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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Group life and health insurance
- Advertising |
| Topic 2: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Insurance Commissioner
- Definitions
|
| Topic 3: Accident & Health – General Knowledge | 50% | - Field Underwriting Procedures
|
| Topic 4: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Medicare
- Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Hospice care - Coverage for reconstructive surgery |
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NEW QUESTION # 113
If coverage has stayed in force with the same insurance company, what is the maximum number of years for which reconstructive surgery (mastectomy) benefits must be provided?
Answer: A
Explanation:
If reconstructive surgery is begun within three years after a mastectomy, the amount of benefits for that surgery must equal the amount provided by the policy at the time of the mastectomy. Therefore, the tested maximum period is three years.
Nevada requires a policy that covers mastectomy to provide commensurate coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to create symmetry, prostheses, and treatment of physical complications of all stages of mastectomy, including lymphedema. The attending physician and patient determine the appropriate care.
The three-year rule protects an insured from losing the original level of reconstruction benefits merely because reconstruction is delayed. If surgery begins more than three years after the mastectomy, benefits are governed by the policy terms, conditions, and exclusions in effect at the time reconstructive surgery begins.
This question does not ask how long all reconstruction coverage disappears. It tests the period during which the policy must preserve the benefit amount available at the time of mastectomy.
Study Guide references/topics: mastectomy coverage; reconstructive surgery; breast reconstruction; mandated health benefits; NRS 689B.0375 .
NEW QUESTION # 114
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: C
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 # 115
Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member:
Answer: A
Explanation:
The correct answer is D. A guaranteed renewable provision protects an insured against termination based solely on health deterioration or disability, provided the premium is paid and the insured continues to meet the policy's stated conditions. Therefore, the insurer may not terminate coverage merely because the member becomes disabled. The insurer may, however, terminate or end coverage when a member no longer meets an eligibility requirement, such as leaving the eligible occupational classification, ceasing active employment, or reaching a policy-specified terminating age. Those conditions concern the member's contractual eligibility for the group coverage rather than the member's health status. Guaranteed renewable does not necessarily mean that premiums can never change. The insurer may generally change premiums on a class basis, but it cannot single out one insured for an individual premium increase or cancellation because that person became ill or disabled. This concept should be distinguished from noncancellable coverage, which provides stronger protection by preventing the insurer from changing either premiums or benefits during the stated period.
Study Guide References/Topics: Group Health Insurance; Renewability Provisions; Guaranteed Renewable Coverage.
NEW QUESTION # 116
A Long-Term Care policy provides coverage for:
Answer: D
Explanation:
Long-term care insurance is designed primarily to cover services required when an insured cannot perform activities of daily living independently or has a severe cognitive impairment. Custodial care in a nursing home is a core example of long-term care coverage. Custodial care involves assistance with everyday personal needs, such as bathing, dressing, eating, transferring, toileting, and continence, rather than acute medical treatment.
Long-term care benefits may be provided in a nursing home, assisted-living setting, adult day-care setting, or the insured's home, depending on the policy. Coverage can include skilled nursing care, intermediate care, custodial care, home health care, hospice care, respite care, and care-management services, subject to policy conditions and benefit triggers.
Hospital-expense and medical-expense policies generally focus on acute treatment, physician services, surgery, hospitalization, and related medical costs. Medicare Supplement insurance is designed to help pay certain Medicare deductibles, coinsurance, and copayments; it is not long-term care insurance.
The distinction is crucial: long-term care insurance addresses prolonged assistance and supervision resulting from chronic illness, disability, frailty, or cognitive impairment, whereas major medical insurance focuses principally on acute medical treatment.
Study Guide references/topics: long-term care insurance; custodial care; skilled care; activities of daily living; nursing-home benefits; Nevada long-term-care regulations .
NEW QUESTION # 117
Nevada insurance laws define a domestic insurance company as one formed under the laws of:
Answer: D
Explanation:
A domestic insurer in Nevada is an insurer formed under the laws of Nevada, unless it has converted to foreign-insurer status. Therefore, "the state of Nevada only" is the correct answer.
The terms domestic, foreign, and alien describe the jurisdiction in which an insurer is formed or domiciled; they do not describe the insurer's size, financial condition, or whether it is authorized to do business in Nevada. A foreign insurer is formed under the laws of another jurisdiction, generally another U.S. state, but may be authorized to transact insurance in Nevada. An alien insurer is formed under the laws of a country other than the United States.
An insurer may be domestic in one state and foreign in every other state. For example, an insurer incorporated under Nevada law is domestic in Nevada but foreign in California, Arizona, or any other state. Conversely, a company formed in another state is foreign in Nevada even if it holds a Nevada certificate of authority.
Study Guide references/topics: domestic insurers; foreign insurers; alien insurers; insurer domicile; NRS
679A.090 .
NEW QUESTION # 118
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