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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionObjectives
Topic 1: Producer Duties and Ethics- Ethical Responsibilities
  • 1. Fiduciary responsibilities
    • 2. Consumer protection requirements
      - Sales Practices
      • 1. Unfair trade practices
        • 2. Advertising and marketing rules
          Topic 2: General Insurance Regulation- Licensing Requirements and Responsibilities
          • 1. Producer licensing requirements
            • 2. Continuing education and license maintenance
              - Nevada Insurance Department and Regulatory Authority
              • 1. Commissioner of Insurance powers and duties
                • 2. Insurance laws, rules, and regulations
                  Topic 3: Accident and Health Insurance Fundamentals- Medical Expense Insurance
                  • 1. Major medical plans
                    • 2. Hospital, surgical, and physician expense coverage
                      - Types of Health Insurance Policies
                      • 1. Managed care plans
                        • 2. Individual health insurance
                          • 3. Group health insurance
                            - Disability Income Insurance
                            • 1. Elimination periods and benefit periods
                              • 2. Disability definitions and benefits
                                Topic 4: Health Insurance Policy Provisions- Mandatory and Optional Provisions
                                • 1. Renewability provisions
                                  • 2. Policy requirements and clauses
                                    - Claims and Benefits
                                    • 1. Claim procedures
                                      • 2. Benefit determination and payment
                                        Topic 5: Insurance Basics- Insurance Contracts
                                        • 1. Contract elements
                                          • 2. Policy provisions, riders, and exclusions
                                            - Risk Management and Insurance Concepts
                                            • 1. Types of risk and methods of handling risk
                                              • 2. Insurance principles and contract characteristics
                                                Topic 6: Government Health Insurance Programs- Medicare
                                                • 1. Medicare supplement insurance
                                                  • 2. Medicare parts and eligibility
                                                    - Medicaid and Other Programs
                                                    • 1. Medicaid eligibility and coverage

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                                                      Insurance Licensing NV Accident and Health Sample Questions (Q60-Q65):

                                                      NEW QUESTION # 60
                                                      Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member:

                                                      Answer: B

                                                      Explanation:
                                                      The correct answer is D. A guaranteed renewable provision protects an insured against termination based solely on health deterioration or disability, provided the premium is paid and the insured continues to meet the policy's stated conditions. Therefore, the insurer may not terminate coverage merely because the member becomes disabled. The insurer may, however, terminate or end coverage when a member no longer meets an eligibility requirement, such as leaving the eligible occupational classification, ceasing active employment, or reaching a policy-specified terminating age. Those conditions concern the member's contractual eligibility for the group coverage rather than the member's health status. Guaranteed renewable does not necessarily mean that premiums can never change. The insurer may generally change premiums on a class basis, but it cannot single out one insured for an individual premium increase or cancellation because that person became ill or disabled. This concept should be distinguished from noncancellable coverage, which provides stronger protection by preventing the insurer from changing either premiums or benefits during the stated period.
                                                      Study Guide References/Topics: Group Health Insurance; Renewability Provisions; Guaranteed Renewable Coverage.


                                                      NEW QUESTION # 61
                                                      Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?

                                                      Answer: B

                                                      Explanation:
                                                      A family is not an eligible blanket-health-insurance group under Nevada law. Blanket accident and health insurance is designed for defined groups connected by a common activity, organization, occupation, event, or exposure to a specified hazard. It is not designed as a substitute for ordinary individual or family health insurance.
                                                      Nevada specifically recognizes various groups that may be covered under a blanket policy. These include religious, charitable, recreational, educational, and civic organizations; newspaper publishers covering their carriers; and volunteer fire departments or similar emergency organizations covering members or participants.
                                                      The organization acts as the policyholder, and the covered persons are defined by their relationship to the group activity or specified hazard.
                                                      A church is eligible as a religious organization. A newspaper corporation may qualify when covering its carriers. A volunteer fire department is specifically listed as an eligible organization. A family, however, is a private household relationship rather than a qualifying blanket group formed around an authorized organizational purpose or activity.
                                                      Study Guide references/topics: blanket accident and health insurance; eligible groups; policyholder; specified hazards; NRS 689B.070 .


                                                      NEW QUESTION # 62
                                                      J and K are married and have several children. J is the primary beneficiary on K ' s Accidental Death and Dismemberment (AD & D) policy, and K ' s sibling, L, is the contingent beneficiary. J, K, and L are involved in a train accident, and K and L are killed instantly. The Accidental Death benefits will be paid to:

                                                      Answer: A

                                                      Explanation:
                                                      The correct answer is D, J only. A primary beneficiary has the first right to receive policy proceeds. J is named as K's primary beneficiary and survives the accident. Therefore, the AD & D benefit is paid directly to
                                                      J. The contingent beneficiary, L, would receive the proceeds only if the primary beneficiary had died before K or could not receive the benefit under the policy terms. Because J remains alive, L's death does not change the payment outcome. The proceeds do not pass to K's estate because a living named primary beneficiary exists.
                                                      They also do not pass to L's estate, because L never became entitled to the benefit; the contingency never occurred. Beneficiary designations control over general assumptions about family relationships or estates. The insured should keep beneficiary designations current after changes in family status, death, divorce, or estate- planning decisions. A simultaneous-death provision can alter outcomes if the beneficiary and insured die in the same event and survivorship cannot be determined, but the facts here identify K and L as deceased while J survives. Study Guide References/Topics: Group Health Insurance; Accidental Death and Dismemberment; Beneficiary Designations.


                                                      NEW QUESTION # 63
                                                      Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?

                                                      Answer: D


                                                      NEW QUESTION # 64
                                                      Which of the following persons is NOT required to be licensed by the Nevada Insurance Commissioner?

                                                      Answer: A

                                                      Explanation:
                                                      A salaried insurance company employee performing only clerical and administrative work is not required to hold an insurance producer license. The exemption applies when the employee does not sell, solicit, or negotiate insurance and is not compensated by commission based on insurance transactions.
                                                      Licensing is required for persons whose activities bring them into the regulated functions of insurance production, brokering, adjusting, or other licensed insurance activity. A person who procures insurance for an insured is acting in a producer or broker capacity and requires appropriate authority. An individual involved in investigating and settling claims may require an adjuster license depending on the duties performed.
                                                      Likewise, an agency clerk who receives commissions related to processed applications is no longer functioning solely as a clerical employee; commission-based activity indicates involvement in the insurance transaction.
                                                      The distinction is based on the actual work performed, not merely the person's job title. A company may call someone an assistant, representative, clerk, or customer-service employee, but the individual must be licensed if the person sells, solicits, negotiates, or otherwise performs regulated insurance functions.
                                                      Study Guide references/topics: producer licensing; licensing exemptions; clerical employees; sales, solicitation, and negotiation; NRS 683A.117 .


                                                      NEW QUESTION # 65
                                                      ......

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