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| Section | Objectives |
|---|---|
| General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
| Health Insurance Policy Provisions | - Mandatory and Optional Provisions
|
| Accident and Health Insurance Fundamentals | - Disability Income Insurance
|
| Insurance Basics | - Insurance Contracts
|
| Government Health Insurance Programs | - Medicare
|
| Producer Duties and Ethics | - Sales Practices
|
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100. Frage
In a disability income policy, the elimination period is best described as:
Antwort: A
Begründung:
The elimination period is the waiting period that begins when a covered disability starts and ends before disability-income benefits become payable. It functions much like a time deductible. For example, if a policy has a 30-day elimination period, the insured must remain disabled for the required period before weekly or monthly benefits begin, subject to the policy's definition of disability and proof-of-loss requirements.
The elimination period is not the benefit period. The benefit period is the maximum length of time benefits may continue once the insured becomes eligible, such as two years, five years, or to a stated age. It is also not the probationary period, which may apply at the beginning of a policy before coverage for sickness becomes effective. Accident coverage is often effective immediately, while sickness coverage may have a probationary period depending on the contract.
A longer elimination period generally lowers the premium because the insured retains more of the initial loss.
A shorter elimination period generally increases the premium because the insurer begins paying sooner. When comparing disability policies, producers should evaluate the elimination period together with the monthly benefit amount, definition of disability, residual-benefit features, and benefit period.
References/topics from the Study Guide: Disability Income Insurance; Elimination Period; Benefit Period; Probationary Period; Time Deductible.
101. Frage
Which of the following statements is CORRECT about Business Overhead Expense insurance?
Antwort: B
Begründung:
Business Overhead Expense insurance reimburses a business for specified ongoing operating expenses when a business owner becomes disabled. Eligible expenses commonly include employee salaries, rent, utilities, office expenses, and other ordinary fixed costs identified in the policy. Accordingly, choice B is correct. The purpose is business continuity: it helps keep the office or practice operating during the owner's disability rather than replacing the owner's personal income. A disability income policy, not Business Overhead Expense insurance, is the product intended to replace an individual's lost earned income. The coverage is not restricted to corporations; it may be appropriate for sole proprietors, partners, and owners of closely held businesses, depending on underwriting and policy eligibility. It also is not limited to staff expenses alone, because rent, utilities, and other contractually covered overhead are central components of the protection.
Benefits are generally limited by the actual covered overhead incurred and the policy's monthly benefit amount. Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Business Overhead Expense Coverage.
102. Frage
Under a Gold health insurance plan, an insurer would be expected to pay which percentage of medical costs?
Antwort: B
Begründung:
A Gold Marketplace health plan has an actuarial value of approximately 80%. Therefore, the insurer is expected to pay about 80% of covered medical costs for a standard population, while enrollees as a group pay approximately 20% through deductibles, copayments, and coinsurance.
Actuarial value does not mean that the insurer pays exactly 80% of every individual's bills. A particular insured may pay more or less than 20% in a year depending on the services used, the plan's deductible, copayment structure, provider network, prescription-drug costs, and whether the annual out-of-pocket maximum has been reached. It is an overall measure of expected cost sharing for covered benefits.
The standard metal levels are Bronze at 60%, Silver at 70%, Gold at 80%, and Platinum at 90%. Gold plans generally have higher monthly premiums than Bronze or Silver plans but lower cost sharing when health care is received. Platinum plans generally have the highest premiums and the lowest cost sharing.
Study Guide references/topics: Affordable Care Act; Marketplace plans; metal levels; actuarial value; deductibles; copayments; HealthCare.gov plan categories .
103. Frage
The commission for the placement of nonadmitted insurance is paid by the insurer to the:
Antwort: B
Begründung:
The commission for the placement of nonadmitted insurance is paid to the surplus lines broker. A surplus lines broker is specially licensed to place eligible insurance with a nonadmitted insurer when coverage cannot be procured from authorized insurers under the conditions required by Nevada's Nonadmitted Insurance Law.
A nonadmitted insurer is not licensed or authorized to transact insurance generally in Nevada, but it may provide qualifying surplus-lines coverage through a properly licensed surplus lines broker. The broker performs the regulated placement function, documents the effort to obtain coverage from the admitted market when required, handles applicable filings, and ensures that statutory taxes and disclosures are addressed.
The policyholder purchases the insurance and pays the premium; the policyholder is not paid the placement commission. The Division of Insurance regulates the transaction and may receive taxes, fees, and reports as provided by law, but it is not the recipient of the insurer's commission. A third-party claimant is someone asserting a claim against an insured and has no role in the placement commission.
Study Guide references/topics: nonadmitted insurance; surplus lines; broker licensing; commissions; Nevada Nonadmitted Insurance Law .
104. Frage
Which premium-payment mode usually results in the lowest total annual premium cost for the policyowner?
Antwort: D
Begründung:
Annual premium payment generally produces the lowest total cost over the policy year because the insurer receives the full annual premium at the beginning of the coverage period. Monthly, quarterly, and semiannual payment modes are convenient for budgeting, but they commonly include an additional charge or produce a higher total annual premium. The difference reflects the insurer's additional administrative expense and the fact that the insurer receives portions of the premium later.
Premium mode does not change the policy's face amount, underwriting classification, or contractual benefits.
It changes only the schedule and total cost of paying the premium. A producer should present all available modes clearly and explain the actual amount due under each option. A consumer with predictable annual cash flow may prefer annual mode to reduce total cost, while a consumer who needs more frequent payments may choose a higher-cost mode to preserve affordability and avoid lapse.
This issue is distinct from the grace period. The grace period protects the policyowner after a premium due date by allowing a limited time to make payment before coverage lapses. Premium mode establishes how frequently the regular premium is due; it does not eliminate the policyowner's obligation to pay.
References/topics from the Study Guide: Premium Payment; Premium Modes; Grace Period; Policy Lapse; Life Insurance Contract Provisions.
105. Frage
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