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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health — General Knowledge | ~68% | - Types of Health Insurance Policies
|
| Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
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NEW QUESTION # 110
A person insured under a policy of Long Term Care insurance issued pursuant to a direct response solicitation has how many days after delivery to return the policy for a full refund?
Answer: B
Explanation:
A long-term care insurance policy may be returned within 30 days after delivery for a full premium refund if the applicant is dissatisfied for any reason. This is known as a free-look or right-to-return provision. It gives the insured time to examine the contract after delivery and determine whether the coverage is appropriate.
The right is especially important in a direct-response sale, where the consumer may not have met face-to-face with a producer. Long-term care policies can contain detailed provisions concerning benefit triggers, elimination periods, activities of daily living, cognitive impairment, benefit periods, inflation protection, exclusions, premium changes, and nonforfeiture benefits. The 30-day review period allows a buyer to examine those terms without forfeiting premium.
The policy must prominently disclose the right to return the contract and receive a refund. The insurer must make the refund within the required period after the policy is returned. This rule differs from other health- insurance free-look, cancellation, grace-period, and reinstatement provisions, which can use different deadlines.
Study Guide references/topics: long-term care insurance; direct response solicitation; free-look provision; return of policy; NAC 687B.060 .
NEW QUESTION # 111
Which premium-payment mode usually results in the lowest total annual premium cost for the policyowner?
Answer: D
Explanation:
Annual premium payment generally produces the lowest total cost over the policy year because the insurer receives the full annual premium at the beginning of the coverage period. Monthly, quarterly, and semiannual payment modes are convenient for budgeting, but they commonly include an additional charge or produce a higher total annual premium. The difference reflects the insurer's additional administrative expense and the fact that the insurer receives portions of the premium later.
Premium mode does not change the policy's face amount, underwriting classification, or contractual benefits.
It changes only the schedule and total cost of paying the premium. A producer should present all available modes clearly and explain the actual amount due under each option. A consumer with predictable annual cash flow may prefer annual mode to reduce total cost, while a consumer who needs more frequent payments may choose a higher-cost mode to preserve affordability and avoid lapse.
This issue is distinct from the grace period. The grace period protects the policyowner after a premium due date by allowing a limited time to make payment before coverage lapses. Premium mode establishes how frequently the regular premium is due; it does not eliminate the policyowner's obligation to pay.
References/topics from the Study Guide: Premium Payment; Premium Modes; Grace Period; Policy Lapse; Life Insurance Contract Provisions.
NEW QUESTION # 112
According to Nevada law, an authorized insurer is BEST defined as:
Answer: A
Explanation:
An authorized insurer is an insurer that holds a certificate of authority issued by the Nevada Insurance Commissioner and remains authorized to transact insurance in the state. The certificate of authority is the formal approval allowing the insurer to conduct the kinds of insurance business for which it has been approved.
Having sufficient assets may be one consideration in an insurer's application and ongoing financial regulation, but assets alone do not make an insurer authorized. The National Association of Insurance Commissioners develops model laws, standards, and regulatory resources; it does not issue Nevada certificates of authority. The Governor of Nevada likewise does not issue insurance certificates of authority.
This distinction is central to Nevada insurance regulation. Authorized, or admitted, insurers are subject to Nevada's ongoing solvency oversight, market-conduct regulation, rate and form requirements where applicable, examinations, and other statutory obligations. Nonadmitted insurers may be used only through the surplus-lines process or another applicable statutory exception.
A producer must understand whether an insurer is authorized before placing ordinary insurance business.
Selling or placing insurance with an unauthorized insurer outside a lawful exception can create serious regulatory consequences.
Study Guide references/topics: authorized insurers; admitted insurers; certificates of authority; insurer regulation; NRS 680A.020 .
NEW QUESTION # 113
A group health policy that covers hospital expenses MUST also cover:
Answer: A
Explanation:
A group health policy that provides hospital-expense coverage must also provide coverage for routine physical examinations. Routine examinations are preventive services intended to identify health concerns early, promote wellness, and reduce the risk that a medical condition will progress before treatment begins.
Burial expenses are not health-insurance benefits. They are ordinarily addressed through life insurance, final- expense coverage, or other arrangements. Elective cosmetic surgery is generally excluded unless it is medically necessary, reconstructive, or otherwise required by the policy or applicable law. Travel expenses for caretakers are likewise not a standard mandatory group health benefit.
The key point is that group health coverage is not confined to hospitalization after illness or injury occurs.
Required provisions can include preventive and health-maintenance benefits. Routine physical examinations allow the insured to receive medical assessment before a condition requires hospital confinement or major treatment.
The exact scope of a routine examination, frequency limitations, network requirements, and whether additional diagnostic services are covered may depend on the policy and applicable preventive-care rules. But among the choices, routine physical examinations are the mandated benefit associated with hospital-expense group coverage.
Study Guide references/topics: group health required provisions; hospital expense coverage; preventive care; routine physical examinations; Nevada group-health policy requirements .
NEW QUESTION # 114
Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?
Answer: D
Explanation:
A newborn is automatically covered under the applicable Nevada health-policy rule for 31 days after birth.
Coverage begins from the moment of birth and includes necessary care and treatment for injury or sickness, including medically diagnosed congenital defects and birth abnormalities.
To continue coverage beyond the initial 31-day period, the policy may require timely notice of the birth and payment of any additional premium or fee required by the insurer. The notification and payment requirement must be satisfied within the 31-day period if the policy requires it. This rule protects newborns during the immediate post-birth period, when medical care may be urgently necessary.
The automatic coverage is not limited to routine newborn care. It includes necessary treatment of medical conditions identified at birth, subject to the policy's applicable limits. The law also prevents the policy from excluding premature births under the mandated newborn coverage.
Two, five, and ten days are incorrect because they would not provide the statutory protection required for newborn coverage. The exam point is that the initial automatic period is 31 days, while continuation beyond that period may require prompt enrollment action by the insured.
Study Guide references/topics: individual health insurance; newborn coverage; congenital defects; notification requirements; Nevada newborn-coverage requirements .
NEW QUESTION # 115
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