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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 # 113
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:
Answer: B
Explanation:
The correct answer is C, Proof of Loss. Proof of loss is the written documentation supplied to the insurer to establish that a covered loss occurred and to provide the facts needed to evaluate the claim. It may include claim forms, medical records, bills, physician statements, dates of treatment, disability information, and other evidence required under the policy. Notice of claim is different: it simply informs the insurer that a loss has occurred or that a claim may be made. After receiving notice, the insurer ordinarily provides claim forms or instructions. A loss form may be one document used in the proof-of-loss process, but it is not the complete legal concept. An inspection report may be used by an insurer in some lines of insurance but is not the insured' s required statement establishing a health or disability claim. Timely proof of loss is important because it triggers the insurer's claim-review duties and helps determine when payment is due. Policy provisions specify the timing and form of proof required. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Notice of Claim; Proof of Loss; Claim Procedures.
NEW QUESTION # 114
An insured has a $1,000 deductible and then pays 20% of covered medical expenses, while the insurer pays
80%. What is the insured's 20% share called?
Answer: B
Explanation:
Coinsurance is the percentage of covered expenses that the insured shares with the insurer after the deductible has been satisfied. In this question, the insured pays 20% and the insurer pays 80%; this is commonly described as 80/20 coinsurance. The deductible is separate. It is the amount the insured must pay before the insurer begins sharing covered expenses, subject to any services that the policy covers before the deductible.
A copayment is a fixed dollar amount paid for a covered service, such as a stated amount for a physician visit or prescription. It is not normally expressed as a percentage. An elimination period is a waiting period in disability-income insurance before benefits begin. A stop-loss feature, also called an out-of-pocket maximum in many plans, limits the insured's covered cost sharing after a stated maximum has been reached, subject to plan rules.
Understanding these terms is essential when comparing health plans. A plan may have a lower premium but a higher deductible, greater coinsurance, or a larger out-of-pocket maximum. Producers must clearly explain the consumer's potential financial responsibility and must not imply that the insurer pays every medical expense once a policy is issued.
References/topics from the Study Guide: Major Medical Insurance; Deductibles; Coinsurance; Copayments; Out-of-Pocket Maximums.
NEW QUESTION # 115
A producer aggrieved by any regulation or order of the Insurance Commissioner may request:
Answer: A
Explanation:
A producer who is aggrieved by a regulation or order of the Nevada Insurance Commissioner may request an administrative hearing. Nevada law requires the Commissioner to hold a hearing upon a proper written application from a person aggrieved by an act, failure to act, report, rule, regulation, or order related to the business of insurance, subject to statutory timing and procedural requirements.
The request is a due-process mechanism. It gives the affected producer an opportunity to state the grounds for relief, present evidence, challenge the factual or legal basis of the regulatory action, and create an administrative record. The application must generally be filed with the Division within 60 days after the person knew or reasonably should have known of the action, unless another law establishes a different period.
The Secretary of State does not provide the administrative remedy described in this question. Legislative review and peer review are not the standard appeal mechanisms for an individual Commissioner action.
Judicial review may become available after the administrative process, but the immediate remedy tested here is the request for an administrative hearing.
Study Guide references/topics: Commissioner authority; hearings; producer rights; administrative due process; NRS 679B.310 .
NEW QUESTION # 116
A client needs a $250,000 death benefit for exactly 20 years to protect a home mortgage. The client wants the lowest practical initial premium and does not need cash-value accumulation. Which policy is most appropriate?
Answer: D
Explanation:
Level term life insurance is the appropriate recommendation because it provides a stated death benefit for a stated period, such as 20 years. It is designed for temporary protection where the financial need has a known end date-for example, the remaining duration of a mortgage, a child's dependency period, or a short-to- medium-term income-replacement need. The premium is generally level for the selected term period, while the death benefit remains level if the policy stays in force.
Whole life insurance provides permanent protection and cash-value accumulation, but its premium is ordinarily higher because the insurer expects coverage to continue for the insured's lifetime. Universal life offers flexible premiums and adjustable death-benefit structures, but it is not the simplest match when the client's purpose is fixed, time-limited mortgage protection. Variable life has investment risk because policy values depend on separate-account performance and is not selected merely to obtain low-cost temporary coverage.
The producer should confirm that the term period aligns with the mortgage obligation and explain that coverage normally ends at the term's expiration unless the policy is renewed, converted, or otherwise continued under its provisions.
References/topics from the Study Guide: Types of Life Insurance; Term Life Insurance; Needs Analysis; Mortgage Protection.
NEW QUESTION # 117
The Fair Credit Reporting Act requires that:
Answer: D
Explanation:
The Fair Credit Reporting Act governs the collection, use, and disclosure of consumer-report information.
Choice B is correct because an insurance applicant must receive appropriate notice when an insurer may obtain a consumer report or investigative consumer report in connection with underwriting. Consumer reports can contain information relevant to an insurer's evaluation of risk, including credit-related information and other data permitted by law. The notice requirement promotes transparency and gives applicants the opportunity to understand that reporting information may be used in the underwriting process. The remaining choices concern different legal issues. Interest on premium loans is governed by policy and insurance-law rules, not the FCRA. Unfair discrimination is addressed through insurance regulation and unfair-trade-practice standards. Interest for late claim payments is governed by applicable claims-handling requirements, not the FCRA. The FCRA permits insurance companies to obtain consumer reports only for a permissible purpose and imposes duties regarding notices and adverse actions when report information is used. See the Consumer Financial Protection Bureau's FCRA guidance . Study Guide References/Topics: Nevada Insurance Regulation and Licensing; Consumer Reports; Fair Credit Reporting Act.
NEW QUESTION # 118
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