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| Section | Objectives |
|---|---|
| Topic 1: Government Health Insurance Programs | - Medicaid and Other Programs
|
| Topic 2: Producer Duties and Ethics | - Ethical Responsibilities
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| Topic 3: Health Insurance Policy Provisions | - Mandatory and Optional Provisions
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| Topic 4: Accident and Health Insurance Fundamentals | - Types of Health Insurance Policies
|
| Topic 5: General Insurance Regulation | - Licensing Requirements and Responsibilities
|
| Topic 6: Insurance Basics | - Insurance Contracts
|
>> Insurance Licensing InsNV_Health02 Brain Dumps <<
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NEW QUESTION # 99
When a criminal violation of the insurance code has occurred, the Nevada Insurance Commissioner is required to report the violation to the:
Answer: D
Explanation:
When the Nevada Insurance Commissioner has reason to believe that a person has violated the Insurance Code or another law applicable to insurance operations and criminal prosecution appears appropriate, the Commissioner must provide the relevant information to the appropriate district attorney or to the Attorney General. Of the choices given, District Attorney is the correct answer.
The Commissioner administers and enforces Nevada insurance laws, investigates potential violations, conducts examinations, and may impose administrative sanctions where authorized. Criminal prosecution, however, is handled by the appropriate prosecutorial authority rather than by the Commissioner personally.
This division of responsibility preserves due process and ensures that criminal cases are evaluated and prosecuted by officials with criminal-law authority.
The Secretary of State, Lieutenant Governor, and State Police may have governmental roles that occasionally relate to business records, executive functions, or investigations, but they are not the statutory prosecutorial recipients identified in Nevada's insurance law. The examination point is that an insurance violation can produce both administrative consequences, such as a fine or license action, and criminal referral when the conduct warrants prosecution.
Study Guide references/topics: powers and duties of the Commissioner; insurance-code enforcement; criminal violations; NRS 679B.150 .
NEW QUESTION # 100
The Affordable Care Act (ACA) requires every individual policy to provide minimum coverages known as:
Answer: D
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 # 101
Under Nevada law, the definition of " insurer " includes:
Answer: D
Explanation:
Nevada law defines an insurer to include every person engaged as principal and as an indemnitor, surety, or contractor in the business of entering into insurance contracts. Therefore, an indemnitor is specifically included in the statutory definition of insurer.
An indemnitor is a party that agrees to compensate another for specified loss or damage. That obligation is central to insurance: the insurer assumes a defined risk and promises to provide a benefit, payment, service, or indemnity when a covered loss occurs. A surety and a contractor entering insurance agreements can likewise fall within the statutory definition when operating in the insurance business.
A security dealer sells or handles securities and is regulated under securities law rather than by the insurance definition in this question. A financial planner may provide financial advice but is not automatically an insurer. A syndicate may participate in insurance arrangements in certain contexts, but it is not the statutory term specifically identified in the definition.
The exam point is to recognize the broad legal definition of insurer. It encompasses more than a company labeled "insurance company"; it includes persons acting as indemnitors, sureties, or insurance contractors.
Study Guide references/topics: Nevada Insurance Code; definitions; insurer; indemnity; surety; NRS 679A.
100 .
NEW QUESTION # 102
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?
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 # 103
Which rider allows a terminally ill insured to receive part of the death benefit while still alive, subject to the policy terms?
Answer: B
Explanation:
An accelerated death benefit rider permits an insured who meets the rider's qualifying conditions to receive a portion of the policy's death benefit while alive. Qualifying conditions commonly include terminal illness and may include chronic illness or other severe conditions, depending on the contract. The advance is not additional insurance. It is an acceleration of part of the death benefit otherwise payable at death. As a result, the remaining death benefit available to beneficiaries is reduced by the amount paid, together with any applicable charges or adjustments under the policy.
This rider can provide funds for medical care, home modifications, long-term care, living expenses, or other needs created by a serious illness. However, the producer must explain that eligibility is determined by the contract and supporting medical documentation. The rider should not be described as a replacement for comprehensive health insurance, disability income protection, or long-term-care insurance.
The other choices serve different purposes. A guaranteed-insurability rider allows future purchases of coverage without evidence of insurability at stated times or events. A payor-benefit rider waives premiums if a designated payor becomes disabled or dies. An accidental-death rider pays an additional benefit for qualifying accidental death.
References/topics from the Study Guide: Living Benefits; Accelerated Death Benefit Rider; Terminal Illness; Policy Riders; Beneficiary Considerations.
NEW QUESTION # 104
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