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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q103-Q108):

NEW QUESTION # 103
When a nonqualified annuity is surrendered for more than the owner's investment in the contract, how is the gain generally treated for federal income-tax purposes?

A. As ordinary income
B. As a tax-free return of principal only
C. As a deductible business loss
D. As a long-term capital gain in all cases

Answer: A

Explanation:
Gain from a nonqualified annuity is generally taxed as ordinary income when distributed. The owner's investment in the contract, often called the cost basis, is not taxed again because it was paid with after-tax dollars. However, the growth above that basis is tax-deferred only while it remains inside the annuity. When the owner surrenders the contract or receives a taxable distribution, the gain is subject to ordinary-income treatment rather than the preferential capital-gains treatment that may apply to certain investments.
A nonqualified annuity is funded with after-tax money and is not held inside a qualified retirement arrangement such as an IRA or employer plan. The contract's tax deferral can be valuable for long-term planning, but it does not mean that every distribution is tax free. In addition, distributions before age 59½ may be subject to an additional federal tax penalty unless an exception applies. A full surrender may also trigger a surrender charge under the contract if it occurs during the surrender-charge period.
The producer should never present an annuity as tax avoidance. The accurate explanation is tax deferral, possible ordinary-income taxation of gain upon distribution, potential penalties for early distributions, and the importance of consulting a qualified tax adviser for individual circumstances.
References/topics from the Study Guide: Annuity Taxation; Nonqualified Annuities; Cost Basis; Tax Deferral; Surrender Charges.

NEW QUESTION # 104
Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?

A. The insured may periodically increase the amount of benefits payable under the policy.
B. The insurance company must exchange the original policy for a new one at the insurability date.
C. The insurance company guarantees the premium rate for the life of the policy.
D. The insured must periodically provide proof of insurability to the insurance company.

Answer: A

Explanation:
A Guaranteed Insurability rider gives the disability income policyowner the right to purchase additional disability income coverage at stated future option dates without furnishing evidence of insurability. The rider is valuable because an insured's income may increase over time while health may decline; the rider allows benefit amounts to be increased when the option is exercised, subject to the rider's conditions and insurer limits. Therefore, choice C is correct. The rider does not guarantee a premium rate for life. Premiums for the added coverage are based on the insured's attained age and the insurer's rates applicable when the additional coverage is purchased. It also does not require periodic proof of insurability; eliminating that requirement is the central purpose of the rider. The existing policy remains in force and normally does not have to be exchanged for a new policy. On an examination, distinguish guaranteed insurability from noncancellable and guaranteed renewable provisions: those provisions concern renewability and premiums, whereas the rider concerns the future purchase of additional benefits. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Optional Benefits Riders.

NEW QUESTION # 105
In a typical HMO arrangement, what is the primary role of the primary care provider?

A. To coordinate routine care and referrals under the plan's rules
B. To sell insurance policies to other patients
C. To guarantee that all out-of-network care is covered
D. To determine the insurer's investment return

Answer: A

Explanation:
In a typical health maintenance organization, the primary care provider acts as the central coordinator of the insured's routine medical care. The primary care provider may deliver preventive and basic medical services, maintain the patient's care plan, and refer the patient to specialists or other facilities when required by the HMO's rules. This gatekeeper function is intended to coordinate care, reduce unnecessary duplication, and manage costs through the plan's provider network.
The precise referral rules depend on the particular HMO. Some plans may allow direct access to certain specialists, such as obstetricians or behavioral-health providers, while others require prior referral or authorization. Emergency services are subject to separate protections and should not be described as ordinary out-of-network elective care. The producer must explain the network, referral, prior-authorization, and out-of- network rules before enrollment.
A PPO also has a preferred provider network but commonly allows members to use nonnetwork providers at a reduced benefit level and without the same referral structure. An indemnity plan may provide broader provider choice but may have different reimbursement limits and cost sharing. The test distinction is that an HMO commonly emphasizes coordinated, network-based care through a primary care provider.
References/topics from the Study Guide: Managed Care; HMO; Primary Care Provider; Gatekeeper Model; Provider Networks.

NEW QUESTION # 106
Which of the following is permitted by a licensee?

A. Returning the commission to the client to ensure policy renewal
B. Lowering the premium by rebating the commission
C. Altering the client ' s application information to lower the premium rate
D. Buying the client a nominal gift at Christmas

Answer: D

Explanation:
A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada's statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.
Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.
Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant's information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.
The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.
Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .

NEW QUESTION # 107
Which person is the measuring life whose survival determines the timing and duration of annuity payments?

A. Producer
B. Beneficiary
C. Policyowner
D. Annuitant

Answer: D

Explanation:
The annuitant is the person whose life expectancy is used to determine the amount, timing, or duration of annuity payments. The annuitant is not necessarily the contract owner or the beneficiary. In many personally owned annuities, one person may occupy more than one role, but examination questions frequently separate them. The owner controls contractual rights, including premium payments, beneficiary changes, withdrawals when permitted, and surrender decisions. The annuitant is the measuring life. The beneficiary receives remaining contract value or death proceeds if the owner or annuitant dies, depending on the contract design.
During the accumulation period, the owner pays premiums or transfers funds into the annuity. During the annuitization period, the accumulated value is converted into a stream of income payments. The annuitant's age and selected payout option influence the payment calculation. A life-income option normally provides larger periodic payments for an older annuitant because the expected payment period is shorter.
Do not confuse the annuitant with the insured under life insurance. Life insurance is designed primarily to create a death benefit upon the insured's death. An annuity is designed primarily to provide income during life, although death-benefit provisions may apply before annuitization.
References/topics from the Study Guide: Annuities; Parties to an Annuity; Accumulation Period; Annuitization Period; Payout Options.

NEW QUESTION # 108
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