InsNV_Health02 Simulated Test, InsNV_Health02 Minimum Pass Score

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q111-Q116):

NEW QUESTION # 111
Which policy is designed to pay benefits upon diagnosis or treatment of a specifically named illness, such as cancer?

A. Major medical insurance
B. Specified disease insurance
C. Credit disability insurance
D. Group term life insurance

Answer: B

Explanation:
Specified disease insurance provides limited benefits for a condition or group of conditions specifically named in the policy, such as cancer, heart disease, or stroke. The benefits may be paid as reimbursement for certain covered expenses, as fixed cash amounts for treatment events, or through a schedule of benefits. The scope of coverage is controlled by the policy and is substantially narrower than comprehensive major medical insurance.
A producer must not represent specified disease coverage as complete health insurance. It may help with deductibles, travel, household costs, experimental-treatment expenses not covered elsewhere, or income disruption, but it is not a substitute for comprehensive coverage that addresses a broad range of illnesses and injuries. The client should understand covered conditions, waiting periods, recurrence provisions, preexisting- condition limitations where permitted, benefit schedules, exclusions, and whether the policy pays in addition to other coverage.
Major medical insurance is intended to cover a broad spectrum of medically necessary expenses. Credit disability insurance is connected to repayment of a debt if the debtor becomes disabled. Group term life insurance pays a death benefit and does not provide medical-expense coverage. The examination point is to identify the limited, condition-specific purpose of specified disease insurance.
References/topics from the Study Guide: Specified Disease Insurance; Cancer Insurance; Critical Illness Coverage; Limited-Benefit Health Insurance; Major Medical.

NEW QUESTION # 112
Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?

A. 31 days
B. 15 days
C. 30 days
D. 45 days

Answer: A

NEW QUESTION # 113
The Affordable Care Act (ACA) requires every individual policy to provide minimum coverages known as:

A. Medicaid Buy-Back coverage
B. Silver Saver Value coverages
C. Essential Health Benefits
D. Gold Value coverages

Answer: C

Explanation:
The Affordable Care Act established Essential Health Benefits as the minimum categories of benefits that qualifying individual and small-group health plans must cover. These required benefit categories create a baseline of comprehensive coverage rather than allowing a major medical plan to omit fundamental types of care.
Essential Health Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance-use-disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic-disease management, and pediatric services, including oral and vision care.
Gold and Silver are metal-level plan categories. They describe the general actuarial value of a plan-the approximate division of covered health-care costs between the insurer and enrollees-not a separate legal list of mandatory minimum benefits. A Gold plan generally pays a larger share of covered costs than a Silver plan, but both must include the applicable Essential Health Benefits. "Silver Saver Value" and "Medicaid Buy- Back" are not the ACA's required minimum-coverage terminology.
For examination purposes, distinguish the benefit package itself-Essential Health Benefits-from plan metal levels and from public programs such as Medicaid.
Study Guide references/topics: Affordable Care Act; individual health insurance; qualified health plans; Essential Health Benefits; HealthCare.gov coverage protections .

NEW QUESTION # 114
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?

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

Answer: D

Explanation:
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.

NEW QUESTION # 115
If coverage has stayed in force with the same insurance company, what is the maximum number of years for which reconstructive surgery (mastectomy) benefits must be provided?

A. 0
B. 1
C. 2
D. 3

Answer: A

Explanation:
If reconstructive surgery is begun within three years after a mastectomy, the amount of benefits for that surgery must equal the amount provided by the policy at the time of the mastectomy. Therefore, the tested maximum period is three years.
Nevada requires a policy that covers mastectomy to provide commensurate coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to create symmetry, prostheses, and treatment of physical complications of all stages of mastectomy, including lymphedema. The attending physician and patient determine the appropriate care.
The three-year rule protects an insured from losing the original level of reconstruction benefits merely because reconstruction is delayed. If surgery begins more than three years after the mastectomy, benefits are governed by the policy terms, conditions, and exclusions in effect at the time reconstructive surgery begins.
This question does not ask how long all reconstruction coverage disappears. It tests the period during which the policy must preserve the benefit amount available at the time of mastectomy.
Study Guide references/topics: mastectomy coverage; reconstructive surgery; breast reconstruction; mandated health benefits; NRS 689B.0375 .

NEW QUESTION # 116
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