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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health — General Knowledge | ~68% | - Policy Provisions, Clauses & Riders
|
| Nevada Statutes, Rules and Regulations | ~32% | - Nevada Health-Specific Regulations
|
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NEW QUESTION # 89
A life insurance policy owner has paid $1,200 in premiums in six months for a $250,000 policy. The policyowner dies suddenly and the insurer pays the beneficiary $250,000. This exchange of unequal values reflects which of the following insurance contract features?
Answer: A
Explanation:
An insurance contract is aleatory because the values exchanged by the parties may be unequal and depend on an uncertain event. Choice A is correct. In this example, the policyowner paid only $1,200 in premiums before death, while the insurer paid a $250,000 death benefit. The insurer's obligation was much greater than the premium amount received because the insured event occurred early in the policy period. If death had not occurred for many years, the total premiums paid could have been much closer to or greater than the eventual benefit value. That uncertainty is the defining aleatory feature. A personal contract is based on the insured's individual characteristics and insurable interest. A unilateral contract means only the insurer makes a legally enforceable promise to perform after the applicant accepts the contract and pays premium. A conditional contract requires stated conditions, such as premium payment and proof of loss, to be met before performance is due. None of those terms focuses on the unequal exchange demonstrated here. Study Guide References
/Topics: Policy Provisions, Clauses, and Riders; Insurance Contract Characteristics; Aleatory Contracts.
NEW QUESTION # 90
In a cross-purchase buy-sell agreement funded by life insurance, who typically owns the policy on each business owner?
Answer: C
Explanation:
In a cross-purchase buy-sell agreement, each business owner purchases, owns, and is beneficiary of life insurance on the other owner or owners. If one owner dies, the surviving owner receives the policy proceeds and uses them to purchase the deceased owner's business interest from the estate or designated successor. The arrangement provides liquidity and a predetermined method for transferring ownership, helping the business continue without forcing a sale of assets or requiring the surviving owner to obtain financing at a difficult time.
An entity-purchase agreement differs because the business itself owns policies on each owner and uses the proceeds to redeem the deceased owner's interest. The number of policies can be an important distinction.
With two owners, a cross-purchase arrangement usually requires two policies. With several owners, each may need policies on all other owners, which can become administratively complex.
The agreement should be drafted and reviewed by qualified legal and tax professionals. The insurance policy alone does not create the buy-sell obligation; the written agreement establishes the purchase terms, valuation method, triggering events, and funding mechanism. The producer's role is to help identify appropriate funding, not to draft legal agreements.
References/topics from the Study Guide: Buy-Sell Agreements; Cross-Purchase Plans; Entity-Purchase Plans; Business Continuation; Life Insurance Funding.
NEW QUESTION # 91
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:
Answer: B
Explanation:
For insured women age 40 or older, Nevada requires group health insurance coverage for an annual mammogram to screen for breast cancer. The required benefit must be available through an in-network provider, and the insurer generally may not impose a deductible, copayment, coinsurance, or another form of cost sharing for that mandated screening.
Mammography is preventive screening. It is intended to detect breast cancer early, often before symptoms appear. This differs from diagnostic imaging, which may be ordered after an abnormal screening result, a finding on examination, or another clinical concern. Nevada law also addresses medically necessary imaging and diagnostic testing when the insured's provider recommends them based on medical history, family history, risk factors, or an observed abnormality.
A family history of breast cancer does not eliminate coverage; instead, it may support the need for additional screening or imaging. The benefit is not restricted only to plans that voluntarily choose to offer mammography. It is a required coverage provision for applicable group health policies.
Study Guide references/topics: preventive care; breast-cancer screening; mandated benefits; deductibles and coinsurance; NRS 689B.0374 .
NEW QUESTION # 92
Under a Medicare Supplement policy that is issued in response to a direct solicitation, a policyowner may return the policy to the insurance company for a full premium refund within a MAXIMUM of how many days?
Answer: C
Explanation:
A Medicare Supplement policy issued in response to direct solicitation may be returned for a full premium refund within 30 days. This is commonly called a free-look or right-to-return period. It gives the policyowner time to examine the policy after delivery and decide whether the coverage is suitable.
Direct solicitation presents a heightened consumer-protection concern because the purchaser may not have received the same personal explanation and comparison assistance available in a face-to-face sale. The 30-day period allows the consumer to review benefits, exclusions, premiums, Medicare coordination, replacement implications, and suitability without financial penalty.
The policyowner should return the policy within the required period and follow the insurer's return instructions. Once timely returned, the insurer must refund the premium in accordance with the applicable rule. The free-look right does not mean that every policy can be cancelled at any time for a complete refund; it is a specific statutory or regulatory rescission period following delivery.
Ten, 45, and 60 days are common distractors because various insurance rules use different deadlines. For Medicare Supplement direct-solicitation policies, the tested maximum period is 30 days.
Study Guide references/topics: Medicare Supplement insurance; direct solicitation; free-look period; consumer protections; Nevada Medicare Supplement regulations .
NEW QUESTION # 93
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:
Answer: D
Explanation:
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.
NEW QUESTION # 94
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