Free Practice Questions for the Insurance Licensing Nevada Insurance InsNV_Health02 Exam (2026 Updated)

A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada’s statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.

Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.

Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant’s information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.

The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.

Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .

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The correct answer is B, Medicare. A person with end-stage renal disease—permanent kidney failure requiring regular dialysis or a kidney transplant—may qualify for Medicare regardless of age, provided the applicable work or family eligibility requirements are met. The employee’s status as full-time does not prevent Medicare eligibility based on end-stage renal disease. Medicaid is a needs-based program and is not the best answer solely from the fact s given. Workers’ compensation would apply only to a qualifying work-related injury or illness. Social Security Disability benefits can provide income support to qualifying disabled persons, but they are not the medical coverage program identified in the question. Medicare coverage for dialysis-related services is subject to eligibility and enrollment rules, and an employer group health plan may coordinate with Medicare during the ESRD coordination period. Medicare confirms that people with permanent kidney failure requiring regular dialysis or a transplant can qualify for coverage before age 65. See Medicare’s ESRD eligibility guidance . Study Guide References/Topics: Social Insurance Programs; Medicare; End-Stage Renal Disease.

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A consumer’s pre-existing condition does not prevent enrollment in a Qualified Health Plan offered through the Exchange. Marketplace plans must cover treatment for pre-existing medical conditions and cannot reject an applicant, charge a higher premium, or refuse to pay Essential Health Benefits solely because of the applicant’s health history.

The producer should accurately explain that coverage is subject to the plan’s normal terms, provider network, formulary, deductibles, copayments, coinsurance, and out-of-pocket maximum. The prohibition against pre-existing-condition discrimination does not mean the consumer has no out-of-pocket costs. The insured may still have ordinary cost sharing for covered medical services, just as other enrollees do.

Option A is incorrect because Qualified Health Plans do cover pre-existing conditions. Option B is incorrect because a QHP may not impose a surcharge based on health status or medical history. Option C is incorrect because the Affordable Care Act’s protection against discrimination does not eliminate all deductibles, copayments, coinsurance, or other permitted cost sharing.

For exam purposes, remember the core rule: health status cannot be used to deny enrollment in a QHP or set a higher premium based solely on a pre-existing condition.

Study Guide references/topics: Affordable Care Act; Qualified Health Plans; guaranteed issue; pre-existing conditions; HealthCare.gov pre-existing-condition coverage .

Long-term-care insurance commonly uses functional and cognitive triggers to determine benefit eligibility. A typical trigger is certification that the insured cannot perform at least two activities of daily living, or ADLs, without substantial assistance for the required period. Common ADLs include bathing, continence, dressing, eating, toileting, and transferring. Another common trigger is severe cognitive impairment requiring substantial supervision to protect the insured’s health and safety.

Long-term-care coverage is not based merely on reaching a certain age, unemployment, or a premium-payment issue. It is designed to help pay for qualifying long-term services when the insured needs ongoing assistance because of chronic illness, disability, or cognitive impairment. Covered services may include nursing-home care, assisted living, adult day care, home health care, hospice care, and respite care, depending on the policy.

The producer should explain the elimination period, daily or monthly benefit limit, benefit period, inflation-protection options, facility restrictions, and policy exclusions. An insured may need care for years, so a policy with a low daily benefit or short benefit period may not meet the client’s needs. Suitability requires evaluating likely care preferences, assets, family support, and affordability.

References/topics from the Study Guide: Long-Term Care Insurance; Activities of Daily Living; Cognitive Impairment; Benefit Triggers; Elimination Period.

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The correct answer is A. A residual benefit clause permits an insured who has returned to work on a limited basis, but still suffers a loss of income because of disability, to receive partial disability benefits. The doctor is able to practice part-time but cannot resume full-time work, so the disability continues to cause an earnings loss. Residual benefits are intended to encourage rehabilitation and return to productive work without forcing the insured to lose all benefits immediately. The benefit amount is usually tied to the percentage of income lost compared with pre-disability earnings, subject to policy requirements. A contingent benefit clause and concurrent benefit clause are not the standard disability-income provisions that address partial return to work. A guaranteed insurability rider permits future increases in coverage without proof of insurability; it does not pay benefits for a continuing partial disability. Residual disability should be distinguished from total disability, which generally requires inability to perform the duties defined in the policy. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Residual Disability Benefits.

Medicare is a federal social insurance program that provides hospital and medical expense coverage to eligible persons. Therefore, choice B is correct. Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services. Medicare Part B primarily covers physician services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Choice A describes Medicaid, which is a needs-based medical assistance program jointly administered by federal and state governments. Choice C is incorrect because Medicare also serves people age 65 or older and individuals with qualifying end-stage renal disease or ALS; it is not limited to totally disabled persons. Choice D is incorrect because physician bills are generally associated with Part B, not Part A. Medicare beneficiaries may also choose Medicare Advantage plans, which provide Medicare-covered benefits through private plans, and may obtain prescription drug coverage under Part D. Study Guide References/Topics: Social Insurance Programs; Medicare Parts A and B; Federal Health Programs.

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Nevada law defines an insurer to include every person engaged as principal and as an indemnitor, surety, or contractor in the business of entering into insurance contracts. Therefore, an indemnitor is specifically included in the statutory definition of insurer.

An indemnitor is a party that agrees to compensate another for specified loss or damage. That obligation is central to insurance: the insurer assumes a defined risk and promises to provide a benefit, payment, service, or indemnity when a covered loss occurs. A surety and a contractor entering insurance agreements can likewise fall within the statutory definition when operating in the insurance business.

A security dealer sells or handles securities and is regulated under securities law rather than by the insurance definition in this question. A financial planner may provide financial advice but is not automatically an insurer. A syndicate may participate in insurance arrangements in certain contexts, but it is not the statutory term specifically identified in the definition.

The exam point is to recognize the broad legal definition of insurer. It encompasses more than a company labeled “insurance company”; it includes persons acting as indemnitors, sureties, or insurance contractors.

Study Guide references/topics: Nevada Insurance Code; definitions; insurer; indemnity; surety; NRS 679A.100 .

Coordination of Benefits, commonly called COB, applies when an insured is covered by more than one health plan. It establishes the order in which plans pay and limits the combined payment so the insured does not receive more than the amount of the covered expense. Choice B is correct because COB prevents a profit from duplicate health coverage while still allowing the insured to receive the benefits to which the insured is entitled. One plan is identified as primary and pays first under its policy terms. The secondary plan then considers the unpaid covered balance, subject to its own coordination provisions and limits. COB does not prohibit a person from owning more than one health policy, does not guarantee uninterrupted benefits when changing insurers, and does not authorize a general delay of a workers’ compensation claim until benefits expire. Workers’ compensation coordination depends on the applicable policy and governing law. On the examination, distinguish COB from nonduplication of benefits and from other insurance clauses; COB specifically allocates payment responsibility among multiple health plans. Study Guide References/Topics: Group Health Insurance; Coordination of Benefits; Other Insurance Provisions.

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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.

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A Medicare Supplement insurer must provide an Outline of Coverage to the applicant at the time the application is presented. The outline is a consumer-disclosure document designed to summarize the policy’s principal benefits, premiums, limitations, exclusions, and other important features before the applicant makes a final purchasing decision.

The outline is not the insurance contract itself. The policy contains the full contractual rights and obligations, but the outline allows an applicant to compare Medicare Supplement plans in a clear and standardized format. It helps the consumer understand how the policy works with Original Medicare and whether it duplicates other existing coverage.

If the issued policy differs from the coverage described in the original outline, the insurer must provide a substitute outline describing the policy actually issued when delivering it. That later document does not change the initial requirement: the first outline is provided at application.

The premium-payment date and claim-submission date occur too late to serve the purpose of pre- sale disclosure. The key examination concept is timing: applicants receive the Outline of Coverage before purchasing the Medicare Supplement policy.

Study Guide references/topics: Medicare Supplement insurance; consumer disclosures; Outline of Coverage; NAC 687B.250 .

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Variable life insurance is permanent life insurance with cash values invested in separate-account investment options. Because the value of those investments can rise or fall, the policyowner bears the investment risk. The policy’s cash value may fluctuate based on market performance, and the death benefit may vary above a guaranteed minimum amount, subject to policy provisions. The insurer does not guarantee the investment performance of the separate account.

Variable life insurance differs from whole life, where the insurer’s general account supports guaranteed cash values and fixed premiums. It also differs from universal life, which emphasizes flexible premiums and adjustable death-benefit structures. Variable universal life combines flexible-premium features with separate-account investment options. All such products must be described accurately because the potential for growth is accompanied by potential loss.

Because variable life is a security as well as an insurance product, a producer generally needs appropriate securities registration and authorization in addition to life insurance licensing. Suitability is especially important. The product may be appropriate only for a consumer with a long time horizon, tolerance for market volatility, and a need for permanent life insurance. It should not be sold as a guaranteed investment or as equivalent to a fixed life policy.

References/topics from the Study Guide: Variable Life Insurance; Separate Accounts; General Accounts; Securities Registration; Investment Risk; Suitability.

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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.

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A natural person applying for a resident Nevada producer license must be at least 18 years old. Age is only one part of the licensing standard. Before approving a resident producer application, the Commissioner must also find that the applicant has not committed an act that would justify refusal, suspension, or revocation of a license; has paid the applicable fees; and has passed the required examination for the requested line of authority unless an examination exemption applies.

A life and health producer must hold the appropriate line or lines of authority before selling, soliciting, or negotiating those classes of insurance. Nevada separately identifies life insurance and accident-and-health insurance as producer authorities. A producer must also comply with renewal, continuing education, appointment, recordkeeping, and reporting requirements as applicable.

A business organization may also be licensed as a producer, but it must designate a properly licensed natural person who is authorized to transact business on its behalf and is responsible for the organization’s compliance with Nevada insurance laws and regulations. Licensing is therefore not merely a test-passing event; it is an ongoing regulatory responsibility.

For examination purposes, remember the basic resident-producer requirements: age 18 or older, proper application, fees, good character and eligibility, and examination success unless exempt.

References/topics from the Study Guide: Nevada Producer Licensing; Resident Producer Requirements; Lines of Authority; License Application; NRS 683A.251.

A long-term care insurance policy may be returned within 30 days after delivery for a full premium refund if the applicant is dissatisfied for any reason. This is known as a free-look or right-to-return provision. It gives the insured time to examine the contract after delivery and determine whether the coverage is appropriate.

The right is especially important in a direct-response sale, where the consumer may not have met face-to-face with a producer. Long-term care policies can contain detailed provisions concerning benefit triggers, elimination periods, activities of daily living, cognitive impairment, benefit periods, inflation protection, exclusions, premium changes, and nonforfeiture benefits. The 30-day review period allows a buyer to examine those terms without forfeiting premium.

The policy must prominently disclose the right to return the contract and receive a refund. The insurer must make the refund within the required period after the policy is returned. This rule differs from other health-insurance free-look, cancellation, grace-period, and reinstatement provisions, which can use different deadlines.

Study Guide references/topics: long-term care insurance; direct response solicitation; free-look provision; return of policy; NAC 687B.060 .

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A group health policy that terminates dependent-child coverage at a stated limiting age must continue coverage for an eligible dependent child who remains incapable of self-sustaining employment because of a qualifying disability and who remains dependent on the insured group member for support and maintenance. To preserve that continuation right, the required proof must be furnished within 31 days after the child reaches the policy’s limiting age.

This is a time-sensitive protection. The purpose is to prevent automatic termination of coverage solely because a dependent reaches the normal age limit when the child remains disabled and financially dependent. After initial proof is provided, the insurer may require continuing proof of incapacity and dependency, but it may not demand that proof more often than permitted by law.

The 31-day rule should be distinguished from notice periods for newborn coverage, conversion rights, premium grace periods, and claim notices. Each insurance provision may use a different time period, so examination questions often test the exact statutory deadline.

Study Guide references/topics: group health dependents; limiting age; continuation of coverage; NRS 689B.035 .

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A salaried insurance company employee performing only clerical and administrative work is not required to hold an insurance producer license. The exemption applies when the employee does not sell, solicit, or negotiate insurance and is not compensated by commission based on insurance transactions.

Licensing is required for persons whose activities bring them into the regulated functions of insurance production, brokering, adjusting, or other licensed insurance activity. A person who procures insurance for an insured is acting in a producer or broker capacity and requires appropriate authority. An individual involved in investigating and settling claims may require an adjuster license depending on the duties performed. Likewise, an agency clerk who receives commissions related to processed applications is no longer functioning solely as a clerical employee; commission-based activity indicates involvement in the insurance transaction.

The distinction is based on the actual work performed, not merely the person’s job title. A company may call someone an assistant, representative, clerk, or customer-service employee, but the individual must be licensed if the person sells, solicits, negotiates, or otherwise performs regulated insurance functions.

Study Guide references/topics: producer licensing; licensing exemptions; clerical employees; sales, solicitation, and negotiation; NRS 683A.117 .

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The correct answer is D. A conditional receipt may provide temporary or conditional coverage when the application and required premium are submitted, subject to the receipt’s terms and the applicant meeting underwriting requirements. Once the insurer approves the application, issues the policy, and mails it to the insured, the policy is generally considered delivered through constructive delivery. Physical receipt by the insured is not required when the insurer has completed issuance and mailing without retaining control over the policy. Accordingly, failure of the insured to receive the mailed policy does not, by itself, prevent the policy from being in force. Choice A incorrectly assumes that personal delivery is always essential. Choices B and C introduce conditions that are not part of the usual delivery rule. The policy’s effective date remains governed by the application, conditional receipt, policy provisions, and underwriting approval. This question tests the distinction between actual delivery, where the insured personally receives the policy, and constructive delivery, where the insurer’s completed mailing is sufficient to establish delivery. Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Conditional Receipts; Policy Delivery.

Basic cancer policies are limited-benefit plans intended to supplement, rather than replace, comprehensive medical coverage. They commonly provide benefits for cancer-specific treatment such as chemotherapy, radiotherapy, and immunotherapy, subject to the policy’s definitions, schedules, and limits. Therefore, choice C is correct because physical therapy is not ordinarily a core cancer-treatment benefit under a basic cancer policy. Physical therapy may be covered under a comprehensive medical plan or under a more expansive supplemental policy if expressly included, but it is not a standard basic cancer-plan benefit. Cancer policies can pay specified amounts for surgery, hospital confinement, physician services, diagnostic testing, drugs, radiation, chemotherapy, or other treatment tied directly to a covered cancer diagnosis. The insured should not assume that every medical expense arising during cancer treatment is covered. Benefits may be subject to waiting periods, preexisting-condition restrictions, recurrence rules, benefit schedules, and exclusions. The appropriate exam distinction is between benefits directly associated with treatment of cancer and general rehabilitative or medical services that are not expressly included in the cancer policy. Study Guide References/Topics: Types of Health Insurance Policies; Limited-Coverage Health Policies; Cancer Insurance.

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COBRA generally gives qualified beneficiaries the right to continue employer-sponsored group health coverage after certain qualifying events. For termination of employment, other than gross misconduct, or a reduction in work hours, the standard maximum continuation period is generally 18 months. Other qualifying events, such as death of the covered employee, divorce, legal separation, or a dependent child’s loss of dependent status, may result in a longer maximum continuation period, commonly 36 months.

Continuation coverage is not free coverage. The qualified beneficiary typically pays the full group premium plus a permitted administrative charge. COBRA can preserve the same group coverage and provider access for a limited time, but it may be expensive because the employer is no longer subsidizing premiums. Enrollment deadlines, election notices, payment rules, and employer-plan size requirements are important.

COBRA should not be confused with conversion coverage or an Affordable Care Act marketplace plan. Conversion coverage is an individual policy issued after group coverage ends under stated conditions. Marketplace coverage is a separate individual-market option that may be available following loss of employer-sponsored coverage. Producers should explain options carefully and avoid presenting one continuation route as automatically best for every consumer.

References/topics from the Study Guide: COBRA; Group Health Continuation; Qualifying Events; Conversion Privilege; Employer-Sponsored Health Insurance.

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Medicare supplement insurance, often called Medigap, is designed to help pay certain out-of-pocket costs left by Original Medicare, such as deductibles, coinsurance, copayments, and other covered gaps, depending on the standardized policy type and current rules. It supplements Original Medicare Parts A and B; it does not replace Medicare coverage. The insured must generally remain enrolled in Original Medicare to use a Medicare supplement policy.

Medigap differs from Medicare Advantage. A Medicare Advantage plan is a private plan through which an eligible beneficiary receives Medicare-covered services, usually with plan networks, plan rules, and an annual out-of-pocket maximum. A consumer generally does not use a Medicare supplement policy to supplement a Medicare Advantage plan. Medigap also differs from stand-alone Part D prescription-drug coverage, which is separately arranged for many Original Medicare beneficiaries.

Producers selling Medicare-related products must make accurate comparisons, use required disclosures, and avoid misleading consumers about benefits, provider access, premiums, or enrollment rights. A client’s health needs, travel patterns, provider preferences, prescription needs, affordability, and enrollment timing are important factors. No single Medicare arrangement is automatically best for every beneficiary.

References/topics from the Study Guide: Medicare Supplement Insurance; Original Medicare; Medicare Advantage; Medicare Part D; Medicare Cost Sharing.

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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 .

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Misappropriating money belonging to policyholders is a direct and serious ground for license revocation. A producer commonly receives premiums, return premiums, claim funds, or other property in the course of insurance business. Those funds must be handled honestly, promptly, and in accordance with the producer’s fiduciary responsibilities. Using, converting, improperly withholding, or diverting that money violates Nevada producer-licensing law.

The Commissioner may refuse to issue, suspend, revoke, or refuse to renew a producer’s license and may impose administrative fines or other disciplinary action for specified misconduct. Misappropriation is specifically identified as conduct warranting discipline because it threatens consumers and undermines the integrity of the insurance marketplace.

A civil judgment alone does not automatically establish a licensing-revocation ground under the wording of this question. Likewise, reporting requirements and address-change obligations may lead to administrative consequences when violated, but the question asks for the clear statutory cause for revocation. Misappropriation of policyholder money is the most direct and legally significant answer.

Producers should maintain accurate premium records, promptly remit funds, segregate money when required, and never treat policyholder or insurer funds as personal assets.

Study Guide references/topics: producer fiduciary duties; prohibited practices; license denial, suspension, and revocation; NRS 683A.451 .

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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.

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Annual premium payment generally produces the lowest total cost over the policy year because the insurer receives the full annual premium at the beginning of the coverage period. Monthly, quarterly, and semiannual payment modes are convenient for budgeting, but they commonly include an additional charge or produce a higher total annual premium. The difference reflects the insurer’s additional administrative expense and the fact that the insurer receives portions of the premium later.

Premium mode does not change the policy’s face amount, underwriting classification, or contractual benefits. It changes only the schedule and total cost of paying the premium. A producer should present all available modes clearly and explain the actual amount due under each option. A consumer with predictable annual cash flow may prefer annual mode to reduce total cost, while a consumer who needs more frequent payments may choose a higher-cost mode to preserve affordability and avoid lapse.

This issue is distinct from the grace period. The grace period protects the policyowner after a premium due date by allowing a limited time to make payment before coverage lapses. Premium mode establishes how frequently the regular premium is due; it does not eliminate the policyowner’s obligation to pay.

References/topics from the Study Guide: Premium Payment; Premium Modes; Grace Period; Policy Lapse; Life Insurance Contract Provisions.

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An insurance contract is aleatory because the values exchanged by the parties may be unequal and depend on an uncertain event. Choice A is correct. In this example, the policyowner paid only $1,200 in premiums before death, while the insurer paid a $250,000 death benefit. The insurer’s obligation was much greater than the premium amount received because the insured event occurred early in the policy period. If death had not occurred for many years, the total premiums paid could have been much closer to or greater than the eventual benefit value. That uncertainty is the defining aleatory feature. A personal contract is based on the insured’s individual characteristics and insurable interest. A unilateral contract means only the insurer makes a legally enforceable promise to perform after the applicant accepts the contract and pays premium. A conditional contract requires stated conditions, such as premium payment and proof of loss, to be met before performance is due. None of those terms focuses on the unequal exchange demonstrated here. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Insurance Contract Characteristics; Aleatory Contracts.

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If reconstructive surgery is begun within three years after a mastectomy, the amount of benefits for that surgery must equal the amount provided by the policy at the time of the mastectomy. Therefore, the tested maximum period is three years.

Nevada requires a policy that covers mastectomy to provide commensurate coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to create symmetry, prostheses, and treatment of physical complications of all stages of mastectomy, including lymphedema. The attending physician and patient determine the appropriate care.

The three-year rule protects an insured from losing the original level of reconstruction benefits merely because reconstruction is delayed. If surgery begins more than three years after the mastectomy, benefits are governed by the policy terms, conditions, and exclusions in effect at the time reconstructive surgery begins.

This question does not ask how long all reconstruction coverage disappears. It tests the period during which the policy must preserve the benefit amount available at the time of mastectomy.

Study Guide references/topics: mastectomy coverage; reconstructive surgery; breast reconstruction; mandated health benefits; NRS 689B.0375 .

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Choice C is correct. Group insurance is designed to cover members of an eligible class, commonly all full-time employees of an employer, subject to the plan’s participation, waiting-period, and eligibility rules. The employer or policyholder receives the master contract, while individual employees receive certificates of coverage describing their benefits. Therefore, choice B is incorrect because employees ordinarily do not receive separate individual policies. Medical examinations are generally not required for eligible employees during an initial enrollment period, especially when coverage is guaranteed issue. Choice A is therefore not a typical group-insurance feature. Enrollment is also not automatically available at any time. Employees normally enroll when first eligible or during an open enrollment period; late entrants may face evidence-of-insurability requirements or other conditions. Group insurance spreads risk across a defined group and is typically less individually underwritten than individual insurance. The key requirement is that the group be formed for a purpose other than obtaining insurance and that coverage be offered according to objective eligibility standards. Study Guide References/Topics: Group Health Insurance; Group Eligibility; Master Contract and Certificate of Coverage.

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A family is not an eligible blanket-health-insurance group under Nevada law. Blanket accident and health insurance is designed for defined groups connected by a common activity, organization, occupation, event, or exposure to a specified hazard. It is not designed as a substitute for ordinary individual or family health insurance.

Nevada specifically recognizes various groups that may be covered under a blanket policy. These include religious, charitable, recreational, educational, and civic organizations; newspaper publishers covering their carriers; and volunteer fire departments or similar emergency organizations covering members or participants. The organization acts as the policyholder, and the covered persons are defined by their relationship to the group activity or specified hazard.

A church is eligible as a religious organization. A newspaper corporation may qualify when covering its carriers. A volunteer fire department is specifically listed as an eligible organization. A family, however, is a private household relationship rather than a qualifying blanket group formed around an authorized organizational purpose or activity.

Study Guide references/topics: blanket accident and health insurance; eligible groups; policyholder; specified hazards; NRS 689B.070 .

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Nevada requires group health insurance policies to include benefits for expenses arising from hospice care. Hospice care is designed for individuals facing terminal illness and focuses on comfort, pain and symptom management, emotional support, and assistance for the patient and family rather than curative treatment.

The group-policy required-provisions statute specifically includes hospice-care benefits. It also recognizes benefits for care at home or health supportive services when prescribed by a physician and otherwise covered if provided in a medical facility. This reflects the policy goal of allowing appropriate end-of-life care in a setting suited to the patient’s needs.

Adult vision care and adult dental care are not universally required benefits under every group health policy. They may be offered through separate policies, riders, employer benefit arrangements, or plan designs. Cosmetic surgery is generally not a mandatory health insurance benefit and may be excluded unless medically necessary or required because of injury, congenital condition, reconstruction, or another covered circumstance.

The key examination point is that hospice care is a specifically required group-policy benefit in Nevada, while the other choices may be optional, limited, or excluded depending on the plan.

Study Guide references/topics: group health required provisions; hospice care; mandated benefits; NRS 689B.030 .

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Rebating occurs when a producer or insurer offers, gives, or allows an inducement not specified in the policy to persuade a person to purchase insurance. A gift card offered solely because the applicant buys a life or health policy is a classic example of a potentially prohibited rebate. Nevada trade-practice law restricts rebates and other improper inducements because they can create unfair competition, mislead consumers, and distort insurance pricing.

The prohibition does not mean that every item of nominal value, educational material, or lawful consumer program is automatically illegal. The legality of a benefit depends on the statute, regulations, insurer programs, value, purpose, and whether it is tied improperly to the sale. Producers should follow current Nevada rules and insurer compliance guidance before offering anything of value in connection with a sale.

Coinsurance is a health-policy cost-sharing method. Subrogation is an insurer’s right to recover from a responsible third party after paying a loss. Assignment transfers some or all policy rights from one party to another. None of those terms describes an improper sales inducement.

A producer should avoid promising gifts, refunds, premium reductions, or extra benefits unless specifically authorized and properly disclosed under applicable law and policy provisions.

References/topics from the Study Guide: Unfair Trade Practices; Rebating; Inducements; Producer Ethics; NRS 686A.110.

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The Affordable Care Act established Essential Health Benefits as the minimum categories of benefits that qualifying individual and small-group health plans must cover. These required benefit categories create a baseline of comprehensive coverage rather than allowing a major medical plan to omit fundamental types of care.

Essential Health Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance-use-disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic-disease management, and pediatric services, including oral and vision care.

Gold and Silver are metal-level plan categories. They describe the general actuarial value of a plan—the approximate division of covered health-care costs between the insurer and enrollees—not a separate legal list of mandatory minimum benefits. A Gold plan generally pays a larger share of covered costs than a Silver plan, but both must include the applicable Essential Health Benefits. “Silver Saver Value” and “Medicaid Buy-Back” are not the ACA’s required minimum-coverage terminology.

For examination purposes, distinguish the benefit package itself—Essential Health Benefits—from plan metal levels and from public programs such as Medicaid.

Study Guide references/topics: Affordable Care Act; individual health insurance; qualified health plans; Essential Health Benefits; HealthCare.gov coverage protections .

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A policy loan is a loan made by the insurer to the policyowner and secured by the policy’s available cash value. It is not a withdrawal that automatically terminates the coverage. However, the outstanding principal and accrued interest become indebtedness against the policy. If the insured dies before repayment, the insurer deducts that indebtedness from the amount otherwise payable to the beneficiary. Therefore, the usual result is a reduced death benefit.

This concept is especially important with permanent life insurance, including whole life and certain universal-life policies, because cash value may support policy loans. Interest continues to accrue under the policy’s loan provision. If the debt becomes large enough, it can threaten the policy’s continuation because a lapse may occur if the cash value is insufficient to support the indebtedness and required charges. A producer should explain both the availability of loans and their consequences; presenting a loan as “free money” would be misleading.

Nevada’s life-insurance standards require a loan provision in policies to which the requirement applies. The contractual terms control such matters as interest, notice, repayment, and the effect of indebtedness on policy values and proceeds.

References/topics from the Study Guide: Cash Value; Policy Loans; Nonforfeiture Values; NRS 688A.110—Loan Secured by Policy.

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A Health Savings Account is available only to an eligible individual, and a central eligibility requirement is coverage under a qualified High Deductible Health Plan. Therefore, choice A is correct. The individual also generally must not have disqualifying other health coverage, be enrolled in Medicare, or be claimable as another person’s tax dependent. Long-term care insurance does not itself establish HSA eligibility. Medicare enrollment generally prevents new HSA contributions, although the account balance may still be used for qualified expenses under applicable tax rules. An HSA offers tax-favored contributions, tax-deferred growth, and tax-free distributions for qualified medical expenses when statutory requirements are met. The HDHP must satisfy annual federal deductible and out-of-pocket limits, which are adjusted periodically. The IRS states that eligible individuals must have HDHP coverage and no disqualifying health coverage to make HSA contributions. See IRS HSA guidance . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Health Savings Accounts; High Deductible Health Plans.

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The commission for the placement of nonadmitted insurance is paid to the surplus lines broker. A surplus lines broker is specially licensed to place eligible insurance with a nonadmitted insurer when coverage cannot be procured from authorized insurers under the conditions required by Nevada’s Nonadmitted Insurance Law.

A nonadmitted insurer is not licensed or authorized to transact insurance generally in Nevada, but it may provide qualifying surplus-lines coverage through a properly licensed surplus lines broker. The broker performs the regulated placement function, documents the effort to obtain coverage from the admitted market when required, handles applicable filings, and ensures that statutory taxes and disclosures are addressed.

The policyholder purchases the insurance and pays the premium; the policyholder is not paid the placement commission. The Division of Insurance regulates the transaction and may receive taxes, fees, and reports as provided by law, but it is not the recipient of the insurer’s commission. A third-party claimant is someone asserting a claim against an insured and has no role in the placement commission.

Study Guide references/topics: nonadmitted insurance; surplus lines; broker licensing; commissions; Nevada Nonadmitted Insurance Law .

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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.

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Reinstatement restores a lapsed life insurance policy to active status if the policyowner satisfies the policy’s requirements. Those requirements generally include applying for reinstatement within the permitted period, providing evidence of insurability satisfactory to the insurer, and paying overdue premiums plus interest. The exact reinstatement period and underwriting requirements are controlled by the policy and applicable law.

A new medical examination is not required in every case. The insurer may request medical information or an examination when needed to evaluate the applicant’s current insurability, but it is not an automatic universal requirement. The key examination principle is that evidence of insurability is required, not that a physical examination must always occur. Reinstatement is often preferable to purchasing a new policy because the existing policy may have more favorable premium rates, accumulated cash value, or a prior issue age. However, the policyowner must understand that contestability and certain exclusions may begin again with respect to the reinstatement.

A producer should explain the difference between reinstatement and renewal. Reinstatement restores a policy that lapsed; renewal continues or extends a policy under its existing terms. Neither should be assumed available without reviewing the contract.

References/topics from the Study Guide: Reinstatement Provision; Policy Lapse; Evidence of Insurability; Premium Payment; NRS 688A.130.

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