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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Topic 1: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Nevada Life and Health Insurance Guaranty Association - Marketing Practices 1. Affordable Care Act 2. Fiduciary responsibilities 3. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation 4. Commissions and payment restrictions 5. Required records and record retention 6. Silver State Health Insurance Exchange - Definitions 1. Insurer 2. Cost-sharing 3. Domestic, foreign, and alien 4. Premiums 5. Certificate of authority 6. Authorized and unauthorized 7. Transacting insurance - Licensing 1. Name of licensee 2. Renewal and continuing education 3. Obtaining a license 4. Termination of license 5. Persons required to be licensed 6. Suspension, revocation, and refusal of license - Insurance Commissioner 1. Notice and hearings and penalties 2. General powers and duties 3. Examinations
Topic 2: Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Advertising - Credit life and health insurance - Group life and health insurance 1. Eligible groups 2. Required provisions
Topic 3: Accident & Health – General Knowledge	50%	- Field Underwriting Procedures 1. Explaining policy provisions, riders, exclusions, and ratings 2. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 3. Policy delivery 4. Initial premium payment and receipt 5. Sources of insurability and HIPAA privacy information 6. Submitting application and initial premium to company for underwriting 7. Completing the application 8. Replacement - Other Insurance Concepts 1. Tax treatment of premiums and proceeds of insurance contracts 2. Cost containment 3. Subrogation 4. Workers Compensation 5. Modes of premium payments 6. Total, partial, recurrent, and residual disability 7. Managed care 8. Dependent children benefits 9. Primary and contingent beneficiaries 10. Occupational vs. non-occupational 11. Nonduplication and coordination of benefits 12. Owner's rights - Types of Policies 1. Medicare supplement policies 2. Accidental death and dismemberment 3. Individual and Group Long Term Care Eligibility Levels of care 4. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy 5. Medical expense insurance Basic hospital, medical, and surgical policies Major medical policies Health Maintenance Organizations Preferred Provider Organizations Point of Service plans Flexible Spending Accounts High Deductible Health Plans and Health Savings Accounts Health Reimbursement Accounts 6. Group insurance Differences between individual and group contracts General characteristics COBRA 7. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident - Social Insurance 1. Medicaid 2. Social Security benefits 3. Medicare Parts A, B, C, and D - Policy Provisions, Clauses, and Riders 1. Mandatory and optional provisions Entire contract Time limit on certain defenses Grace period Reinstatement Notice of claim Claim forms Proof of loss Time of payment of claims Payment of claims Physical examination and autopsy Legal actions Change of beneficiary Misstatement of age or gender Change of occupation Illegal occupation Relation of earnings to insurance 2. Riders Impairment and exclusions Guaranteed insurability Future increase option 3. Other provisions and clauses Insuring clause Free look Consideration clause Probationary period Elimination period Waiver of premium Exclusions and limitations Preexisting conditions Coinsurance Deductibles Eligible expenses Copayments Pre-authorizations and prior approval requirements Usual, reasonable, and customary charges Lifetime, annual, or per cause maximum benefit limits 4. Rights of renewability Noncancelable Cancelable Guaranteed renewable
Topic 4: Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Coverage for reconstructive surgery - Hospice care - Medicare 1. Medicare supplement regulation 2. Medicare Advantage Plans 3. Prescription Drug Plan - Long Term Care - Mandatory policy clauses and provisions 1. Coverage for preventive healthcare services 2. Coverage for newborn children 3. Coverage for physical handicap or intellectual disability for dependent children

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Insurance Licensing NV Accident and Health Sample Questions (Q12-Q17):

NEW QUESTION # 12
Which policy is designed to pay benefits upon diagnosis or treatment of a specifically named illness, such as cancer?

A. Group term life insurance
B. Credit disability insurance
C. Specified disease insurance
D. Major medical insurance

Answer: C

Explanation:
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.

NEW QUESTION # 13
Under a life insurance policy with a revocable beneficiary designation, who normally has the authority to change the beneficiary?

A. The insurer
B. The insured, regardless of ownership
C. The beneficiary
D. The policyowner

Answer: D

Explanation:
The policyowner normally holds the contractual rights known as incidents of ownership. When the beneficiary designation is revocable, the policyowner may generally change the beneficiary without obtaining that beneficiary's consent, provided the policy is in force and no assignment or court order restricts the right.
The owner may also ordinarily exercise other ownership rights, such as selecting premium-payment modes, assigning the policy, taking a policy loan when available, surrendering the policy for cash value, and electing settlement options.
The insured and the owner can be the same person, but they do not have to be. The insured is the person whose life is covered and whose death triggers payment of the death benefit. A beneficiary is the person or entity designated to receive policy proceeds. Those roles must be kept separate on examination questions. A revocable beneficiary has only an expectancy until the insured dies; by contrast, an irrevocable beneficiary usually has a vested interest that limits the owner's ability to change the designation or exercise certain policy rights without consent.
Correctly identifying the owner is essential because ownership determines control of the policy during the insured's lifetime.
References/topics from the Study Guide: Policyowners' Rights; Beneficiary Designations; Revocable and Irrevocable Beneficiaries; Assignments.

NEW QUESTION # 14
The Nevada Life and Health Insurance Guaranty Association is financed by which of the following methods?

A. Assessing insureds
B. Assessing a premium tax
C. Assessing agent association members
D. Assessing member insurance companies

Answer: D

Explanation:
The Nevada Life and Health Insurance Guaranty Association is financed through assessments on member insurance companies. Insurers authorized to transact covered life, health, or annuity business in Nevada are members of the Association as a condition of their authority to operate in the state. When an assessment is necessary, the Association assesses member insurers according to the statutory assessment system.
The Association exists to provide limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not financed by direct assessments against insureds, policyowners, agents, or association members. It is also not simply funded through a general premium tax imposed on consumers.
Nevada law establishes assessment classes, including assessments for administrative and legal expenses and assessments needed to carry out the Association's obligations regarding an impaired or insolvent insurer.
Member insurers may consider the cost of assessments when establishing rates and dividends, but that does not change the source of the Association's direct funding: the member insurers themselves.
The Guaranty Association is a safety mechanism with statutory limits. It is not a substitute for evaluating an insurer's financial strength, and insurers and producers may not use its existence as a sales inducement.
Study Guide references/topics: insurer insolvency; guaranty associations; member insurer assessments; NRS Chapter 686C .

NEW QUESTION # 15
Life insurance death proceeds paid to a named beneficiary are generally:

A. Taxed as capital gains
B. Subject to ordinary federal income tax in every case
C. Treated as a deductible premium refund
D. Received free of federal income tax, subject to exceptions and special circumstances

Answer: D

Explanation:
Life insurance death proceeds paid to a named beneficiary are generally excluded from the beneficiary's gross income for federal income-tax purposes. This favorable treatment is one reason life insurance is widely used for family income protection, estate liquidity, business continuation, and debt protection. However, the producer should use the word "generally" because exceptions and special circumstances can affect taxation.
For example, interest paid by the insurer because it retains proceeds under an interest option is generally taxable as interest income. Transfers of a policy for valuable consideration can create a transfer-for-value issue. Business-owned life insurance can involve additional notice, consent, and tax rules. Estate-tax treatment is also separate from income-tax treatment; incidents of ownership or other estate-planning facts may cause proceeds to be included in the insured's taxable estate even though the beneficiary does not owe income tax on the benefit.
Premiums paid for personally owned life insurance are generally not deductible. The producer should not provide individualized tax or legal advice. The proper explanation is that life insurance provides a generally income-tax-favored death benefit, while policy ownership, beneficiary designation, business arrangements, and estate planning should be reviewed with qualified advisers.
References/topics from the Study Guide: Life Insurance Taxation; Death Proceeds; Transfer-for-Value Rule; Estate Tax Concepts; Business-Owned Life Insurance.

NEW QUESTION # 16
Which of the following statements is generally CORRECT about a major medical policy?

A. It provides benefits for in-hospital expenses only, subject to policy limits.
B. It contains a 30-day Elimination period for losses due to sickness.
C. It contains more limitations than a Basic Hospital, Medical, or Surgical policy.
D. It provides benefits for reasonable and necessary medical expenses, subject to policy limits.

Answer: D

Explanation:
Major medical insurance is designed to provide broad protection against substantial medical expenses. It commonly covers hospital, surgical, physician, diagnostic, and other medically necessary services, subject to deductibles, coinsurance, exclusions, and stated policy limits. Therefore, choice D is correct. A major medical policy is not limited to in-hospital expenses; that description is more characteristic of basic hospital coverage.
It also is generally broader-not more limited-than a basic hospital, medical, or surgical policy. A 30-day elimination period is associated more closely with disability income insurance and does not define major medical coverage. The phrase "reasonable and necessary" is important because it allows the insurer to evaluate whether a service was medically appropriate and whether the charge falls within the policy's payment standard. Major medical policies are comprehensive, but they are not unlimited: coverage remains subject to deductibles, coinsurance, exclusions, maximum benefits, network terms, and utilization requirements. Study Guide References/Topics: Types of Health Insurance Policies; Major Medical Expense Insurance; Medical Expense Coverage.

NEW QUESTION # 17
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