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| Section | Weight | Objectives |
|---|---|---|
| Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Marketing Practices
- Licensing
|
| Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Mandatory policy clauses and provisions
- Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Long Term Care - Medicare
|
| Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Group life and health insurance
|
| Accident & Health – General Knowledge | 50% | - Field Underwriting Procedures
|
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NEW QUESTION # 26
One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:
Answer: D
Explanation:
A licensed producer may recommend a health plan for a consumer because the producer is authorized to sell, solicit, and negotiate insurance. That authority permits the producer to discuss coverage choices in a personalized manner, explain how plan provisions apply to the consumer's situation, and recommend a particular policy or plan when appropriate.
An Exchange Enrollment Facilitator is certified to help consumers enroll in qualified health plans through the Exchange. The EEF role is designed to provide impartial enrollment assistance, application support, and general program information. However, an EEF may not sell, solicit, or negotiate insurance. That restriction prevents an EEF from functioning as an insurance producer or steering a consumer toward a particular carrier or plan.
Explaining general terminology, such as deductibles, copayments, and eligibility rules, can be part of enrollment assistance and is not the defining distinction. Compensation is also not the key answer because the legal distinction turns on insurance authority, not simply whether a person receives payment. A Nevada EEF also may not concurrently hold a producer license.
Study Guide references/topics: Exchange Enrollment Facilitators; producer authority; solicitation and negotiation; NRS Chapter 695J .
NEW QUESTION # 27
Which policy is designed to pay benefits upon diagnosis or treatment of a specifically named illness, such as cancer?
Answer: C
Explanation:
Specified disease insurance provides limited benefits for a condition or group of conditions specifically named in the policy, such as cancer, heart disease, or stroke. The benefits may be paid as reimbursement for certain covered expenses, as fixed cash amounts for treatment events, or through a schedule of benefits. The scope of coverage is controlled by the policy and is substantially narrower than comprehensive major medical insurance.
A producer must not represent specified disease coverage as complete health insurance. It may help with deductibles, travel, household costs, experimental-treatment expenses not covered elsewhere, or income disruption, but it is not a substitute for comprehensive coverage that addresses a broad range of illnesses and injuries. The client should understand covered conditions, waiting periods, recurrence provisions, preexisting- condition limitations where permitted, benefit schedules, exclusions, and whether the policy pays in addition to other coverage.
Major medical insurance is intended to cover a broad spectrum of medically necessary expenses. Credit disability insurance is connected to repayment of a debt if the debtor becomes disabled. Group term life insurance pays a death benefit and does not provide medical-expense coverage. The examination point is to identify the limited, condition-specific purpose of specified disease insurance.
References/topics from the Study Guide: Specified Disease Insurance; Cancer Insurance; Critical Illness Coverage; Limited-Benefit Health Insurance; Major Medical.
NEW QUESTION # 28
The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured ' s age on the policy application?
Answer: C
Explanation:
A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.
NEW QUESTION # 29
For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?
Answer: B
Explanation:
Choice B is correct because accidental loss of eyesight is a standard covered dismemberment loss under most AD & D policies. These policies pay benefits for accidental death and for specifically listed losses, often including loss of life, both hands, both feet, one h and and one foot, sight in one or both eyes, hearing, speech, or specified paralysis. The loss must result directly from accidental bodily injury and occur within the policy's required loss period. Death from a heart attack is generally illness-related rather than accidental. Loss of the spleen, even when caused by an accident, is not usually one of the specifically scheduled losses in a basic AD
& D policy. Partial paralysis due to a stroke is caused by illness rather than accidental injury. AD & D policies are limited-benefit contracts, so the policy does not pay merely because an injury is serious; the loss must match the policy's defined covered loss. The benefit amount varies according to the loss, with full principal sums often payable for death or loss of both eyes and smaller percentages for certain partial losses.
Study Guide References/Topics: Types of Health Insurance Policies; Accidental Death and Dismemberment; Covered Losses.
NEW QUESTION # 30
An applicant unintentionally gives an incorrect answer about a material health condition on a life insurance application. This is best described as:
Answer: C
Explanation:
An application statement is generally a representation rather than a warranty. A representation is a statement believed to be true to the best of the applicant's knowledge and belief. If a representation is false and material to the insurer's underwriting decision, it may create a basis for the insurer to investigate, contest, rescind, or adjust the policy according to applicable law and the policy's contestability provision. Materiality means the information would have influenced the insurer's decision to issue the policy, set the premium, determine the rating class, or limit coverage.
A warranty is a statement or promise that must be literally true or strictly complied with. Life and health insurance applications are not ordinarily treated as a collection of warranties because that result would be excessively harsh for innocent or immaterial errors. Nevada life insurance law states that, absent fraud, statements in an attached application are deemed representations rather than warranties.
Intent matters in distinguishing an innocent mistake from intentional fraud, but an unintentional error can still be material. Producers should read each question clearly, ensure the applicant understands it, record answers accurately, and allow the applicant to review the completed application before signing. The producer should never suggest that a medical condition, medication, or prior treatment can be omitted.
References/topics from the Study Guide: Representations and Warranties; Material Misrepresentation; Application Statements; Fraud; NRS 688A.070.
NEW QUESTION # 31
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