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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Group life and health insurance
|
| Topic 2: Accident & Health – General Knowledge | 50% | - Social Insurance
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| Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Licensing
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| Topic 4: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Medicare
- Coverage for reconstructive surgery - Hospice care - Mandatory policy clauses and provisions
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NEW QUESTION # 101
Under a group health policy, which of the following coverages MUST be provided for newborn children?
Answer: B
Explanation:
Nevada requires qualifying group health policies that cover family members to provide coverage for a newborn child from the moment of birth. Required newborn coverage includes injury or sickness and specifically includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Therefore, congenital health defects are the required coverage identified in this question.
The rule is important because congenital defects may be present at birth and can require immediate diagnostic, surgical, medical, or hospital treatment. Nevada law prevents a policy from excluding this necessary care simply because the condition existed at birth. The statute also prohibits exclusion of premature births under the applicable coverage requirement.
The transportation option is incorrect because the law addresses necessary transportation from the place of birth to the nearest specialized treatment center, within policy limits; it does not mandate transportation from the hospital to the child's residence. Routine eye examinations and genetic testing may be covered under a particular policy or health plan, but they are not the specific newborn mandate tested here. Continued coverage beyond the initial period may depend on timely notice and payment of required premium within 31 days.
Study Guide references/topics: group health insurance; newborn coverage; mandated benefits; NRS 689B.033
.
NEW QUESTION # 102
What is the principal purpose of Medicare supplement insurance?
Answer: D
Explanation:
Medicare supplement insurance, often called Medigap, is designed to help pay certain out-of-pocket costs left by Original Medicare, such as deductibles, coinsurance, copayments, and other covered gaps, depending on the standardized policy type and current rules. It supplements Original Medicare Parts A and B; it does not replace Medicare coverage. The insured must generally remain enrolled in Original Medicare to use a Medicare supplement policy.
Medigap differs from Medicare Advantage. A Medicare Advantage plan is a private plan through which an eligible beneficiary receives Medicare-covered services, usually with plan networks, plan rules, and an annual out-of-pocket maximum. A consumer generally does not use a Medicare supplement policy to supplement a Medicare Advantage plan. Medigap also differs from stand-alone Part D prescription-drug coverage, which is separately arranged for many Original Medicare beneficiaries.
Producers selling Medicare-related products must make accurate comparisons, use required disclosures, and avoid misleading consumers about benefits, provider access, premiums, or enrollment rights. A client's health needs, travel patterns, provider preferences, prescription needs, affordability, and enrollment timing are important factors. No single Medicare arrangement is automatically best for every beneficiary.
References/topics from the Study Guide: Medicare Supplement Insurance; Original Medicare; Medicare Advantage; Medicare Part D; Medicare Cost Sharing.
NEW QUESTION # 103
All insurance companies and producers who sell Group Life or Accident and Health policies in Nevada MUST:
Answer: C
Explanation:
Group insurance is generally issued through a master policy. The policyholder-often an employer, association, trustee, or creditor-receives the master contract. Individual insured members do not receive a separate master policy; instead, they receive certificates describing the coverage, benefits, limitations, and applicable rights.
Nevada requires companies, resident agents, and nonresident agents or brokers conducting group life or group accident and health business to provide for delivery of the required individual certificates to the policyholder.
They must also use their best efforts to ensure that the policyholder distributes the certificates to covered debtors, members, or employees. Accordingly, option B correctly states the required delivery process.
Option C is incorrect because each group member is not entitled to receive the full group policy. Option A adds a receipt requirement that is not the applicable rule. Option D is also incorrect because the regulation does not require notice to the Commissioner each time certificates are issued.
This requirement ensures that insured individuals receive understandable evidence of their group coverage even though the policyholder owns the master policy. Certificates are central to informing members of benefits, exclusions, and conversion rights.
Study Guide references/topics: group life insurance; group accident and health insurance; certificates of coverage; NAC 687B.405 .
NEW QUESTION # 104
J and K are married and have several children. J is the primary beneficiary on K ' s Accidental Death and Dismemberment (AD & D) policy, and K ' s sibling, L, is the contingent beneficiary. J, K, and L are involved in a train accident, and K and L are killed instantly. The Accidental Death benefits will be paid to:
Answer: D
Explanation:
The correct answer is D, J only. A primary beneficiary has the first right to receive policy proceeds. J is named as K's primary beneficiary and survives the accident. Therefore, the AD & D benefit is paid directly to
J. The contingent beneficiary, L, would receive the proceeds only if the primary beneficiary had died before K or could not receive the benefit under the policy terms. Because J remains alive, L's death does not change the payment outcome. The proceeds do not pass to K's estate because a living named primary beneficiary exists.
They also do not pass to L's estate, because L never became entitled to the benefit; the contingency never occurred. Beneficiary designations control over general assumptions about family relationships or estates. The insured should keep beneficiary designations current after changes in family status, death, divorce, or estate- planning decisions. A simultaneous-death provision can alter outcomes if the beneficiary and insured die in the same event and survivorship cannot be determined, but the facts here identify K and L as deceased while J survives. Study Guide References/Topics: Group Health Insurance; Accidental Death and Dismemberment; Beneficiary Designations.
NEW QUESTION # 105
Under a Medicare Supplement policy that is issued in response to a direct solicitation, a policyowner may return the policy to the insurance company for a full premium refund within a MAXIMUM of how many days?
Answer: B
Explanation:
A Medicare Supplement policy issued in response to direct solicitation may be returned for a full premium refund within 30 days. This is commonly called a free-look or right-to-return period. It gives the policyowner time to examine the policy after delivery and decide whether the coverage is suitable.
Direct solicitation presents a heightened consumer-protection concern because the purchaser may not have received the same personal explanation and comparison assistance available in a face-to-face sale. The 30-day period allows the consumer to review benefits, exclusions, premiums, Medicare coordination, replacement implications, and suitability without financial penalty.
The policyowner should return the policy within the required period and follow the insurer's return instructions. Once timely returned, the insurer must refund the premium in accordance with the applicable rule. The free-look right does not mean that every policy can be cancelled at any time for a complete refund; it is a specific statutory or regulatory rescission period following delivery.
Ten, 45, and 60 days are common distractors because various insurance rules use different deadlines. For Medicare Supplement direct-solicitation policies, the tested maximum period is 30 days.
Study Guide references/topics: Medicare Supplement insurance; direct solicitation; free-look period; consumer protections; Nevada Medicare Supplement regulations .
NEW QUESTION # 106
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