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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Accident and Health — General Knowledge~68%- Insurance Concepts and Underwriting
  • 1. Premiums and Renewal
  • 2. Application and Underwriting
  • 3. Insurance Basics and Risk
- Types of Health Insurance Policies
  • 1. Medicare Supplement Policies
  • 2. Long-Term Care (LTC) Insurance
  • 3. Limited Benefit Plans
  • 4. Accidental Death & Dismemberment
  • 5. Group Health Insurance
  • 6. Medical Expense / Major Medical Insurance
  • 7. Disability Income Insurance
- Social Insurance / Government Plans
  • 1. Medicare (Parts A, B, C, D)
  • 2. Social Security Disability Benefits
  • 3. Medicaid
- Policy Provisions, Clauses & Riders
  • 1. Optional Provisions
  • 2. Mandatory Uniform Provisions
  • 3. Common Riders
  • 4. Other Provisions and Clauses
Nevada Statutes, Rules and Regulations~32%- General State Insurance Regulations
  • 1. Definitions and General Provisions
  • 2. Insurance Commissioner Authority
  • 3. Marketing Practices and Unfair Trade
  • 4. Insurance Guaranty Associations
  • 5. Agent Licensing Requirements
- Nevada Health-Specific Regulations
  • 1. Group and Credit Health Rules
  • 2. Replacement and Free-Look Provisions
  • 3. Advertising and Disclosure Rules

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Insurance Licensing NV Accident and Health Sample Questions (Q73-Q78):

NEW QUESTION # 73
In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:

Answer: C

Explanation:
A person may not concurrently hold a Nevada producer license and an Exchange Enrollment Facilitator certificate. Therefore, a health insurance producer who wishes to become an EEF must surrender the producer authority and apply for certification as an Exchange Enrollment Facilitator.
An EEF assists consumers with enrollment in qualified health plans offered through the Exchange. The role is designed to provide objective enrollment help, application assistance, and general information. An EEF may not sell, solicit, or negotiate insurance. The EEF also may not receive consideration from a health insurance issuer or insurer in connection with enrollment and may not receive remuneration arising from EEF activities from a licensed producer, insurance consultant, surplus lines broker, or insurer.
For that reason, a producer cannot receive commissions while acting as an EEF, cannot collect both commission and EEF compensation in the manner described, and cannot steer a consumer toward a particular coverage choice. Producers and EEFs have different legal roles, compensation structures, and consumer- protection limitations.
Study Guide references/topics: Exchange Enrollment Facilitators; producer licensing; prohibited acts; compensation; NRS 695J.210 .


NEW QUESTION # 74
The Nevada Life and Health Insurance Guaranty Association becomes involved in an insurance company ' s affairs when the company:

Answer: A

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 # 75
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: B

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 # 76
Under a Disability policy, the Elimination period is:

Answer: D

Explanation:
The elimination period is the waiting period that must pass after disability begins before disability income benefits become payable. Choice C is correct because it performs a function similar to a deductible, but it is measured in time rather than dollars. For example, a policy may require an insured to remain disabled for 30,
60, 90, or 180 days before benefits begin. The insured bears the financial impact of the disability during that initial period, just as an insured bears a deductible before medical expense benefits apply. A longer elimination period generally reduces the policy premium because the insurer begins payments later and may avoid paying shorter-duration claims. The elimination period is not necessarily longer for accidents than sickness; many policies use the same waiting period for both. It is selected under the policy terms, rather than being an undefined period solely controlled by the insurer. It is also not the same as a probationary period, which is a period at the beginning of a policy during which sickness losses may be excluded. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Elimination Period.


NEW QUESTION # 77
Group health policies MUST provide which of the following benefits?

Answer: D

Explanation:
Nevada requires group health insurance policies to include benefits for expenses arising from hospice care.
Hospice care is designed for individuals facing terminal illness and focuses on comfort, pain and symptom management, emotional support, and assistance for the patient and family rather than curative treatment.
The group-policy required-provisions statute specifically includes hospice-care benefits. It also recognizes benefits for care at home or health supportive services when prescribed by a physician and otherwise covered if provided in a medical facility. This reflects the policy goal of allowing appropriate end-of-life care in a setting suited to the patient's needs.
Adult vision care and adult dental care are not universally required benefits under every group health policy.
They may be offered through separate policies, riders, employer benefit arrangements, or plan designs.
Cosmetic surgery is generally not a mandatory health insurance benefit and may be excluded unless medically necessary or required because of injury, congenital condition, reconstruction, or another covered circumstance.
The key examination point is that hospice care is a specifically required group-policy benefit in Nevada, while the other choices may be optional, limited, or excluded depending on the plan.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; NRS 689B.
030 .


NEW QUESTION # 78
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