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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% | - Nevada Health-Specific Regulations
|
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NEW QUESTION # 106
Which of the following statements is CORRECT about the Medicaid program?
Answer: A
Explanation:
Medicaid is a means-tested public medical assistance program for eligible low-income individuals and families. Eligibility may include persons who are blind, disabled, aged, pregnant, children, or otherwise within an eligible category under federal and state rules. Therefore, choice A is correct. There is no universal minimum age of 55 for Medicaid eligibility; eligibility is based principally on financial and categorical requirements. Medicaid is also not simply a program supplemented by Medicare at age 62. Medicare eligibility is generally associated with age 65 or qualifying disability or disease status, while Medicaid may assist certain eligible persons with limited income and resources, including some Medicare beneficiaries.
Medicaid is jointly financed by federal and state governments but is administered by the states within federal standards. In Nevada, the state administers the program through its designated health and human-services structure. Examination questions commonly test the distinction between Medicare as social insurance and Medicaid as needs-based medical assistance. Study Guide References/Topics: Social Insurance Programs; Medicaid; Federal-State Health Programs.
NEW QUESTION # 107
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 # 108
Under federal law, a tax exempt Health Savings Account can only be opened for an individual who is:
Answer: D
Explanation:
A Health Savings Account is available only to an eligible individual, and a central eligibility requirement is coverage under a qualified High Deductible Health Plan. Therefore, choice A is correct. The individual also generally must not have disqualifying other health coverage, be enrolled in Medicare, or be claimable as another person's tax dependent. Long-term care insurance does not itself establish HSA eligibility. Medicare enrollment generally prevents new HSA contributions, although the account balance may still be used for qualified expenses under applicable tax rules. An HSA offers tax-favored contributions, tax-deferred growth, and tax-free distributions for qualified medical expenses when statutory requirements are met. The HDHP must satisfy annual federal deductible and out-of-pocket limits, which are adjusted periodically. The IRS states that eligible individuals must have HDHP coverage and no disqualifying health coverage to make HSA contributions. See IRS HSA guidance . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Health Savings Accounts; High Deductible Health Plans.
NEW QUESTION # 109
In a disability income policy, the elimination period is best described as:
Answer: D
Explanation:
The elimination period is the waiting period that begins when a covered disability starts and ends before disability-income benefits become payable. It functions much like a time deductible. For example, if a policy has a 30-day elimination period, the insured must remain disabled for the required period before weekly or monthly benefits begin, subject to the policy's definition of disability and proof-of-loss requirements.
The elimination period is not the benefit period. The benefit period is the maximum length of time benefits may continue once the insured becomes eligible, such as two years, five years, or to a stated age. It is also not the probationary period, which may apply at the beginning of a policy before coverage for sickness becomes effective. Accident coverage is often effective immediately, while sickness coverage may have a probationary period depending on the contract.
A longer elimination period generally lowers the premium because the insured retains more of the initial loss.
A shorter elimination period generally increases the premium because the insurer begins paying sooner. When comparing disability policies, producers should evaluate the elimination period together with the monthly benefit amount, definition of disability, residual-benefit features, and benefit period.
References/topics from the Study Guide: Disability Income Insurance; Elimination Period; Benefit Period; Probationary Period; Time Deductible.
NEW QUESTION # 110
Which rider allows a terminally ill insured to receive part of the death benefit while still alive, subject to the policy terms?
Answer: A
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 # 111
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