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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
| Accident and Health — General Knowledge | ~68% | - Policy Provisions, Clauses & Riders
|
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NEW QUESTION # 128
In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:
Answer: C
Explanation:
A person may not concurrently hold a Nevada producer license and an Exchange Enrollment Facilitator certificate. Therefore, a health insurance producer who wishes to become an EEF must surrender the producer authority and apply for certification as an Exchange Enrollment Facilitator.
An EEF assists consumers with enrollment in qualified health plans offered through the Exchange. The role is designed to provide objective enrollment help, application assistance, and general information. An EEF may not sell, solicit, or negotiate insurance. The EEF also may not receive consideration from a health insurance issuer or insurer in connection with enrollment and may not receive remuneration arising from EEF activities from a licensed producer, insurance consultant, surplus lines broker, or insurer.
For that reason, a producer cannot receive commissions while acting as an EEF, cannot collect both commission and EEF compensation in the manner described, and cannot steer a consumer toward a particular coverage choice. Producers and EEFs have different legal roles, compensation structures, and consumer- protection limitations.
Study Guide references/topics: Exchange Enrollment Facilitators; producer licensing; prohibited acts; compensation; NRS 695J.210 .
NEW QUESTION # 129
Medicaid is best described as:
Answer: A
Explanation:
Medicaid is a joint federal-state medical-assistance program serving eligible individuals and families under income, resource, categorical, residency, and other program rules. The federal government establishes broad requirements and provides funding, while each state administers its program within federal parameters.
Nevada administers Medicaid through its state health and human-services structure and contracted delivery systems. Eligibility and benefits can vary by category and may change with law and program administration.
Medicaid is not the same as Medicare. Medicare is principally a federal social-insurance program associated with age 65 or older, certain disabilities, and end-stage renal disease or other qualifying conditions. Medicaid is generally means tested, although eligibility is determined by detailed program standards and should never be assumed from income alone. Some people may qualify for both Medicare and Medicaid; these individuals are often referred to as dual-eligible beneficiaries.
A producer should avoid giving legal or public-benefit eligibility advice beyond the scope of insurance licensing. The proper role is to identify the program accurately, explain how private coverage may coordinate where applicable, and direct a consumer to the appropriate state agency or benefits specialist for an eligibility determination.
References/topics from the Study Guide: Medicaid; Medicare; Dual Eligibility; Government-Sponsored Health Programs; Nevada Public Health Benefits.
NEW QUESTION # 130
An insured purchases a rider that pays an additional amount only if death results from a covered accident.
This rider is best described as:
Answer: C
Explanation:
An accidental death benefit rider provides an additional death benefit when the insured dies as the direct result of a covered accident. It is often described as "double indemnity" when the additional benefit equals the policy's face amount, although the actual amount and conditions depend on the rider. The rider supplements the base life policy; it does not replace the base death benefit. If the insured dies from a covered accident, the beneficiary may receive the base policy amount plus the rider benefit. If death results from illness or a noncovered cause, only the base policy benefit is generally payable.
Accidental-death riders contain important limitations. They typically require death to occur within a stated time after the accident and may exclude deaths resulting from specified causes, such as war, suicide, certain hazardous activities, intoxication, or illegal acts, depending on the contract. The producer must explain that the benefit is conditional and is not the same as comprehensive life insurance.
A guaranteed-insurability rider permits future coverage increases without new evidence of insurability. A cost- of-living rider increases coverage under specified inflation-related terms. A return-of-premium feature returns qualifying premiums under stated conditions, usually at the end of a term period.
References/topics from the Study Guide: Accidental Death Benefit Rider; Double Indemnity; Exclusions; Supplementary Benefits; Policy Riders.
NEW QUESTION # 131
As a condition to granting a loan, a creditor can:
Answer: A
Explanation:
A creditor may accept an assignment from an existing policy as security for a loan. When consumer credit insurance is required as additional security for debt, Nevada law allows the debtor to furnish the required insurance through existing policies owned or controlled by the debtor, or through any insurer authorized to transact insurance in Nevada.
A creditor may not require the borrower to purchase insurance from a particular insurer. That would improperly limit the borrower's freedom of choice. The creditor also may not require coverage in an amount greater than the debt being secured. Credit insurance is intended to protect the creditor against the unpaid obligation, not to create excess insurance for the creditor's benefit.
Similarly, a creditor may not impose a higher interest rate merely because the borrower declines to purchase credit insurance. Credit insurance must not be represented as a mandatory condition of loan approval when it is optional.
Assignment allows the borrower's existing coverage to be used as collateral or security without forcing the borrower to buy duplicative insurance. The creditor may require proof that the existing insurance is adequate for the risk and debt involved.
Study Guide references/topics: credit insurance; creditor-debtor relationship; assignment; consumer protections; NRS 690A.140 .
NEW QUESTION # 132
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:
Answer: C
Explanation:
The correct answer is C, Proof of Loss. Proof of loss is the written documentation supplied to the insurer to establish that a covered loss occurred and to provide the facts needed to evaluate the claim. It may include claim forms, medical records, bills, physician statements, dates of treatment, disability information, and other evidence required under the policy. Notice of claim is different: it simply informs the insurer that a loss has occurred or that a claim may be made. After receiving notice, the insurer ordinarily provides claim forms or instructions. A loss form may be one document used in the proof-of-loss process, but it is not the complete legal concept. An inspection report may be used by an insurer in some lines of insurance but is not the insured' s required statement establishing a health or disability claim. Timely proof of loss is important because it triggers the insurer's claim-review duties and helps determine when payment is due. Policy provisions specify the timing and form of proof required. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Notice of Claim; Proof of Loss; Claim Procedures.
NEW QUESTION # 133
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