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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
| Topic 2: Accident and Health โ General Knowledge | ~68% | - Policy Provisions, Clauses & Riders
|
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NEW QUESTION # 100
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 # 101
Which of the following is permitted by a licensee?
Answer: D
Explanation:
A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada's statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.
Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.
Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant's information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.
The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.
Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .
NEW QUESTION # 102
An Outline of Coverage for Medicare Supplement policies must be provided to a prospective insured at which of the following times?
Answer: D
Explanation:
A Medicare Supplement insurer must provide an Outline of Coverage to the applicant at the time the application is presented. The outline is a consumer-disclosure document designed to summarize the policy's principal benefits, premiums, limitations, exclusions, and other important features before the applicant makes a final purchasing decision.
The outline is not the insurance contract itself. The policy contains the full contractual rights and obligations, but the outline allows an applicant to compare Medicare Supplement plans in a clear and standardized format.
It helps the consumer understand how the policy works with Original Medicare and whether it duplicates other existing coverage.
If the issued policy differs from the coverage described in the original outline, the insurer must provide a substitute outline describing the policy actually issued when delivering it. That later document does not change the initial requirement: the first outline is provided at application.
The premium-payment date and claim-submission date occur too late to serve the purpose of pre- sale disclosure. The key examination concept is timing: applicants receive the Outline of Coverage before purchasing the Medicare Supplement policy.
Study Guide references/topics: Medicare Supplement insurance; consumer disclosures; Outline of Coverage; NAC 687B.250 .
NEW QUESTION # 103
A policyowner names two children as beneficiaries "per stirpes." If one child dies before the insured but leaves children, how are that deceased child's share and the surviving child's share handled?
Answer: D
Explanation:
A per stirpes beneficiary designation means "by the branch" or "by the bloodline." If a named beneficiary dies before the insured, that beneficiary's descendants take the deceased beneficiary's share. In this question, the deceased child's children receive the share that would have gone to their parent, while the surviving child receives that child's own share. This preserves each family branch's intended portion of the life insurance proceeds.
A per capita designation works differently. Under a per capita arrangement, surviving members of a named class generally share equally, and a deceased beneficiary's descendants do not automatically take the deceased beneficiary's share unless the designation or policy language provides otherwise. The precise result always depends on the policy designation, applicable law, and any contingent- beneficiary provisions.
Beneficiary designations should be reviewed after divorce, marriage, birth, death, adoption, or other major changes. A producer should not provide legal advice about estate planning, but should encourage the policyowner to obtain professional legal guidance when the designation involves trusts, minors, estates, complex family arrangements, or special-needs planning.
The test point is straightforward: per stirpes preserves the deceased beneficiary's branch; per capita distributes among the surviving members of the class.
References/topics from the Study Guide: Beneficiary Designations; Per Stirpes; Per Capita; Primary and Contingent Beneficiaries; Estate Planning Basics.
NEW QUESTION # 104
The Fair Credit Reporting Act requires that:
Answer: B
Explanation:
The Fair Credit Reporting Act governs the collection, use, and disclosure of consumer-report information.
Choice B is correct because an insurance applicant must receive appropriate notice when an insurer may obtain a consumer report or investigative consumer report in connection with underwriting. Consumer reports can contain information relevant to an insurer's evaluation of risk, including credit-related information and other data permitted by law. The notice requirement promotes transparency and gives applicants the opportunity to understand that reporting information may be used in the underwriting process. The remaining choices concern different legal issues. Interest on premium loans is governed by policy and insurance-law rules, not the FCRA. Unfair discrimination is addressed through insurance regulation and unfair-trade-practice standards. Interest for late claim payments is governed by applicable claims-handling requirements, not the FCRA. The FCRA permits insurance companies to obtain consumer reports only for a permissible purpose and imposes duties regarding notices and adverse actions when report information is used. See the Consumer Financial Protection Bureau's FCRA guidance . Study Guide References/Topics: Nevada Insurance Regulation and Licensing; Consumer Reports; Fair Credit Reporting Act.
NEW QUESTION # 105
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