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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Medicare
- Long Term Care - Mandatory policy clauses and provisions
- Hospice care |
| Topic 2: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Definitions
- Licensing
|
| Topic 3: Accident & Health – General Knowledge | 50% | - Policy Provisions, Clauses, and Riders
|
| Topic 4: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Advertising - Credit life and health insurance - Group life and health insurance
|
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NEW QUESTION # 25
Which of the following situations describes a representation?
Answer: D
Explanation:
A representation is a statement made by an applicant on an insurance application that is believed to be true to the best of the applicant's knowledge and is required to be substantially true. Choice C correctly states that principle. A representation differs from a warranty. A warranty is a statement or promise that must be literally and absolutely true; choice D describes that stricter standard rather than a representation. Application answers help the insurer evaluate risk during underwriting, so material misrepresentations can affect coverage or the insurer's decision to issue the policy. However, not every immaterial or innocent inaccuracy has the same legal effect. The significance of a misstatement depends on its materiality and the applicable policy and insurance-law rules. Choices A and B describe potential policy promises or contract features, not statements made by a prospect in the application. For licensing purposes, remember that insurance applications are generally treated as containing representations, not warranties, unless the policy or law provides otherwise.
Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Representations and Warranties; Underwriting.
NEW QUESTION # 26
Which policy is designed to pay benefits upon diagnosis or treatment of a specifically named illness, such as cancer?
Answer: C
Explanation:
Specified disease insurance provides limited benefits for a condition or group of conditions specifically named in the policy, such as cancer, heart disease, or stroke. The benefits may be paid as reimbursement for certain covered expenses, as fixed cash amounts for treatment events, or through a schedule of benefits. The scope of coverage is controlled by the policy and is substantially narrower than comprehensive major medical insurance.
A producer must not represent specified disease coverage as complete health insurance. It may help with deductibles, travel, household costs, experimental-treatment expenses not covered elsewhere, or income disruption, but it is not a substitute for comprehensive coverage that addresses a broad range of illnesses and injuries. The client should understand covered conditions, waiting periods, recurrence provisions, preexisting- condition limitations where permitted, benefit schedules, exclusions, and whether the policy pays in addition to other coverage.
Major medical insurance is intended to cover a broad spectrum of medically necessary expenses. Credit disability insurance is connected to repayment of a debt if the debtor becomes disabled. Group term life insurance pays a death benefit and does not provide medical-expense coverage. The examination point is to identify the limited, condition-specific purpose of specified disease insurance.
References/topics from the Study Guide: Specified Disease Insurance; Cancer Insurance; Critical Illness Coverage; Limited-Benefit Health Insurance; Major Medical.
NEW QUESTION # 27
A life policy has been in force during the insured's lifetime for more than two years. Which circumstance may still permit the insurer to deny a claim under the policy's incontestability provision?
Answer: D
Explanation:
The incontestability provision limits the insurer's ability to contest the validity of a life insurance policy after it has been in force during the insured's lifetime for the stated period, which Nevada law permits to be no longer than two years from issue. Once that period has passed, an insurer ordinarily cannot avoid the policy because of misstatements in the application, except as provided by the policy and law. The rule promotes certainty for beneficiaries and prevents an insurer from indefinitely reopening underwriting issues after accepting premiums for years.
Nonpayment of premiums remains an exception. Incontestability does not require an insurer to pay a claim on a policy that lapsed because required premiums were not paid. A policy can also contain provisions concerning total and permanent disability benefits or additional accidental-death benefits that are treated separately under the applicable statutory rule. In addition, an incontestability clause concerns contesting the policy's validity; it does not automatically override every policy exclusion or restriction on coverage.
The producer should distinguish contestability from the grace period, reinstatement, and exclusions. Each provision serves a different function. For test purposes, the durable rule is that incontestability does not eliminate the insurer's defense of nonpayment of premium.
References/topics from the Study Guide: Incontestability Clause; Premium Payment; Policy Lapse; NRS
688A.080.
NEW QUESTION # 28
For a group health plan subject to the federal waiting-period rule, the waiting period for otherwise eligible employees generally may not exceed:
Answer: A
Explanation:
A health plan's waiting period generally may not exceed 90 calendar days for an individual who is otherwise eligible to enroll. A waiting period is the period that must pass before coverage becomes effective for an employee or dependent who has met the plan's substantive eligibility conditions. The rule is intended to limit extended gaps in employer-sponsored health coverage for eligible individuals.
The 90-day limitation does not mean that every new employee must receive coverage immediately on the first day of work. An employer may use reasonable eligibility requirements, such as a bona fide job classification or an hours-of-service requirement, as long as the arrangement is structured and administered in compliance with applicable federal rules. The producer should not treat every orientation period or administrative condition as automatically permissible; plan documents and current legal guidance matter.
This issue is distinct from preexisting-condition exclusions. Modern health-insurance rules significantly restrict the use of preexisting-condition exclusions in major medical coverage. It is also distinct from an elimination period in disability insurance, which is a waiting period after a disability begins rather than a waiting period for plan eligibility.
References/topics from the Study Guide: Group Health Eligibility; Waiting Periods; Employer-Sponsored Coverage; Federal Health-Insurance Requirements; Nevada Group Health Rules.
NEW QUESTION # 29
The maximum cost share for preventive screening from an in-network provider is:
Answer: A
Explanation:
The maximum cost share for a covered preventive screening received from an in-network provider is 0%. In practical terms, the insured generally pays no deductible, copayment, or coinsurance for qualifying preventive services delivered in-network. This rule is intended to encourage early detection of illness and promote preventive care before conditions become more serious and costly.
Examples of qualifying preventive care can include certain screenings, immunizations, counseling, and wellness services. The precise covered service and frequency may depend on age, sex, medical circumstances, and the applicable preventive-service recommendations. The in-network condition is important because services received outside the plan's network may be subject to different cost-sharing rules, except where other law or plan provisions apply.
The choices of 10%, 20%, and 30% reflect ordinary coinsurance levels that may apply to nonpreventive treatment or to services that do not qualify for first-dollar preventive coverage. They do not apply to an eligible preventive screening under the in-network preventive-care rule.
Always distinguish preventive screening from diagnostic care. A screening is generally performed when no symptom or suspected condition is being evaluated; a diagnostic service may generate cost sharing depending on the circumstances and plan terms.
Study Guide references/topics: preventive services; in-network providers; deductibles; copayments; coinsurance; HealthCare.gov preventive-care guidance .
NEW QUESTION # 30
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