InsNV_Health02최신버전시험덤프자료 - InsNV_Health02최신덤프샘플문제

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Long Term Care - 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 physical handicap or intellectual disability for dependent children 3. Coverage for newborn children - Hospice care - Medicare 1. Medicare Advantage Plans 2. Medicare supplement regulation 3. Prescription Drug Plan
Accident & Health – General Knowledge	50%	- Social Insurance 1. Medicaid 2. Medicare Parts A, B, C, and D 3. Social Security benefits - Types of Policies 1. Accidental death and dismemberment 2. Group insurance Differences between individual and group contracts General characteristics COBRA 3. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy 4. Individual and Group Long Term Care Eligibility Levels of care 5. 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 6. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident 7. Medicare supplement policies - 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. 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 3. Rights of renewability Noncancelable Cancelable Guaranteed renewable 4. Riders Impairment and exclusions Guaranteed insurability Future increase option - Field Underwriting Procedures 1. Completing the application 2. Initial premium payment and receipt 3. Policy delivery 4. Explaining policy provisions, riders, exclusions, and ratings 5. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 6. Sources of insurability and HIPAA privacy information 7. Replacement 8. Submitting application and initial premium to company for underwriting - Other Insurance Concepts 1. Tax treatment of premiums and proceeds of insurance contracts 2. Managed care 3. Subrogation 4. Occupational vs. non-occupational 5. Modes of premium payments 6. Total, partial, recurrent, and residual disability 7. Nonduplication and coordination of benefits 8. Dependent children benefits 9. Workers Compensation 10. Cost containment 11. Owner's rights 12. Primary and contingent beneficiaries
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Licensing 1. Persons required to be licensed 2. Obtaining a license 3. Suspension, revocation, and refusal of license 4. Name of licensee 5. Renewal and continuing education 6. Termination of license - Definitions 1. Authorized and unauthorized 2. Cost-sharing 3. Certificate of authority 4. Domestic, foreign, and alien 5. Insurer 6. Transacting insurance 7. Premiums - Nevada Life and Health Insurance Guaranty Association - Insurance Commissioner 1. General powers and duties 2. Notice and hearings and penalties 3. Examinations - Marketing Practices 1. Fiduciary responsibilities 2. Commissions and payment restrictions 3. Affordable Care Act 4. Required records and record retention 5. Silver State Health Insurance Exchange 6. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation
Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Group life and health insurance 1. Required provisions 2. Eligible groups - Credit life and health insurance - Advertising

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InsNV_Health02최신버전 시험덤프자료최신버전 시험기출문제

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최신 Nevada Insurance InsNV_Health02 무료샘플문제 (Q76-Q81):

질문 # 76
In a cross-purchase buy-sell agreement funded by life insurance, who typically owns the policy on each business owner?

A. Each owner owns policies on the other owners.
B. The business entity owns every policy.
C. The insured owner's children own the policy.
D. The producer owns the policy until death occurs.

정답：A

설명：
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.

질문 # 77
Which of the following is NOT a preventive benefit for adults?

A. Physical therapy
B. Mammograms
C. High blood pressure screening
D. Skin cancer screening

정답：D

설명：
Skin cancer screening is the correct answer because it is not included as a broadly required preventive benefit for adults in the same manner as the other listed services. Preventive-service requirements are tied to specified recommended services and may vary by population, risk status, and recommendation level. A service may be medically useful or covered by a particular policy without being a universally required no-cost preventive benefit.
High blood pressure screening is a standard adult preventive screening. Mammography is a recognized preventive screening benefit for eligible women. Physical therapy can be included in preventive fall- intervention services for certain adults, particularly older adults at risk of falls, when the preventive-service criteria are met. Thus, the question is testing the distinction between services commonly covered in some circumstances and services specifically identified as preventive benefits.
Skin examinations or skin cancer evaluations may be medically necessary when a lesion, symptom, prior diagnosis, or risk factor is present. In that circumstance, the service may be classified as diagnostic rather than preventive and can be subject to policy terms and cost sharing.
For examination purposes, remember that preventive-benefit questions focus on the mandated screening list and preventive-care criteria, not merely on whether a service can be medically valuable.
Study Guide references/topics: preventive care; adult screenings; in-network preventive benefits; adult preventive-care benefits .

질문 # 78
One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:

A. can explain insurance terms like copayments and deductibles
B. can recommend a health plan for a consumer
C. can answer questions regarding program eligibility
D. are compensated monetarily

정답：B

설명：
A licensed producer may recommend a health plan for a consumer because the producer is authorized to sell, solicit, and negotiate insurance. That authority permits the producer to discuss coverage choices in a personalized manner, explain how plan provisions apply to the consumer's situation, and recommend a particular policy or plan when appropriate.
An Exchange Enrollment Facilitator is certified to help consumers enroll in qualified health plans through the Exchange. The EEF role is designed to provide impartial enrollment assistance, application support, and general program information. However, an EEF may not sell, solicit, or negotiate insurance. That restriction prevents an EEF from functioning as an insurance producer or steering a consumer toward a particular carrier or plan.
Explaining general terminology, such as deductibles, copayments, and eligibility rules, can be part of enrollment assistance and is not the defining distinction. Compensation is also not the key answer because the legal distinction turns on insurance authority, not simply whether a person receives payment. A Nevada EEF also may not concurrently hold a producer license.
Study Guide references/topics: Exchange Enrollment Facilitators; producer authority; solicitation and negotiation; NRS Chapter 695J .

질문 # 79
Most insurance companies use the usual, customary, and reasonable (UCR) charges to:

A. reimburse the employee for expenses charged by the medical facilities
B. limit the insurance company claims liability
C. pay dollars direct to the employers for health insurance
D. reimburse physicians for excess expense

정답：B

설명：
Usual, customary, and reasonable charges are payment standards used to determine the portion of a medical charge that a health insurer recognizes as eligible for reimbursement. Choice D is correct because UCR standards limit the insurer's claim liability to an amount considered appropriate for the service in the relevant geographic area. "Usual" refers to the fee commonly charged by a particular provider; "customary" refers to fees generally charged by comparable providers in the area; and "reasonable" considers the circumstances and complexity of the service. If a provider's charge exceeds the plan's allowed amount, the insurer may pay only the UCR amount, and the patient may remain responsible for the difference unless a network agreement or other policy provision prevents balance billing. UCR does not mean that insurers reimburse excess charges, pay funds to employers, or reimburse every amount billed by a medical facility. This concept is tested as a cost-control mechanism within medical expense coverage and should be distinguished from deductibles, coinsurance, copayments, and maximum benefit limits. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Medical Expense Insurance; Usual, Customary, and Reasonable Charges.

질문 # 80
An incorporated licensee who seeks to do business under a fictitious name is required to file a document about the name with the:

A. Nevada Attorney General ' s office
B. Nevada Insurance Commissioner
C. National Association of Insurance and Financial Advisors
D. National Association of Health Underwriters

정답：B

설명：
An incorporated insurance licensee using a name other than its true legal name must obtain approval and file the required fictitious-name documentation with the Nevada Insurance Commissioner. This ensures that insurance business is conducted under a name that has been reviewed, recorded, and can be connected to the actual licensed person or entity responsible for the transaction. It supports consumer protection, regulatory oversight, complaint handling, and enforcement of licensing laws.
Nevada's producer-licensing law requires an applicant or licensee wishing to use a name other than the true name shown on the license to submit a request for approval and file with the Commissioner a certified copy of the applicable certificate. The purpose is not merely administrative. A producer may not use a trade, assumed, or fictitious name in a way that could conceal the responsible licensee or mislead an insurance consumer.
The Attorney General, NAHU, and NAIFA do not approve fictitious names used by Nevada insurance licensees. The Nevada Division of Insurance, acting through the Commissioner, is the proper regulatory authority.
Study Guide references/topics: Nevada producer licensing; use of true or fictitious names; regulatory authority of the Commissioner; NRS 683A.301 .

질문 # 81
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