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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Coverage for reconstructive surgery - Mandatory policy clauses and provisions
- Long Term Care - Hospice care |
| Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Marketing Practices
|
| Accident & Health – General Knowledge | 50% | - Policy Provisions, Clauses, and Riders
|
| Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Group life and health insurance
- Credit life and health insurance |
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NEW QUESTION # 127
For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?
Answer: A
Explanation:
Choice B is correct because accidental loss of eyesight is a standard covered dismemberment loss under most AD & D policies. These policies pay benefits for accidental death and for specifically listed losses, often including loss of life, both hands, both feet, one h and and one foot, sight in one or both eyes, hearing, speech, or specified paralysis. The loss must result directly from accidental bodily injury and occur within the policy's required loss period. Death from a heart attack is generally illness-related rather than accidental. Loss of the spleen, even when caused by an accident, is not usually one of the specifically scheduled losses in a basic AD
& D policy. Partial paralysis due to a stroke is caused by illness rather than accidental injury. AD & D policies are limited-benefit contracts, so the policy does not pay merely because an injury is serious; the loss must match the policy's defined covered loss. The benefit amount varies according to the loss, with full principal sums often payable for death or loss of both eyes and smaller percentages for certain partial losses.
Study Guide References/Topics: Types of Health Insurance Policies; Accidental Death and Dismemberment; Covered Losses.
NEW QUESTION # 128
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:
Answer: D
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 # 129
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: B
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 # 130
A client needs a $250,000 death benefit for exactly 20 years to protect a home mortgage. The client wants the lowest practical initial premium and does not need cash-value accumulation. Which policy is most appropriate?
Answer: A
Explanation:
Level term life insurance is the appropriate recommendation because it provides a stated death benefit for a stated period, such as 20 years. It is designed for temporary protection where the financial need has a known end date-for example, the remaining duration of a mortgage, a child's dependency period, or a short-to- medium-term income-replacement need. The premium is generally level for the selected term period, while the death benefit remains level if the policy stays in force.
Whole life insurance provides permanent protection and cash-value accumulation, but its premium is ordinarily higher because the insurer expects coverage to continue for the insured's lifetime. Universal life offers flexible premiums and adjustable death-benefit structures, but it is not the simplest match when the client's purpose is fixed, time-limited mortgage protection. Variable life has investment risk because policy values depend on separate-account performance and is not selected merely to obtain low-cost temporary coverage.
The producer should confirm that the term period aligns with the mortgage obligation and explain that coverage normally ends at the term's expiration unless the policy is renewed, converted, or otherwise continued under its provisions.
References/topics from the Study Guide: Types of Life Insurance; Term Life Insurance; Needs Analysis; Mortgage Protection.
NEW QUESTION # 131
Which of the following BEST describes Medicare Advantage Plans?
Answer: B
Explanation:
Medicare Advantage Plans are best described as government-subsidized private insurance. Medicare Advantage, also called Medicare Part C, is offered by private companies that contract with Medicare and must follow Medicare rules. Eligible beneficiaries receive their Medicare-covered benefits through the private plan instead of receiving benefits through Original Medicare directly.
The federal Medicare program pays private Medicare Advantage organizations to provide covered services to enrolled beneficiaries. The plans must provide all medically necessary services covered by Original Medicare, except hospice care, which remains covered under Original Medicare. Many Medicare Advantage plans also include prescription drug coverage and may provide additional benefits such as dental, vision, hearing, wellness, or transportation benefits.
The plans are private, but they are not privately subsidized government insurance. They are federally regulated Medicare arrangements supported by Medicare payments. They are not long-term care riders and are not welfare benefit plans. Enrollees generally continue paying their Medicare Part B premium and may also pay a plan premium, although some plans have a $0 additional premium.
Study Guide references/topics: Medicare Part C; Medicare Advantage; private insurers; federal Medicare program; Medicare Advantage overview .
NEW QUESTION # 132
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