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| Section | Weight | Objectives |
|---|---|---|
| Accident & Health – General Knowledge | 50% | - Field Underwriting Procedures
|
| Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Group life and health insurance
|
| Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Coverage for reconstructive surgery - Mandatory policy clauses and provisions
- Long Term Care - Medicare
|
| Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Insurance Commissioner
- Marketing Practices
|
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NEW QUESTION # 124
Group health policies MUST provide which of the following benefits?
Answer: D
Explanation:
Nevada requires group health insurance policies to include benefits for expenses arising from hospice care.
Hospice care is designed for individuals facing terminal illness and focuses on comfort, pain and symptom management, emotional support, and assistance for the patient and family rather than curative treatment.
The group-policy required-provisions statute specifically includes hospice-care benefits. It also recognizes benefits for care at home or health supportive services when prescribed by a physician and otherwise covered if provided in a medical facility. This reflects the policy goal of allowing appropriate end-of-life care in a setting suited to the patient's needs.
Adult vision care and adult dental care are not universally required benefits under every group health policy.
They may be offered through separate policies, riders, employer benefit arrangements, or plan designs.
Cosmetic surgery is generally not a mandatory health insurance benefit and may be excluded unless medically necessary or required because of injury, congenital condition, reconstruction, or another covered circumstance.
The key examination point is that hospice care is a specifically required group-policy benefit in Nevada, while the other choices may be optional, limited, or excluded depending on the plan.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; NRS 689B.
030 .
NEW QUESTION # 125
In Nevada, a producer or examining physician who knowingly and willfully makes a false statement on an application for insurance may be guilty of:
Answer: C
Explanation:
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 .
NEW QUESTION # 126
An applicant submits the first premium with a life insurance application and receives a conditional receipt.
When does coverage generally become effective?
Answer: B
Explanation:
A conditional receipt may provide temporary coverage from the application date or medical-examination date, but only if the conditions stated in the receipt are satisfied. A common condition is that the insurer, applying its normal underwriting standards, would have issued the policy to the applicant as applied for or at the requested rating. The receipt does not guarantee coverage for every applicant merely because the first premium was submitted.
The exact effect of a conditional receipt depends on its language. Some receipts use an "approval" approach, under which coverage begins only when the insurer approves the application. Others use an "insurability" approach, under which coverage may relate back to an earlier date if the applicant was insurable under the insurer's standards. A producer must not describe a conditional receipt as an unconditional binder or promise that the policy has been issued.
The producer should collect and transmit premium funds according to insurer instructions, deliver the receipt, explain its limited nature, and avoid making coverage representations outside the receipt's terms. If the insurer declines the application, the premium is ordinarily returned according to the applicable procedure.
Proper explanation is especially important because applicants may assume that payment alone creates permanent insurance.
References/topics from the Study Guide: Conditional Receipt; Premium with Application; Temporary Insurance; Underwriting Approval; Policy Delivery.
NEW QUESTION # 127
Which of the following is NOT a preventive benefit for adults?
Answer: A
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 # 128
Under a Disability policy, the Elimination period is:
Answer: D
Explanation:
The elimination period is the waiting period that must pass after disability begins before disability income benefits become payable. Choice C is correct because it performs a function similar to a deductible, but it is measured in time rather than dollars. For example, a policy may require an insured to remain disabled for 30,
60, 90, or 180 days before benefits begin. The insured bears the financial impact of the disability during that initial period, just as an insured bears a deductible before medical expense benefits apply. A longer elimination period generally reduces the policy premium because the insurer begins payments later and may avoid paying shorter-duration claims. The elimination period is not necessarily longer for accidents than sickness; many policies use the same waiting period for both. It is selected under the policy terms, rather than being an undefined period solely controlled by the insurer. It is also not the same as a probationary period, which is a period at the beginning of a policy during which sickness losses may be excluded. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Elimination Period.
NEW QUESTION # 129
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