NV Accident and Health: Actual InsNV_Health02 Exam InsNV_Health02 Exam Questions

A consumer’s pre-existing condition does not prevent enrollment in a Qualified Health Plan offered through the Exchange. Marketplace plans must cover treatment for pre-existing medical conditions and cannot reject an applicant, charge a higher premium, or refuse to pay Essential Health Benefits solely because of the applicant’s health history.

The producer should accurately explain that coverage is subject to the plan’s normal terms, provider network, formulary, deductibles, copayments, coinsurance, and out-of-pocket maximum. The prohibition against pre-existing-condition discrimination does not mean the consumer has no out-of-pocket costs. The insured may still have ordinary cost sharing for covered medical services, just as other enrollees do.

Option A is incorrect because Qualified Health Plans do cover pre-existing conditions. Option B is incorrect because a QHP may not impose a surcharge based on health status or medical history. Option C is incorrect because the Affordable Care Act’s protection against discrimination does not eliminate all deductibles, copayments, coinsurance, or other permitted cost sharing.

For exam purposes, remember the core rule: health status cannot be used to deny enrollment in a QHP or set a higher premium based solely on a pre-existing condition.

Study Guide references/topics: Affordable Care Act; Qualified Health Plans; guaranteed issue; pre-existing conditions; HealthCare.gov pre-existing-condition coverage 

Long-term-care insurance commonly uses functional and cognitive triggers to determine benefit eligibility. A typical trigger is certification that the insured cannot perform at least two activities of daily living, or ADLs, without substantial assistance for the required period. Common ADLs include bathing, continence, dressing, eating, toileting, and transferring. Another common trigger is severe cognitive impairment requiring substantial supervision to protect the insured’s health and safety.

Long-term-care coverage is not based merely on reaching a certain age, unemployment, or a premium-payment issue. It is designed to help pay for qualifying long-term services when the insured needs ongoing assistance because of chronic illness, disability, or cognitive impairment. Covered services may include nursing-home care, assisted living, adult day care, home health care, hospice care, and respite care, depending on the policy.

The producer should explain the elimination period, daily or monthly benefit limit, benefit period, inflation-protection options, facility restrictions, and policy exclusions. An insured may need care for years, so a policy with a low daily benefit or short benefit period may not meet the client’s needs. Suitability requires evaluating likely care preferences, assets, family support, and affordability.

References/topics from the Study Guide: Long-Term Care Insurance; Activities of Daily Living; Cognitive Impairment; Benefit Triggers; Elimination Period.

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The correct answer is A. A residual benefit clause permits an insured who has returned to work on a limited basis, but still suffers a loss of income because of disability, to receive partial disability benefits. The doctor is able to practice part-time but cannot resume full-time work, so the disability continues to cause an earnings loss. Residual benefits are intended to encourage rehabilitation and return to productive work without forcing the insured to lose all benefits immediately. The benefit amount is usually tied to the percentage of income lost compared with pre-disability earnings, subject to policy requirements. A contingent benefit clause and concurrent benefit clause are not the standard disability-income provisions that address partial return to work. A guaranteed insurability rider permits future increases in coverage without proof of insurability; it does not pay benefits for a continuing partial disability. Residual disability should be distinguished from total disability, which generally requires inability to perform the duties defined in the policy. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Residual Disability Benefits.

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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Nevada law defines an insurer to include every person engaged as principal and as an indemnitor, surety, or contractor in the business of entering into insurance contracts. Therefore, an indemnitor is specifically included in the statutory definition of insurer.

An indemnitor is a party that agrees to compensate another for specified loss or damage. That obligation is central to insurance: the insurer assumes a defined risk and promises to provide a benefit, payment, service, or indemnity when a covered loss occurs. A surety and a contractor entering insurance agreements can likewise fall within the statutory definition when operating in the insurance business.

A security dealer sells or handles securities and is regulated under securities law rather than by the insurance definition in this question. A financial planner may provide financial advice but is not automatically an insurer. A syndicate may participate in insurance arrangements in certain contexts, but it is not the statutory term specifically identified in the definition.

The exam point is to recognize the broad legal definition of insurer. It encompasses more than a company labeled “insurance company”; it includes persons acting as indemnitors, sureties, or insurance contractors.

Study Guide references/topics: Nevada Insurance Code; definitions; insurer; indemnity; surety; NRS 679A.100 .