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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
| Accident and Health — General Knowledge | ~68% | - Social Insurance / Government Plans
|
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NEW QUESTION # 91
A Major Medical policy insured is injured in an auto collision during a police chase. The occupants in the police car are killed. The insured is convicted of reckless driving and manslaughter. If the insured files a claim, the insurance company will MOST likely take which of the following actions?
Answer: B
Explanation:
Major medical coverage pays covered medical expenses resulting from accidental injury or sickness, subject to the policy's stated exclusions and limitations. The facts establish reckless and criminal conduct, but they do not establish an intentional self-inflicted injury or identify a policy exclusion that removes coverage.
Therefore, choice A is the best answer: the insurer will pay the covered benefits according to the policy.
Insurance examination questions require careful separation of criminal conduct from intentional injury.
Reckless driving and a resulting conviction do not automatically mean that the insured intended to injure himself. A health insurer may deny a claim only when a valid policy exclusion, limitation, misrepresentation defense, or other contract basis applies. The insurer does not reduce benefits merely to "partial benefits" because of the conviction, and it does not return all premiums after denying a properly covered accidental- injury claim. The controlling analysis is the policy language, including exclusions for intentional self-inflicted injury, war, occupational losses, or other listed circumstances. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Major Medical Insurance; Exclusions and Limitations.
NEW QUESTION # 92
In a contributory group health insurance plan, which statement is correct?
Answer: B
Explanation:
A contributory group health plan is one in which covered employees pay a portion of the premium. Because employees must elect coverage and contribute financially, insurers commonly require a minimum percentage of eligible employees to participate. The participation requirement reduces adverse selection by helping ensure that enrollment includes a broad cross-section of the eligible group rather than only individuals who expect immediate medical expenses.
A noncontributory plan is one in which the employer pays the full premium for eligible employees. Because employees are not required to contribute, participation is generally expected to be much higher and may be mandatory for eligible employees under the employer's plan rules. The distinction is based on premium contribution, not on whether the coverage includes dependents, dental benefits, or a network.
Group insurance is characterized by a master policy issued to the policyholder, commonly an employer or association. Individual insureds receive certificates of coverage that describe the benefits and rights under the group contract. The employer's role, employee eligibility rules, waiting periods, and contribution structure must all be disclosed accurately.
On an examination question, remember the primary rule: contributory means employees contribute toward premium; noncontributory means the employer pays the entire premium for the covered employees.
References/topics from the Study Guide: Group Health Insurance; Contributory Plans; Noncontributory Plans; Participation Requirements; Certificates of Coverage.
NEW QUESTION # 93
As a condition to granting a loan, a creditor can:
Answer: D
Explanation:
A creditor may accept an assignment from an existing policy as security for a loan. When consumer credit insurance is required as additional security for debt, Nevada law allows the debtor to furnish the required insurance through existing policies owned or controlled by the debtor, or through any insurer authorized to transact insurance in Nevada.
A creditor may not require the borrower to purchase insurance from a particular insurer. That would improperly limit the borrower's freedom of choice. The creditor also may not require coverage in an amount greater than the debt being secured. Credit insurance is intended to protect the creditor against the unpaid obligation, not to create excess insurance for the creditor's benefit.
Similarly, a creditor may not impose a higher interest rate merely because the borrower declines to purchase credit insurance. Credit insurance must not be represented as a mandatory condition of loan approval when it is optional.
Assignment allows the borrower's existing coverage to be used as collateral or security without forcing the borrower to buy duplicative insurance. The creditor may require proof that the existing insurance is adequate for the risk and debt involved.
Study Guide references/topics: credit insurance; creditor-debtor relationship; assignment; consumer protections; NRS 690A.140 .
NEW QUESTION # 94
Nevada insurance laws define a domestic insurance company as one formed under the laws of:
Answer: A
Explanation:
A domestic insurer in Nevada is an insurer formed under the laws of Nevada, unless it has converted to foreign-insurer status. Therefore, "the state of Nevada only" is the correct answer.
The terms domestic, foreign, and alien describe the jurisdiction in which an insurer is formed or domiciled; they do not describe the insurer's size, financial condition, or whether it is authorized to do business in Nevada. A foreign insurer is formed under the laws of another jurisdiction, generally another U.S. state, but may be authorized to transact insurance in Nevada. An alien insurer is formed under the laws of a country other than the United States.
An insurer may be domestic in one state and foreign in every other state. For example, an insurer incorporated under Nevada law is domestic in Nevada but foreign in California, Arizona, or any other state. Conversely, a company formed in another state is foreign in Nevada even if it holds a Nevada certificate of authority.
Study Guide references/topics: domestic insurers; foreign insurers; alien insurers; insurer domicile; NRS
679A.090 .
NEW QUESTION # 95
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: C
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 # 96
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