InsNV_Health02 Exam Dumps - Insurance Licensing Nevada Insurance Questions and Answers

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.

===============

The Nevada Life and Health Insurance Guaranty Association becomes involved when a covered member insurer becomes impaired or insolvent. Its statutory purpose is to provide limited protection to eligible policyowners, certificate holders, enrollees, beneficiaries, and other covered persons when a member insurer cannot perform its contractual obligations because of financial failure.

An ordinary lawsuit, claim denial, or membership withdrawal does not by itself trigger Guaranty Association protection. Claim disputes are normally handled through the insurer’s claims process, internal appeals, administrative complaint procedures, or litigation. The Guaranty Association is not a general claims-review agency.

When a member insurer is impaired or insolvent, the Association may guarantee, assume, reissue, or reinsure covered policies and contracts, or provide other support necessary to meet covered obligations. Coverage is subject to statutory limits, eligibility requirements, exclusions, and residency rules. It does not protect every type of policy or every amount of loss.

Insurers must not use the Association as a sales inducement. Consumers should evaluate an insurer’s financial strength and coverage terms rather than assume that all benefits are fully guaranteed.

Study Guide references/topics: insurer insolvency; impaired insurer; Guaranty Association; member insurers; NRS Chapter 686C .

===============

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.

===============

The correct answer is B. An AD & D policy may give the insurer the right to conduct an autopsy when death occurs, provided the autopsy is not prohibited by law. The autopsy provision helps the insurer determine whether the cause of death falls within the policy’s accidental-death coverage and whether an exclusion applies. A beneficiary’s refusal does not necessarily defeat the insurer’s contractual right if applicable law permits the examination. The fact that death resulted from illness rather than an accident may affect whether an AD & D benefit is payable, but it does not itself state the legal restriction on performing an autopsy. Likewise, an accidental cause of death is precisely the type of circumstance in which the insurer may need medical evidence to verify coverage. The insurer’s right is not unlimited: it must comply with legal requirements, including restrictions imposed by statute, court order, or other controlling authority. The exam rule is straightforward: the insurer may conduct an autopsy at its own expense unless doing so is prohibited by law. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Accidental Death and Dismemberment; Autopsy Provision.

===============

A newborn is automatically covered under the applicable Nevada health-policy rule for 31 days after birth. Coverage begins from the moment of birth and includes necessary care and treatment for injury or sickness, including medically diagnosed congenital defects and birth abnormalities.

To continue coverage beyond the initial 31-day period, the policy may require timely notice of the birth and payment of any additional premium or fee required by the insurer. The notification and payment requirement must be satisfied within the 31-day period if the policy requires it. This rule protects newborns during the immediate post-birth period, when medical care may be urgently necessary.

The automatic coverage is not limited to routine newborn care. It includes necessary treatment of medical conditions identified at birth, subject to the policy’s applicable limits. The law also prevents the policy from excluding premature births under the mandated newborn coverage.

Two, five, and ten days are incorrect because they would not provide the statutory protection required for newborn coverage. The exam point is that the initial automatic period is 31 days, while continuation beyond that period may require prompt enrollment action by the insured.

Study Guide references/topics: individual health insurance; newborn coverage; congenital defects; notification requirements; Nevada newborn-coverage requirements .

===============

When the Nevada Insurance Commissioner has reason to believe that a person has violated the Insurance Code or another law applicable to insurance operations and criminal prosecution appears appropriate, the Commissioner must provide the relevant information to the appropriate district attorney or to the Attorney General. Of the choices given, District Attorney is the correct answer.

The Commissioner administers and enforces Nevada insurance laws, investigates potential violations, conducts examinations, and may impose administrative sanctions where authorized. Criminal prosecution, however, is handled by the appropriate prosecutorial authority rather than by the Commissioner personally. This division of responsibility preserves due process and ensures that criminal cases are evaluated and prosecuted by officials with criminal-law authority.

The Secretary of State, Lieutenant Governor, and State Police may have governmental roles that occasionally relate to business records, executive functions, or investigations, but they are not the statutory prosecutorial recipients identified in Nevada’s insurance law. The examination point is that an insurance violation can produce both administrative consequences, such as a fine or license action, and criminal referral when the conduct warrants prosecution.

Study Guide references/topics: powers and duties of the Commissioner; insurance-code enforcement; criminal violations; NRS 679B.150 .

===============

A creditor may accept an assignment from an existing policy as security for a loan. When consumer credit insurance is required as additional security for debt, Nevada law allows the debtor to furnish the required insurance through existing policies owned or controlled by the debtor, or through any insurer authorized to transact insurance in Nevada.

A creditor may not require the borrower to purchase insurance from a particular insurer. That would improperly limit the borrower’s freedom of choice. The creditor also may not require coverage in an amount greater than the debt being secured. Credit insurance is intended to protect the creditor against the unpaid obligation, not to create excess insurance for the creditor’s benefit.

Similarly, a creditor may not impose a higher interest rate merely because the borrower declines to purchase credit insurance. Credit insurance must not be represented as a mandatory condition of loan approval when it is optional.

Assignment allows the borrower’s existing coverage to be used as collateral or security without forcing the borrower to buy duplicative insurance. The creditor may require proof that the existing insurance is adequate for the risk and debt involved.

Study Guide references/topics: credit insurance; creditor-debtor relationship; assignment; consumer protections; NRS 690A.140 .

===============

Universal life insurance is a flexible-premium permanent life insurance policy. It generally provides a cash-value account, interest crediting, mortality charges, expense charges, and flexible premium-payment options within policy limits. The owner may often adjust the amount and timing of premiums and may have death-benefit options, subject to minimum funding requirements, underwriting rules for increases, and the policy’s terms. The flexibility does not mean the owner can stop paying indefinitely without consequence. If cash value is insufficient to cover monthly deductions and charges, the policy can lapse.

Universal life differs from traditional whole life, which typically has fixed premiums, a guaranteed cash-value schedule, and a fixed death benefit. It also differs from variable life, in which cash value and death benefit are linked to separate-account investments and market performance. Universal life typically uses the insurer’s general account for interest crediting, although variable universal life is a separate product combining flexibility with separate-account investment risk.

A producer must explain that illustrated values are not guaranteed unless identified as such. Policyowners should receive in-force illustrations and review funding adequacy periodically, particularly after taking loans, withdrawals, or reducing premium payments.

References/topics from the Study Guide: Universal Life Insurance; Flexible Premiums; Adjustable Death Benefit; Cash Value; Policy Lapse Risk.

===============

A producer, examining physician, applicant, or other person who knowingly and willfully makes a false or fraudulent statement or representation in, or in reference to, an insurance application may be guilty of fraud. Nevada law expressly prohibits this conduct because insurance underwriting depends on truthful and complete information concerning the proposed insured and the risk.

Fraud requires knowing and willful conduct. An innocent clerical error or an inadvertent misunderstanding may require correction, but the exam question describes intentional falsification. Examples can include knowingly misstating medical history, concealing material treatment, falsifying income information in a disability application, or knowingly submitting an untrue medical statement.

Twisting is an improper sales practice involving inducing a policyowner to replace coverage through misleading comparisons or representations. Misrepresentation is a broader term that may describe false statements in insurance transactions, but the statute specifically identifies false or fraudulent application statements as insurance fraud. Coercion involves forcing or improperly pressuring a person to act and is not the conduct described here.

A producer must ensure that application answers are accurately recorded, should not alter answers without authorization, and should promptly correct discovered inaccuracies before policy issuance.

Study Guide references/topics: insurance fraud; applications; producer ethics; prohibited trade practices; NRS 686A.290 .

===============

Group insurance is generally issued through a master policy. The policyholder—often an employer, association, trustee, or creditor—receives the master contract. Individual insured members do not receive a separate master policy; instead, they receive certificates describing the coverage, benefits, limitations, and applicable rights.

Nevada requires companies, resident agents, and nonresident agents or brokers conducting group life or group accident and health business to provide for delivery of the required individual certificates to the policyholder. They must also use their best efforts to ensure that the policyholder distributes the certificates to covered debtors, members, or employees. Accordingly, option B correctly states the required delivery process.

Option C is incorrect because each group member is not entitled to receive the full group policy. Option A adds a receipt requirement that is not the applicable rule. Option D is also incorrect because the regulation does not require notice to the Commissioner each time certificates are issued.

This requirement ensures that insured individuals receive understandable evidence of their group coverage even though the policyholder owns the master policy. Certificates are central to informing members of benefits, exclusions, and conversion rights.

Study Guide references/topics: group life insurance; group accident and health insurance; certificates of coverage; NAC 687B.405 .

===============