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| Section | Objectives |
|---|---|
| Health Insurance Policy Provisions | - Mandatory and Optional Provisions
|
| Government Health Insurance Programs | - Medicaid and Other Programs
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| Insurance Basics | - Insurance Contracts
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| Producer Duties and Ethics | - Ethical Responsibilities
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| Accident and Health Insurance Fundamentals | - Medical Expense Insurance
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| General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
>> Most InsNV_Health02 Reliable Questions <<
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NEW QUESTION # 68
The Nevada Life and Health Insurance Guaranty Association becomes involved in an insurance company ' s affairs when the company:
Answer: B
Explanation:
The Nevada Life and Health Insurance Guaranty Association becomes involved when a covered member insurer becomes impaired or insolvent. Its statutory purpose is to provide limited protection to eligible policyowners, certificate holders, enrollees, beneficiaries, and other covered persons when a member insurer cannot perform its contractual obligations because of financial failure.
An ordinary lawsuit, claim denial, or membership withdrawal does not by itself trigger Guaranty Association protection. Claim disputes are normally handled through the insurer's claims process, internal appeals, administrative complaint procedures, or litigation. The Guaranty Association is not a general claims-review agency.
When a member insurer is impaired or insolvent, the Association may guarantee, assume, reissue, or reinsure covered policies and contracts, or provide other support necessary to meet covered obligations. Coverage is subject to statutory limits, eligibility requirements, exclusions, and residency rules. It does not protect every type of policy or every amount of loss.
Insurers must not use the Association as a sales inducement. Consumers should evaluate an insurer's financial strength and coverage terms rather than assume that all benefits are fully guaranteed.
Study Guide references/topics: insurer insolvency; impaired insurer; Guaranty Association; member insurers; NRS Chapter 686C .
NEW QUESTION # 69
An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?
Answer: B
Explanation:
Nevada group-life law protects an insured person during the conversion interval. If a person covered under a group life policy dies during the period in which the person was entitled to obtain an individual conversion policy-and before that individual policy becomes effective-the amount of life insurance the person could have converted is payable as a claim under the group policy. This protection applies whether or not the person submitted the individual-policy application or paid the first premium before death.
The conversion privilege is important because group coverage is usually tied to employment or membership.
When eligibility ends, the individual may lose the group policy's protection. Conversion gives the former insured an opportunity to obtain individual life insurance without new evidence of insurability, subject to the statute and policy terms. The converted amount may be limited by the group policy and applicable law, and the individual policy's premium is based on the insurer's conversion rates.
This rule should not be confused with portability. Portability allows continuation of group-style coverage under certain conditions, whereas conversion replaces group coverage with an individual policy. The producer should explain notice requirements, the available conversion amount, deadlines, and premium differences whenever group coverage terminates.
References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Termination of Employment; NRS 688B.120-688B.130.
NEW QUESTION # 70
A producer who makes misleading policy comparisons for the purpose of inducing an insured to surrender an existing policy is guilty of:
Answer: C
Explanation:
Twisting is the use of misleading, incomplete, or fraudulent policy comparisons to induce, or attempt to induce, a policyowner to lapse, forfeit, surrender, terminate, exchange, convert, or replace an existing insurance policy. The producer's conduct described in the question is a classic example of twisting because the misleading comparison is used to convince the insured to surrender existing coverage.
Twisting is prohibited because replacement decisions can have serious consequences. A new policy may have different exclusions, waiting periods, contestability periods, benefit limits, premiums, surrender charges, or underwriting requirements. A producer must provide accurate, balanced, and complete comparisons when discussing replacement or surrender of coverage.
Rebating involves offering an unlawful return of premium, commission, or other inducement not stated in the policy. Coercion involves forcing or improperly pressuring a person to act. Defamation involves false statements that harm another person's reputation. None of those terms specifically describes misleading comparisons intended to cause surrender of an existing policy.
Study Guide references/topics: unfair trade practices; policy replacement; twisting; misleading comparisons; NRS 686A.050 .
NEW QUESTION # 71
Under an Accidental Death and Dismemberment policy, in which of the following circumstances will an autopsy NOT be performed?
Answer: C
Explanation:
The correct answer is B. An AD & D policy may give the insurer the right to conduct an autopsy when death occurs, provided the autopsy is not prohibited by law. The autopsy provision helps the insurer determine whether the cause of death falls within the policy's accidental-death coverage and whether an exclusion applies. A beneficiary's refusal does not necessarily defeat the insurer's contractual right if applicable law permits the examination. The fact that death resulted from illness rather than an accident may affect whether an AD & D benefit is payable, but it does not itself state the legal restriction on performing an autopsy.
Likewise, an accidental cause of death is precisely the type of circumstance in which the insurer may need medical evidence to verify coverage. The insurer's right is not unlimited: it must comply with legal requirements, including restrictions imposed by statute, court order, or other controlling authority. The exam rule is straightforward: the insurer may conduct an autopsy at its own expense unless doing so is prohibited by law. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Accidental Death and Dismemberment; Autopsy Provision.
NEW QUESTION # 72
For Social Security disability benefits, which statement is generally correct?
Answer: C
Explanation:
Social Security disability benefits are based on a strict federal definition of disability. In general, the claimant must be unable to engage in substantial gainful activity because of a medically determinable physical or mental impairment that has lasted, or is expected to last, for at least 12 months or is expected to result in death. The program is not designed to insure every short-term illness, temporary injury, or partial loss of earnings.
Eligibility also depends on work history and Social Security credits in many cases. The Social Security Administration evaluates whether the person can perform past work or adjust to other substantial work, considering medical and vocational factors. A waiting period may apply before cash disability benefits begin.
Separate programs, such as Supplemental Security Income, have different eligibility and income-resource rules.
For insurance examination purposes, distinguish Social Security disability from private disability-income insurance. Private coverage is based on the policy definition of disability, elimination period, benefit amount, and benefit period. Social Security disability uses the federal program's statutory standard and administrative determination process. A producer should describe private coverage as a possible supplement to-not a replacement for-government disability benefits.
References/topics from the Study Guide: Social Security Disability; Definitions of Disability; Disability Income Insurance; Government Benefit Coordination.
NEW QUESTION # 73
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