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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident and Health — General Knowledge | ~68% | - Policy Provisions, Clauses & Riders
|
| Topic 2: Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
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NEW QUESTION # 98
Basic cancer plans pay for all of the following EXCEPT:
Answer: C
Explanation:
Basic cancer policies are limited-benefit plans intended to supplement, rather than replace, comprehensive medical coverage. They commonly provide benefits for cancer-specific treatment such as chemotherapy, radiotherapy, and immunotherapy, subject to the policy's definitions, schedules, and limits. Therefore, choice C is correct because physical therapy is not ordinarily a core cancer-treatment benefit under a basic cancer policy. Physical therapy may be covered under a comprehensive medical plan or under a more expansive supplemental policy if expressly included, but it is not a standard basic cancer-plan benefit. Cancer policies can pay specified amounts for surgery, hospital confinement, physician services, diagnostic testing, drugs, radiation, chemotherapy, or other treatment tied directly to a covered cancer diagnosis. The insured should not assume that every medical expense arising during cancer treatment is covered. Benefits may be subject to waiting periods, preexisting-condition restrictions, recurrence rules, benefit schedules, and exclusions. The appropriate exam distinction is between benefits directly associated with treatment of cancer and general rehabilitative or medical services that are not expressly included in the cancer policy. Study Guide References
/Topics: Types of Health Insurance Policies; Limited-Coverage Health Policies; Cancer Insurance.
NEW QUESTION # 99
Medicaid is best described as:
Answer: A
Explanation:
Medicaid is a joint federal-state medical-assistance program serving eligible individuals and families under income, resource, categorical, residency, and other program rules. The federal government establishes broad requirements and provides funding, while each state administers its program within federal parameters.
Nevada administers Medicaid through its state health and human-services structure and contracted delivery systems. Eligibility and benefits can vary by category and may change with law and program administration.
Medicaid is not the same as Medicare. Medicare is principally a federal social-insurance program associated with age 65 or older, certain disabilities, and end-stage renal disease or other qualifying conditions. Medicaid is generally means tested, although eligibility is determined by detailed program standards and should never be assumed from income alone. Some people may qualify for both Medicare and Medicaid; these individuals are often referred to as dual-eligible beneficiaries.
A producer should avoid giving legal or public-benefit eligibility advice beyond the scope of insurance licensing. The proper role is to identify the program accurately, explain how private coverage may coordinate where applicable, and direct a consumer to the appropriate state agency or benefits specialist for an eligibility determination.
References/topics from the Study Guide: Medicaid; Medicare; Dual Eligibility; Government-Sponsored Health Programs; Nevada Public Health Benefits.
NEW QUESTION # 100
Which of the following is true regarding Medicare Advantage Plans?
Answer: A
Explanation:
Medicare Advantage, also called Medicare Part C, is private-plan coverage approved by Medicare. These plans must provide at least the services covered by Original Medicare, subject to Medicare rules, but they may structure deductibles, copayments, and coinsurance differently. For many enrollees, a plan's benefit design can reduce or eliminate certain cost-sharing amounts that would otherwise apply under Original Medicare.
Medicare Advantage plans also include a yearly maximum out-of-pocket limit for covered Medicare services.
Vision, hearing, and dental benefits may be offered as supplemental benefits by many Medicare Advantage plans, but they are not universally mandated as a standard benefit in every plan. Drug coverage is commonly included, but it is not restricted to generic medications only. Part D formularies can include both generic and brand-name drugs, subject to plan rules and Medicare requirements.
The final option is incorrect because an enrollee does not receive a reduced premium merely by opting out of preventive care. Preventive benefits and plan premiums are governed by Medicare and plan design rules rather than by an individual's decision to decline a preventive program.
Study Guide references/topics: Medicare Part C; Medicare Advantage; deductibles; coinsurance; out-of- pocket limits; Medicare Advantage cost rules .
NEW QUESTION # 101
A producer who makes misleading policy comparisons for the purpose of inducing an insured to surrender an existing policy is guilty of:
Answer: B
Explanation:
Twisting is the use of misleading, incomplete, or fraudulent policy comparisons to induce, or attempt to induce, a policyowner to lapse, forfeit, surrender, terminate, exchange, convert, or replace an existing insurance policy. The producer's conduct described in the question is a classic example of twisting because the misleading comparison is used to convince the insured to surrender existing coverage.
Twisting is prohibited because replacement decisions can have serious consequences. A new policy may have different exclusions, waiting periods, contestability periods, benefit limits, premiums, surrender charges, or underwriting requirements. A producer must provide accurate, balanced, and complete comparisons when discussing replacement or surrender of coverage.
Rebating involves offering an unlawful return of premium, commission, or other inducement not stated in the policy. Coercion involves forcing or improperly pressuring a person to act. Defamation involves false statements that harm another person's reputation. None of those terms specifically describes misleading comparisons intended to cause surrender of an existing policy.
Study Guide references/topics: unfair trade practices; policy replacement; twisting; misleading comparisons; NRS 686A.050 .
NEW QUESTION # 102
The Nevada Life and Health Insurance Guaranty Association becomes involved in an insurance company ' s affairs when the company:
Answer: B
Explanation:
The Nevada Life and Health Insurance Guaranty Association becomes involved when a covered member insurer becomes impaired or insolvent. Its statutory purpose is to provide limited protection to eligible policyowners, certificate holders, enrollees, beneficiaries, and other covered persons when a member insurer cannot perform its contractual obligations because of financial failure.
An ordinary lawsuit, claim denial, or membership withdrawal does not by itself trigger Guaranty Association protection. Claim disputes are normally handled through the insurer's claims process, internal appeals, administrative complaint procedures, or litigation. The Guaranty Association is not a general claims-review agency.
When a member insurer is impaired or insolvent, the Association may guarantee, assume, reissue, or reinsure covered policies and contracts, or provide other support necessary to meet covered obligations. Coverage is subject to statutory limits, eligibility requirements, exclusions, and residency rules. It does not protect every type of policy or every amount of loss.
Insurers must not use the Association as a sales inducement. Consumers should evaluate an insurer's financial strength and coverage terms rather than assume that all benefits are fully guaranteed.
Study Guide references/topics: insurer insolvency; impaired insurer; Guaranty Association; member insurers; NRS Chapter 686C .
NEW QUESTION # 103
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