完成InsNV_Health02熱門認證|第一次嘗試輕鬆學習並通過考試 &最近更正的InsNV_Health02：NV Accident and Health

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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InsNV_Health02題庫更新資訊 - InsNV_Health02認證

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最新的 Nevada Insurance InsNV_Health02 免費考試真題 (Q48-Q53):

問題 #48
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. 30 days
B. 15 days
C. 45 days
D. 31 days

答案：D

問題 #49
Most insurance companies use the usual, customary, and reasonable (UCR) charges to:

A. reimburse physicians for excess expense
B. reimburse the employee for expenses charged by the medical facilities
C. limit the insurance company claims liability
D. pay dollars direct to the employers for health insurance

答案：C

解題說明：
Usual, customary, and reasonable charges are payment standards used to determine the portion of a medical charge that a health insurer recognizes as eligible for reimbursement. Choice D is correct because UCR standards limit the insurer's claim liability to an amount considered appropriate for the service in the relevant geographic area. "Usual" refers to the fee commonly charged by a particular provider; "customary" refers to fees generally charged by comparable providers in the area; and "reasonable" considers the circumstances and complexity of the service. If a provider's charge exceeds the plan's allowed amount, the insurer may pay only the UCR amount, and the patient may remain responsible for the difference unless a network agreement or other policy provision prevents balance billing. UCR does not mean that insurers reimburse excess charges, pay funds to employers, or reimburse every amount billed by a medical facility. This concept is tested as a cost-control mechanism within medical expense coverage and should be distinguished from deductibles, coinsurance, copayments, and maximum benefit limits. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Medical Expense Insurance; Usual, Customary, and Reasonable Charges.

問題 #50
Which of the following is permitted by a licensee?

A. Lowering the premium by rebating the commission
B. Buying the client a nominal gift at Christmas
C. Altering the client ' s application information to lower the premium rate
D. Returning the commission to the client to ensure policy renewal

答案：B

解題說明：
A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada's statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.
Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.
Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant's information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.
The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.
Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .

問題 #51
A $100,000 group Accidental Death and Dismemberment policy will pay double indemnity if the insured dies in a commercial airplane crash. If the insured is killed when flying to a business meeting on a commercial flight, the policy will pay a MAXIMUM of:

A. $100,000
B. $300,000
C. $200,000
D. $0

答案：C

解題說明：
The correct answer is C, $200,000. The policy's principal sum is $100,000, and the double-indemnity provision pays twice that amount when death results from the stated qualifying accident: a commercial airplane crash. Because the insured was flying on a commercial flight and was killed in the crash, the maximum payable benefit is two times $100,000, or $200,000. The fact that the trip was to a business meeting does not reduce the benefit under the facts given. Choice A would be appropriate only if an exclusion applied, such as an excluded type of aviation activity. Choice B states only the policy's base amount and ignores the double-indemnity provision. Choice D incorrectly adds an additional amount beyond the stated double benefit. AD & D coverage pays only when the loss falls within the policy's accidental-loss definition and occurs within any stated loss period. Aviation wording matters: commercial passenger travel is commonly covered, while piloting, crew duties, private aircraft, or military aviation may be treated differently under the contract. Study Guide References/Topics: Group Health Insurance; Accidental Death and Dismemberment; Double Indemnity.

問題 #52
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

答案：C

解題說明：
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 .

問題 #53
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