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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Medicare
- Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Coverage for reconstructive surgery - Hospice care - Mandatory policy clauses and provisions
|
| Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Advertising - Group life and health insurance
|
| Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Nevada Life and Health Insurance Guaranty Association - Definitions
|
| Accident & Health – General Knowledge | 50% | - Other Insurance Concepts
|
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NEW QUESTION # 79
A producer who makes misleading policy comparisons for the purpose of inducing an insured to surrender an existing policy is guilty of:
Answer: B
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 # 80
Which of the following is permitted by a licensee?
Answer: B
Explanation:
A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada's statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.
Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.
Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant's information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.
The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.
Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .
NEW QUESTION # 81
One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:
Answer: D
Explanation:
A licensed producer may recommend a health plan for a consumer because the producer is authorized to sell, solicit, and negotiate insurance. That authority permits the producer to discuss coverage choices in a personalized manner, explain how plan provisions apply to the consumer's situation, and recommend a particular policy or plan when appropriate.
An Exchange Enrollment Facilitator is certified to help consumers enroll in qualified health plans through the Exchange. The EEF role is designed to provide impartial enrollment assistance, application support, and general program information. However, an EEF may not sell, solicit, or negotiate insurance. That restriction prevents an EEF from functioning as an insurance producer or steering a consumer toward a particular carrier or plan.
Explaining general terminology, such as deductibles, copayments, and eligibility rules, can be part of enrollment assistance and is not the defining distinction. Compensation is also not the key answer because the legal distinction turns on insurance authority, not simply whether a person receives payment. A Nevada EEF also may not concurrently hold a producer license.
Study Guide references/topics: Exchange Enrollment Facilitators; producer authority; solicitation and negotiation; NRS Chapter 695J .
NEW QUESTION # 82
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 # 83
An insured who wants to guarantee that an Accident and Health policy will remain in force even in the event of being disabled should purchase which of the following riders?
Answer: D
Explanation:
The Waiver of Premium rider is designed to prevent a disability from causing the insured to lose coverage because premiums cannot be paid. When the rider's qualifying disability conditions are met, the insurer waives future premiums after the applicable waiting period while the disability continues. The policy therefore remains in force without premium payment during the qualifying period. Choice C is correct because it directly addresses continuation of coverage during disability. AD & D pays a benefit for accidental death or specified accidental losses; it does not waive premiums. Double indemnity generally increases the death benefit for a qualifying accidental death and likewise does not preserve health coverage during disability. Guaranteed insurability permits the future purchase of additional coverage without new evidence of insurability, but it does not relieve the policyowner of the duty to pay premiums on existing coverage. The rider's exact definition of disability, elimination period, age limitation, and proof-of-disability requirements are controlled by the policy. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Waiver of Premium.
NEW QUESTION # 84
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