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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Hospice care - Medicare 1. Medicare Advantage Plans 2. Medicare supplement regulation 3. Prescription Drug Plan - Mandatory policy clauses and provisions 1. Coverage for preventive healthcare services 2. Coverage for physical handicap or intellectual disability for dependent children 3. Coverage for newborn children - Coverage for reconstructive surgery - Long Term Care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
Accident & Health – General Knowledge	50%	- Types of Policies 1. Medicare supplement policies 2. Accidental death and dismemberment 3. Individual and Group Long Term Care Eligibility Levels of care 4. 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 5. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy 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 - 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. Rights of renewability Noncancelable Cancelable Guaranteed renewable 3. Riders Impairment and exclusions Guaranteed insurability Future increase option 4. 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 - Social Insurance 1. Medicare Parts A, B, C, and D 2. Medicaid 3. Social Security benefits - Other Insurance Concepts 1. Tax treatment of premiums and proceeds of insurance contracts 2. Managed care 3. Cost containment 4. Workers Compensation 5. Modes of premium payments 6. Nonduplication and coordination of benefits 7. Occupational vs. non-occupational 8. Total, partial, recurrent, and residual disability 9. Subrogation 10. Dependent children benefits 11. Owner's rights 12. Primary and contingent beneficiaries - Field Underwriting Procedures 1. Initial premium payment and receipt 2. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 3. Submitting application and initial premium to company for underwriting 4. Policy delivery 5. Completing the application 6. Explaining policy provisions, riders, exclusions, and ratings 7. Replacement 8. Sources of insurability and HIPAA privacy information
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Definitions 1. Certificate of authority 2. Insurer 3. Cost-sharing 4. Authorized and unauthorized 5. Transacting insurance 6. Premiums 7. Domestic, foreign, and alien - Nevada Life and Health Insurance Guaranty Association - Insurance Commissioner 1. Examinations 2. General powers and duties 3. Notice and hearings and penalties - Licensing 1. Persons required to be licensed 2. Suspension, revocation, and refusal of license 3. Renewal and continuing education 4. Termination of license 5. Name of licensee 6. Obtaining a license - Marketing Practices 1. Commissions and payment restrictions 2. Affordable Care Act 3. Silver State Health Insurance Exchange 4. Required records and record retention 5. Fiduciary responsibilities 6. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation
Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Credit life and health insurance - Group life and health insurance 1. Required provisions 2. Eligible groups - Advertising

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Insurance Licensing NV Accident and Health Sample Questions (Q105-Q110):

NEW QUESTION # 105
One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:

A. can explain insurance terms like copayments and deductibles
B. can answer questions regarding program eligibility
C. are compensated monetarily
D. can recommend a health plan for a consumer

Answer: D

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 # 106
Under Nevada law, the definition of " insurer " includes:

A. a security dealer
B. an indemnitor
C. a financial planner
D. a syndicate

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 # 107
Nevada insurance laws define a domestic insurance company as one formed under the laws of:

A. any territory of the United States of America
B. any jurisdiction of the United States of America
C. the state of Nevada only
D. the state of Nevada as well as any of its neighboring states

Answer: C

Explanation:
A domestic insurer in Nevada is an insurer formed under the laws of Nevada, unless it has converted to foreign-insurer status. Therefore, "the state of Nevada only" is the correct answer.
The terms domestic, foreign, and alien describe the jurisdiction in which an insurer is formed or domiciled; they do not describe the insurer's size, financial condition, or whether it is authorized to do business in Nevada. A foreign insurer is formed under the laws of another jurisdiction, generally another U.S. state, but may be authorized to transact insurance in Nevada. An alien insurer is formed under the laws of a country other than the United States.
An insurer may be domestic in one state and foreign in every other state. For example, an insurer incorporated under Nevada law is domestic in Nevada but foreign in California, Arizona, or any other state. Conversely, a company formed in another state is foreign in Nevada even if it holds a Nevada certificate of authority.
Study Guide references/topics: domestic insurers; foreign insurers; alien insurers; insurer domicile; NRS
679A.090 .

NEW QUESTION # 108
After appointing a producer as its agent, when must an insurer generally file its notice of appointment with the Nevada Commissioner?

A. Within 15 days after the contract is executed or the first application is submitted
B. Within 90 days after the first premium is collected
C. Before the producer completes any insurance training
D. Only at the producer's next license renewal

Answer: A

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 # 109
Under a group health policy, which of the following coverages MUST be provided for newborn children?

A. Genetic Testing
B. Transportation costs from the hospital to the child ' s residence
C. Congenital health defects
D. Routine eye examinations

Answer: C

Explanation:
Nevada requires qualifying group health policies that cover family members to provide coverage for a newborn child from the moment of birth. Required newborn coverage includes injury or sickness and specifically includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Therefore, congenital health defects are the required coverage identified in this question.
The rule is important because congenital defects may be present at birth and can require immediate diagnostic, surgical, medical, or hospital treatment. Nevada law prevents a policy from excluding this necessary care simply because the condition existed at birth. The statute also prohibits exclusion of premature births under the applicable coverage requirement.
The transportation option is incorrect because the law addresses necessary transportation from the place of birth to the nearest specialized treatment center, within policy limits; it does not mandate transportation from the hospital to the child's residence. Routine eye examinations and genetic testing may be covered under a particular policy or health plan, but they are not the specific newborn mandate tested here. Continued coverage beyond the initial period may depend on timely notice and payment of required premium within 31 days.
Study Guide references/topics: group health insurance; newborn coverage; mandated benefits; NRS 689B.033
.

NEW QUESTION # 110
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