the in-network preventive-care rule.
Always distinguish preventive screening from diagnostic care. A screening is generally performed when no symptom or suspected condition is being evaluated; a diagnostic service may generate cost sharing depending on the circumstances and plan terms.
Study Guide references/topics: preventive services; in-network providers; deductibles; copayments; coinsurance; HealthCare.gov preventive-care guidance .
NEW QUESTION # 120
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