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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
| Accident and Health — General Knowledge | ~68% | - Social Insurance / Government Plans
|
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NEW QUESTION # 103
Which feature most clearly distinguishes a health maintenance organization (HMO) from a traditional indemnity health insurance plan?
Answer: D
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 # 104
An insurer shall not issue an individual long-term care insurance contract in Nevada unless the insurer has received from the applicant:
Answer: D
Explanation:
Nevada requires an individual long-term care insurer to obtain a written designation of at least one additional person who will receive notice if coverage is about to lapse or terminate for nonpayment of premium. This protection is intended to reduce unintended lapses, particularly when an insured experiences cognitive decline, illness, disability, or another circumstance that interferes with managing premiums.
The applicant may instead submit a written waiver, dated and signed, stating that the applicant chooses not to designate another person. The waiver is not required to be notarized. Because option B incorrectly adds a notarization requirement, option A is the best answer as written.
The designated person does not become responsible for paying premiums and does not assume liability for the applicant's care. The person's role is simply to receive notice, allowing the person an opportunity to alert the insured or help address an overlooked payment. Payroll or pension deduction is not a required payment method.
Before an individual long-term care policy can lapse for nonpayment, notice requirements apply to both the policyholder and the designated person. This is a key long-term-care consumer-protection provision.
Study Guide references/topics: long-term care insurance; lapse protection; nonpayment of premium; designation of another person; NAC 687B.0681 .
NEW QUESTION # 105
In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:
Answer: C
Explanation:
A person may not concurrently hold a Nevada producer license and an Exchange Enrollment Facilitator certificate. Therefore, a health insurance producer who wishes to become an EEF must surrender the producer authority and apply for certification as an Exchange Enrollment Facilitator.
An EEF assists consumers with enrollment in qualified health plans offered through the Exchange. The role is designed to provide objective enrollment help, application assistance, and general information. An EEF may not sell, solicit, or negotiate insurance. The EEF also may not receive consideration from a health insurance issuer or insurer in connection with enrollment and may not receive remuneration arising from EEF activities from a licensed producer, insurance consultant, surplus lines broker, or insurer.
For that reason, a producer cannot receive commissions while acting as an EEF, cannot collect both commission and EEF compensation in the manner described, and cannot steer a consumer toward a particular coverage choice. Producers and EEFs have different legal roles, compensation structures, and consumer- protection limitations.
Study Guide references/topics: Exchange Enrollment Facilitators; producer licensing; prohibited acts; compensation; NRS 695J.210 .
NEW QUESTION # 106
What is the minimum age requirement for a natural person applying for a resident Nevada producer license?
Answer: D
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 # 107
For an individual health insurance policy, which document is generally part of the entire contract when a copy is attached to or endorsed on the policy?
Answer: B
Explanation:
The application is generally part of the entire contract only when a copy is attached to or endorsed on the policy. The entire-contract provision identifies the documents that form the binding agreement between the insurer and the insured. In an individual health policy, the policy itself and the attached application are the principal contract documents. Material statements made in the application are treated according to the policy and governing law, but outside papers, advertisements, and verbal discussions ordinarily do not become policy terms merely because they were used in the sales process.
This rule protects both parties. The insured can review the documents that govern coverage, while the insurer can rely on the written application it used for underwriting. A producer's notes, informal assurances, or advertising language cannot expand benefits, remove exclusions, or alter policy conditions unless formally incorporated into the contract. Producers must avoid statements that conflict with the issued policy and should deliver the policy promptly so the applicant can examine it during any applicable free-look period.
Nevada's individual health-insurance law requires specified policy provisions and permits approved substitutions only when they are not less favorable to the insured or beneficiary. The exact wording and placement of the application therefore matter.
References/topics from the Study Guide: Entire Contract; Application; Policy Delivery; Individual Health Policy Provisions; NRS 689A.040.
NEW QUESTION # 108
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