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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident and Health — General Knowledge | ~68% | - Social Insurance / Government Plans
|
| Topic 2: Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
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NEW QUESTION # 16
Which person is the measuring life whose survival determines the timing and duration of annuity payments?
Answer: A
Explanation:
The annuitant is the person whose life expectancy is used to determine the amount, timing, or duration of annuity payments. The annuitant is not necessarily the contract owner or the beneficiary. In many personally owned annuities, one person may occupy more than one role, but examination questions frequently separate them. The owner controls contractual rights, including premium payments, beneficiary changes, withdrawals when permitted, and surrender decisions. The annuitant is the measuring life. The beneficiary receives remaining contract value or death proceeds if the owner or annuitant dies, depending on the contract design.
During the accumulation period, the owner pays premiums or transfers funds into the annuity. During the annuitization period, the accumulated value is converted into a stream of income payments. The annuitant's age and selected payout option influence the payment calculation. A life-income option normally provides larger periodic payments for an older annuitant because the expected payment period is shorter.
Do not confuse the annuitant with the insured under life insurance. Life insurance is designed primarily to create a death benefit upon the insured's death. An annuity is designed primarily to provide income during life, although death-benefit provisions may apply before annuitization.
References/topics from the Study Guide: Annuities; Parties to an Annuity; Accumulation Period; Annuitization Period; Payout Options.
NEW QUESTION # 17
For an individual health insurance policy, which document is generally part of the entire contract when a copy is attached to or endorsed on the policy?
Answer: D
Explanation:
The application is generally part of the entire contract only when a copy is attached to or endorsed on the policy. The entire-contract provision identifies the documents that form the binding agreement between the insurer and the insured. In an individual health policy, the policy itself and the attached application are the principal contract documents. Material statements made in the application are treated according to the policy and governing law, but outside papers, advertisements, and verbal discussions ordinarily do not become policy terms merely because they were used in the sales process.
This rule protects both parties. The insured can review the documents that govern coverage, while the insurer can rely on the written application it used for underwriting. A producer's notes, informal assurances, or advertising language cannot expand benefits, remove exclusions, or alter policy conditions unless formally incorporated into the contract. Producers must avoid statements that conflict with the issued policy and should deliver the policy promptly so the applicant can examine it during any applicable free-look period.
Nevada's individual health-insurance law requires specified policy provisions and permits approved substitutions only when they are not less favorable to the insured or beneficiary. The exact wording and placement of the application therefore matter.
References/topics from the Study Guide: Entire Contract; Application; Policy Delivery; Individual Health Policy Provisions; NRS 689A.040.
NEW QUESTION # 18
Under federal COBRA continuation rules, an employee who loses group health coverage because of termination of employment or reduction in hours will generally be offered continuation coverage for up to:
Answer: C
Explanation:
COBRA generally gives qualified beneficiaries the right to continue employer-sponsored group health coverage after certain qualifying events. For termination of employment, other than gross misconduct, or a reduction in work hours, the standard maximum continuation period is generally 18 months. Other qualifying events, such as death of the covered employee, divorce, legal separation, or a dependent child's loss of dependent status, may result in a longer maximum continuation period, commonly 36 months.
Continuation coverage is not free coverage. The qualified beneficiary typically pays the full group premium plus a permitted administrative charge. COBRA can preserve the same group coverage and provider access for a limited time, but it may be expensive because the employer is no longer subsidizing premiums.
Enrollment deadlines, election notices, payment rules, and employer-plan size requirements are important.
COBRA should not be confused with conversion coverage or an Affordable Care Act marketplace plan.
Conversion coverage is an individual policy issued after group coverage ends under stated conditions.
Marketplace coverage is a separate individual-market option that may be available following loss of employer- sponsored coverage. Producers should explain options carefully and avoid presenting one continuation route as automatically best for every consumer.
References/topics from the Study Guide: COBRA; Group Health Continuation; Qualifying Events; Conversion Privilege; Employer-Sponsored Health Insurance.
NEW QUESTION # 19
R, a self-employed stockbroker, becomes totally disabled on January 1 and receives $1,500 a month for the next twelve months from her own Individual Disability Income policy, for which she had paid the premium.
How much of this income is subject to federal income tax?
Answer: D
Explanation:
The correct answer is D, $0. Disability income benefits generally are not taxable to the insured when the insured personally paid the premiums with after-tax dollars. R paid the premium for her own individual disability income policy, so the $1,500 monthly benefit is excluded from federal taxable income. The total annual benefit is $18,000, but the fact that it totals $18,000 does not make it taxable. Tax treatment changes when an employer pays the premium and does not include that premium amount in the employee's taxable income; in that case, disability benefits are generally taxable. Similarly, benefits can be taxable when premiums were paid through certain pre-tax arrangements. The central exam rule is: personally paid, after-tax disability premiums normally produce income-tax-free disability benefits. The Internal Revenue Service confirms that benefits from an accident or health policy are not taxable when the taxpayer paid the premiums.
See IRS Publication 525 . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Tax Treatment of Disability Benefits.
NEW QUESTION # 20
Which of the following is NOT a preventive benefit for adults?
Answer: C
Explanation:
Skin cancer screening is the correct answer because it is not included as a broadly required preventive benefit for adults in the same manner as the other listed services. Preventive-service requirements are tied to specified recommended services and may vary by population, risk status, and recommendation level. A service may be medically useful or covered by a particular policy without being a universally required no-cost preventive benefit.
High blood pressure screening is a standard adult preventive screening. Mammography is a recognized preventive screening benefit for eligible women. Physical therapy can be included in preventive fall- intervention services for certain adults, particularly older adults at risk of falls, when the preventive-service criteria are met. Thus, the question is testing the distinction between services commonly covered in some circumstances and services specifically identified as preventive benefits.
Skin examinations or skin cancer evaluations may be medically necessary when a lesion, symptom, prior diagnosis, or risk factor is present. In that circumstance, the service may be classified as diagnostic rather than preventive and can be subject to policy terms and cost sharing.
For examination purposes, remember that preventive-benefit questions focus on the mandated screening list and preventive-care criteria, not merely on whether a service can be medically valuable.
Study Guide references/topics: preventive care; adult screenings; in-network preventive benefits; adult preventive-care benefits .
NEW QUESTION # 21
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