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| Section | Objectives |
|---|---|
| Topic 1: Accident and Health Insurance Fundamentals | - Types of Health Insurance Policies
|
| Topic 2: Government Health Insurance Programs | - Medicare
|
| Topic 3: Health Insurance Policy Provisions | - Claims and Benefits
|
| Topic 4: General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
| Topic 5: Producer Duties and Ethics | - Ethical Responsibilities
|
| Topic 6: Insurance Basics | - Insurance Contracts
|
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NEW QUESTION # 121
An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for:
Answer: B
Explanation:
The correct answer is D. Underwriting for an individual disability income policy focuses on facts that affect the proposed insured's probability of disability, ability to work, existing income protection, and potential for overinsurance. Marital status and occupation may be relevant to financial and occupational underwriting.
Medical history is directly relevant because past and current health conditions can affect eligibility, exclusions, ratings, or benefit limitations. Other disability policies already in force are important because insurers must evaluate the total amount of disability benefits relative to earned income and avoid excessive coverage. The spouse's occupation ordinarily does not determine the proposed insured's disability risk or benefit eligibility and is therefore the least relevant item. Insurers also may request information about income, employer, job duties, hazardous activities, tobacco use, prior claims, and other sources of disability income.
The producer must obtain complete and accurate answers from the applicant, explain questions when necessary, and avoid making assumptions or completing answers without the applicant's direction. Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Disability Income Underwriting; Application Information.
NEW QUESTION # 122
A life policy has been in force during the insured's lifetime for more than two years. Which circumstance may still permit the insurer to deny a claim under the policy's incontestability provision?
Answer: C
Explanation:
The incontestability provision limits the insurer's ability to contest the validity of a life insurance policy after it has been in force during the insured's lifetime for the stated period, which Nevada law permits to be no longer than two years from issue. Once that period has passed, an insurer ordinarily cannot avoid the policy because of misstatements in the application, except as provided by the policy and law. The rule promotes certainty for beneficiaries and prevents an insurer from indefinitely reopening underwriting issues after accepting premiums for years.
Nonpayment of premiums remains an exception. Incontestability does not require an insurer to pay a claim on a policy that lapsed because required premiums were not paid. A policy can also contain provisions concerning total and permanent disability benefits or additional accidental-death benefits that are treated separately under the applicable statutory rule. In addition, an incontestability clause concerns contesting the policy's validity; it does not automatically override every policy exclusion or restriction on coverage.
The producer should distinguish contestability from the grace period, reinstatement, and exclusions. Each provision serves a different function. For test purposes, the durable rule is that incontestability does not eliminate the insurer's defense of nonpayment of premium.
References/topics from the Study Guide: Incontestability Clause; Premium Payment; Policy Lapse; NRS
688A.080.
NEW QUESTION # 123
What is the primary purpose of a waiver-of-premium rider on a life insurance policy?
Answer: B
Explanation:
A waiver-of-premium rider keeps qualifying life insurance coverage in force by waiving required premiums when the insured becomes totally disabled as defined in the rider. The rider protects against the risk that disability will interrupt income and make premium payments unaffordable. Once the rider's requirements are satisfied, the insurer pays or waives the premium according to the policy terms, allowing the coverage and any applicable cash-value features to continue.
The definition of total disability, the waiting period, the age limitation, proof-of-disability requirements, and the duration of the waiver are contractual matters. The rider does not usually mean that premiums are waived for every illness, injury, or temporary work interruption. The insured must meet the stated definition and provide required evidence. Some riders also require that disability begin before a specified age.
This rider should not be confused with disability-income insurance. Disability income pays a periodic benefit to replace a portion of income. Waiver of premium does not provide an income payment; it protects the life policy from lapse due to qualifying disability. It also differs from a payor-benefit rider, which is commonly used with juvenile policies and protects the policy when the premium-paying adult dies or becomes disabled.
References/topics from the Study Guide: Waiver of Premium Rider; Total Disability; Disability Income; Payor Benefit Rider; Policy Continuation.
NEW QUESTION # 124
Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?
Answer: D
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 # 125
Which of the following statements is CORRECT about the Medicaid program?
Answer: D
Explanation:
Medicaid is a means-tested public medical assistance program for eligible low-income individuals and families. Eligibility may include persons who are blind, disabled, aged, pregnant, children, or otherwise within an eligible category under federal and state rules. Therefore, choice A is correct. There is no universal minimum age of 55 for Medicaid eligibility; eligibility is based principally on financial and categorical requirements. Medicaid is also not simply a program supplemented by Medicare at age 62. Medicare eligibility is generally associated with age 65 or qualifying disability or disease status, while Medicaid may assist certain eligible persons with limited income and resources, including some Medicare beneficiaries.
Medicaid is jointly financed by federal and state governments but is administered by the states within federal standards. In Nevada, the state administers the program through its designated health and human-services structure. Examination questions commonly test the distinction between Medicare as social insurance and Medicaid as needs-based medical assistance. Study Guide References/Topics: Social Insurance Programs; Medicaid; Federal-State Health Programs.
NEW QUESTION # 126
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