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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health — General Knowledge | ~68% | - Insurance Concepts and Underwriting
|
| Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
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NEW QUESTION # 91
In a contributory group health insurance plan, which statement is correct?
Answer: B
Explanation:
A contributory group health plan is one in which covered employees pay a portion of the premium. Because employees must elect coverage and contribute financially, insurers commonly require a minimum percentage of eligible employees to participate. The participation requirement reduces adverse selection by helping ensure that enrollment includes a broad cross-section of the eligible group rather than only individuals who expect immediate medical expenses.
A noncontributory plan is one in which the employer pays the full premium for eligible employees. Because employees are not required to contribute, participation is generally expected to be much higher and may be mandatory for eligible employees under the employer's plan rules. The distinction is based on premium contribution, not on whether the coverage includes dependents, dental benefits, or a network.
Group insurance is characterized by a master policy issued to the policyholder, commonly an employer or association. Individual insureds receive certificates of coverage that describe the benefits and rights under the group contract. The employer's role, employee eligibility rules, waiting periods, and contribution structure must all be disclosed accurately.
On an examination question, remember the primary rule: contributory means employees contribute toward premium; noncontributory means the employer pays the entire premium for the covered employees.
References/topics from the Study Guide: Group Health Insurance; Contributory Plans; Noncontributory Plans; Participation Requirements; Certificates of Coverage.
NEW QUESTION # 92
Which of the following statements is correct about the Coordination of Benefits provision?
Answer: B
Explanation:
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 References/Topics:
Group Health Insurance; Coordination of Benefits; Other Insurance Provisions.
NEW QUESTION # 93
A $100,000 group Accidental Death and Dismemberment policy will pay double indemnity if the insured dies in a commercial airplane crash. If the insured is killed when flying to a business meeting on a commercial flight, the policy will pay a MAXIMUM of:
Answer: D
Explanation:
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.
NEW QUESTION # 94
A policy pays a stated dollar amount for each day an insured is confined to a hospital, regardless of the actual hospital bill. What type of coverage is this?
Answer: A
Explanation:
Hospital indemnity insurance pays a fixed benefit for a covered hospital confinement, often expressed as a stated dollar amount per day. The payment is not based on the actual amount of the hospital bill. The insured may use the benefit for deductibles, transportation, household expenses, lost income, or other needs, subject to the policy terms. Because it pays a predetermined amount rather than reimbursing actual expenses, hospital indemnity coverage is generally considered limited-benefit or supplemental coverage.
Major medical insurance operates differently. It is designed to cover a broad range of medical expenses, subject to deductibles, coinsurance, network provisions, and out-of-pocket maximums. Major medical coverage generally reimburses or pays eligible expenses rather than merely paying a fixed daily hospital amount. The existence of hospital indemnity coverage does not replace the need for comprehensive health insurance.
The producer must clearly explain the limitations of indemnity products. It would be misleading to present a
$200-per-day hospital indemnity benefit as if it pays all hospital charges. Consumers should understand whether the policy is supplemental, what events trigger payment, whether preexisting-condition or waiting- period provisions apply, and whether benefits are payable in addition to other coverage.
References/topics from the Study Guide: Hospital Indemnity Insurance; Limited-Benefit Coverage; Supplemental Health Insurance; Major Medical; Fixed Indemnity Benefits.
NEW QUESTION # 95
The Nevada Life and Health Insurance Guaranty Association is financed by which of the following methods?
Answer: B
Explanation:
The Nevada Life and Health Insurance Guaranty Association is financed through assessments on member insurance companies. Insurers authorized to transact covered life, health, or annuity business in Nevada are members of the Association as a condition of their authority to operate in the state. When an assessment is necessary, the Association assesses member insurers according to the statutory assessment system.
The Association exists to provide limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not financed by direct assessments against insureds, policyowners, agents, or association members. It is also not simply funded through a general premium tax imposed on consumers.
Nevada law establishes assessment classes, including assessments for administrative and legal expenses and assessments needed to carry out the Association's obligations regarding an impaired or insolvent insurer.
Member insurers may consider the cost of assessments when establishing rates and dividends, but that does not change the source of the Association's direct funding: the member insurers themselves.
The Guaranty Association is a safety mechanism with statutory limits. It is not a substitute for evaluating an insurer's financial strength, and insurers and producers may not use its existence as a sales inducement.
Study Guide references/topics: insurer insolvency; guaranty associations; member insurer assessments; NRS Chapter 686C .
NEW QUESTION # 96
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