InsNV_Health02 New Braindumps - New InsNV_Health02 Real Exam

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Advertising - Credit life and health insurance - Group life and health insurance 1. Eligible groups 2. Required provisions
Accident & Health – General Knowledge	50%	- Policy Provisions, Clauses, and Riders 1. Other provisions and clauses Insuring clause Free look Consideration clause Probationary period Elimination period Waiver of premium Exclusions and limitations Preexisting conditions Coinsurance Deductibles Eligible expenses Copayments Pre-authorizations and prior approval requirements Usual, reasonable, and customary charges Lifetime, annual, or per cause maximum benefit limits 2. Rights of renewability Noncancelable Cancelable Guaranteed renewable 3. Mandatory and optional provisions Entire contract Time limit on certain defenses Grace period Reinstatement Notice of claim Claim forms Proof of loss Time of payment of claims Payment of claims Physical examination and autopsy Legal actions Change of beneficiary Misstatement of age or gender Change of occupation Illegal occupation Relation of earnings to insurance 4. Riders Impairment and exclusions Guaranteed insurability Future increase option - Types of Policies 1. Accidental death and dismemberment 2. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident 3. Medicare supplement policies 4. Medical expense insurance Basic hospital, medical, and surgical policies Major medical policies Health Maintenance Organizations Preferred Provider Organizations Point of Service plans Flexible Spending Accounts High Deductible Health Plans and Health Savings Accounts Health Reimbursement Accounts 5. Individual and Group Long Term Care Eligibility Levels of care 6. Group insurance Differences between individual and group contracts General characteristics COBRA 7. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy - Social Insurance 1. Social Security benefits 2. Medicare Parts A, B, C, and D 3. Medicaid - Field Underwriting Procedures 1. Initial premium payment and receipt 2. Replacement 3. Explaining policy provisions, riders, exclusions, and ratings 4. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 5. Policy delivery 6. Completing the application 7. Sources of insurability and HIPAA privacy information 8. Submitting application and initial premium to company for underwriting - Other Insurance Concepts 1. Owner's rights 2. Dependent children benefits 3. Cost containment 4. Total, partial, recurrent, and residual disability 5. Modes of premium payments 6. Workers Compensation 7. Primary and contingent beneficiaries 8. Tax treatment of premiums and proceeds of insurance contracts 9. Subrogation 10. Managed care 11. Nonduplication and coordination of benefits 12. Occupational vs. non-occupational
Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Medicare 1. Prescription Drug Plan 2. Medicare supplement regulation 3. Medicare Advantage Plans - Coverage for reconstructive surgery - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Mandatory policy clauses and provisions 1. Coverage for preventive healthcare services 2. Coverage for newborn children 3. Coverage for physical handicap or intellectual disability for dependent children - Hospice care - Long Term Care
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Nevada Life and Health Insurance Guaranty Association - Definitions 1. Authorized and unauthorized 2. Transacting insurance 3. Domestic, foreign, and alien 4. Cost-sharing 5. Premiums 6. Certificate of authority 7. Insurer - Insurance Commissioner 1. General powers and duties 2. Examinations 3. Notice and hearings and penalties - Marketing Practices 1. Silver State Health Insurance Exchange 2. Affordable Care Act 3. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation 4. Fiduciary responsibilities 5. Required records and record retention 6. Commissions and payment restrictions - Licensing 1. Name of licensee 2. Renewal and continuing education 3. Obtaining a license 4. Termination of license 5. Persons required to be licensed 6. Suspension, revocation, and refusal of license

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Insurance Licensing NV Accident and Health Sample Questions (Q30-Q35):

NEW QUESTION # 30
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?

A. No benefit is payable because the employee did not submit an application.
B. The employer must personally pay the former employee's beneficiary.
C. Only any accumulated cash value is payable.
D. The amount that could have been converted is payable under the group policy.

Answer: D

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 # 31
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?

A. A verbal statement made by the applicant
B. The application
C. An advertisement used during the sale
D. A producer's personal notes

Answer: B

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 # 32
Medicaid is best described as:

A. A Medicare supplement insurance plan
B. A joint federal-state program that provides medical assistance to eligible individuals
C. A federal retirement program funded only by payroll taxes
D. A private insurance policy sold by producers

Answer: B

Explanation:
Medicaid is a joint federal-state medical-assistance program serving eligible individuals and families under income, resource, categorical, residency, and other program rules. The federal government establishes broad requirements and provides funding, while each state administers its program within federal parameters.
Nevada administers Medicaid through its state health and human-services structure and contracted delivery systems. Eligibility and benefits can vary by category and may change with law and program administration.
Medicaid is not the same as Medicare. Medicare is principally a federal social-insurance program associated with age 65 or older, certain disabilities, and end-stage renal disease or other qualifying conditions. Medicaid is generally means tested, although eligibility is determined by detailed program standards and should never be assumed from income alone. Some people may qualify for both Medicare and Medicaid; these individuals are often referred to as dual-eligible beneficiaries.
A producer should avoid giving legal or public-benefit eligibility advice beyond the scope of insurance licensing. The proper role is to identify the program accurately, explain how private coverage may coordinate where applicable, and direct a consumer to the appropriate state agency or benefits specialist for an eligibility determination.
References/topics from the Study Guide: Medicaid; Medicare; Dual Eligibility; Government-Sponsored Health Programs; Nevada Public Health Benefits.

NEW QUESTION # 33
A prospect submits an Accident and Health application with the premium and receives a conditional receipt.
The insurance company issues a policy and mails it to the insured, but the insured never receives it. Which of the following statements is CORRECT about this situation?

A. The policy will be in force five business days after the prospect notifies the company that the prospect has not received the policy.
B. The policy will be in force as soon as the company issues a replacement policy.
C. The policy is not in force because delivery was not completed.
D. The policy is in force.

Answer: D

Explanation:
The correct answer is D. A conditional receipt may provide temporary or conditional coverage when the application and required premium are submitted, subject to the receipt's terms and the applicant meeting underwriting requirements. Once the insurer approves the application, issues the policy, and mails it to the insured, the policy is generally considered delivered through constructive delivery. Physical receipt by the insured is not required when the insurer has completed issuance and mailing without retaining control over the policy. Accordingly, failure of the insured to receive the mailed policy does not, by itself, prevent the policy from being in force. Choice A incorrectly assumes that personal delivery is always essential. Choices B and C introduce conditions that are not part of the usual delivery rule. The policy's effective date remains governed by the application, conditional receipt, policy provisions, and underwriting approval. This question tests the distinction between actual delivery, where the insured personally receives the policy, and constructive delivery, where the insurer's completed mailing is sufficient to establish delivery. Study Guide References
/Topics: Completing the Application, Underwriting, and Delivering the Policy; Conditional Receipts; Policy Delivery.

NEW QUESTION # 34
An insured purchases a rider that pays an additional amount only if death results from a covered accident.
This rider is best described as:

A. A guaranteed-insurability rider
B. A cost-of-living rider
C. An accidental death benefit rider
D. A return-of-premium rider

Answer: C

Explanation:
An accidental death benefit rider provides an additional death benefit when the insured dies as the direct result of a covered accident. It is often described as "double indemnity" when the additional benefit equals the policy's face amount, although the actual amount and conditions depend on the rider. The rider supplements the base life policy; it does not replace the base death benefit. If the insured dies from a covered accident, the beneficiary may receive the base policy amount plus the rider benefit. If death results from illness or a noncovered cause, only the base policy benefit is generally payable.
Accidental-death riders contain important limitations. They typically require death to occur within a stated time after the accident and may exclude deaths resulting from specified causes, such as war, suicide, certain hazardous activities, intoxication, or illegal acts, depending on the contract. The producer must explain that the benefit is conditional and is not the same as comprehensive life insurance.
A guaranteed-insurability rider permits future coverage increases without new evidence of insurability. A cost- of-living rider increases coverage under specified inflation-related terms. A return-of-premium feature returns qualifying premiums under stated conditions, usually at the end of a term period.
References/topics from the Study Guide: Accidental Death Benefit Rider; Double Indemnity; Exclusions; Supplementary Benefits; Policy Riders.

NEW QUESTION # 35
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