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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health — General Knowledge | ~68% | - Insurance Concepts and Underwriting
|
| Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
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NEW QUESTION # 58
A doctor who is receiving Disability Income benefits is not able to return to work full-time but continues practicing on a part-time basis. Which of the following policy features would allow the doctor to continue receiving benefits?
Answer: A
Explanation:
The correct answer is A. A residual benefit clause permits an insured who has returned to work on a limited basis, but still suffers a loss of income because of disability, to receive partial disability benefits. The doctor is able to practice part-time but cannot resume full-time work, so the disability continues to cause an earnings loss. Residual benefits are intended to encourage rehabilitation and return to productive work without forcing the insured to lose all benefits immediately. The benefit amount is usually tied to the percentage of income lost compared with pre-disability earnings, subject to policy requirements. A contingent benefit clause and concurrent benefit clause are not the standard disability-income provisions that address partial return to work.
A guaranteed insurability rider permits future increases in coverage without proof of insurability; it does not pay benefits for a continuing partial disability. Residual disability should be distinguished from total disability, which generally requires inability to perform the duties defined in the policy. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Residual Disability Benefits.
NEW QUESTION # 59
Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?
Answer: B
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 # 60
Which of the following characteristics is typical of group insurance?
Answer: C
Explanation:
Choice C is correct. Group insurance is designed to cover members of an eligible class, commonly all full- time employees of an employer, subject to the plan's participation, waiting-period, and eligibility rules. The employer or policyholder receives the master contract, while individual employees receive certificates of coverage describing their benefits. Therefore, choice B is incorrect because employees ordinarily do not receive separate individual policies. Medical examinations are generally not required for eligible employees during an initial enrollment period, especially when coverage is guaranteed issue. Choice A is therefore not a typical group-insurance feature. Enrollment is also not automatically available at any time. Employees normally enroll when first eligible or during an open enrollment period; late entrants may face evidence-of- insurability requirements or other conditions. Group insurance spreads risk across a defined group and is typically less individually underwritten than individual insurance. The key requirement is that the group be formed for a purpose other than obtaining insurance and that coverage be offered according to objective eligibility standards. Study Guide References/Topics: Group Health Insurance; Group Eligibility; Master Contract and Certificate of Coverage.
NEW QUESTION # 61
Which of the following policies provides a specified income benefit when the insured person becomes unable to work because of illness or accident?
Answer: C
Explanation:
Disability Income insurance is designed to replace a portion of an insured's earned income when illness or accidental injury prevents the insured from working. Choice D is correct. Unlike medical expense insurance, which pays for covered health-care costs, disability income coverage pays a stated periodic benefit- commonly monthly-to help the insured meet ordinary financial obligations during disability. Benefits are subject to the policy definition of disability, elimination period, benefit period, maximum monthly benefit, and any offsets or residual-disability provisions. "Emergency Income," "Supplemental Income," and
"Temporary Income" are not standard policy classifications that describe the core income-replacement product tested here. Disability policies may be written on an own-occupation, modified-own-occupation, or any-occupation basis, and that definition materially affects when benefits are payable. Individual disability income is commonly purchased by self-employed persons, professionals, and others who want income protection beyond employer-sponsored benefits. Group disability plans often provide short-term and long- term benefits, while individual policies can offer more customized benefit levels, riders, and noncancellable or guaranteed-renewable features. Study Guide References/Topics: Types of Health Insurance Policies; Disability Income Insurance; Income Replacement.
NEW QUESTION # 62
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 # 63
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