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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Mandatory policy clauses and provisions
- Medicare
- Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Long Term Care |
| Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Marketing Practices
- Insurance Commissioner
|
| Accident & Health – General Knowledge | 50% | - Other Insurance Concepts
|
| Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Advertising - Credit life and health insurance - Group life and health insurance
|
>> Insurance Licensing InsNV_Health02유효한 시험덤프 <<
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질문 # 81
Which of the following organizations is the BEST example of a mutual insurance company?
정답：C
설명：
A mutual insurance company is an incorporated insurer without capital stock that is owned by its policyholders. Its governing body is elected by policyholders rather than by outside shareholders. Therefore, option B is the best description of a mutual insurer.
A stock insurer, described in option A, has capital divided into shares and is owned by stockholders.
Stockholders elect the board of directors and may receive dividends based on corporate profitability.
Policyholders of a stock insurer are customers, not owners, unless they separately own stock in the company.
Options C and D describe characteristics associated with a reciprocal insurer or interinsurance exchange. A reciprocal is an unincorporated aggregation of subscribers who insure one another through an attorney-in-fact.
Subscribers are both insureds and insurers of one another in that arrangement.
The mutual-company structure matters because policyholders may participate in governance and may receive policyholder dividends when declared. Those dividends are not guaranteed and are different from investment dividends paid to stockholders of a stock insurer.
Study Guide references/topics: insurer ownership; mutual insurers; stock insurers; reciprocal insurers; Nevada domestic insurer law .
질문 # 82
All insurance companies and producers who sell Group Life or Accident and Health policies in Nevada MUST:
정답：B
설명：
Group insurance is generally issued through a master policy. The policyholder-often an employer, association, trustee, or creditor-receives the master contract. Individual insured members do not receive a separate master policy; instead, they receive certificates describing the coverage, benefits, limitations, and applicable rights.
Nevada requires companies, resident agents, and nonresident agents or brokers conducting group life or group accident and health business to provide for delivery of the required individual certificates to the policyholder.
They must also use their best efforts to ensure that the policyholder distributes the certificates to covered debtors, members, or employees. Accordingly, option B correctly states the required delivery process.
Option C is incorrect because each group member is not entitled to receive the full group policy. Option A adds a receipt requirement that is not the applicable rule. Option D is also incorrect because the regulation does not require notice to the Commissioner each time certificates are issued.
This requirement ensures that insured individuals receive understandable evidence of their group coverage even though the policyholder owns the master policy. Certificates are central to informing members of benefits, exclusions, and conversion rights.
Study Guide references/topics: group life insurance; group accident and health insurance; certificates of coverage; NAC 687B.405 .
질문 # 83
Which underwriting duty is most directly performed by a producer during a life insurance application interview?
정답：B
설명：
A producer performs field underwriting by gathering complete and accurate application information, explaining questions to the applicant without coaching answers, observing relevant facts, and submitting the application promptly to the insurer. Relevant observations may include obvious health conditions, the applicant's demeanor, financial circumstances, hazardous occupation or avocation information, and whether answers appear complete and consistent. The producer must report material information obtained in the course of the sale rather than deciding independently that an unfavorable fact is unimportant.
The insurer, not the producer, makes the final underwriting decision. The insurer may use the application, medical records, attending-physician statements, inspection reports, prescription-history reports, credit-related information where permitted, and other lawful underwriting tools. Based on that review, the insurer may issue the policy as applied for, issue it with a rating or modification, postpone it, or decline it.
A producer must never alter an applicant's answers, conceal material information, or sign an application for an applicant without authority. Accurate field underwriting protects the applicant, insurer, producer, and beneficiaries by reducing the risk of misrepresentation, rescission, claim disputes, or regulatory action. The producer's role is factual collection and proper submission-not final risk selection.
References/topics from the Study Guide: Field Underwriting; Application Completion; Producer Responsibilities; Insurer Underwriting; Material Facts.
질문 # 84
Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?
정답：A
설명：
A family is not an eligible blanket-health-insurance group under Nevada law. Blanket accident and health insurance is designed for defined groups connected by a common activity, organization, occupation, event, or exposure to a specified hazard. It is not designed as a substitute for ordinary individual or family health insurance.
Nevada specifically recognizes various groups that may be covered under a blanket policy. These include religious, charitable, recreational, educational, and civic organizations; newspaper publishers covering their carriers; and volunteer fire departments or similar emergency organizations covering members or participants.
The organization acts as the policyholder, and the covered persons are defined by their relationship to the group activity or specified hazard.
A church is eligible as a religious organization. A newspaper corporation may qualify when covering its carriers. A volunteer fire department is specifically listed as an eligible organization. A family, however, is a private household relationship rather than a qualifying blanket group formed around an authorized organizational purpose or activity.
Study Guide references/topics: blanket accident and health insurance; eligible groups; policyholder; specified hazards; NRS 689B.070 .
질문 # 85
The maximum cost share for preventive screening from an in-network provider is:
정답：D
설명：
The maximum cost share for a covered preventive screening received from an in-network provider is 0%. In practical terms, the insured generally pays no deductible, copayment, or coinsurance for qualifying preventive services delivered in-network. This rule is intended to encourage early detection of illness and promote preventive care before conditions become more serious and costly.
Examples of qualifying preventive care can include certain screenings, immunizations, counseling, and wellness services. The precise covered service and frequency may depend on age, sex, medical circumstances, and the applicable preventive-service recommendations. The in-network condition is important because services received outside the plan's network may be subject to different cost-sharing rules, except where other law or plan provisions apply.
The choices of 10%, 20%, and 30% reflect ordinary coinsurance levels that may apply to nonpreventive treatment or to services that do not qualify for first-dollar preventive coverage. They do not apply to an eligible preventive screening under the in-network preventive-care rule.
Always distinguish preventive screening from diagnostic care. A screening is generally performed when no symptom or suspected condition is being evaluated; a diagnostic service may generate cost sharing depending on the circumstances and plan terms.
Study Guide references/topics: preventive services; in-network providers; deductibles; copayments; coinsurance; HealthCare.gov preventive-care guidance .
질문 # 86
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