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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Coverage for reconstructive surgery - Mandatory policy clauses and provisions
- Long Term Care - Medicare
|
| Topic 2: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Group life and health insurance
- Advertising |
| Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Insurance Commissioner
- Marketing Practices
|
| Topic 4: Accident & Health – General Knowledge | 50% | - Social Insurance
|
>> Latest InsNV_Health02 Braindumps Questions <<
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NEW QUESTION # 51
The Affordable Care Act (ACA) requires every individual policy to provide minimum coverages known as:
Answer: B
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 # 52
Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?
Answer: C
Explanation:
A newborn is automatically covered under the applicable Nevada health-policy rule for 31 days after birth.
Coverage begins from the moment of birth and includes necessary care and treatment for injury or sickness, including medically diagnosed congenital defects and birth abnormalities.
To continue coverage beyond the initial 31-day period, the policy may require timely notice of the birth and payment of any additional premium or fee required by the insurer. The notification and payment requirement must be satisfied within the 31-day period if the policy requires it. This rule protects newborns during the immediate post-birth period, when medical care may be urgently necessary.
The automatic coverage is not limited to routine newborn care. It includes necessary treatment of medical conditions identified at birth, subject to the policy's applicable limits. The law also prevents the policy from excluding premature births under the mandated newborn coverage.
Two, five, and ten days are incorrect because they would not provide the statutory protection required for newborn coverage. The exam point is that the initial automatic period is 31 days, while continuation beyond that period may require prompt enrollment action by the insured.
Study Guide references/topics: individual health insurance; newborn coverage; congenital defects; notification requirements; Nevada newborn-coverage requirements .
NEW QUESTION # 53
Which person is generally eligible to establish and contribute to a health savings account (HSA)?
Answer: C
Explanation:
An HSA is generally available to an eligible individual who is covered by a qualified high-deductible health plan, commonly called an HDHP, and who meets the other federal eligibility requirements. The account is owned by the individual, not the employer or insurer. Contributions may be made by the individual, an employer, or another person, subject to annual contribution limits. Qualified distributions used for eligible medical expenses are generally tax advantaged under federal rules.
Eligibility is not based solely on having a high deductible. The health plan must meet the federal HDHP requirements for the applicable year. In addition, an individual generally cannot be enrolled in Medicare, cannot be claimed as another person's tax dependent, and cannot have disqualifying other health coverage.
Because federal limits and requirements can change, the producer should not provide individualized tax advice and should refer the consumer to current IRS guidance or a qualified tax professional.
An HSA differs from a flexible spending arrangement because unused HSA funds generally remain with the account owner and may carry forward. It also differs from health insurance itself; the HSA is a tax- advantaged account used alongside an eligible health plan.
References/topics from the Study Guide: Health Savings Accounts; High-Deductible Health Plans; Consumer- Directed Health Plans; Tax-Advantaged Medical Accounts.
NEW QUESTION # 54
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:
Answer: B
Explanation:
The policy remains in force during its contractual grace period after a premium becomes due. For individual accident and health policies, the required grace period generally depends on premium mode: seven days for weekly premiums, ten days for monthly premiums, and 31 days for other premium modes. A claim occurring within the applicable grace period is not automatically denied simply because the premium has not yet been paid. Instead, the insurer may pay the covered claim and deduct the overdue premium from the amount otherwise payable. Therefore, choice B is the best answer. Reinstatement is unnecessary because the policy has not yet lapsed while the grace period is still running. Cancellation and return of all prior premiums would be inconsistent with the purpose of the grace-period provision. The question tests the difference between a late premium during grace and a lapsed policy after grace expires. Once grace expires without payment, coverage can lapse; if coverage later is reinstated, loss coverage may be subject to reinstatement provisions and limitations. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.
NEW QUESTION # 55
For an individual health insurance policy, which document is generally part of the entire contract when a copy is attached to or endorsed on the policy?
Answer: C
Explanation:
The application is generally part of the entire contract only when a copy is attached to or endorsed on the policy. The entire-contract provision identifies the documents that form the binding agreement between the insurer and the insured. In an individual health policy, the policy itself and the attached application are the principal contract documents. Material statements made in the application are treated according to the policy and governing law, but outside papers, advertisements, and verbal discussions ordinarily do not become policy terms merely because they were used in the sales process.
This rule protects both parties. The insured can review the documents that govern coverage, while the insurer can rely on the written application it used for underwriting. A producer's notes, informal assurances, or advertising language cannot expand benefits, remove exclusions, or alter policy conditions unless formally incorporated into the contract. Producers must avoid statements that conflict with the issued policy and should deliver the policy promptly so the applicant can examine it during any applicable free-look period.
Nevada's individual health-insurance law requires specified policy provisions and permits approved substitutions only when they are not less favorable to the insured or beneficiary. The exact wording and placement of the application therefore matter.
References/topics from the Study Guide: Entire Contract; Application; Policy Delivery; Individual Health Policy Provisions; NRS 689A.040.
NEW QUESTION # 56
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