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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Hospice care
- Mandatory policy clauses and provisions
  • 1. Coverage for newborn children
    • 2. Coverage for physical handicap or intellectual disability for dependent children
      • 3. Coverage for preventive healthcare services
        - Coverage for reconstructive surgery
        - Long Term Care
        - Medicare
        • 1. Prescription Drug Plan
          • 2. Medicare Advantage Plans
            • 3. Medicare supplement regulation
              - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
              Topic 2: Accident & Health – General Knowledge50%- Other Insurance Concepts
              • 1. Modes of premium payments
                • 2. Occupational vs. non-occupational
                  • 3. Nonduplication and coordination of benefits
                    • 4. Workers Compensation
                      • 5. Total, partial, recurrent, and residual disability
                        • 6. Tax treatment of premiums and proceeds of insurance contracts
                          • 7. Cost containment
                            • 8. Owner's rights
                              • 9. Dependent children benefits
                                • 10. Subrogation
                                  • 11. Managed care
                                    • 12. Primary and contingent beneficiaries
                                      - Social Insurance
                                      • 1. Medicaid
                                        • 2. Social Security benefits
                                          • 3. Medicare Parts A, B, C, and D
                                            - Types of Policies
                                            • 1. Group insurance
                                              • Differences between individual and group contracts
                                              • General characteristics
                                              • COBRA
                                            • 2. Disability income
                                              • Individual disability income policy
                                              • Business overhead expense policy
                                              • Business disability buyout policy
                                              • Group disability income policy
                                              • Key employee policy
                                            • 3. Accidental death and dismemberment
                                              • 4. Medicare supplement policies
                                                • 5. Other policies
                                                  • Dental
                                                  • Vision
                                                  • Cancer
                                                  • Critical illness or specified disease
                                                  • Worksite employer-sponsored
                                                  • Hospital indemnity
                                                  • Short-term medical
                                                  • Accident
                                                • 6. 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
                                                • 7. Individual and Group Long Term Care
                                                  • Eligibility
                                                  • Levels of care
                                                - Field Underwriting Procedures
                                                • 1. Explaining policy provisions, riders, exclusions, and ratings
                                                  • 2. Replacement
                                                    • 3. Sources of insurability and HIPAA privacy information
                                                      • 4. Policy delivery
                                                        • 5. Completing the application
                                                          • 6. Contract law
                                                            • Elements of a contract
                                                            • Insurable interest
                                                            • Warranties and representations
                                                            • Unique aspects of the insurance contract
                                                          • 7. Initial premium payment and receipt
                                                            • 8. Submitting application and initial premium to company for underwriting
                                                              - Policy Provisions, Clauses, and Riders
                                                              • 1. 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
                                                              • 2. Rights of renewability
                                                                • Noncancelable
                                                                • Cancelable
                                                                • Guaranteed renewable
                                                              • 3. 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
                                                              • 4. Riders
                                                                • Impairment and exclusions
                                                                • Guaranteed insurability
                                                                • Future increase option
                                                              Topic 3: Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Group life and health insurance
                                                              • 1. Required provisions
                                                                • 2. Eligible groups
                                                                  - Credit life and health insurance
                                                                  - Advertising
                                                                  Topic 4: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Marketing Practices
                                                                  • 1. Unfair practices
                                                                    • Unfair claims methods and practices and settlement of claims
                                                                    • Rebating and inducement
                                                                    • Twisting
                                                                    • Misrepresentation
                                                                    • Fraud
                                                                    • Unfair discrimination
                                                                    • Defamation
                                                                  • 2. Required records and record retention
                                                                    • 3. Commissions and payment restrictions
                                                                      • 4. Silver State Health Insurance Exchange
                                                                        • 5. Affordable Care Act
                                                                          • 6. Fiduciary responsibilities
                                                                            - Nevada Life and Health Insurance Guaranty Association
                                                                            - Licensing
                                                                            • 1. Renewal and continuing education
                                                                              • 2. Suspension, revocation, and refusal of license
                                                                                • 3. Obtaining a license
                                                                                  • 4. Persons required to be licensed
                                                                                    • 5. Name of licensee
                                                                                      • 6. Termination of license
                                                                                        - Definitions
                                                                                        • 1. Certificate of authority
                                                                                          • 2. Authorized and unauthorized
                                                                                            • 3. Premiums
                                                                                              • 4. Transacting insurance
                                                                                                • 5. Insurer
                                                                                                  • 6. Cost-sharing
                                                                                                    • 7. Domestic, foreign, and alien
                                                                                                      - Insurance Commissioner
                                                                                                      • 1. Notice and hearings and penalties
                                                                                                        • 2. General powers and duties
                                                                                                          • 3. Examinations

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                                                                                                            Quiz Insurance Licensing - Perfect InsNV_Health02 - Guaranteed NV Accident and Health Success

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q33-Q38):

                                                                                                            NEW QUESTION # 33
                                                                                                            Under Nevada law, the definition of " insurer " includes:

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            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 .


                                                                                                            NEW QUESTION # 34
                                                                                                            One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            A licensed producer may recommend a health plan for a consumer because the producer is authorized to sell, solicit, and negotiate insurance. That authority permits the producer to discuss coverage choices in a personalized manner, explain how plan provisions apply to the consumer's situation, and recommend a particular policy or plan when appropriate.
                                                                                                            An Exchange Enrollment Facilitator is certified to help consumers enroll in qualified health plans through the Exchange. The EEF role is designed to provide impartial enrollment assistance, application support, and general program information. However, an EEF may not sell, solicit, or negotiate insurance. That restriction prevents an EEF from functioning as an insurance producer or steering a consumer toward a particular carrier or plan.
                                                                                                            Explaining general terminology, such as deductibles, copayments, and eligibility rules, can be part of enrollment assistance and is not the defining distinction. Compensation is also not the key answer because the legal distinction turns on insurance authority, not simply whether a person receives payment. A Nevada EEF also may not concurrently hold a producer license.
                                                                                                            Study Guide references/topics: Exchange Enrollment Facilitators; producer authority; solicitation and negotiation; NRS Chapter 695J .


                                                                                                            NEW QUESTION # 35
                                                                                                            Which of the following situations describes a representation?

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            A representation is a statement made by an applicant on an insurance application that is believed to be true to the best of the applicant's knowledge and is required to be substantially true. Choice C correctly states that principle. A representation differs from a warranty. A warranty is a statement or promise that must be literally and absolutely true; choice D describes that stricter standard rather than a representation. Application answers help the insurer evaluate risk during underwriting, so material misrepresentations can affect coverage or the insurer's decision to issue the policy. However, not every immaterial or innocent inaccuracy has the same legal effect. The significance of a misstatement depends on its materiality and the applicable policy and insurance-law rules. Choices A and B describe potential policy promises or contract features, not statements made by a prospect in the application. For licensing purposes, remember that insurance applications are generally treated as containing representations, not warranties, unless the policy or law provides otherwise.
                                                                                                            Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Representations and Warranties; Underwriting.


                                                                                                            NEW QUESTION # 36
                                                                                                            Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            A newborn is automatically covered under the applicable Nevada health-policy rule for 31 days after birth.
                                                                                                            Coverage begins from the moment of birth and includes necessary care and treatment for injury or sickness, including medically diagnosed congenital defects and birth abnormalities.
                                                                                                            To continue coverage beyond the initial 31-day period, the policy may require timely notice of the birth and payment of any additional premium or fee required by the insurer. The notification and payment requirement must be satisfied within the 31-day period if the policy requires it. This rule protects newborns during the immediate post-birth period, when medical care may be urgently necessary.
                                                                                                            The automatic coverage is not limited to routine newborn care. It includes necessary treatment of medical conditions identified at birth, subject to the policy's applicable limits. The law also prevents the policy from excluding premature births under the mandated newborn coverage.
                                                                                                            Two, five, and ten days are incorrect because they would not provide the statutory protection required for newborn coverage. The exam point is that the initial automatic period is 31 days, while continuation beyond that period may require prompt enrollment action by the insured.
                                                                                                            Study Guide references/topics: individual health insurance; newborn coverage; congenital defects; notification requirements; Nevada newborn-coverage requirements .


                                                                                                            NEW QUESTION # 37
                                                                                                            Medicaid is best described as:

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            Medicaid is a joint federal-state medical-assistance program serving eligible individuals and families under income, resource, categorical, residency, and other program rules. The federal government establishes broad requirements and provides funding, while each state administers its program within federal parameters.
                                                                                                            Nevada administers Medicaid through its state health and human-services structure and contracted delivery systems. Eligibility and benefits can vary by category and may change with law and program administration.
                                                                                                            Medicaid is not the same as Medicare. Medicare is principally a federal social-insurance program associated with age 65 or older, certain disabilities, and end-stage renal disease or other qualifying conditions. Medicaid is generally means tested, although eligibility is determined by detailed program standards and should never be assumed from income alone. Some people may qualify for both Medicare and Medicaid; these individuals are often referred to as dual-eligible beneficiaries.
                                                                                                            A producer should avoid giving legal or public-benefit eligibility advice beyond the scope of insurance licensing. The proper role is to identify the program accurately, explain how private coverage may coordinate where applicable, and direct a consumer to the appropriate state agency or benefits specialist for an eligibility determination.
                                                                                                            References/topics from the Study Guide: Medicaid; Medicare; Dual Eligibility; Government-Sponsored Health Programs; Nevada Public Health Benefits.


                                                                                                            NEW QUESTION # 38
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