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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            >> Trustworthy InsNV_Health02 Practice <<

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q23-Q28):

                                                                                                            NEW QUESTION # 23
                                                                                                            After appointing a producer as its agent, when must an insurer generally file its notice of appointment with the Nevada Commissioner?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            In Nevada, an insurer appointing a producer as its agent must generally file a notice of appointment with the Commissioner within 15 days after the agency contract is executed or the first application for insurance is submitted, whichever event triggers the statutory timing. The appointment establishes the producer's authority to act as the insurer's agent for the applicable business. An agent is a producer compensated by the insurer who sells, solicits, or negotiates insurance for that insurer.
                                                                                                            A producer who is not acting as an insurer's agent may act as a broker, subject to the statutory definition and applicable requirements. The distinction matters because an agent represents the insurer in the agency relationship, while a broker acts on behalf of the insured or prospective insured and lacks authority to bind an insurer through the broker's own actions.
                                                                                                            The appointment requirement does not replace the producer-license requirement. Before selling, soliciting, or negotiating a class of insurance in Nevada, the person must hold the appropriate line of authority. A life or health producer must therefore have the relevant licensing authority and, when acting as an insurer's agent, be properly appointed.
                                                                                                            Examination questions often test both the 15-day filing timeline and the difference between an agent and a broker.
                                                                                                            References/topics from the Study Guide: Producer Appointments; Agent and Broker Distinction; Insurer Appointments; Nevada Producer Licensing; NRS 683A.321.


                                                                                                            NEW QUESTION # 24
                                                                                                            Which feature is most characteristic of universal life insurance?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            Universal life insurance is a flexible-premium permanent life insurance policy. It generally provides a cash- value account, interest crediting, mortality charges, expense charges, and flexible premium-payment options within policy limits. The owner may often adjust the amount and timing of premiums and may have death- benefit options, subject to minimum funding requirements, underwriting rules for increases, and the policy's terms. The flexibility does not mean the owner can stop paying indefinitely without consequence. If cash value is insufficient to cover monthly deductions and charges, the policy can lapse.
                                                                                                            Universal life differs from traditional whole life, which typically has fixed premiums, a guaranteed cash-value schedule, and a fixed death benefit. It also differs from variable life, in which cash value and death benefit are linked to separate-account investments and market performance. Universal life typically uses the insurer's general account for interest crediting, although variable universal life is a separate product combining flexibility with separate-account investment risk.
                                                                                                            A producer must explain that illustrated values are not guaranteed unless identified as such. Policyowners should receive in-force illustrations and review funding adequacy periodically, particularly after taking loans, withdrawals, or reducing premium payments.
                                                                                                            References/topics from the Study Guide: Universal Life Insurance; Flexible Premiums; Adjustable Death Benefit; Cash Value; Policy Lapse Risk.


                                                                                                            NEW QUESTION # 25
                                                                                                            When a criminal violation of the insurance code has occurred, the Nevada Insurance Commissioner is required to report the violation to the:

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            When the Nevada Insurance Commissioner has reason to believe that a person has violated the Insurance Code or another law applicable to insurance operations and criminal prosecution appears appropriate, the Commissioner must provide the relevant information to the appropriate district attorney or to the Attorney General. Of the choices given, District Attorney is the correct answer.
                                                                                                            The Commissioner administers and enforces Nevada insurance laws, investigates potential violations, conducts examinations, and may impose administrative sanctions where authorized. Criminal prosecution, however, is handled by the appropriate prosecutorial authority rather than by the Commissioner personally.
                                                                                                            This division of responsibility preserves due process and ensures that criminal cases are evaluated and prosecuted by officials with criminal-law authority.
                                                                                                            The Secretary of State, Lieutenant Governor, and State Police may have governmental roles that occasionally relate to business records, executive functions, or investigations, but they are not the statutory prosecutorial recipients identified in Nevada's insurance law. The examination point is that an insurance violation can produce both administrative consequences, such as a fine or license action, and criminal referral when the conduct warrants prosecution.
                                                                                                            Study Guide references/topics: powers and duties of the Commissioner; insurance-code enforcement; criminal violations; NRS 679B.150 .


                                                                                                            NEW QUESTION # 26
                                                                                                            Under Nevada law, the definition of " insurer " includes:

                                                                                                            Answer: B

                                                                                                            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 # 27
                                                                                                            Which of the following benefits are usually EXCLUDED or limited under a Long Term Care policy?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            Long-term care insurance is intended to provide benefits for qualified services needed because of chronic illness, cognitive impairment, or inability to perform activities of daily living. Typical covered settings and services include skilled nursing facilities, home health care, and hospice care, subject to the policy's benefit triggers, elimination period, daily or monthly limits, and plan of care requirements. Therefore, choice D is correct. Treatment or rehabilitation for addictive behavior is commonly excluded or restricted because it is not ordinarily a qualifying l ong-term care service under the policy's chronic-care purpose. Long-term care insurance is not the same as comprehensive medical insurance, disability income insurance, or substance-use treatment coverage. Before benefits become payable, the insured usually must be certified as chronically ill, often based on inability to perform at least two activities of daily living or severe cognitive impairment.
                                                                                                            Policies may cover institutional care, assisted living, adult day care, respite care, and home-based services, but each benefit is subject to contractual definitions and limits. Study Guide References/Topics: Types of Health Insurance Policies; Long-Term Care Insurance; Long-Term Care Exclusions and Benefit Triggers.


                                                                                                            NEW QUESTION # 28
                                                                                                            ......

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