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| Section | Objectives |
|---|---|
| Insurance Basics | - Insurance Contracts
|
| Producer Duties and Ethics | - Ethical Responsibilities
|
| General Insurance Regulation | - Nevada Insurance Department and Regulatory Authority
|
| Health Insurance Policy Provisions | - Claims and Benefits
|
| Accident and Health Insurance Fundamentals | - Disability Income Insurance
|
| Government Health Insurance Programs | - Medicaid and Other Programs
|
>> InsNV_Health02 Valid Study Notes <<
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NEW QUESTION # 112
An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for:
Answer: C
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 # 113
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:
Answer: C
Explanation:
The policy remains in force during its contractual grace period after a premium becomes due. For individual accident and health policies, the required grace period generally depends on premium mode: seven days for weekly premiums, ten days for monthly premiums, and 31 days for other premium modes. A claim occurring within the applicable grace period is not automatically denied simply because the premium has not yet been paid. Instead, the insurer may pay the covered claim and deduct the overdue premium from the amount otherwise payable. Therefore, choice B is the best answer. Reinstatement is unnecessary because the policy has not yet lapsed while the grace period is still running. Cancellation and return of all prior premiums would be inconsistent with the purpose of the grace-period provision. The question tests the difference between a late premium during grace and a lapsed policy after grace expires. Once grace expires without payment, coverage can lapse; if coverage later is reinstated, loss coverage may be subject to reinstatement provisions and limitations. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.
NEW QUESTION # 114
J and K are married and have several children. J is the primary beneficiary on K ' s Accidental Death and Dismemberment (AD & D) policy, and K ' s sibling, L, is the contingent beneficiary. J, K, and L are involved in a train accident, and K and L are killed instantly. The Accidental Death benefits will be paid to:
Answer: A
Explanation:
The correct answer is D, J only. A primary beneficiary has the first right to receive policy proceeds. J is named as K's primary beneficiary and survives the accident. Therefore, the AD & D benefit is paid directly to
J. The contingent beneficiary, L, would receive the proceeds only if the primary beneficiary had died before K or could not receive the benefit under the policy terms. Because J remains alive, L's death does not change the payment outcome. The proceeds do not pass to K's estate because a living named primary beneficiary exists.
They also do not pass to L's estate, because L never became entitled to the benefit; the contingency never occurred. Beneficiary designations control over general assumptions about family relationships or estates. The insured should keep beneficiary designations current after changes in family status, death, divorce, or estate- planning decisions. A simultaneous-death provision can alter outcomes if the beneficiary and insured die in the same event and survivorship cannot be determined, but the facts here identify K and L as deceased while J survives. Study Guide References/Topics: Group Health Insurance; Accidental Death and Dismemberment; Beneficiary Designations.
NEW QUESTION # 115
Which underwriting duty is most directly performed by a producer during a life insurance application interview?
Answer: B
Explanation:
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.
NEW QUESTION # 116
An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:
Answer: C
Explanation:
The Change of Occupation provision allows an insurer to adjust benefits when the insured changes to a more hazardous occupation after policy issue. Choice A is correct. If the same premium would have purchased a lower benefit amount for the new, more hazardous occupati on, the insurer may reduce the benefit to the amount that premium would have bought under the new occupational classification. The purpose is to preserve fairness between the risk assumed and the premium paid without automatically cancelling the policy.
The insurer does not simply increase the waiting period or deductible, because those are not the contractual adjustment method addressed by the provision. It also does not deny every claim for misrepresentation, because a later change in occupation is not necessarily a misrepresentation in the original application. If the insured changes to a less hazardous occupation, the provision may allow the insured to apply for an adjusted premium rate or greater benefit as appropriate under policy terms. The key examination rule is that occupational changes affect the amount of benefits or premium classification, not the basic validity of coverage. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Change of Occupation Provision; Individual Accident and Health Policies.
NEW QUESTION # 117
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