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| Section | Weight | Objectives |
|---|---|---|
| Accident & Health – General Knowledge | 50% | - Social Insurance
|
| Nevada Statutes and Codes Common to Life and Health Insurance Only | 4% | - Credit life and health insurance - Group life and health insurance
|
| Nevada Statutes and Codes Pertinent to Health Insurance Only | 14% | - Hospice care - Mandatory policy clauses and provisions
- Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Coverage for reconstructive surgery |
| Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance | 20% | - Definitions
- Insurance Commissioner
|
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NEW QUESTION # 44
Which of the following policies provides a specified income benefit when the insured person becomes unable to work because of illness or accident?
Answer: B
Explanation:
Disability Income insurance is designed to replace a portion of an insured's earned income when illness or accidental injury prevents the insured from working. Choice D is correct. Unlike medical expense insurance, which pays for covered health-care costs, disability income coverage pays a stated periodic benefit- commonly monthly-to help the insured meet ordinary financial obligations during disability. Benefits are subject to the policy definition of disability, elimination period, benefit period, maximum monthly benefit, and any offsets or residual-disability provisions. "Emergency Income," "Supplemental Income," and
"Temporary Income" are not standard policy classifications that describe the core income-replacement product tested here. Disability policies may be written on an own-occupation, modified-own-occupation, or any-occupation basis, and that definition materially affects when benefits are payable. Individual disability income is commonly purchased by self-employed persons, professionals, and others who want income protection beyond employer-sponsored benefits. Group disability plans often provide short-term and long- term benefits, while individual policies can offer more customized benefit levels, riders, and noncancellable or guaranteed-renewable features. Study Guide References/Topics: Types of Health Insurance Policies; Disability Income Insurance; Income Replacement.
NEW QUESTION # 45
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 # 46
An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?
Answer: D
Explanation:
Nevada group-life law protects an insured person during the conversion interval. If a person covered under a group life policy dies during the period in which the person was entitled to obtain an individual conversion policy-and before that individual policy becomes effective-the amount of life insurance the person could have converted is payable as a claim under the group policy. This protection applies whether or not the person submitted the individual-policy application or paid the first premium before death.
The conversion privilege is important because group coverage is usually tied to employment or membership.
When eligibility ends, the individual may lose the group policy's protection. Conversion gives the former insured an opportunity to obtain individual life insurance without new evidence of insurability, subject to the statute and policy terms. The converted amount may be limited by the group policy and applicable law, and the individual policy's premium is based on the insurer's conversion rates.
This rule should not be confused with portability. Portability allows continuation of group-style coverage under certain conditions, whereas conversion replaces group coverage with an individual policy. The producer should explain notice requirements, the available conversion amount, deadlines, and premium differences whenever group coverage terminates.
References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Termination of Employment; NRS 688B.120-688B.130.
NEW QUESTION # 47
R, a self-employed stockbroker, becomes totally disabled on January 1 and receives $1,500 a month for the next twelve months from her own Individual Disability Income policy, for which she had paid the premium.
How much of this income is subject to federal income tax?
Answer: A
Explanation:
The correct answer is D, $0. Disability income benefits generally are not taxable to the insured when the insured personally paid the premiums with after-tax dollars. R paid the premium for her own individual disability income policy, so the $1,500 monthly benefit is excluded from federal taxable income. The total annual benefit is $18,000, but the fact that it totals $18,000 does not make it taxable. Tax treatment changes when an employer pays the premium and does not include that premium amount in the employee's taxable income; in that case, disability benefits are generally taxable. Similarly, benefits can be taxable when premiums were paid through certain pre-tax arrangements. The central exam rule is: personally paid, after-tax disability premiums normally produce income-tax-free disability benefits. The Internal Revenue Service confirms that benefits from an accident or health policy are not taxable when the taxpayer paid the premiums.
See IRS Publication 525 . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Tax Treatment of Disability Benefits.
NEW QUESTION # 48
A Major Medical policy insured is injured in an auto collision during a police chase. The occupants in the police car are killed. The insured is convicted of reckless driving and manslaughter. If the insured files a claim, the insurance company will MOST likely take which of the following actions?
Answer: C
Explanation:
Major medical coverage pays covered medical expenses resulting from accidental injury or sickness, subject to the policy's stated exclusions and limitations. The facts establish reckless and criminal conduct, but they do not establish an intentional self-inflicted injury or identify a policy exclusion that removes coverage.
Therefore, choice A is the best answer: the insurer will pay the covered benefits according to the policy.
Insurance examination questions require careful separation of criminal conduct from intentional injury.
Reckless driving and a resulting conviction do not automatically mean that the insured intended to injure himself. A health insurer may deny a claim only when a valid policy exclusion, limitation, misrepresentation defense, or other contract basis applies. The insurer does not reduce benefits merely to "partial benefits" because of the conviction, and it does not return all premiums after denying a properly covered accidental- injury claim. The controlling analysis is the policy language, including exclusions for intentional self-inflicted injury, war, occupational losses, or other listed circumstances. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Major Medical Insurance; Exclusions and Limitations.
NEW QUESTION # 49
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