Nevada Statutes-Health and Life Insurance | 78 questions and answers

Domestic insurer

insurance company that is incorporated in this state. Domicile is when e company's home office is in the state in which it was formed. If a company was chartered in Nevada it would be a Nevada domesticated company.

Foreign insurer

An insurance company that is incorporated in another state or territorial possession. A company chartered in California would be a foreign company in New York

Alien insurer

Insurance company that is incorporated outside the United States

Stock companies

Owned by the stockholders who provide the capital necessary to establish and operate the insurance company and who share in any profits or losses. Officers are elected by stockholders and manage stock insurance companies. Issue nonparticipating policies where policy owners don't share profits or losses-- no dividends to policyholders but tax dividends to stockholders

Mutual companies

owned by the policy owners and issue participating policies. With participating policies, policy owners are entitled to dividends which in this case are return of excess premiums and are nontaxable.

Insurers are not required o hold certificate of authority for the following instances:

- investigation, settlement of litigation claims

- liquidation of assets of the insurer

- transactions written and delivered out of the state

- lawsuits

-surpluses

- actions related to the insurers rights

-reinsurance

- issuance of annuities by an affiliate

General powers, duties, and responsibilities of the commissioner include, but are not limited to:

- organize, manage, and supervise all the activities of the insurance department

- enforce provisions of the insurance code

- adopt regulations necessary to carry out the provisions of the insurance code

- conduct examinations and investigations of all insurance matters

Examinations

Done by commissioner to ensure insurance companies are abiding by the rules. Must be done at least every 5 years. Must examine every insurance company applying for initial certificate of authorization. Person being examined is responsible for the cost of the examination. Anybody who refuses the examination is guilty of a misdemeanor.

Notice and hearing

If commissioner suspects an insurer or it's agent as committed a violation or is engaged in unfair trade practice e commissioner may issue a statement of charges and hold a hearing. Application must be filed within 60 days after the person knew or reasonably should have known of the act. Application must briefly state the respects in which the applicant is aggrieved and the evidence. If it is accepted there will be a hearing within 30 days. If it will be a different day it will need to be notified at least 20 days before.

Producer of insurance

person required to be licensed under the Nevada law to sell, solicit, or negotiate insurance. Anyone who transacts insurance without a license is subject to an administrative fine of $1000 for each violation

Managing General Agent (MGA)

Negotiates and binds ceding reinsurance contracts on behalf of the insurer or manages ll of part of the insurance business of an insurer, including e management of a separate division, department of underwriting office, or

Nonresident applicant

Must file a change in addresses within 30 days of this change.

licensed person moving states must

apply for licensing within 90 days of establishing legal residency

Certificate of registration

valid for 3 years- if violations occur registration can be revoked and a fine of up to $2000 can occur

Exchange Enrollment Facilitator (EEF)

Certified professional whose responsibilities include enrolling qualified individuals, employers and employees in a Qualified Health Plan on the Exchange. Also help consumers with complains and such.

Which of the following licensees are not compensated directly for the amount of insurance sold?

Insurance consultant

What is required for a producer to transact business on behalf of the insurer?

An agent appointment

Producer license vs insurance license

producer stays in effect until suspended or revoked, insurance expires and must be renewed

Continuing education

rules that are established to protect the public by maintaining high standards of professional competence in the insurance industry and to maintain and improve insurance skills and knowledge of licensed producers. 30 hour approved continuing education and 3 hours of ethics training

How often are producers required to take the continuing education exam

every 3 years

rebating

defined as any inducement offered to the insured in the sale of insurance products that is not specified in the policy. both the offer and the acceptance are illegal

twisting

a misrepresentation, or incomplete or fraudulent comparison of insurance policies that persuades an insured/owner, to his or her detriment, to cancel, lapse, switch policies, or take out policy with another insurer

defamation

oral or written statement is made that is intended to injure a person engaged in the insurance business

Fraud

if convicted of insurance fraud, individuals can be charged with a Category D felony and are subject to imprisonment for 1 to 4 years, or $5000 fine or more

Which of the following is issued by the State Department of insurance to show the the insurer has the power to write insurance contracts?

Certificate of Authority

When an gent is handling premium funds while conducting business, the insurance agent acts in a

fiduciary capacity: the handling of money

Credit insurance

a special type of coverage written to insure the life of the debtor and pay off the balance of a loan in the event of the death of the debtor- usually written as decreasing term insurance. Creditor is usually the owner and the beneficiary of the policy, but the borrower is the one paying premiums

Converting from group to individual policy

whenever an insured under a group plan becomes eligible for conversion for an individual policy he insurer must provide a notice of the right to convert.

All of the following are true regarding Credit Life Insurance except

Benefits are paid to the borrower's beneficiary

How many days after the death of an insured does the insurer have to pay group life insurance policy benefits?

30 days

Replacement

Any transaction in which new life insurance or a new annuity is purchased and the the existing life insurance has been or will be lapsed, forfeited, reissued, converted, amended, or used in a financial purchase.

Duties of the replacing producer

-Present to the applicant a Notice Regarding Replacement that is signed by both the applicant and the producer. A copy must be left with the applicant.

-Obtain a list of all existing life insurance and/or annuity policies to be replaced including policy numbers and the names of all companies being replaced.

-Leave the applicant with the original or a copy of written or printed communications used for presentation to the applicant.

-Submit to the replacing insurance company a copy of the replacement notice with the application.

Duties of the replacing insurance company

- Require from the producer a list of the applicant's life insurance or annuity contracts to be replaced/copy of the replacement notice provided to the applicant

- Send each existing insurance company a written communication advising of the proposed replacement within a specified period of time of the date that the application is received in the replacing insurance company's home or regional office

- A policy summary or ledger statement containing policy data on the proposed life insurance or annuity must be included.

During replacement of life insurance, a replacing insurer must do which of the following?

Obtain a list of all life insurance policies that will be replaced

Each replacing insurer must:

- Inform it's agents about the requirements

- Give each applicable applicant 3 copies of notice

- Retain copies of policy summary for at least 3 years

- Send a copy of notice to the insurer within at least 3 business days

- Attach a copy of the notice on the application

Disclosure agreements don't apply to

Annuities

Credit life

Group life

Variable life

life insurance plans in connection with pension and welfare

Fraternal benefit society

A life or health insurance company formed to provide insurance for members of an affiliated lodge, religious, or fraternal organization with a representative form of government. Many society w capital stock.

- 10+ people if all are U.S. citizens and a majority Nevada residents

- Election must occur within one year of the date of certificate of authority's issuance

Ten Day Free Look Provision

required by law, 10 days from date of receiving the policy and allows policyowner to read the policy over and return it to the insurance company for a full premium refund without giving a reason

Viatical Settlement

Allows someone with a terminal illness to sell their existing life insurance policy to a third party for a percentage of the death benefit. The new owner continues to make the premium payments and will eventually collect the entire death benefit.

Chronically ill

Being unable to perform at least 2 activities from daily living such as eating, using the restroom, transferring, bathing, dressing, or continence or conditions requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.

Terminally ill

Having a illness or a sickness that is reasonably expected to result in death within 24 months or less.

Viator

Owner of a life insurance policy ho seeks to enter or enters into a viatical settlement contract- viaticals are not allowed within the fisrt 5 years of insurance

Right of rescission

All viatical settlement contracts entered into in this state must must contain an unconditional right for the Viator to cancel or rescind the contract. The rescission period is the shorter of the 60 days after the date all parties signed the contract or 30 days after the Viator received the proceeds. 3 days after purchasers disclosure is received.

A life producer applying for viatical settlement broker license y be exempt from the relicensing and examination process if the producer has held an active license for how many years?

1 year

Which of the following documents must be provided to the policy owner or the applicant using the policy replacement?

notice regarding replacement

Which of the following will be included in the policy summary?

premium amounts and surrender amounts

When a Viator sells a life insurance company

absolute signalment is given to he viatical settlement company

Which rule would apply if an agent knows an applicant is going to cash in an old policy and use the funds to purchase new insurance?

replacement rule

Viator

owner of a life insurance policy who seeks to enter or enters not a viatical settlement contract

Coverage of a newborn child

All individual and group health plans make it where the newborn child is insured from the moment of birth. This coverage includes coverage for injury and sickness, including treatment for congenital birth defects and abnormalities.

coverage for children can continue if

- incapable of self-sustaining employment due to a physical handicap/ intellectual disability

- dependent on the policyholder for support and maintenance

must provide proof within 31 days of the and must re-provide proof at least once a year

Insurance for alcoholism and drug abuse

- treatment for withdrawal: up to $1500 a year

- inpatient treatment up to $9000 per year

- counseling for a group, person, or family not admitted to a facility $2500 a year

Coverage for reconstructive surgery

Any policy that covers mastectomies must cover reconstructive surgery. if the reconstructive surgery takes place 3 years from the mastectomy then the coverage must equal he amount provided for in the policy during the time of the mastectomy. if more than 3 years have lapsed then surgery benefits are subject to whatever the policy says

Essential benefits

include hospitalization, maternity, emergency services, wellness and preventive services, and chronic disease management

Guaranteed issue

Insurance companies must accept any eligible applicant for individual or group insurance coverage. Enrollment for coverage may be restricted to open or special enrollment periods.

Guaranteed renewability

An insurance company that offers either group or individual health insurance coverage must renew or continue the policy at the option of the plan sponsor or the individual.

Pre-existing conditions

The law creates a new program, the Pre-Existing Condition Insurance Plan, to make health coverage available to individuals who have been denied health insurance by private insurance companies because of a pre-existing condition.

Appeal rights

- If insurers rescind individual or group coverage for reasons of fraud or an intentional misrepresentation of material facts by the insured, they must provide at least 30 days advance notice to allow the insured time to appeal.

-An enrollee or insured has the right to review their file, to present evidence and testimony as part of the appeal process, and to keep their coverage in force pending the outcomes of the appeals process.

Coverage or children of the insured

The law extends coverage or children of the insured to age 26 regardless of their marital status, residency, financial dependence of their parents, or eligibility to enroll in their employee's plan

Lifetime and annual limits

Health plans are restricted from applying a dollar limit on essential benefits, nor can they establish a dollar limit on the amount of benefits paid during the course of an insured's lifetime.

Emergency care

Emergency services must be covered, even at an out-of-network provider, for amounts that would have been paid to an in-network provider for the same services.

Preventive benefits

The Act requires that 100% of preventive care be covered without cost sharing. Preventive care includes routine checkups, screenings, and counseling to prevent health problems.

Cost-sharing under Group Health Plans

A group health plan must ensure that any annual cost-sharing imposed does not exceed provided limitations

Affordable Care Act (ACA)

requires that all health care plans include the following essential benefits

Plans are classified into 5 categories of coverage in the Marketplace

4 metal levels and catastrophic plans

- Bronze 60%

- Silver 70%

- Gold 80%

- Platinum 90%

% of cost expected to be covered under this plan

Catastrophic plan: lower monthly premiums but high deductibles

Stacey receives her medical supplement policy but decides he doesn't want to keep it. he has how many days to return her policy for a full refund?

30 days- supplement policies have a 30 day free look provision

Medicare cannot be delivered in Nevada if it limits or excludes coverage based on

type of illness, treatment, medical conditions, or accident

How many consecutive months of coverage does LTC cover in Nevada?

24

Patient Protection and Affordable Care Act (PPACA) includes

Right to appeal, no lifetime dollar limits, and coverage for preventative benefits

After someone give birth to their first child, what must they do n order to have coverage for their child?

Notify the insurer within 31 days in order for the coverage to continue without any evidence of insurability

What amount of care is provided in LTC's intermediate care?

Daily care by medical personnel

For what period of time can coverage be excluded on permissible pre-existing conditions applicable to a medicare supplement insurance policy?

6 months after the effective date of the policy

The following are examples of allowable exclusions of Medicare supplement insurance

hearing aids, emotional disorders, dental treatment

For an agent to sell continuous care coverage, the agent must meet all of the following requirements

- be licensed as a casualty insurance producer

- receive approval from the commissioner

- be licensed as an accident and health insurance producer

What is continuous care coverage in Nevada?

Workers compensation

What are the most common variations in LTC policy?

- number of days in confinement covered

- number of home health health visits

- he amount paid for nursing home care

Accident and health producers may qualify to sell continuous care coverage if they complete a minimum of how many hours of approved instruction in workers compensation and employer liability insurance?

8 hours

insurance