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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Long Term Care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Coverage for reconstructive surgery - Hospice care - Medicare
|
| Topic 2: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Nevada Life and Health Insurance Guaranty Association - Definitions
|
| Topic 3: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Advertising - Group life and health insurance
|
| Topic 4: Accident & Health – General Knowledge | 50% | - Field Underwriting Procedures
|
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NEW QUESTION # 25
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: D
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 # 26
Which statement best describes a preferred provider organization (PPO)?
Answer: B
Explanation:
A preferred provider organization, or PPO, contracts with a network of preferred providers who agree to provide services under negotiated payment arrangements. Members generally receive the highest level of benefit and lowest out-of-pocket cost when they use participating providers. Many PPOs also permit use of nonnetwork providers, but the member normally pays more through a higher deductible, higher coinsurance, balance billing exposure, or reduced reimbursement.
A PPO differs from a traditional HMO because it commonly provides more flexibility in choosing providers and may not require a primary-care referral for specialist care. However, the tradeoff may be higher premiums, higher cost sharing, and more complex reimbursement rules. A PPO is still managed care; it may use prior authorization, utilization review, formularies, and network rules.
A producer should explain provider-network access, emergency-care rules, deductible and coinsurance amounts, out-of-network payment limitations, and whether a provider is actually participating at the time of enrollment. The phrase "you can see any doctor" can be misleading if nonnetwork care is covered at a lower level or exposes the insured to significant unpaid charges.
References/topics from the Study Guide: PPO; Managed Care; Provider Networks; In-Network and Out-of- Network Benefits; Cost Sharing.
NEW QUESTION # 27
A group health policy that covers hospital expenses MUST also cover:
Answer: C
Explanation:
A group health policy that provides hospital-expense coverage must also provide coverage for routine physical examinations. Routine examinations are preventive services intended to identify health concerns early, promote wellness, and reduce the risk that a medical condition will progress before treatment begins.
Burial expenses are not health-insurance benefits. They are ordinarily addressed through life insurance, final- expense coverage, or other arrangements. Elective cosmetic surgery is generally excluded unless it is medically necessary, reconstructive, or otherwise required by the policy or applicable law. Travel expenses for caretakers are likewise not a standard mandatory group health benefit.
The key point is that group health coverage is not confined to hospitalization after illness or injury occurs.
Required provisions can include preventive and health-maintenance benefits. Routine physical examinations allow the insured to receive medical assessment before a condition requires hospital confinement or major treatment.
The exact scope of a routine examination, frequency limitations, network requirements, and whether additional diagnostic services are covered may depend on the policy and applicable preventive-care rules. But among the choices, routine physical examinations are the mandated benefit associated with hospital-expense group coverage.
Study Guide references/topics: group health required provisions; hospital expense coverage; preventive care; routine physical examinations; Nevada group-health policy requirements .
NEW QUESTION # 28
An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for:
Answer: B
Explanation:
The correct answer is D. Underwriting for an individual disability income policy focuses on facts that affect the proposed insured's probability of disability, ability to work, existing income protection, and potential for overinsurance. Marital status and occupation may be relevant to financial and occupational underwriting.
Medical history is directly relevant because past and current health conditions can affect eligibility, exclusions, ratings, or benefit limitations. Other disability policies already in force are important because insurers must evaluate the total amount of disability benefits relative to earned income and avoid excessive coverage. The spouse's occupation ordinarily does not determine the proposed insured's disability risk or benefit eligibility and is therefore the least relevant item. Insurers also may request information about income, employer, job duties, hazardous activities, tobacco use, prior claims, and other sources of disability income.
The producer must obtain complete and accurate answers from the applicant, explain questions when necessary, and avoid making assumptions or completing answers without the applicant's direction. Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Disability Income Underwriting; Application Information.
NEW QUESTION # 29
In a cross-purchase buy-sell agreement funded by life insurance, who typically owns the policy on each business owner?
Answer: B
Explanation:
In a cross-purchase buy-sell agreement, each business owner purchases, owns, and is beneficiary of life insurance on the other owner or owners. If one owner dies, the surviving owner receives the policy proceeds and uses them to purchase the deceased owner's business interest from the estate or designated successor. The arrangement provides liquidity and a predetermined method for transferring ownership, helping the business continue without forcing a sale of assets or requiring the surviving owner to obtain financing at a difficult time.
An entity-purchase agreement differs because the business itself owns policies on each owner and uses the proceeds to redeem the deceased owner's interest. The number of policies can be an important distinction.
With two owners, a cross-purchase arrangement usually requires two policies. With several owners, each may need policies on all other owners, which can become administratively complex.
The agreement should be drafted and reviewed by qualified legal and tax professionals. The insurance policy alone does not create the buy-sell obligation; the written agreement establishes the purchase terms, valuation method, triggering events, and funding mechanism. The producer's role is to help identify appropriate funding, not to draft legal agreements.
References/topics from the Study Guide: Buy-Sell Agreements; Cross-Purchase Plans; Entity-Purchase Plans; Business Continuation; Life Insurance Funding.
NEW QUESTION # 30
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