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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
| Accident and Health — General Knowledge | ~68% | - Insurance Concepts and Underwriting
|
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NEW QUESTION # 47
Which of the following statements is correct about the Coordination of Benefits provision?
Answer: D
Explanation:
Coordination of Benefits, commonly called COB, applies when an insured is covered by more than one health plan. It establishes the order in which plans pay and limits the combined payment so the insured does not receive more than the amount of the covered expense. Choice B is correct because COB prevents a profit from duplicate health coverage while still allowing the insured to receive the benefits to which the insured is entitled. One plan is identified as primary and pays first under its policy terms. The secondary plan then considers the unpaid covered balance, subject to its own coordination provisions and limits. COB does not prohibit a person from owning more than one health policy, does not guarantee uninterrupted benefits when changing insurers, and does not authorize a general delay of a workers' compensation claim until benefits expire. Workers' compensation coordination depends on the applicable policy and governing law. On the examination, distinguish COB from nonduplication of benefits and from other insurance clauses; COB specifically allocates payment responsibility among multiple health plans. Study Guide References/Topics:
Group Health Insurance; Coordination of Benefits; Other Insurance Provisions.
NEW QUESTION # 48
Under an Accidental Death and Dismemberment policy, in which of the following circumstances will an autopsy NOT be performed?
Answer: D
Explanation:
The correct answer is B. An AD & D policy may give the insurer the right to conduct an autopsy when death occurs, provided the autopsy is not prohibited by law. The autopsy provision helps the insurer determine whether the cause of death falls within the policy's accidental-death coverage and whether an exclusion applies. A beneficiary's refusal does not necessarily defeat the insurer's contractual right if applicable law permits the examination. The fact that death resulted from illness rather than an accident may affect whether an AD & D benefit is payable, but it does not itself state the legal restriction on performing an autopsy.
Likewise, an accidental cause of death is precisely the type of circumstance in which the insurer may need medical evidence to verify coverage. The insurer's right is not unlimited: it must comply with legal requirements, including restrictions imposed by statute, court order, or other controlling authority. The exam rule is straightforward: the insurer may conduct an autopsy at its own expense unless doing so is prohibited by law. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Accidental Death and Dismemberment; Autopsy Provision.
NEW QUESTION # 49
A producer offers a prospective life insurance applicant a gift card that is not stated in the policy as an inducement to purchase coverage. Which prohibited practice is most directly implicated?
Answer: C
Explanation:
Rebating occurs when a producer or insurer offers, gives, or allows an inducement not specified in the policy to persuade a person to purchase insurance. A gift card offered solely because the applicant buys a life or health policy is a classic example of a potentially prohibited rebate. Nevada trade-practice law restricts rebates and other improper inducements because they can create unfair competition, mislead consumers, and distort insurance pricing.
The prohibition does not mean that every item of nominal value, educational material, or lawful consumer program is automatically illegal. The legality of a benefit depends on the statute, regulations, insurer programs, value, purpose, and whether it is tied improperly to the sale. Producers should follow current Nevada rules and insurer compliance guidance before offering anything of value in connection with a sale.
Coinsurance is a health-policy cost-sharing method. Subrogation is an insurer's right to recover from a responsible third party after paying a loss. Assignment transfers some or all policy rights from one party to another. None of those terms describes an improper sales inducement.
A producer should avoid promising gifts, refunds, premium reductions, or extra benefits unless specifically authorized and properly disclosed under applicable law and policy provisions.
References/topics from the Study Guide: Unfair Trade Practices; Rebating; Inducements; Producer Ethics; NRS 686A.110.
NEW QUESTION # 50
A group health insurance policy MUST include coverage for which of the following expenses?
Answer: C
Explanation:
A group health insurance policy in Nevada must include coverage for expenses arising from hospice care.
Hospice care is intended for patients with terminal illness and emphasizes comfort, pain control, symptom management, supportive services, and assistance for the patient and family rather than curative treatment.
Nevada's group-policy required-provisions statute specifically identifies benefits for expenses arising from hospice care. This makes hospice the correct answer. Adult dental and adult vision benefits may be offered by separate policies, riders, employer plans, or benefit arrangements, but they are not universally required in every group health policy. Over-the-counter dietary supplements are not a standard mandated group health benefit and are generally covered only when specifically provided by a policy or health plan.
Hospice coverage should be distinguished from ordinary inpatient hospital coverage. Hospice care may be delivered in a home, residential setting, hospice facility, or other appropriate location, depending on the patient's needs and the terms of coverage. It frequently involves an interdisciplinary team and includes both patient care and family-support services.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; supportive services; NRS 689B.030 .
NEW QUESTION # 51
Which of the following information is included in the Consideration clause in an Accident and Health policy?
Answer: D
Explanation:
The consideration clause identifies the exchange of value that creates the insurance contract. The insurer's consideration is its promise to provide the stated coverage and pay covered claims. The applicant's consideration consists of the application statements and payment of the required premium. Therefore, choice D is correct because the policy identifies the schedule and amount of premium payments as part of that contractual consideration. The coverage description is found in the insuring clause and benefit provisions.
Contestability is addressed in the time-limit or incontestability provisions. The grace period is stated in a separate mandatory policy provision dealing with late premium payments and continuation of coverage. The consideration clause is important because it establishes that insurance is a reciprocal exchange: the insurer assumes risk in return for the applicant's premium and representations. If the premium is not paid as required, the policy can lapse after the grace period unless another provision applies. The clause also connects the policy and attached application as part of the entire contract, subject to applicable individual accident and health insurance requirements. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Consideration Clause; Entire Contract.
NEW QUESTION # 52
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