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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Marketing Practices
|
| Topic 2: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Group life and health insurance
- Advertising |
| Topic 3: 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 |
| Topic 4: Accident & Health – General Knowledge | 50% | - Policy Provisions, Clauses, and Riders
|
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質問 # 80
In Nevada, a producer or examining physician who knowingly and willfully makes a false statement on an application for insurance may be guilty of:
正解：A
解説：
A producer, examining physician, applicant, or other person who knowingly and willfully makes a false or fraudulent statement or representation in, or in reference to, an insurance application may be guilty of fraud.
Nevada law expressly prohibits this conduct because insurance underwriting depends on truthful and complete information concerning the proposed insured and the risk.
Fraud requires knowing and willful conduct. An innocent clerical error or an inadvertent misunderstanding may require correction, but the exam question describes intentional falsification. Examples can include knowingly misstating medical history, concealing material treatment, falsifying income information in a disability application, or knowingly submitting an untrue medical statement.
Twisting is an improper sales practice involving inducing a policyowner to replace coverage through misleading comparisons or representations. Misrepresentation is a broader term that may describe false statements in insurance transactions, but the statute specifically identifies false or fraudulent application statements as insurance fraud. Coercion involves forcing or improperly pressuring a person to act and is not the conduct described here.
A producer must ensure that application answers are accurately recorded, should not alter answers without authorization, and should promptly correct discovered inaccuracies before policy issuance.
Study Guide references/topics: insurance fraud; applications; producer ethics; prohibited trade practices; NRS
686A.290 .
質問 # 81
According to Nevada law, an authorized insurer is BEST defined as:
正解：A
解説：
An authorized insurer is an insurer that holds a certificate of authority issued by the Nevada Insurance Commissioner and remains authorized to transact insurance in the state. The certificate of authority is the formal approval allowing the insurer to conduct the kinds of insurance business for which it has been approved.
Having sufficient assets may be one consideration in an insurer's application and ongoing financial regulation, but assets alone do not make an insurer authorized. The National Association of Insurance Commissioners develops model laws, standards, and regulatory resources; it does not issue Nevada certificates of authority. The Governor of Nevada likewise does not issue insurance certificates of authority.
This distinction is central to Nevada insurance regulation. Authorized, or admitted, insurers are subject to Nevada's ongoing solvency oversight, market-conduct regulation, rate and form requirements where applicable, examinations, and other statutory obligations. Nonadmitted insurers may be used only through the surplus-lines process or another applicable statutory exception.
A producer must understand whether an insurer is authorized before placing ordinary insurance business.
Selling or placing insurance with an unauthorized insurer outside a lawful exception can create serious regulatory consequences.
Study Guide references/topics: authorized insurers; admitted insurers; certificates of authority; insurer regulation; NRS 680A.020 .
質問 # 82
Under a Medicare Supplement policy that is issued in response to a direct solicitation, a policyowner may return the policy to the insurance company for a full premium refund within a MAXIMUM of how many days?
正解：D
解説：
A Medicare Supplement policy issued in response to direct solicitation may be returned for a full premium refund within 30 days. This is commonly called a free-look or right-to-return period. It gives the policyowner time to examine the policy after delivery and decide whether the coverage is suitable.
Direct solicitation presents a heightened consumer-protection concern because the purchaser may not have received the same personal explanation and comparison assistance available in a face-to-face sale. The 30-day period allows the consumer to review benefits, exclusions, premiums, Medicare coordination, replacement implications, and suitability without financial penalty.
The policyowner should return the policy within the required period and follow the insurer's return instructions. Once timely returned, the insurer must refund the premium in accordance with the applicable rule. The free-look right does not mean that every policy can be cancelled at any time for a complete refund; it is a specific statutory or regulatory rescission period following delivery.
Ten, 45, and 60 days are common distractors because various insurance rules use different deadlines. For Medicare Supplement direct-solicitation policies, the tested maximum period is 30 days.
Study Guide references/topics: Medicare Supplement insurance; direct solicitation; free-look period; consumer protections; Nevada Medicare Supplement regulations .
質問 # 83
Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?
正解：C
解説：
A group health policy that terminates dependent-child coverage at a stated limiting age must continue coverage for an eligible dependent child who remains incapable of self-sustaining employment because of a qualifying disability and who remains dependent on the insured group member for support and maintenance.
To preserve that continuation right, the required proof must be furnished within 31 days after the child reaches the policy's limiting age.
This is a time-sensitive protection. The purpose is to prevent automatic termination of coverage solely because a dependent reaches the normal age limit when the child remains disabled and financially dependent.
After initial proof is provided, the insurer may require continuing proof of incapacity and dependency, but it may not demand that proof more often than permitted by law.
The 31-day rule should be distinguished from notice periods for newborn coverage, conversion rights, premium grace periods, and claim notices. Each insurance provision may use a different time period, so examination questions often test the exact statutory deadline.
Study Guide references/topics: group health dependents; limiting age; continuation of coverage; NRS 689B.
035 .
質問 # 84
A consumer wishes to purchase an insurance policy that covers pre-existing illnesses. The consumer contacted the producer who informed the consumer:
正解：D
解説：
A consumer's pre-existing condition does not prevent enrollment in a Qualified Health Plan offered through the Exchange. Marketplace plans must cover treatment for pre-existing medical conditions and cannot reject an applicant, charge a higher premium, or refuse to pay Essential Health Benefits solely because of the applicant's health history.
The producer should accurately explain that coverage is subject to the plan's normal terms, provider network, formulary, deductibles, copayments, coinsurance, and out-of-pocket maximum. The prohibition against pre- existing-condition discrimination does not mean the consumer has no out-of-pocket costs. The insured may still have ordinary cost sharing for covered medical services, just as other enrollees do.
Option A is incorrect because Qualified Health Plans do cover pre-existing conditions. Option B is incorrect because a QHP may not impose a surcharge based on health status or medical history. Option C is incorrect because the Affordable Care Act's protection against discrimination does not eliminate all deductibles, copayments, coinsurance, or other permitted cost sharing.
For exam purposes, remember the core rule: health status cannot be used to deny enrollment in a QHP or set a higher premium based solely on a pre-existing condition.
Study Guide references/topics: Affordable Care Act; Qualified Health Plans; guaranteed issue; pre-existing conditions; HealthCare.gov pre-existing-condition coverage .
質問 # 85
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