NLHI - Nevada Life and Health Insurance Exam

Question 1: A health insurer tries to enforce a company underwriting manual against an insured, arguing it is part of the coverage even though it was never attached. A mandatory uniform provision defines exactly what documents make up the coverage. Which provision governs this point?

The insuring clause

The reinstatement provision

The entire contract provision

The legal actions provision

Question 2: An insured dies with unpaid medical benefits still owed under a health policy that names no beneficiary. A mandatory uniform provision directs to whom the insurer must pay benefits, including any that remain after the insured's death. Which provision addresses this?

The payment of claims provision

The time of payment of claims provision

The proof of loss provision

The change of beneficiary provision

Question 3: A health policy lapses for nonpayment and is later reinstated. Under the reinstatement provision, the treatment of a new sickness differs from a new accident that occurs right after reinstatement. How are accidents and sickness covered following reinstatement?

Both covered immediately upon reinstatement

Both excluded for the first thirty days

Sickness immediately, accidents after ten days

Accidents immediately, sickness after ten days

Question 4: A health insurer includes an optional uniform provision permitting it to cancel the policy on written notice mailed to the insured. When this optional provision is used, the insurer must give the insured advance written notice of at least how many days?

Ten days

Five days

Thirty days

Forty-five days

Question 5: An insured holds two health policies with the same insurer covering identical expenses, potentially allowing double recovery. An optional uniform provision lets the insurer limit total coverage and return excess premium in that situation. Which optional provision addresses this overlap?

Other insurance in this insurer

Relation of earnings to insurance

Change of occupation

Conformity with state statutes

Question 6: A disability insured's monthly benefits from all coverage now exceed his actual earned income, creating an incentive not to return to work. An optional uniform provision lets the insurer reduce benefits to a proportion of earnings and refund excess premium. Which provision is this?

Other insurance with other insurers

Unpaid premium provision

Relation of earnings to insurance

Illegal occupation provision

Question 7: When a health claim becomes payable, the insured happens to owe a premium that is past due. An optional uniform provision lets the insurer handle that shortfall efficiently while settling the claim. What does the unpaid premium provision permit the insurer to do?

Void the policy back to issue

Double the next premium owed

Deny the claim entirely

Deduct the unpaid premium from the claim

Question 8: A health insurer wants an optional provision letting it deny benefits for a loss the insured sustains while committing a felony or working at an unlawful job. The insurer seeks a clear contractual basis. Which optional uniform provision gives the insurer this defense?

Illegal occupation provision

Intoxicants and narcotics provision

Change of occupation provision

Conformity with state statutes

Question 9: A health policy is delivered in a state whose law requires a benefit slightly more generous than the policy's printed language. An optional uniform provision automatically brings the conflicting terms into agreement with that state's law. Which provision accomplishes this?

Entire contract provision

Conformity with state statutes

Legal actions provision

Time limit on certain defenses

Question 10: An instructor explains that health policies contain a standardized set of provisions insurers must include, plus a separate group insurers may choose to add. How many mandatory uniform provisions must a health policy contain under the model law?

Ten mandatory provisions

Seven mandatory provisions

Twelve mandatory provisions

Fifteen mandatory provisions

Question 11: A disability policy pays a set benefit, often about half the total disability amount, when the insured can work but cannot perform every duty or must work reduced hours. This benefit is a fixed fraction rather than being tied to income lost. Which benefit is this?

Residual disability benefit

Presumptive disability benefit

Recurrent disability benefit

Partial disability benefit

Question 12: An employer offers two disability plans, one paying benefits for a few months after a short waiting period and another paying for years after a longer wait. The insured wants to know which is which. What distinguishes short-term from long-term disability coverage?

Benefit duration and elimination length

Only the insurer's home state

The insured's marital status

Whether dividends are payable

Question 13: A worker applies for Social Security disability benefits after a serious injury. Even with a qualifying disability, benefits do not begin right away. Under the Social Security program, how long is the waiting period before disability benefits start?

A thirty-day waiting period

A twelve-month waiting period

A five-month waiting period

No waiting period at all

Question 14: A disability policy includes a rider that pays a benefit only when the insured is eligible for but not yet receiving Social Security disability, or receives less than expected. It coordinates private coverage with government benefits. Which rider is this?

Cost of living adjustment rider

Social insurance supplement rider

Guaranteed insurability rider

Return of premium rider

Question 15: A disability policy offers a rider that pays an extra monthly amount during the first year of a claim, specifically to bridge the time before the insured's Social Security disability benefits are approved and begin. Which rider provides this temporary boost?

Residual disability rider

Waiver of premium rider

Presumptive disability rider

Additional monthly benefit rider

Question 16: A long-term disability claimant worries that a fixed monthly benefit will lose purchasing power over many years of a claim. A rider periodically increases the benefit in step with a published inflation index. Which rider addresses this concern?

Cost of living adjustment rider

Social insurance supplement rider

Additional monthly benefit rider

Guaranteed insurability rider

Question 17: A disabled insured stops working and cannot pay premiums, yet wants the disability policy to stay in force during the claim. A provision keeps coverage active without premium payment once disability has lasted through a short qualifying period. Which provision is this?

Grace period provision

Reinstatement provision

Waiver of premium provision

Relation of earnings provision

Question 18: An instructor contrasts two ways health plans are financed. In one, providers bill for each service rendered and the plan reimburses; in the other, members prepay and receive services from the plan's providers. What term describes people covered under the prepaid model?

Insureds

Certificate holders

Assignees

Subscribers

Question 19: A basic medical policy lists a specific maximum dollar amount payable for each covered procedure, such as a set figure for an appendectomy, regardless of the provider's actual charge. The dollar figure is preset in the policy. What is this method of stating benefits called?

Usual, customary and reasonable

A benefit schedule

A corridor deductible

A stop-loss limit

Question 20: An employer wants a single medical plan that combines basic first-dollar coverage with major medical protection under one deductible and coinsurance structure, rather than layering two separate policies. The employer prefers one integrated contract. Which plan design integrates both into one contract?

Comprehensive major medical

Supplemental major medical

Scheduled basic plan

Hospital indemnity plan

NLHI Nevada Life and Health Insurance Exam - Set 4 - Part 1

Question 1: A health insurer tries to enforce a company underwriting manual against an insured, arguing it is part of the coverage even though it was never attached. A mandatory uniform provision defines exactly what documents make up the coverage. Which provision governs this point?

Question 2: An insured dies with unpaid medical benefits still owed under a health policy that names no beneficiary. A mandatory uniform provision directs to whom the insurer must pay benefits, including any that remain after the insured's death. Which provision addresses this?

Question 3: A health policy lapses for nonpayment and is later reinstated. Under the reinstatement provision, the treatment of a new sickness differs from a new accident that occurs right after reinstatement. How are accidents and sickness covered following reinstatement?

Question 4: A health insurer includes an optional uniform provision permitting it to cancel the policy on written notice mailed to the insured. When this optional provision is used, the insurer must give the insured advance written notice of at least how many days?

Question 5: An insured holds two health policies with the same insurer covering identical expenses, potentially allowing double recovery. An optional uniform provision lets the insurer limit total coverage and return excess premium in that situation. Which optional provision addresses this overlap?

Question 6: A disability insured's monthly benefits from all coverage now exceed his actual earned income, creating an incentive not to return to work. An optional uniform provision lets the insurer reduce benefits to a proportion of earnings and refund excess premium. Which provision is this?

Question 7: When a health claim becomes payable, the insured happens to owe a premium that is past due. An optional uniform provision lets the insurer handle that shortfall efficiently while settling the claim. What does the unpaid premium provision permit the insurer to do?

Question 8: A health insurer wants an optional provision letting it deny benefits for a loss the insured sustains while committing a felony or working at an unlawful job. The insurer seeks a clear contractual basis. Which optional uniform provision gives the insurer this defense?

Question 9: A health policy is delivered in a state whose law requires a benefit slightly more generous than the policy's printed language. An optional uniform provision automatically brings the conflicting terms into agreement with that state's law. Which provision accomplishes this?

Question 10: An instructor explains that health policies contain a standardized set of provisions insurers must include, plus a separate group insurers may choose to add. How many mandatory uniform provisions must a health policy contain under the model law?

Question 11: A disability policy pays a set benefit, often about half the total disability amount, when the insured can work but cannot perform every duty or must work reduced hours. This benefit is a fixed fraction rather than being tied to income lost. Which benefit is this?

Question 12: An employer offers two disability plans, one paying benefits for a few months after a short waiting period and another paying for years after a longer wait. The insured wants to know which is which. What distinguishes short-term from long-term disability coverage?

Question 13: A worker applies for Social Security disability benefits after a serious injury. Even with a qualifying disability, benefits do not begin right away. Under the Social Security program, how long is the waiting period before disability benefits start?

Question 14: A disability policy includes a rider that pays a benefit only when the insured is eligible for but not yet receiving Social Security disability, or receives less than expected. It coordinates private coverage with government benefits. Which rider is this?

Question 15: A disability policy offers a rider that pays an extra monthly amount during the first year of a claim, specifically to bridge the time before the insured's Social Security disability benefits are approved and begin. Which rider provides this temporary boost?

Question 16: A long-term disability claimant worries that a fixed monthly benefit will lose purchasing power over many years of a claim. A rider periodically increases the benefit in step with a published inflation index. Which rider addresses this concern?

Question 17: A disabled insured stops working and cannot pay premiums, yet wants the disability policy to stay in force during the claim. A provision keeps coverage active without premium payment once disability has lasted through a short qualifying period. Which provision is this?

Question 18: An instructor contrasts two ways health plans are financed. In one, providers bill for each service rendered and the plan reimburses; in the other, members prepay and receive services from the plan's providers. What term describes people covered under the prepaid model?

Question 19: A basic medical policy lists a specific maximum dollar amount payable for each covered procedure, such as a set figure for an appendectomy, regardless of the provider's actual charge. The dollar figure is preset in the policy. What is this method of stating benefits called?

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