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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health โ General Knowledge | ~68% | - Insurance Concepts and Underwriting
|
| Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
>> InsNV_Health02 Hot Questions <<
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NEW QUESTION # 51
An insured purchases a rider that pays an additional amount only if death results from a covered accident.
This rider is best described as:
Answer: B
Explanation:
An accidental death benefit rider provides an additional death benefit when the insured dies as the direct result of a covered accident. It is often described as "double indemnity" when the additional benefit equals the policy's face amount, although the actual amount and conditions depend on the rider. The rider supplements the base life policy; it does not replace the base death benefit. If the insured dies from a covered accident, the beneficiary may receive the base policy amount plus the rider benefit. If death results from illness or a noncovered cause, only the base policy benefit is generally payable.
Accidental-death riders contain important limitations. They typically require death to occur within a stated time after the accident and may exclude deaths resulting from specified causes, such as war, suicide, certain hazardous activities, intoxication, or illegal acts, depending on the contract. The producer must explain that the benefit is conditional and is not the same as comprehensive life insurance.
A guaranteed-insurability rider permits future coverage increases without new evidence of insurability. A cost- of-living rider increases coverage under specified inflation-related terms. A return-of-premium feature returns qualifying premiums under stated conditions, usually at the end of a term period.
References/topics from the Study Guide: Accidental Death Benefit Rider; Double Indemnity; Exclusions; Supplementary Benefits; Policy Riders.
NEW QUESTION # 52
Which feature most clearly distinguishes a health maintenance organization (HMO) from a traditional indemnity health insurance plan?
Answer: A
Explanation:
An HMO is a managed-care arrangement that commonly delivers and finances health-care services through a defined network of providers. Covered persons typically select or are assigned a primary care provider who coordinates routine care and, depending on the plan design, provides referrals for specialist services. Services received outside the network may be limited or not covered except for emergencies or specifically authorized care.
Traditional indemnity insurance operates differently. It generally reimburses covered medical expenses subject to policy limits, deductibles, coinsurance, and usual-and-customary or other payment standards. The insured may have broader provider choice, but that flexibility is often paired with less managed coordination and potentially greater out-of-pocket exposure. A preferred provider organization, or PPO, also uses a network but typically allows nonnetwork care at reduced benefit levels rather than requiring the same referral structure associated with many HMOs.
The exam distinction is based on delivery of care and network control, not merely on whether a policy has a deductible. Managed-care plans seek to control cost and improve coordination by negotiating with providers and establishing coverage procedures. Nevada recognizes network plans as policies in which financing and delivery of medical care are provided, at least in part, through defined providers under contract with the insurer.
References/topics from the Study Guide: Managed Care; HMO; PPO; Network Plans; NRS 689A-Network Plan Definition.
NEW QUESTION # 53
Which of the following is permitted by a licensee?
Answer: B
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 # 54
Which of the following information is included in the Consideration clause in an Accident and Health policy?
Answer: B
NEW QUESTION # 55
As a condition to granting a loan, a creditor can:
Answer: A
Explanation:
A creditor may accept an assignment from an existing policy as security for a loan. When consumer credit insurance is required as additional security for debt, Nevada law allows the debtor to furnish the required insurance through existing policies owned or controlled by the debtor, or through any insurer authorized to transact insurance in Nevada.
A creditor may not require the borrower to purchase insurance from a particular insurer. That would improperly limit the borrower's freedom of choice. The creditor also may not require coverage in an amount greater than the debt being secured. Credit insurance is intended to protect the creditor against the unpaid obligation, not to create excess insurance for the creditor's benefit.
Similarly, a creditor may not impose a higher interest rate merely because the borrower declines to purchase credit insurance. Credit insurance must not be represented as a mandatory condition of loan approval when it is optional.
Assignment allows the borrower's existing coverage to be used as collateral or security without forcing the borrower to buy duplicative insurance. The creditor may require proof that the existing insurance is adequate for the risk and debt involved.
Study Guide references/topics: credit insurance; creditor-debtor relationship; assignment; consumer protections; NRS 690A.140 .
NEW QUESTION # 56
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