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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Definitions
- Marketing Practices
|
| Accident & Health – General Knowledge | 50% | - Types of Policies
|
| Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Hospice care - Medicare
- Long Term Care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Mandatory policy clauses and provisions
|
| Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Advertising - Credit life and health insurance - Group life and health insurance
|
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NEW QUESTION # 60
An applicant submits the first premium with a life insurance application and receives a conditional receipt.
When does coverage generally become effective?
Answer: C
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 # 61
If coverage has stayed in force with the same insurance company, what is the maximum number of years for which reconstructive surgery (mastectomy) benefits must be provided?
Answer: A
Explanation:
If reconstructive surgery is begun within three years after a mastectomy, the amount of benefits for that surgery must equal the amount provided by the policy at the time of the mastectomy. Therefore, the tested maximum period is three years.
Nevada requires a policy that covers mastectomy to provide commensurate coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to create symmetry, prostheses, and treatment of physical complications of all stages of mastectomy, including lymphedema. The attending physician and patient determine the appropriate care.
The three-year rule protects an insured from losing the original level of reconstruction benefits merely because reconstruction is delayed. If surgery begins more than three years after the mastectomy, benefits are governed by the policy terms, conditions, and exclusions in effect at the time reconstructive surgery begins.
This question does not ask how long all reconstruction coverage disappears. It tests the period during which the policy must preserve the benefit amount available at the time of mastectomy.
Study Guide references/topics: mastectomy coverage; reconstructive surgery; breast reconstruction; mandated health benefits; NRS 689B.0375 .
NEW QUESTION # 62
A whole life policyowner stops paying premiums and chooses to use the policy's cash value to purchase the same face amount of insurance for as long as that cash value will buy. Which nonforfeiture option was selected?
Answer: D
Explanation:
Extended term insurance uses the policy's accumulated cash value to purchase term insurance for the original face amount. Because the cash value is limited, the coverage lasts only for a stated period. During that period, the death benefit remains equal to the original policy's face amount, but no additional cash value normally accumulates. When the extended term period ends, coverage terminates unless another policy provision applies.
Reduced paid-up insurance works differently. It uses the cash value to purchase a smaller amount of permanent, paid-up life insurance. The face amount is reduced, but the coverage continues for the insured's lifetime without further premium payments. Cash surrender ends the policy and pays the available cash value to the owner, less any indebtedness and applicable charges. An automatic premium loan provision uses available cash value to pay overdue premiums temporarily, thereby attempting to prevent lapse.
Nonforfeiture options are designed to preserve some policy value when a cash-value life policy is discontinued. They are not typically available in pure term insurance because term policies ordinarily do not accumulate cash value. The correct option depends on whether the owner values the original death benefit for a limited period or a smaller death benefit permanently.
References/topics from the Study Guide: Nonforfeiture Options; Extended Term Insurance; Reduced Paid-Up Insurance; Cash Surrender; Automatic Premium Loan.
NEW QUESTION # 63
R, a self-employed stockbroker, becomes totally disabled on January 1 and receives $1,500 a month for the next twelve months from her own Individual Disability Income policy, for which she had paid the premium.
How much of this income is subject to federal income tax?
Answer: D
Explanation:
The correct answer is D, $0. Disability income benefits generally are not taxable to the insured when the insured personally paid the premiums with after-tax dollars. R paid the premium for her own individual disability income policy, so the $1,500 monthly benefit is excluded from federal taxable income. The total annual benefit is $18,000, but the fact that it totals $18,000 does not make it taxable. Tax treatment changes when an employer pays the premium and does not include that premium amount in the employee's taxable income; in that case, disability benefits are generally taxable. Similarly, benefits can be taxable when premiums were paid through certain pre-tax arrangements. The central exam rule is: personally paid, after-tax disability premiums normally produce income-tax-free disability benefits. The Internal Revenue Service confirms that benefits from an accident or health policy are not taxable when the taxpayer paid the premiums.
See IRS Publication 525 . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Tax Treatment of Disability Benefits.
NEW QUESTION # 64
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.
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NEW QUESTION # 65
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