Pass the Insurance Licensing Nevada Insurance InsNV_Health02 Questions and answers with Dumpstech

The policy remains in force during its contractual grace period after a premium becomes due. For individual accident and health policies, the required grace period generally depends on premium mode: seven days for weekly premiums, ten days for monthly premiums, and 31 days for other premium modes. A claim occurring within the applicable grace period is not automatically denied simply because the premium has not yet been paid. Instead, the insurer may pay the covered claim and deduct the overdue premium from the amount otherwise payable. Therefore, choice B is the best answer. Reinstatement is unnecessary because the policy has not yet lapsed while the grace period is still running. Cancellation and return of all prior premiums would be inconsistent with the purpose of the grace-period provision. The question tests the difference between a late premium during grace and a lapsed policy after grace expires. Once grace expires without payment, coverage can lapse; if coverage later is reinstated, loss coverage may be subject to reinstatement provisions and limitations. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.

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The correct answer is B, Medicare. A person with end-stage renal disease—permanent kidney failure requiring regular dialysis or a kidney transplant—may qualify for Medicare regardless of age, provided the applicable work or family eligibility requirements are met. The employee’s status as full-time does not prevent Medicare eligibility based on end-stage renal disease. Medicaid is a needs-based program and is not the best answer solely from the fact s given. Workers’ compensation would apply only to a qualifying work-related injury or illness. Social Security Disability benefits can provide income support to qualifying disabled persons, but they are not the medical coverage program identified in the question. Medicare coverage for dialysis-related services is subject to eligibility and enrollment rules, and an employer group health plan may coordinate with Medicare during the ESRD coordination period. Medicare confirms that people with permanent kidney failure requiring regular dialysis or a transplant can qualify for coverage before age 65. See Medicare’s ESRD eligibility guidance . Study Guide References/Topics: Social Insurance Programs; Medicare; End-Stage Renal Disease.

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A Gold Marketplace health plan has an actuarial value of approximately 80%. Therefore, the insurer is expected to pay about 80% of covered medical costs for a standard population, while enrollees as a group pay approximately 20% through deductibles, copayments, and coinsurance.

Actuarial value does not mean that the insurer pays exactly 80% of every individual’s bills. A particular insured may pay more or less than 20% in a year depending on the services used, the plan’s deductible, copayment structure, provider network, prescription-drug costs, and whether the annual out-of-pocket maximum has been reached. It is an overall measure of expected cost sharing for covered benefits.

The standard metal levels are Bronze at 60%, Silver at 70%, Gold at 80%, and Platinum at 90%. Gold plans generally have higher monthly premiums than Bronze or Silver plans but lower cost sharing when health care is received. Platinum plans generally have the highest premiums and the lowest cost sharing.

Study Guide references/topics: Affordable Care Act; Marketplace plans; metal levels; actuarial value; deductibles; copayments; HealthCare.gov plan categories .

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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.

The correct answer is C, $200,000. The policy’s principal sum is $100,000, and the double-indemnity provision pays twice that amount when death results from the stated qualifying accident: a commercial airplane crash. Because the insured was flying on a commercial flight and was killed in the crash, the maximum payable benefit is two times $100,000, or $200,000. The fact that the trip was to a business meeting does not reduce the benefit under the facts given. Choice A would be appropriate only if an exclusion applied, such as an excluded type of aviation activity. Choice B states only the policy’s base amount and ignores the double-indemnity provision. Choice D incorrectly adds an additional amount beyond the stated double benefit. AD & D coverage pays only when the loss falls within the policy’s accidental-loss definition and occurs within any stated loss period. Aviation wording matters: commercial passenger travel is commonly covered, while piloting, crew duties, private aircraft, or military aviation may be treated differently under the contract. Study Guide References/Topics: Group Health Insurance; Accidental Death and Dismemberment; Double Indemnity.

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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.

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A newborn is automatically covered under the applicable Nevada health-policy rule for 31 days after birth. Coverage begins from the moment of birth and includes necessary care and treatment for injury or sickness, including medically diagnosed congenital defects and birth abnormalities.

To continue coverage beyond the initial 31-day period, the policy may require timely notice of the birth and payment of any additional premium or fee required by the insurer. The notification and payment requirement must be satisfied within the 31-day period if the policy requires it. This rule protects newborns during the immediate post-birth period, when medical care may be urgently necessary.

The automatic coverage is not limited to routine newborn care. It includes necessary treatment of medical conditions identified at birth, subject to the policy’s applicable limits. The law also prevents the policy from excluding premature births under the mandated newborn coverage.

Two, five, and ten days are incorrect because they would not provide the statutory protection required for newborn coverage. The exam point is that the initial automatic period is 31 days, while continuation beyond that period may require prompt enrollment action by the insured.

Study Guide references/topics: individual health insurance; newborn coverage; congenital defects; notification requirements; Nevada newborn-coverage requirements .

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In Nevada, an insurer appointing a producer as its agent must generally file a notice of appointment with the Commissioner within 15 days after the agency contract is executed or the first application for insurance is submitted, whichever event triggers the statutory timing. The appointment establishes the producer’s authority to act as the insurer’s agent for the applicable business. An agent is a producer compensated by the insurer who sells, solicits, or negotiates insurance for that insurer.

A producer who is not acting as an insurer’s agent may act as a broker, subject to the statutory definition and applicable requirements. The distinction matters because an agent represents the insurer in the agency relationship, while a broker acts on behalf of the insured or prospective insured and lacks authority to bind an insurer through the broker’s own actions.

The appointment requirement does not replace the producer-license requirement. Before selling, soliciting, or negotiating a class of insurance in Nevada, the person must hold the appropriate line of authority. A life or health producer must therefore have the relevant licensing authority and, when acting as an insurer’s agent, be properly appointed.

Examination questions often test both the 15-day filing timeline and the difference between an agent and a broker.

References/topics from the Study Guide: Producer Appointments; Agent and Broker Distinction; Insurer Appointments; Nevada Producer Licensing; NRS 683A.321.

An insurance contract is aleatory because the values exchanged by the parties may be unequal and depend on an uncertain event. Choice A is correct. In this example, the policyowner paid only $1,200 in premiums before death, while the insurer paid a $250,000 death benefit. The insurer’s obligation was much greater than the premium amount received because the insured event occurred early in the policy period. If death had not occurred for many years, the total premiums paid could have been much closer to or greater than the eventual benefit value. That uncertainty is the defining aleatory feature. A personal contract is based on the insured’s individual characteristics and insurable interest. A unilateral contract means only the insurer makes a legally enforceable promise to perform after the applicant accepts the contract and pays premium. A conditional contract requires stated conditions, such as premium payment and proof of loss, to be met before performance is due. None of those terms focuses on the unequal exchange demonstrated here. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Insurance Contract Characteristics; Aleatory Contracts.

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Medicare is a federal social insurance program that provides hospital and medical expense coverage to eligible persons. Therefore, choice B is correct. Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services. Medicare Part B primarily covers physician services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Choice A describes Medicaid, which is a needs-based medical assistance program jointly administered by federal and state governments. Choice C is incorrect because Medicare also serves people age 65 or older and individuals with qualifying end-stage renal disease or ALS; it is not limited to totally disabled persons. Choice D is incorrect because physician bills are generally associated with Part B, not Part A. Medicare beneficiaries may also choose Medicare Advantage plans, which provide Medicare-covered benefits through private plans, and may obtain prescription drug coverage under Part D. Study Guide References/Topics: Social Insurance Programs; Medicare Parts A and B; Federal Health Programs.

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