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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Long Term Care - Mandatory policy clauses and provisions
- Hospice care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse |
| Topic 2: Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Advertising - Group life and health insurance
|
| Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Insurance Commissioner
- Definitions
|
| Topic 4: Accident & Health – General Knowledge | 50% | - Social Insurance
|
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42. Frage
An insurance company MUST take which of the following actions to terminate a producer ' s appointment?
Antwort: A
Begründung:
When an insurer terminates the appointment, employment, or other relationship of a producer, it must notify the Nevada Insurance Commissioner. The notice must be made in the form prescribed by the Commissioner within 30 days after the effective date of termination.
An appointment is the insurer's authorization for a licensed producer to act as its agent. Ending an appointment does not automatically cancel the producer's underlying license. A producer may remain properly licensed and may be appointed by another insurer or operate as a broker when permitted by law.
Therefore, option B is incorrect.
The insurer must provide the required notice to the Commissioner; it is not required to obtain a hearing before ending the appointment. The producer is sent a copy of the insurer's notification after the Commissioner is notified, but the statute does not require the insurer to provide 30 days' advance notice to the producer. The producer has an opportunity to file written comments concerning the report with the Commissioner.
The reporting rule supports regulatory oversight and helps the Division identify whether a termination involved conduct that may warrant disciplinary action.
Study Guide references/topics: producer appointments; appointment termination; insurer reporting duties; NRS 683A.331 .
43. Frage
Which of the following policies provides a specified income benefit when the insured person becomes unable to work because of illness or accident?
Antwort: D
Begründung:
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.
44. Frage
In a variable annuity, who bears the investment risk associated with the separate-account investment performance?
Antwort: C
Begründung:
In a variable annuity, the contract owner bears the investment risk because contract values are tied to the performance of selected investment options held in a separate account. If those investments perform well, the accumulation value may increase. If they decline, the account value may decrease. The insurer does not guarantee a fixed return on the separate-account portion of the contract, although the contract may include certain insurance guarantees, such as a death-benefit feature or optional living benefits.
This is the central distinction between fixed and variable annuities. A fixed annuity generally credits interest at a guaranteed minimum rate and may declare additional interest under the contract terms. The insurer bears the investment risk for its general account. A variable annuity offers market-based investment choices and transfers market risk to the owner. Because variable annuity values are securities-linked, the producer must also satisfy applicable securities-registration and licensing requirements in addition to life insurance authority.
The suitability analysis is important. Variable annuities may be appropriate for a consumer seeking long-term growth potential who understands market volatility and has an appropriate time horizon. They are not automatically appropriate for a person who requires principal stability, liquidity, or predictable fixed returns.
References/topics from the Study Guide: Fixed Annuities; Variable Annuities; Separate Accounts; General Accounts; Investment Risk; Suitability.
45. Frage
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:
Antwort: A
Begründung:
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.
46. Frage
Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?
Antwort: D
Begründung:
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 .
47. Frage
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