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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
| Topic 2: Accident and Health — General Knowledge | ~68% | - Social Insurance / Government Plans
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>> InsNV_Health02 Valid Exam Objectives <<
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NEW QUESTION # 52
For Social Security disability benefits, which statement is generally correct?
Answer: C
Explanation:
Social Security disability benefits are based on a strict federal definition of disability. In general, the claimant must be unable to engage in substantial gainful activity because of a medically determinable physical or mental impairment that has lasted, or is expected to last, for at least 12 months or is expected to result in death. The program is not designed to insure every short-term illness, temporary injury, or partial loss of earnings.
Eligibility also depends on work history and Social Security credits in many cases. The Social Security Administration evaluates whether the person can perform past work or adjust to other substantial work, considering medical and vocational factors. A waiting period may apply before cash disability benefits begin.
Separate programs, such as Supplemental Security Income, have different eligibility and income-resource rules.
For insurance examination purposes, distinguish Social Security disability from private disability-income insurance. Private coverage is based on the policy definition of disability, elimination period, benefit amount, and benefit period. Social Security disability uses the federal program's statutory standard and administrative determination process. A producer should describe private coverage as a possible supplement to-not a replacement for-government disability benefits.
References/topics from the Study Guide: Social Security Disability; Definitions of Disability; Disability Income Insurance; Government Benefit Coordination.
NEW QUESTION # 53
Under a group health policy, which of the following coverages MUST be provided for newborn children?
Answer: B
Explanation:
Nevada requires qualifying group health policies that cover family members to provide coverage for a newborn child from the moment of birth. Required newborn coverage includes injury or sickness and specifically includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Therefore, congenital health defects are the required coverage identified in this question.
The rule is important because congenital defects may be present at birth and can require immediate diagnostic, surgical, medical, or hospital treatment. Nevada law prevents a policy from excluding this necessary care simply because the condition existed at birth. The statute also prohibits exclusion of premature births under the applicable coverage requirement.
The transportation option is incorrect because the law addresses necessary transportation from the place of birth to the nearest specialized treatment center, within policy limits; it does not mandate transportation from the hospital to the child's residence. Routine eye examinations and genetic testing may be covered under a particular policy or health plan, but they are not the specific newborn mandate tested here. Continued coverage beyond the initial period may depend on timely notice and payment of required premium within 31 days.
Study Guide references/topics: group health insurance; newborn coverage; mandated benefits; NRS 689B.033
.
NEW QUESTION # 54
An insurance company MUST take which of the following actions to terminate a producer ' s appointment?
Answer: A
Explanation:
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 .
NEW QUESTION # 55
The Coinsurance clause in an individual Medical Expense policy refers to the:
Answer: B
Explanation:
Coinsurance is the contractual sharing of covered medical expenses between the insured and the insurer after any applicable deductible has been satisfied. Choice D is correc t. Under a common 80/20 coinsurance arrangement, for example, the insurer pays 80 percent of an eligible expense and the insured pays the remaining 20 percent, up to any out-of-pocket maximum or other plan limitation. Coinsurance reduces premium cost and encourages insureds to consider the cost of care, while preserving significant protection against major expenses. It does not refer to adding family members to a policy, which concerns eligibility or family coverage. It also does not describe insurers sharing risk with each other; that would involve reinsurance or other insurer-to-insurer arrangements. Coinsurance should be distinguished from a deductible, which is a specified dollar amount the insured pays before policy benefits begin. A copayment is instead a fixed dollar amount paid for a covered service. The exact coinsurance percentage, covered-charge definition, network rules, and annual out-of-pocket limit are determined by the policy. Study Guide References/Topics:
Policy Provisions, Clauses, and Riders; Medical Expense Insurance; Deductibles and Coinsurance.
NEW QUESTION # 56
A whole life policyowner stops paying premiums and chooses to use the policy's cash value to purchase the same face amount of insurance for as long as that cash value will buy. Which nonforfeiture option was selected?
Answer: D
Explanation:
Extended term insurance uses the policy's accumulated cash value to purchase term insurance for the original face amount. Because the cash value is limited, the coverage lasts only for a stated period. During that period, the death benefit remains equal to the original policy's face amount, but no additional cash value normally accumulates. When the extended term period ends, coverage terminates unless another policy provision applies.
Reduced paid-up insurance works differently. It uses the cash value to purchase a smaller amount of permanent, paid-up life insurance. The face amount is reduced, but the coverage continues for the insured's lifetime without further premium payments. Cash surrender ends the policy and pays the available cash value to the owner, less any indebtedness and applicable charges. An automatic premium loan provision uses available cash value to pay overdue premiums temporarily, thereby attempting to prevent lapse.
Nonforfeiture options are designed to preserve some policy value when a cash-value life policy is discontinued. They are not typically available in pure term insurance because term policies ordinarily do not accumulate cash value. The correct option depends on whether the owner values the original death benefit for a limited period or a smaller death benefit permanently.
References/topics from the Study Guide: Nonforfeiture Options; Extended Term Insurance; Reduced Paid-Up Insurance; Cash Surrender; Automatic Premium Loan.
NEW QUESTION # 57
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