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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident & Health – General Knowledge | 50% | - Social Insurance
|
| Topic 2: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Medicare
- Coverage for reconstructive surgery - Mandatory policy clauses and provisions
- Availability of coverage for mental health and treatment of alcohol abuse and drug abuse |
| Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Marketing Practices
- Licensing
|
| Topic 4: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Group life and health insurance
|
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NEW QUESTION # 96
Group health policies MUST provide which of the following benefits?
Answer: A
Explanation:
Nevada requires group health insurance policies to include benefits for expenses arising from hospice care.
Hospice care is designed for individuals facing terminal illness and focuses on comfort, pain and symptom management, emotional support, and assistance for the patient and family rather than curative treatment.
The group-policy required-provisions statute specifically includes hospice-care benefits. It also recognizes benefits for care at home or health supportive services when prescribed by a physician and otherwise covered if provided in a medical facility. This reflects the policy goal of allowing appropriate end-of-life care in a setting suited to the patient's needs.
Adult vision care and adult dental care are not universally required benefits under every group health policy.
They may be offered through separate policies, riders, employer benefit arrangements, or plan designs.
Cosmetic surgery is generally not a mandatory health insurance benefit and may be excluded unless medically necessary or required because of injury, congenital condition, reconstruction, or another covered circumstance.
The key examination point is that hospice care is a specifically required group-policy benefit in Nevada, while the other choices may be optional, limited, or excluded depending on the plan.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; NRS 689B.
030 .
NEW QUESTION # 97
Which premium-payment mode usually results in the lowest total annual premium cost for the policyowner?
Answer: D
Explanation:
Annual premium payment generally produces the lowest total cost over the policy year because the insurer receives the full annual premium at the beginning of the coverage period. Monthly, quarterly, and semiannual payment modes are convenient for budgeting, but they commonly include an additional charge or produce a higher total annual premium. The difference reflects the insurer's additional administrative expense and the fact that the insurer receives portions of the premium later.
Premium mode does not change the policy's face amount, underwriting classification, or contractual benefits.
It changes only the schedule and total cost of paying the premium. A producer should present all available modes clearly and explain the actual amount due under each option. A consumer with predictable annual cash flow may prefer annual mode to reduce total cost, while a consumer who needs more frequent payments may choose a higher-cost mode to preserve affordability and avoid lapse.
This issue is distinct from the grace period. The grace period protects the policyowner after a premium due date by allowing a limited time to make payment before coverage lapses. Premium mode establishes how frequently the regular premium is due; it does not eliminate the policyowner's obligation to pay.
References/topics from the Study Guide: Premium Payment; Premium Modes; Grace Period; Policy Lapse; Life Insurance Contract Provisions.
NEW QUESTION # 98
A producer aggrieved by any regulation or order of the Insurance Commissioner may request:
Answer: D
Explanation:
A producer who is aggrieved by a regulation or order of the Nevada Insurance Commissioner may request an administrative hearing. Nevada law requires the Commissioner to hold a hearing upon a proper written application from a person aggrieved by an act, failure to act, report, rule, regulation, or order related to the business of insurance, subject to statutory timing and procedural requirements.
The request is a due-process mechanism. It gives the affected producer an opportunity to state the grounds for relief, present evidence, challenge the factual or legal basis of the regulatory action, and create an administrative record. The application must generally be filed with the Division within 60 days after the person knew or reasonably should have known of the action, unless another law establishes a different period.
The Secretary of State does not provide the administrative remedy described in this question. Legislative review and peer review are not the standard appeal mechanisms for an individual Commissioner action.
Judicial review may become available after the administrative process, but the immediate remedy tested here is the request for an administrative hearing.
Study Guide references/topics: Commissioner authority; hearings; producer rights; administrative due process; NRS 679B.310 .
NEW QUESTION # 99
A whole life policyowner stops paying premiums and chooses to use the policy's cash value to purchase the same face amount of insurance for as long as that cash value will buy. Which nonforfeiture option was selected?
Answer: A
Explanation:
Extended term insurance uses the policy's accumulated cash value to purchase term insurance for the original face amount. Because the cash value is limited, the coverage lasts only for a stated period. During that period, the death benefit remains equal to the original policy's face amount, but no additional cash value normally accumulates. When the extended term period ends, coverage terminates unless another policy provision applies.
Reduced paid-up insurance works differently. It uses the cash value to purchase a smaller amount of permanent, paid-up life insurance. The face amount is reduced, but the coverage continues for the insured's lifetime without further premium payments. Cash surrender ends the policy and pays the available cash value to the owner, less any indebtedness and applicable charges. An automatic premium loan provision uses available cash value to pay overdue premiums temporarily, thereby attempting to prevent lapse.
Nonforfeiture options are designed to preserve some policy value when a cash-value life policy is discontinued. They are not typically available in pure term insurance because term policies ordinarily do not accumulate cash value. The correct option depends on whether the owner values the original death benefit for a limited period or a smaller death benefit permanently.
References/topics from the Study Guide: Nonforfeiture Options; Extended Term Insurance; Reduced Paid-Up Insurance; Cash Surrender; Automatic Premium Loan.
NEW QUESTION # 100
Which Medicare part generally helps cover inpatient hospital care, skilled nursing facility care following a qualifying hospital stay, hospice care, and certain home health services?
Answer: C
Explanation:
Medicare Part A is commonly called hospital insurance. It generally helps cover inpatient hospital care, limited skilled nursing facility care following a qualifying hospital stay, hospice care, and certain home health services. Part A benefits are subject to program rules, benefit periods, deductibles, coinsurance, eligibility conditions, and coverage limitations. It does not mean that every hospital-related service is fully paid.
Medicare Part B is medical insurance. It generally covers physicians' services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Part C, Medicare Advantage, is an alternative way for eligible beneficiaries to receive Medicare-covered benefits through approved private plans. Part D provides outpatient prescription-drug coverage through private plans approved by Medicare.
A producer must understand that Medicare supplements and Medicare Advantage plans coordinate differently with Original Medicare. A Medicare supplement policy is designed to help pay certain deductibles, coinsurance, and other gaps in Original Medicare. A Medicare Advantage plan generally replaces the method of receiving Parts A and B services through a private managed plan rather than functioning as a standard supplement.
The examination focus is the basic division: Part A is primarily hospital-related coverage; Part B is primarily medical and outpatient coverage.
References/topics from the Study Guide: Medicare; Medicare Part A; Medicare Part B; Medicare Advantage; Medicare Supplement Insurance.
NEW QUESTION # 101
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