Insurance Licensing Updated InsNV_Health02 Exam Questions and Answers by ovie

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 .

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

A Gold Marketplace health plan has an actuarial value of approximately 80%. Therefore, the insurer is expected to pay about 80% of covered medical costs for a standard population, while enrollees as a group pay approximately 20% through deductibles, copayments, and coinsurance.

Actuarial value does not mean that the insurer pays exactly 80% of every individual’s bills. A particular insured may pay more or less than 20% in a year depending on the services used, the plan’s deductible, copayment structure, provider network, prescription-drug costs, and whether the annual out-of-pocket maximum has been reached. It is an overall measure of expected cost sharing for covered benefits.

The standard metal levels are Bronze at 60%, Silver at 70%, Gold at 80%, and Platinum at 90%. Gold plans generally have higher monthly premiums than Bronze or Silver plans but lower cost sharing when health care is received. Platinum plans generally have the highest premiums and the lowest cost sharing.

Study Guide references/topics: Affordable Care Act; Marketplace plans; metal levels; actuarial value; deductibles; copayments; HealthCare.gov plan categories .

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

An incorporated insurance licensee using a name other than its true legal name must obtain approval and file the required fictitious-name documentation with the Nevada Insurance Commissioner. This ensures that insurance business is conducted under a name that has been reviewed, recorded, and can be connected to the actual licensed person or entity responsible for the transaction. It supports consumer protection, regulatory oversight, complaint handling, and enforcement of licensing laws.

Nevada’s producer-licensing law requires an applicant or licensee wishing to use a name other than the true name shown on the license to submit a request for approval and file with the Commissioner a certified copy of the applicable certificate. The purpose is not merely administrative. A producer may not use a trade, assumed, or fictitious name in a way that could conceal the responsible licensee or mislead an insurance consumer.

The Attorney General, NAHU, and NAIFA do not approve fictitious names used by Nevada insurance licensees. The Nevada Division of Insurance, acting through the Commissioner, is the proper regulatory authority.

Study Guide references/topics: Nevada producer licensing; use of true or fictitious names; regulatory authority of the Commissioner; NRS 683A.301 .

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

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 .

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