Quiz Insurance Licensing - Fantastic InsNV_Health02 Instant Download

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionObjectives
Producer Duties and Ethics- Ethical Responsibilities
  • 1. Consumer protection requirements
    • 2. Fiduciary responsibilities
      - Sales Practices
      • 1. Advertising and marketing rules
        • 2. Unfair trade practices
          Government Health Insurance Programs- Medicare
          • 1. Medicare supplement insurance
            • 2. Medicare parts and eligibility
              - Medicaid and Other Programs
              • 1. Medicaid eligibility and coverage
                General Insurance Regulation- Nevada Insurance Department and Regulatory Authority
                • 1. Insurance laws, rules, and regulations
                  • 2. Commissioner of Insurance powers and duties
                    - Licensing Requirements and Responsibilities
                    • 1. Continuing education and license maintenance
                      • 2. Producer licensing requirements
                        Accident and Health Insurance Fundamentals- Disability Income Insurance
                        • 1. Elimination periods and benefit periods
                          • 2. Disability definitions and benefits
                            - Types of Health Insurance Policies
                            • 1. Group health insurance
                              • 2. Individual health insurance
                                • 3. Managed care plans
                                  - Medical Expense Insurance
                                  • 1. Hospital, surgical, and physician expense coverage
                                    • 2. Major medical plans
                                      Insurance Basics- Insurance Contracts
                                      • 1. Policy provisions, riders, and exclusions
                                        • 2. Contract elements
                                          - Risk Management and Insurance Concepts
                                          • 1. Insurance principles and contract characteristics
                                            • 2. Types of risk and methods of handling risk
                                              Health Insurance Policy Provisions- Claims and Benefits
                                              • 1. Claim procedures
                                                • 2. Benefit determination and payment
                                                  - Mandatory and Optional Provisions
                                                  • 1. Renewability provisions
                                                    • 2. Policy requirements and clauses

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                                                      Insurance Licensing NV Accident and Health Sample Questions (Q36-Q41):

                                                      NEW QUESTION # 36
                                                      A group health insurance policy MUST include coverage for which of the following expenses?

                                                      Answer: B

                                                      Explanation:
                                                      A group health insurance policy in Nevada must include coverage for expenses arising from hospice care.
                                                      Hospice care is intended for patients with terminal illness and emphasizes comfort, pain control, symptom management, supportive services, and assistance for the patient and family rather than curative treatment.
                                                      Nevada's group-policy required-provisions statute specifically identifies benefits for expenses arising from hospice care. This makes hospice the correct answer. Adult dental and adult vision benefits may be offered by separate policies, riders, employer plans, or benefit arrangements, but they are not universally required in every group health policy. Over-the-counter dietary supplements are not a standard mandated group health benefit and are generally covered only when specifically provided by a policy or health plan.
                                                      Hospice coverage should be distinguished from ordinary inpatient hospital coverage. Hospice care may be delivered in a home, residential setting, hospice facility, or other appropriate location, depending on the patient's needs and the terms of coverage. It frequently involves an interdisciplinary team and includes both patient care and family-support services.
                                                      Study Guide references/topics: group health required provisions; hospice care; mandated benefits; supportive services; NRS 689B.030 .


                                                      NEW QUESTION # 37
                                                      Which Medicare part generally helps cover inpatient hospital care, skilled nursing facility care following a qualifying hospital stay, hospice care, and certain home health services?

                                                      Answer: A

                                                      Explanation:
                                                      Medicare Part A is commonly called hospital insurance. It generally helps cover inpatient hospital care, limited skilled nursing facility care following a qualifying hospital stay, hospice care, and certain home health services. Part A benefits are subject to program rules, benefit periods, deductibles, coinsurance, eligibility conditions, and coverage limitations. It does not mean that every hospital-related service is fully paid.
                                                      Medicare Part B is medical insurance. It generally covers physicians' services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Part C, Medicare Advantage, is an alternative way for eligible beneficiaries to receive Medicare-covered benefits through approved private plans. Part D provides outpatient prescription-drug coverage through private plans approved by Medicare.
                                                      A producer must understand that Medicare supplements and Medicare Advantage plans coordinate differently with Original Medicare. A Medicare supplement policy is designed to help pay certain deductibles, coinsurance, and other gaps in Original Medicare. A Medicare Advantage plan generally replaces the method of receiving Parts A and B services through a private managed plan rather than functioning as a standard supplement.
                                                      The examination focus is the basic division: Part A is primarily hospital-related coverage; Part B is primarily medical and outpatient coverage.
                                                      References/topics from the Study Guide: Medicare; Medicare Part A; Medicare Part B; Medicare Advantage; Medicare Supplement Insurance.


                                                      NEW QUESTION # 38
                                                      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?

                                                      Answer: A

                                                      Explanation:
                                                      A group health policy that terminates dependent-child coverage at a stated limiting age must continue coverage for an eligible dependent child who remains incapable of self-sustaining employment because of a qualifying disability and who remains dependent on the insured group member for support and maintenance.
                                                      To preserve that continuation right, the required proof must be furnished within 31 days after the child reaches the policy's limiting age.
                                                      This is a time-sensitive protection. The purpose is to prevent automatic termination of coverage solely because a dependent reaches the normal age limit when the child remains disabled and financially dependent.
                                                      After initial proof is provided, the insurer may require continuing proof of incapacity and dependency, but it may not demand that proof more often than permitted by law.
                                                      The 31-day rule should be distinguished from notice periods for newborn coverage, conversion rights, premium grace periods, and claim notices. Each insurance provision may use a different time period, so examination questions often test the exact statutory deadline.
                                                      Study Guide references/topics: group health dependents; limiting age; continuation of coverage; NRS 689B.
                                                      035 .


                                                      NEW QUESTION # 39
                                                      A life policy has been in force during the insured's lifetime for more than two years. Which circumstance may still permit the insurer to deny a claim under the policy's incontestability provision?

                                                      Answer: B

                                                      Explanation:
                                                      The incontestability provision limits the insurer's ability to contest the validity of a life insurance policy after it has been in force during the insured's lifetime for the stated period, which Nevada law permits to be no longer than two years from issue. Once that period has passed, an insurer ordinarily cannot avoid the policy because of misstatements in the application, except as provided by the policy and law. The rule promotes certainty for beneficiaries and prevents an insurer from indefinitely reopening underwriting issues after accepting premiums for years.
                                                      Nonpayment of premiums remains an exception. Incontestability does not require an insurer to pay a claim on a policy that lapsed because required premiums were not paid. A policy can also contain provisions concerning total and permanent disability benefits or additional accidental-death benefits that are treated separately under the applicable statutory rule. In addition, an incontestability clause concerns contesting the policy's validity; it does not automatically override every policy exclusion or restriction on coverage.
                                                      The producer should distinguish contestability from the grace period, reinstatement, and exclusions. Each provision serves a different function. For test purposes, the durable rule is that incontestability does not eliminate the insurer's defense of nonpayment of premium.
                                                      References/topics from the Study Guide: Incontestability Clause; Premium Payment; Policy Lapse; NRS
                                                      688A.080.


                                                      NEW QUESTION # 40
                                                      An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?

                                                      Answer: A

                                                      Explanation:
                                                      Nevada group-life law protects an insured person during the conversion interval. If a person covered under a group life policy dies during the period in which the person was entitled to obtain an individual conversion policy-and before that individual policy becomes effective-the amount of life insurance the person could have converted is payable as a claim under the group policy. This protection applies whether or not the person submitted the individual-policy application or paid the first premium before death.
                                                      The conversion privilege is important because group coverage is usually tied to employment or membership.
                                                      When eligibility ends, the individual may lose the group policy's protection. Conversion gives the former insured an opportunity to obtain individual life insurance without new evidence of insurability, subject to the statute and policy terms. The converted amount may be limited by the group policy and applicable law, and the individual policy's premium is based on the insurer's conversion rates.
                                                      This rule should not be confused with portability. Portability allows continuation of group-style coverage under certain conditions, whereas conversion replaces group coverage with an individual policy. The producer should explain notice requirements, the available conversion amount, deadlines, and premium differences whenever group coverage terminates.
                                                      References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Termination of Employment; NRS 688B.120-688B.130.


                                                      NEW QUESTION # 41
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