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| Section | Objectives |
|---|---|
| Accident and Health Insurance Fundamentals | - Types of Health Insurance Policies
|
| General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
| Government Health Insurance Programs | - Medicare
|
| Health Insurance Policy Provisions | - Claims and Benefits
|
| Insurance Basics | - Insurance Contracts
|
| Producer Duties and Ethics | - Sales Practices
|
>> New InsNV_Health02 Exam Objectives <<
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NEW QUESTION # 54
Which of the following statements is generally CORRECT about a major medical policy?
Answer: D
Explanation:
Major medical insurance is designed to provide broad protection against substantial medical expenses. It commonly covers hospital, surgical, physician, diagnostic, and other medically necessary services, subject to deductibles, coinsurance, exclusions, and stated policy limits. Therefore, choice D is correct. A major medical policy is not limited to in-hospital expenses; that description is more characteristic of basic hospital coverage.
It also is generally broader-not more limited-than a basic hospital, medical, or surgical policy. A 30-day elimination period is associated more closely with disability income insurance and does not define major medical coverage. The phrase "reasonable and necessary" is important because it allows the insurer to evaluate whether a service was medically appropriate and whether the charge falls within the policy's payment standard. Major medical policies are comprehensive, but they are not unlimited: coverage remains subject to deductibles, coinsurance, exclusions, maximum benefits, network terms, and utilization requirements. Study Guide References/Topics: Types of Health Insurance Policies; Major Medical Expense Insurance; Medical Expense Coverage.
NEW QUESTION # 55
The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured ' s age on the policy application?
Answer: C
Explanation:
A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.
NEW QUESTION # 56
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 # 57
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: B
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 # 58
What is the minimum age requirement for a natural person applying for a resident Nevada producer license?
Answer: B
Explanation:
A natural person applying for a resident Nevada producer license must be at least 18 years old. Age is only one part of the licensing standard. Before approving a resident producer application, the Commissioner must also find that the applicant has not committed an act that would justify refusal, suspension, or revocation of a license; has paid the applicable fees; and has passed the required examination for the requested line of authority unless an examination exemption applies.
A life and health producer must hold the appropriate line or lines of authority before selling, soliciting, or negotiating those classes of insurance. Nevada separately identifies life insurance and accident-and-health insurance as producer authorities. A producer must also comply with renewal, continuing education, appointment, recordkeeping, and reporting requirements as applicable.
A business organization may also be licensed as a producer, but it must designate a properly licensed natural person who is authorized to transact business on its behalf and is responsible for the organization's compliance with Nevada insurance laws and regulations. Licensing is therefore not merely a test-passing event; it is an ongoing regulatory responsibility.
For examination purposes, remember the basic resident-producer requirements: age 18 or older, proper application, fees, good character and eligibility, and examination success unless exempt.
References/topics from the Study Guide: Nevada Producer Licensing; Resident Producer Requirements; Lines of Authority; License Application; NRS 683A.251.
NEW QUESTION # 59
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