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| Section | Objectives |
|---|---|
| Health Insurance Policy Provisions | - Mandatory and Optional Provisions
|
| Accident and Health Insurance Fundamentals | - Types of Health Insurance Policies
|
| Government Health Insurance Programs | - Medicare
|
| Producer Duties and Ethics | - Ethical Responsibilities
|
| Insurance Basics | - Risk Management and Insurance Concepts
|
| General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
>> New Insurance Licensing InsNV_Health02 Exam Sample <<
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NEW QUESTION # 101
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:
Answer: D
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 # 102
When must insurable interest generally exist in a life insurance transaction?
Answer: B
Explanation:
Insurable interest must generally exist when a life insurance policy is issued. It is the lawful financial or personal interest that prevents life insurance from becoming a wagering arrangement. A person has an unlimited insurable interest in that person's own life and may name any lawful beneficiary. Insurable interest also commonly exists among close family members because of love and affection, and in certain business relationships where one person or entity would suffer a financial loss from another person's death.
Once a policy is validly issued with insurable interest, the interest does not generally need to continue until the insured's death. For example, a business may purchase life insurance on a key employee when a valid economic relationship exists. If the relationship later changes, the policy's continued validity is not automatically destroyed solely because the original financial relationship ended. However, ownership transfers, stranger-originated life insurance arrangements, and transactions designed to evade insurable- interest requirements raise significant legal and ethical concerns.
Insurable interest differs from beneficiary status. A beneficiary need not always have an insurable interest if the policyowner is insuring the policyowner's own life. The critical point is that the policy must be procured lawfully at inception.
References/topics from the Study Guide: Insurable Interest; Policy Ownership; Beneficiary Designations; Business Life Insurance; Contract Law.
NEW QUESTION # 103
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:
Answer: A
Explanation:
The correct answer is C, Proof of Loss. Proof of loss is the written documentation supplied to the insurer to establish that a covered loss occurred and to provide the facts needed to evaluate the claim. It may include claim forms, medical records, bills, physician statements, dates of treatment, disability information, and other evidence required under the policy. Notice of claim is different: it simply informs the insurer that a loss has occurred or that a claim may be made. After receiving notice, the insurer ordinarily provides claim forms or instructions. A loss form may be one document used in the proof-of-loss process, but it is not the complete legal concept. An inspection report may be used by an insurer in some lines of insurance but is not the insured' s required statement establishing a health or disability claim. Timely proof of loss is important because it triggers the insurer's claim-review duties and helps determine when payment is due. Policy provisions specify the timing and form of proof required. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Notice of Claim; Proof of Loss; Claim Procedures.
NEW QUESTION # 104
An Outline of Coverage for Medicare Supplement policies must be provided to a prospective insured at which of the following times?
Answer: C
Explanation:
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 .
NEW QUESTION # 105
In Nevada, a producer or examining physician who knowingly and willfully makes a false statement on an application for insurance may be guilty of:
Answer: B
Explanation:
A producer, examining physician, applicant, or other person who knowingly and willfully makes a false or fraudulent statement or representation in, or in reference to, an insurance application may be guilty of fraud.
Nevada law expressly prohibits this conduct because insurance underwriting depends on truthful and complete information concerning the proposed insured and the risk.
Fraud requires knowing and willful conduct. An innocent clerical error or an inadvertent misunderstanding may require correction, but the exam question describes intentional falsification. Examples can include knowingly misstating medical history, concealing material treatment, falsifying income information in a disability application, or knowingly submitting an untrue medical statement.
Twisting is an improper sales practice involving inducing a policyowner to replace coverage through misleading comparisons or representations. Misrepresentation is a broader term that may describe false statements in insurance transactions, but the statute specifically identifies false or fraudulent application statements as insurance fraud. Coercion involves forcing or improperly pressuring a person to act and is not the conduct described here.
A producer must ensure that application answers are accurately recorded, should not alter answers without authorization, and should promptly correct discovered inaccuracies before policy issuance.
Study Guide references/topics: insurance fraud; applications; producer ethics; prohibited trade practices; NRS
686A.290 .
NEW QUESTION # 106
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