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| Section | Objectives |
|---|---|
| Accident and Health Insurance Fundamentals | - Disability Income Insurance
|
| Government Health Insurance Programs | - Medicaid and Other Programs
|
| General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
| Producer Duties and Ethics | - Sales Practices
|
| Health Insurance Policy Provisions | - Claims and Benefits
|
| Insurance Basics | - Insurance Contracts
|
>> InsNV_Health02 Answers Real Questions <<
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NEW QUESTION # 105
A Nevada producer wants to solicit an individual disability-income policy. Which license authority is required?
Answer: D
Explanation:
A producer soliciting an individual disability-income policy must hold Nevada accident and health insurance authority. Nevada defines this line as insurance for sickness, bodily injury, or accidental death and permits it to include disability-income benefits. Disability-income insurance replaces a portion of earned income when an insured becomes disabled under the policy definition; it is therefore within the accident-and-health line rather than the property, casualty, or personal-lines authorities.
Nevada requires a person to be licensed for the relevant class of insurance before selling, soliciting, or negotiating insurance in the state. The licensing distinction matters because a life authority and an accident- and-health authority are separately identified lines of authority. Although life insurance may include additional disability-income benefits when permitted as part of its statutory definition, a producer selling an individual health or disability-income policy should not assume that life authority alone authorizes the transaction.
The producer must also comply with appointment requirements when acting as an insurer's agent, continuing education and renewal requirements, and all applicable trade-practice rules. Selling without the proper authority can result in administrative discipline and a monetary penalty. On examination questions, identify the coverage being sold first; then match it to the appropriate Nevada line of authority.
References/topics from the Study Guide: Producer Licensing; Lines of Authority; Accident and Health Insurance; Disability Income; NRS 683A.201; NRS 683A.261.
NEW QUESTION # 106
In a cross-purchase buy-sell agreement funded by life insurance, who typically owns the policy on each business owner?
Answer: C
Explanation:
In a cross-purchase buy-sell agreement, each business owner purchases, owns, and is beneficiary of life insurance on the other owner or owners. If one owner dies, the surviving owner receives the policy proceeds and uses them to purchase the deceased owner's business interest from the estate or designated successor. The arrangement provides liquidity and a predetermined method for transferring ownership, helping the business continue without forcing a sale of assets or requiring the surviving owner to obtain financing at a difficult time.
An entity-purchase agreement differs because the business itself owns policies on each owner and uses the proceeds to redeem the deceased owner's interest. The number of policies can be an important distinction.
With two owners, a cross-purchase arrangement usually requires two policies. With several owners, each may need policies on all other owners, which can become administratively complex.
The agreement should be drafted and reviewed by qualified legal and tax professionals. The insurance policy alone does not create the buy-sell obligation; the written agreement establishes the purchase terms, valuation method, triggering events, and funding mechanism. The producer's role is to help identify appropriate funding, not to draft legal agreements.
References/topics from the Study Guide: Buy-Sell Agreements; Cross-Purchase Plans; Entity-Purchase Plans; Business Continuation; Life Insurance Funding.
NEW QUESTION # 107
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 # 108
Which of the following is permitted by a licensee?
Answer: C
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 # 109
The maximum cost share for preventive screening from an in-network provider is:
Answer: D
Explanation:
The maximum cost share for a covered preventive screening received from an in-network provider is 0%. In practical terms, the insured generally pays no deductible, copayment, or coinsurance for qualifying preventive services delivered in-network. This rule is intended to encourage early detection of illness and promote preventive care before conditions become more serious and costly.
Examples of qualifying preventive care can include certain screenings, immunizations, counseling, and wellness services. The precise covered service and frequency may depend on age, sex, medical circumstances, and the applicable preventive-service recommendations. The in-network condition is important because services received outside the plan's network may be subject to different cost-sharing rules, except where other law or plan provisions apply.
The choices of 10%, 20%, and 30% reflect ordinary coinsurance levels that may apply to nonpreventive treatment or to services that do not qualify for first-dollar preventive coverage. They do not apply to an eligible preventive screening under the in-network preventive-care rule.
Always distinguish preventive screening from diagnostic care. A screening is generally performed when no symptom or suspected condition is being evaluated; a diagnostic service may generate cost sharing depending on the circumstances and plan terms.
Study Guide references/topics: preventive services; in-network providers; deductibles; copayments; coinsurance; HealthCare.gov preventive-care guidance .
NEW QUESTION # 110
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