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| Section | Objectives |
|---|---|
| Topic 1: Accident and Health Insurance Fundamentals | - Disability Income Insurance
|
| Topic 2: Producer Duties and Ethics | - Sales Practices
|
| Topic 3: General Insurance Regulation | - Licensing Requirements and Responsibilities
|
| Topic 4: Insurance Basics | - Insurance Contracts
|
| Topic 5: Health Insurance Policy Provisions | - Mandatory and Optional Provisions
|
| Topic 6: Government Health Insurance Programs | - Medicare
|
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NEW QUESTION # 41
A producer receives a phone call from an insured who already has health insurance and now wants to buy an Accidental Death and Dismemberment (AD & D) policy. In this situation, the producer should take which of the following actions?
Answer: A
Explanation:
The application is a material underwriting document, so the producer must use a process that obtains accurate information and a valid applicant signature before submission. Choice D is correct because the producer should meet with the prospect, have the prospect complete the application, and obtain the prospect's signature. This confirms that the answers are the applicant's statements and that the applicant has reviewed the information before the insurer relies upon it. The producer may explain questions and assist with completion, but should not answer questions on the prospect's behalf. Choice B is improper because the applicant's signature should not be postponed until after insurer approval. Choice C is improper because the producer should not independently answer application questions; the applicant provides the information.
Choice A is less appropriate because it bypasses the producer's opportunity to review the application for completeness, explain disclosures, and verify that required signatures are obtained. The existing health coverage does not eliminate the need for a complete AD & D application. Study Guide References/Topics:
Completing the Application, Underwriting, and Delivering the Policy; Producer Responsibilities; Application Completion.
NEW QUESTION # 42
For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?
Answer: B
Explanation:
Choice B is correct because accidental loss of eyesight is a standard covered dismemberment loss under most AD & D policies. These policies pay benefits for accidental death and for specifically listed losses, often including loss of life, both hands, both feet, one h and and one foot, sight in one or both eyes, hearing, speech, or specified paralysis. The loss must result directly from accidental bodily injury and occur within the policy's required loss period. Death from a heart attack is generally illness-related rather than accidental. Loss of the spleen, even when caused by an accident, is not usually one of the specifically scheduled losses in a basic AD
& D policy. Partial paralysis due to a stroke is caused by illness rather than accidental injury. AD & D policies are limited-benefit contracts, so the policy does not pay merely because an injury is serious; the loss must match the policy's defined covered loss. The benefit amount varies according to the loss, with full principal sums often payable for death or loss of both eyes and smaller percentages for certain partial losses.
Study Guide References/Topics: Types of Health Insurance Policies; Accidental Death and Dismemberment; Covered Losses.
NEW QUESTION # 43
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:
Answer: A
Explanation:
For insured women age 40 or older, Nevada requires group health insurance coverage for an annual mammogram to screen for breast cancer. The required benefit must be available through an in-network provider, and the insurer generally may not impose a deductible, copayment, coinsurance, or another form of cost sharing for that mandated screening.
Mammography is preventive screening. It is intended to detect breast cancer early, often before symptoms appear. This differs from diagnostic imaging, which may be ordered after an abnormal screening result, a finding on examination, or another clinical concern. Nevada law also addresses medically necessary imaging and diagnostic testing when the insured's provider recommends them based on medical history, family history, risk factors, or an observed abnormality.
A family history of breast cancer does not eliminate coverage; instead, it may support the need for additional screening or imaging. The benefit is not restricted only to plans that voluntarily choose to offer mammography. It is a required coverage provision for applicable group health policies.
Study Guide references/topics: preventive care; breast-cancer screening; mandated benefits; deductibles and coinsurance; NRS 689B.0374 .
NEW QUESTION # 44
Group vision insurance plans typically provide insurance benefits that cover the cost of:
Answer: B
Explanation:
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 References/Topics: Group Health Insurance; Types of Health Insurance Policies; Limited-Coverage Health Plans.
NEW QUESTION # 45
A client needs a $250,000 death benefit for exactly 20 years to protect a home mortgage. The client wants the lowest practical initial premium and does not need cash-value accumulation. Which policy is most appropriate?
Answer: D
Explanation:
Level term life insurance is the appropriate recommendation because it provides a stated death benefit for a stated period, such as 20 years. It is designed for temporary protection where the financial need has a known end date-for example, the remaining duration of a mortgage, a child's dependency period, or a short-to- medium-term income-replacement need. The premium is generally level for the selected term period, while the death benefit remains level if the policy stays in force.
Whole life insurance provides permanent protection and cash-value accumulation, but its premium is ordinarily higher because the insurer expects coverage to continue for the insured's lifetime. Universal life offers flexible premiums and adjustable death-benefit structures, but it is not the simplest match when the client's purpose is fixed, time-limited mortgage protection. Variable life has investment risk because policy values depend on separate-account performance and is not selected merely to obtain low-cost temporary coverage.
The producer should confirm that the term period aligns with the mortgage obligation and explain that coverage normally ends at the term's expiration unless the policy is renewed, converted, or otherwise continued under its provisions.
References/topics from the Study Guide: Types of Life Insurance; Term Life Insurance; Needs Analysis; Mortgage Protection.
NEW QUESTION # 46
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