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| Section | Objectives |
|---|---|
| Topic 1: General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
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| Topic 2: Government Health Insurance Programs | - Medicaid and Other Programs
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| Topic 3: Health Insurance Policy Provisions | - Claims and Benefits
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| Topic 4: Insurance Basics | - Risk Management and Insurance Concepts
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| Topic 5: Accident and Health Insurance Fundamentals | - Disability Income Insurance
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| Topic 6: Producer Duties and Ethics | - Ethical Responsibilities
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NEW QUESTION # 94
A policyowner borrows money from the insurer using the cash value of a whole life policy as security. If the loan and accrued interest are unpaid when the insured dies, what is the usual result?
Answer: D
Explanation:
A policy loan is a loan made by the insurer to the policyowner and secured by the policy's available cash value. It is not a withdrawal that automatically terminates the coverage. However, the outstanding principal and accrued interest become indebtedness against the policy. If the insured dies before repayment, the insurer deducts that indebtedness from the amount otherwise payable to the beneficiary. Therefore, the usual result is a reduced death benefit.
This concept is especially important with permanent life insurance, including whole life and certain universal- life policies, because cash value may support policy loans. Interest continues to accrue under the policy's loan provision. If the debt becomes large enough, it can threaten the policy's continuation because a lapse may occur if the cash value is insufficient to support the indebtedness and required charges. A producer should explain both the availability of loans and their consequences; presenting a loan as "free money" would be misleading.
Nevada's life-insurance standards require a loan provision in policies to which the requirement applies. The contractual terms control such matters as interest, notice, repayment, and the effect of indebtedness on policy values and proceeds.
References/topics from the Study Guide: Cash Value; Policy Loans; Nonforfeiture Values; NRS 688A.110- Loan Secured by Policy.
NEW QUESTION # 95
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?
Answer: B
Explanation:
Choice D is correct. A family health policy must provide coverage for a newborn child without requiring evidence of insurability at birth, subject to the policy's notice and premium requirements for continuation of coverage. This protects the child during the period when medical needs can arise immediately after birth and prevents underwriting from becoming a barrier to initial coverage. Nevada law recognizes family coverage for dependent children from birth and establishes rules governing newborn coverage. The policy may require notice and any additional premium within the specified period to continue coverage beyond the initial statutory protection. The other choices do not state standard rights under an individual major medical policy.
Arbitration is not automatically available merely because an insured disagrees with a claim decision. A proof of loss does not create an automatic right to sue precisely 30 days after submission. Reinstatement rights also operate under the policy's reinstatement provision and are not a universal three-year right. Nevada's statutory framework specifically addresses dependent and newborn coverage under individual health insurance. See NRS Chapter 689A . Study Guide References/Topics: Nevada-Specific Health Insurance Mandates and Rules; Individual Major Medical; Newborn Coverage.
NEW QUESTION # 96
Which statement best describes a preferred provider organization (PPO)?
Answer: B
Explanation:
A preferred provider organization, or PPO, contracts with a network of preferred providers who agree to provide services under negotiated payment arrangements. Members generally receive the highest level of benefit and lowest out-of-pocket cost when they use participating providers. Many PPOs also permit use of nonnetwork providers, but the member normally pays more through a higher deductible, higher coinsurance, balance billing exposure, or reduced reimbursement.
A PPO differs from a traditional HMO because it commonly provides more flexibility in choosing providers and may not require a primary-care referral for specialist care. However, the tradeoff may be higher premiums, higher cost sharing, and more complex reimbursement rules. A PPO is still managed care; it may use prior authorization, utilization review, formularies, and network rules.
A producer should explain provider-network access, emergency-care rules, deductible and coinsurance amounts, out-of-network payment limitations, and whether a provider is actually participating at the time of enrollment. The phrase "you can see any doctor" can be misleading if nonnetwork care is covered at a lower level or exposes the insured to significant unpaid charges.
References/topics from the Study Guide: PPO; Managed Care; Provider Networks; In-Network and Out-of- Network Benefits; Cost Sharing.
NEW QUESTION # 97
Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?
Answer: A
Explanation:
A group health policy that terminates dependent-child coverage at a stated limiting age must continue coverage for an eligible dependent child who remains incapable of self-sustaining employment because of a qualifying disability and who remains dependent on the insured group member for support and maintenance.
To preserve that continuation right, the required proof must be furnished within 31 days after the child reaches the policy's limiting age.
This is a time-sensitive protection. The purpose is to prevent automatic termination of coverage solely because a dependent reaches the normal age limit when the child remains disabled and financially dependent.
After initial proof is provided, the insurer may require continuing proof of incapacity and dependency, but it may not demand that proof more often than permitted by law.
The 31-day rule should be distinguished from notice periods for newborn coverage, conversion rights, premium grace periods, and claim notices. Each insurance provision may use a different time period, so examination questions often test the exact statutory deadline.
Study Guide references/topics: group health dependents; limiting age; continuation of coverage; NRS 689B.
035 .
NEW QUESTION # 98
When a criminal violation of the insurance code has occurred, the Nevada Insurance Commissioner is required to report the violation to the:
Answer: A
Explanation:
When the Nevada Insurance Commissioner has reason to believe that a person has violated the Insurance Code or another law applicable to insurance operations and criminal prosecution appears appropriate, the Commissioner must provide the relevant information to the appropriate district attorney or to the Attorney General. Of the choices given, District Attorney is the correct answer.
The Commissioner administers and enforces Nevada insurance laws, investigates potential violations, conducts examinations, and may impose administrative sanctions where authorized. Criminal prosecution, however, is handled by the appropriate prosecutorial authority rather than by the Commissioner personally.
This division of responsibility preserves due process and ensures that criminal cases are evaluated and prosecuted by officials with criminal-law authority.
The Secretary of State, Lieutenant Governor, and State Police may have governmental roles that occasionally relate to business records, executive functions, or investigations, but they are not the statutory prosecutorial recipients identified in Nevada's insurance law. The examination point is that an insurance violation can produce both administrative consequences, such as a fine or license action, and criminal referral when the conduct warrants prosecution.
Study Guide references/topics: powers and duties of the Commissioner; insurance-code enforcement; criminal violations; NRS 679B.150 .
NEW QUESTION # 99
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