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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
| Accident and Health โ General Knowledge | ~68% | - Social Insurance / Government Plans
|
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NEW QUESTION # 45
Group health policies MUST provide which of the following benefits?
Answer: B
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 # 46
In a disability income policy, the elimination period is best described as:
Answer: B
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 # 47
Which of the following statements is CORRECT about the Medicaid program?
Answer: C
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 # 48
Which rider allows a terminally ill insured to receive part of the death benefit while still alive, subject to the policy terms?
Answer: D
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 # 49
In order to be covered under the Nevada Life and Health Insurance Guaranty Association, an insurance company MUST be:
Answer: A
Explanation:
An insurer must be admitted in Nevada-meaning authorized to transact the applicable insurance business in the state-to be a member of the Nevada Life and Health Insurance Guaranty Association. Membership is a condition of authority for insurers and health maintenance organizations writing the kinds of coverage protected by the Guaranty Association Act.
The Association provides limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not a general guarantee of every insurance company or every policy. Coverage is governed by statute, subject to eligibility requirements, benefit limits, exclusions, and residency provisions.
An AM Best rating is an independent financial-strength opinion. It may be useful to consumers and producers evaluating an insurer, but it does not determine membership in the Guaranty Association. A fraternal benefit society is specifically excluded from the definition of a member insurer for this purpose. "Alien" refers to an insurer organized under the laws of another country and does not, by itself, establish Association membership; the key consideration is whether the insurer is authorized to transact covered insurance in Nevada.
Study Guide references/topics: admitted versus nonadmitted insurers; guaranty associations; insurer insolvency; NRS Chapter 686C .
NEW QUESTION # 50
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