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| Section | Objectives |
|---|---|
| Topic 1: Government Health Insurance Programs | - Medicaid and Other Programs
|
| Topic 2: General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
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| Topic 3: Health Insurance Policy Provisions | - Claims and Benefits
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| Topic 4: Insurance Basics | - Risk Management and Insurance Concepts
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| Topic 5: Accident and Health Insurance Fundamentals | - Disability Income Insurance
|
| Topic 6: Producer Duties and Ethics | - Sales Practices
|
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NEW QUESTION # 103
Which of the following organizations is the BEST example of a mutual insurance company?
Answer: A
Explanation:
A mutual insurance company is an incorporated insurer without capital stock that is owned by its policyholders. Its governing body is elected by policyholders rather than by outside shareholders. Therefore, option B is the best description of a mutual insurer.
A stock insurer, described in option A, has capital divided into shares and is owned by stockholders.
Stockholders elect the board of directors and may receive dividends based on corporate profitability.
Policyholders of a stock insurer are customers, not owners, unless they separately own stock in the company.
Options C and D describe characteristics associated with a reciprocal insurer or interinsurance exchange. A reciprocal is an unincorporated aggregation of subscribers who insure one another through an attorney-in-fact.
Subscribers are both insureds and insurers of one another in that arrangement.
The mutual-company structure matters because policyholders may participate in governance and may receive policyholder dividends when declared. Those dividends are not guaranteed and are different from investment dividends paid to stockholders of a stock insurer.
Study Guide references/topics: insurer ownership; mutual insurers; stock insurers; reciprocal insurers; Nevada domestic insurer law .
NEW QUESTION # 104
Group vision insurance plans typically provide insurance benefits that cover the cost of:
Answer: D
Explanation:
Group vision coverage is an ancillary group health benefit designed primarily for routine vision care and corrective eyewear. Its usual covered services include periodic eye examinations, lenses, frames, and-in plans that provide the option-contact lenses. The key distinction is between routine vision expenses and medical or surgical eye treatment. Choice C contains the customary routine vision benefits and is therefore correct. Laser refractive surgery is commonly elective and is not a standard core group vision benefit. Cataract removal and retinal corrective surgery are medical or surgical procedures ordinarily addressed through medical expense coverage, subject to that policy's provisions, rather than through a routine vision plan.
Vision plans often apply a stated allowance, benefit schedule, copayment, provider-network requirement, or frequency limit to exams, frames, lenses, and contacts. The insured should therefore recognize that the plan does not provide unlimited eye-care coverage; it covers specified routine corrective services under the contract's schedule of benefits. Study Guide References/Topics: Group Health Insurance; Types of Health Insurance Policies; Limited-Coverage Health Plans.
NEW QUESTION # 105
Which of the following statements is CORRECT about Medicare?
Answer: B
Explanation:
Medicare is a federal social insurance program that provides hospital and medical expense coverage to eligible persons. Therefore, choice B is correct. Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services.
Medicare Part B primarily covers physician services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Choice A describes Medicaid, which is a needs-based medical assistance program jointly administered by federal and state governments. Choice C is incorrect because Medicare also serves people age 65 or older and individuals with qualifying end-stage renal disease or ALS; it is not limited to totally disabled persons. Choice D is incorrect because physician bills are generally associated with Part B, not Part A. Medicare beneficiaries may also choose Medicare Advantage plans, which provide Medicare-covered benefits through private plans, and may obtain prescription drug coverage under Part D. Study Guide References/Topics: Social Insurance Programs; Medicare Parts A and B; Federal Health Programs.
NEW QUESTION # 106
A policyowner names two children as beneficiaries "per stirpes." If one child dies before the insured but leaves children, how are that deceased child's share and the surviving child's share handled?
Answer: B
Explanation:
A per stirpes beneficiary designation means "by the branch" or "by the bloodline." If a named beneficiary dies before the insured, that beneficiary's descendants take the deceased beneficiary's share. In this question, the deceased child's children receive the share that would have gone to their parent, while the surviving child receives that child's own share. This preserves each family branch's intended portion of the life insurance proceeds.
A per capita designation works differently. Under a per capita arrangement, surviving members of a named class generally share equally, and a deceased beneficiary's descendants do not automatically take the deceased beneficiary's share unless the designation or policy language provides otherwise. The precise result always depends on the policy designation, applicable law, and any contingent- beneficiary provisions.
Beneficiary designations should be reviewed after divorce, marriage, birth, death, adoption, or other major changes. A producer should not provide legal advice about estate planning, but should encourage the policyowner to obtain professional legal guidance when the designation involves trusts, minors, estates, complex family arrangements, or special-needs planning.
The test point is straightforward: per stirpes preserves the deceased beneficiary's branch; per capita distributes among the surviving members of the class.
References/topics from the Study Guide: Beneficiary Designations; Per Stirpes; Per Capita; Primary and Contingent Beneficiaries; Estate Planning Basics.
NEW QUESTION # 107
Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member:
Answer: D
Explanation:
The correct answer is D. A guaranteed renewable provision protects an insured against termination based solely on health deterioration or disability, provided the premium is paid and the insured continues to meet the policy's stated conditions. Therefore, the insurer may not terminate coverage merely because the member becomes disabled. The insurer may, however, terminate or end coverage when a member no longer meets an eligibility requirement, such as leaving the eligible occupational classification, ceasing active employment, or reaching a policy-specified terminating age. Those conditions concern the member's contractual eligibility for the group coverage rather than the member's health status. Guaranteed renewable does not necessarily mean that premiums can never change. The insurer may generally change premiums on a class basis, but it cannot single out one insured for an individual premium increase or cancellation because that person became ill or disabled. This concept should be distinguished from noncancellable coverage, which provides stronger protection by preventing the insurer from changing either premiums or benefits during the stated period.
Study Guide References/Topics: Group Health Insurance; Renewability Provisions; Guaranteed Renewable Coverage.
NEW QUESTION # 108
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