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| Section | Objectives |
|---|---|
| General Insurance Regulation | - Licensing Requirements and Responsibilities
|
| Insurance Basics | - Risk Management and Insurance Concepts
|
| Government Health Insurance Programs | - Medicare
|
| Accident and Health Insurance Fundamentals | - Types of Health Insurance Policies
|
| Health Insurance Policy Provisions | - Mandatory and Optional Provisions
|
| Producer Duties and Ethics | - Sales Practices
|
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NEW QUESTION # 85
A producer offers a prospective life insurance applicant a gift card that is not stated in the policy as an inducement to purchase coverage. Which prohibited practice is most directly implicated?
Answer: C
Explanation:
Rebating occurs when a producer or insurer offers, gives, or allows an inducement not specified in the policy to persuade a person to purchase insurance. A gift card offered solely because the applicant buys a life or health policy is a classic example of a potentially prohibited rebate. Nevada trade-practice law restricts rebates and other improper inducements because they can create unfair competition, mislead consumers, and distort insurance pricing.
The prohibition does not mean that every item of nominal value, educational material, or lawful consumer program is automatically illegal. The legality of a benefit depends on the statute, regulations, insurer programs, value, purpose, and whether it is tied improperly to the sale. Producers should follow current Nevada rules and insurer compliance guidance before offering anything of value in connection with a sale.
Coinsurance is a health-policy cost-sharing method. Subrogation is an insurer's right to recover from a responsible third party after paying a loss. Assignment transfers some or all policy rights from one party to another. None of those terms describes an improper sales inducement.
A producer should avoid promising gifts, refunds, premium reductions, or extra benefits unless specifically authorized and properly disclosed under applicable law and policy provisions.
References/topics from the Study Guide: Unfair Trade Practices; Rebating; Inducements; Producer Ethics; NRS 686A.110.
NEW QUESTION # 86
According to Nevada law, an authorized insurer is BEST defined as:
Answer: A
Explanation:
An authorized insurer is an insurer that holds a certificate of authority issued by the Nevada Insurance Commissioner and remains authorized to transact insurance in the state. The certificate of authority is the formal approval allowing the insurer to conduct the kinds of insurance business for which it has been approved.
Having sufficient assets may be one consideration in an insurer's application and ongoing financial regulation, but assets alone do not make an insurer authorized. The National Association of Insurance Commissioners develops model laws, standards, and regulatory resources; it does not issue Nevada certificates of authority. The Governor of Nevada likewise does not issue insurance certificates of authority.
This distinction is central to Nevada insurance regulation. Authorized, or admitted, insurers are subject to Nevada's ongoing solvency oversight, market-conduct regulation, rate and form requirements where applicable, examinations, and other statutory obligations. Nonadmitted insurers may be used only through the surplus-lines process or another applicable statutory exception.
A producer must understand whether an insurer is authorized before placing ordinary insurance business.
Selling or placing insurance with an unauthorized insurer outside a lawful exception can create serious regulatory consequences.
Study Guide references/topics: authorized insurers; admitted insurers; certificates of authority; insurer regulation; NRS 680A.020 .
NEW QUESTION # 87
Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?
Answer: D
Explanation:
A family is not an eligible blanket-health-insurance group under Nevada law. Blanket accident and health insurance is designed for defined groups connected by a common activity, organization, occupation, event, or exposure to a specified hazard. It is not designed as a substitute for ordinary individual or family health insurance.
Nevada specifically recognizes various groups that may be covered under a blanket policy. These include religious, charitable, recreational, educational, and civic organizations; newspaper publishers covering their carriers; and volunteer fire departments or similar emergency organizations covering members or participants.
The organization acts as the policyholder, and the covered persons are defined by their relationship to the group activity or specified hazard.
A church is eligible as a religious organization. A newspaper corporation may qualify when covering its carriers. A volunteer fire department is specifically listed as an eligible organization. A family, however, is a private household relationship rather than a qualifying blanket group formed around an authorized organizational purpose or activity.
Study Guide references/topics: blanket accident and health insurance; eligible groups; policyholder; specified hazards; NRS 689B.070 .
NEW QUESTION # 88
In a disability income policy, the elimination period is best described as:
Answer: A
Explanation:
The elimination period is the waiting period that begins when a covered disability starts and ends before disability-income benefits become payable. It functions much like a time deductible. For example, if a policy has a 30-day elimination period, the insured must remain disabled for the required period before weekly or monthly benefits begin, subject to the policy's definition of disability and proof-of-loss requirements.
The elimination period is not the benefit period. The benefit period is the maximum length of time benefits may continue once the insured becomes eligible, such as two years, five years, or to a stated age. It is also not the probationary period, which may apply at the beginning of a policy before coverage for sickness becomes effective. Accident coverage is often effective immediately, while sickness coverage may have a probationary period depending on the contract.
A longer elimination period generally lowers the premium because the insured retains more of the initial loss.
A shorter elimination period generally increases the premium because the insurer begins paying sooner. When comparing disability policies, producers should evaluate the elimination period together with the monthly benefit amount, definition of disability, residual-benefit features, and benefit period.
References/topics from the Study Guide: Disability Income Insurance; Elimination Period; Benefit Period; Probationary Period; Time Deductible.
NEW QUESTION # 89
Which person is generally eligible to establish and contribute to a health savings account (HSA)?
Answer: A
Explanation:
An HSA is generally available to an eligible individual who is covered by a qualified high-deductible health plan, commonly called an HDHP, and who meets the other federal eligibility requirements. The account is owned by the individual, not the employer or insurer. Contributions may be made by the individual, an employer, or another person, subject to annual contribution limits. Qualified distributions used for eligible medical expenses are generally tax advantaged under federal rules.
Eligibility is not based solely on having a high deductible. The health plan must meet the federal HDHP requirements for the applicable year. In addition, an individual generally cannot be enrolled in Medicare, cannot be claimed as another person's tax dependent, and cannot have disqualifying other health coverage.
Because federal limits and requirements can change, the producer should not provide individualized tax advice and should refer the consumer to current IRS guidance or a qualified tax professional.
An HSA differs from a flexible spending arrangement because unused HSA funds generally remain with the account owner and may carry forward. It also differs from health insurance itself; the HSA is a tax- advantaged account used alongside an eligible health plan.
References/topics from the Study Guide: Health Savings Accounts; High-Deductible Health Plans; Consumer- Directed Health Plans; Tax-Advantaged Medical Accounts.
NEW QUESTION # 90
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