Quiz InsNV_Health02: Nevada Insurance Licensing NV Accident and Health
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Quiz
Question 1/101/10
Group vision insurance plans typically provide insurance benefits that cover the cost of:
Select the answer:Select the answer
1 correct answerA.
laser surgery, eye exams, lenses
B.
cataract removal, frames, lenses
C.
eye exams, lenses, frames, and contact lenses
D.
eye exams, lenses, retinal corrective surgery 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 8 of 149 Group vision coverage is an ancillary group health benefit designed primarily for routine vision care and corrective eyewear. Its usual covered services include periodic eye examinations, lenses, frames, and---in plans that provide the option---contact lenses. The key distinction is between routine vision expenses and medical or surgical eye treatment. Choice C contains the customary routine vision benefits and is therefore correct. Laser refractive surgery is commonly elective and is not a standard core group vision benefit. Cataract removal and retinal corrective surgery are medical or surgical procedures ordinarily addressed through medical expense coverage, subject to that policy's provisions, rather than through a routine vision plan. Vision plans often apply a stated allowance, benefit schedule, copayment, provider-network requirement, or frequency limit to exams, frames, lenses, and contacts. The insured should therefore recognize that the plan does not provide unlimited eye-care coverage; it covers specified routine corrective services under the contract's schedule of benefits. Study Guide Reference/Topics: Group Health Insurance; Types of Health Insurance Policies; Limited-Coverage Health Plans.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 8 of 149 Group vision coverage is an ancillary group health benefit designed primarily for routine vision care and corrective eyewear. Its usual covered services include periodic eye examinations, lenses, frames, and---in plans that provide the option---contact lenses. The key distinction is between routine vision expenses and medical or surgical eye treatment. Choice C contains the customary routine vision benefits and is therefore correct. Laser refractive surgery is commonly elective and is not a standard core group vision benefit. Cataract removal and retinal corrective surgery are medical or surgical procedures ordinarily addressed through medical expense coverage, subject to that policy's provisions, rather than through a routine vision plan. Vision plans often apply a stated allowance, benefit schedule, copayment, provider-network requirement, or frequency limit to exams, frames, lenses, and contacts. The insured should therefore recognize that the plan does not provide unlimited eye-care coverage; it covers specified routine corrective services under the contract's schedule of benefits. Study Guide Reference/Topics: Group Health Insurance; Types of Health Insurance Policies; Limited-Coverage Health Plans.
Quiz
Question 2/102/10
Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed
Insurability rider?
Insurability rider?
Select the answer:Select the answer
1 correct answerA.
The insurance company guarantees the premium rate for the life of the policy.
B.
The insured must periodically provide proof of insurability to the insurance company.
C.
The insured may periodically increase the amount of benefits payable under the policy.
D.
The insurance company must exchange the original policy for a new one at the insurability date. 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 9 of 149 A Guaranteed Insurability rider gives the disability income policyowner the right to purchase additional disability income coverage at stated future option dates without furnishing evidence of insurability. The rider is valuable because an insured's income may increase over time while health may decline; the rider allows benefit amounts to be increased when the option is exercised, subject to the rider's conditions and insurer limits. Therefore, choice C is correct. The rider does not guarantee a premium rate for life. Premiums for the added coverage are based on the insured's attained age and the insurer's rates applicable when the additional coverage is purchased. It also does not require periodic proof of insurability; eliminating that requirement is the central purpose of the rider. The existing policy remains in force and normally does not have to be exchanged for a new policy. On an examination, distinguish guaranteed insurability from noncancellable and guaranteed renewable provisions: those provisions concern renewability and premiums, whereas the rider concerns the future purchase of additional benefits. Study Guide Reference/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Optional Benefits Riders.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 9 of 149 A Guaranteed Insurability rider gives the disability income policyowner the right to purchase additional disability income coverage at stated future option dates without furnishing evidence of insurability. The rider is valuable because an insured's income may increase over time while health may decline; the rider allows benefit amounts to be increased when the option is exercised, subject to the rider's conditions and insurer limits. Therefore, choice C is correct. The rider does not guarantee a premium rate for life. Premiums for the added coverage are based on the insured's attained age and the insurer's rates applicable when the additional coverage is purchased. It also does not require periodic proof of insurability; eliminating that requirement is the central purpose of the rider. The existing policy remains in force and normally does not have to be exchanged for a new policy. On an examination, distinguish guaranteed insurability from noncancellable and guaranteed renewable provisions: those provisions concern renewability and premiums, whereas the rider concerns the future purchase of additional benefits. Study Guide Reference/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Optional Benefits Riders.
Quiz
Question 3/103/10
An insured who wants to guarantee that an Accident and Health policy will remain in force even in the event
of being disabled should purchase which of the following riders?
of being disabled should purchase which of the following riders?
Select the answer:Select the answer
1 correct answerA.
Accidental Death and Dismemberment (AD&D)
B.
Double Indemnity
C.
Waiver of Premium
D.
Guaranteed Insurability 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 10 of 149 The Waiver of Premium rider is designed to prevent a disability from causing the insured to lose coverage because premiums cannot be paid. When the rider's qualifying disability conditions are met, the insurer waives future premiums after the applicable waiting period while the disability continues. The policy therefore remains in force without premium payment during the qualifying period. Choice C is correct because it directly addresses continuation of coverage during disability. AD&D pays a benefit for accidental death or specified accidental losses; it does not waive premiums. Double indemnity generally increases the death benefit for a qualifying accidental death and likewise does not preserve health coverage during disability. Guaranteed insurability permits the future purchase of additional coverage without new evidence of insurability, but it does not relieve the policyowner of the duty to pay premiums on existing coverage. The rider's exact definition of disability, elimination period, age limitation, and proof-of-disability requirements are controlled by the policy. Study Guide Reference/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Waiver of Premium.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 10 of 149 The Waiver of Premium rider is designed to prevent a disability from causing the insured to lose coverage because premiums cannot be paid. When the rider's qualifying disability conditions are met, the insurer waives future premiums after the applicable waiting period while the disability continues. The policy therefore remains in force without premium payment during the qualifying period. Choice C is correct because it directly addresses continuation of coverage during disability. AD&D pays a benefit for accidental death or specified accidental losses; it does not waive premiums. Double indemnity generally increases the death benefit for a qualifying accidental death and likewise does not preserve health coverage during disability. Guaranteed insurability permits the future purchase of additional coverage without new evidence of insurability, but it does not relieve the policyowner of the duty to pay premiums on existing coverage. The rider's exact definition of disability, elimination period, age limitation, and proof-of-disability requirements are controlled by the policy. Study Guide Reference/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Waiver of Premium.
Quiz
Question 4/104/10
Which of the following statements is CORRECT about Business Overhead Expense insurance?
Select the answer:Select the answer
1 correct answerA.
It can be obtained only by corporations.
B.
It covers eligible expenses for staff, rent, and utilities.
C.
It reimburses the policyowner for loss of income.
D.
It covers eligible expenses for staff only. 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 11 of 149 Business Overhead Expense insurance reimburses a business for specified ongoing operating expenses when a business owner becomes disabled. Eligible expenses commonly include employee salaries, rent, utilities, office expenses, and other ordinary fixed costs identified in the policy. Accordingly, choice B is correct. The purpose is business continuity: it helps keep the office or practice operating during the owner's disability rather than replacing the owner's personal income. A disability income policy, not Business Overhead Expense insurance, is the product intended to replace an individual's lost earned income. The coverage is not restricted to corporations; it may be appropriate for sole proprietors, partners, and owners of closely held businesses, depending on underwriting and policy eligibility. It also is not limited to staff expenses alone, because rent, utilities, and other contractually covered overhead are central components of the protection. Benefits are generally limited by the actual covered overhead incurred and the policy's monthly benefit amount. Study Guide Reference/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Business Overhead Expense Coverage.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 11 of 149 Business Overhead Expense insurance reimburses a business for specified ongoing operating expenses when a business owner becomes disabled. Eligible expenses commonly include employee salaries, rent, utilities, office expenses, and other ordinary fixed costs identified in the policy. Accordingly, choice B is correct. The purpose is business continuity: it helps keep the office or practice operating during the owner's disability rather than replacing the owner's personal income. A disability income policy, not Business Overhead Expense insurance, is the product intended to replace an individual's lost earned income. The coverage is not restricted to corporations; it may be appropriate for sole proprietors, partners, and owners of closely held businesses, depending on underwriting and policy eligibility. It also is not limited to staff expenses alone, because rent, utilities, and other contractually covered overhead are central components of the protection. Benefits are generally limited by the actual covered overhead incurred and the policy's monthly benefit amount. Study Guide Reference/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Business Overhead Expense Coverage.
Quiz
Question 5/105/10
Which of the following statements is CORRECT about the Medicaid program?
Select the answer:Select the answer
1 correct answerA.
It provides medical assistance for participants who are blind.
B.
Participants must be at least 55 years of age.
C.
It is supplemented by Medicare for persons 62 years of age or older.
D.
The program is administered at the federal level. 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 12 of 149 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 Reference/Topics: Social Insurance Programs; Medicaid; Federal-State Health Programs.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 12 of 149 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 Reference/Topics: Social Insurance Programs; Medicaid; Federal-State Health Programs.
Quiz
Question 6/106/10
The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take
which of the following actions if an insured has understated the insured's age on the policy application?
which of the following actions if an insured has understated the insured's age on the policy application?
Select the answer:Select the answer
1 correct answerA.
Increase the premium
B.
Adjust the benefits
C.
Lapse the coverage
D.
Cancel the policy 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 13 of 149 A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide Reference/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 13 of 149 A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide Reference/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.
Quiz
Question 7/107/10
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a
disability claim on July 31, the insurance company will MOST likely:
disability claim on July 31, the insurance company will MOST likely:
Select the answer:Select the answer
1 correct answerA.
deny the claim
B.
pay the claim but deduct the unpaid premium
C.
reinstate the policy and then pay the claim
D.
cancel the policy and return all premiums paid 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 14 of 149 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 Reference/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 14 of 149 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 Reference/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.
Quiz
Question 8/108/10
Which of the following statements is correct about the Coordination of Benefits provision?
Select the answer:Select the answer
1 correct answerA.
It prohibits an insurer from selling a health policy to an applicant who already has similar coverage.
B.
It prevents an insured covered by two health plans from making a profit on a covered loss.
C.
It allows an insured to change insurers without losing benefits.
D.
It permits an insurer to defer paying a claim for a work-related injury until Workers' Compensation Benefits have expired. 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 15 of 149 Coordination of Benefits, commonly called COB, applies when an insured is covered by more than one health plan. It establishes the order in which plans pay and limits the combined payment so the insured does not receive more than the amount of the covered expense. Choice B is correct because COB prevents a profit from duplicate health coverage while still allowing the insured to receive the benefits to which the insured is entitled. One plan is identified as primary and pays first under its policy terms. The secondary plan then considers the unpaid covered balance, subject to its own coordination provisions and limits. COB does not prohibit a person from owning more than one health policy, does not guarantee uninterrupted benefits when changing insurers, and does not authorize a general delay of a workers' compensation claim until benefits expire. Workers' compensation coordination depends on the applicable policy and governing law. On the examination, distinguish COB from nonduplication of benefits and from other insurance clauses; COB specifically allocates payment responsibility among multiple health plans. Study Guide Reference/Topics: Group Health Insurance; Coordination of Benefits; Other Insurance Provisions.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 15 of 149 Coordination of Benefits, commonly called COB, applies when an insured is covered by more than one health plan. It establishes the order in which plans pay and limits the combined payment so the insured does not receive more than the amount of the covered expense. Choice B is correct because COB prevents a profit from duplicate health coverage while still allowing the insured to receive the benefits to which the insured is entitled. One plan is identified as primary and pays first under its policy terms. The secondary plan then considers the unpaid covered balance, subject to its own coordination provisions and limits. COB does not prohibit a person from owning more than one health policy, does not guarantee uninterrupted benefits when changing insurers, and does not authorize a general delay of a workers' compensation claim until benefits expire. Workers' compensation coordination depends on the applicable policy and governing law. On the examination, distinguish COB from nonduplication of benefits and from other insurance clauses; COB specifically allocates payment responsibility among multiple health plans. Study Guide Reference/Topics: Group Health Insurance; Coordination of Benefits; Other Insurance Provisions.
Quiz
Question 9/109/10
Which of the following situations describes a representation?
Select the answer:Select the answer
1 correct answerA.
An insurance company guarantees that policy benefits will be paid promptly on receipt of a Proof of Loss
B.
An insurance company guarantees that premiums paid will be refunded within 30 days after the policy's effective date if an insured is dissatisfied with the policy
C.
A prospect's statement on an application that is held to be substantially true
D.
A prospect's statement on an application that is held to be absolutely true 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 16 of 149 and absolutely true; choice D describes that stricter standard rather than a representation. Application answers prospect in the application. For licensing purposes, remember that insurance applications are generally treated Reference/Topics: Completing the Application, Underwriting, and Delivering the Policy; Representations and
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 16 of 149 and absolutely true; choice D describes that stricter standard rather than a representation. Application answers prospect in the application. For licensing purposes, remember that insurance applications are generally treated Reference/Topics: Completing the Application, Underwriting, and Delivering the Policy; Representations and
Quiz
Question 10/1010/10
A prospect submits an Accident and Health application with the premium and receives a conditional receipt.
The insurance company issues a policy and mails it to the insured, but the insured never receives it. Which of
the following statements is CORRECT about this situation?
The insurance company issues a policy and mails it to the insured, but the insured never receives it. Which of
the following statements is CORRECT about this situation?
Select the answer:Select the answer
1 correct answerA.
The policy is not in force because delivery was not completed.
B.
The policy will be in force five business days after the prospect notifies the company that the prospect has not received the policy.
C.
The policy will be in force as soon as the company issues a replacement policy.
D.
The policy is in force. 
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 17 of 149 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 Reference/Topics: Completing the Application, Underwriting, and Delivering the Policy; Conditional Receipts; Policy Delivery.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 18 of 149 This treatment differs from individual disability income insurance, where premiums may not be deductible but benefits are typically tax-free to the recipient. The other options incorrectly describe the tax treatment or confuse BOE with other disability products.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 17 of 149 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 Reference/Topics: Completing the Application, Underwriting, and Delivering the Policy; Conditional Receipts; Policy Delivery.
Nevada Insurance Licensing InsNV_Health02 COMPLETE STUDY GUIDE Page 18 of 149 This treatment differs from individual disability income insurance, where premiums may not be deductible but benefits are typically tax-free to the recipient. The other options incorrectly describe the tax treatment or confuse BOE with other disability products.
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