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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q112-Q117):

NEW QUESTION # 112
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?

A. Add a newborn child to the policy without providing proof of insurability
B. Demand binding arbitration if there is disagreement over a claim
C. Reinstate the policy within 3 years after it lapses
D. Sue the insurance company for not paying a claim within 30 days after submission of Proof of Loss

Answer: A

Explanation:
Choice D is correct. A family health policy must provide coverage for a newborn child without requiring evidence of insurability at birth, subject to the policy's notice and premium requirements for continuation of coverage. This protects the child during the period when medical needs can arise immediately after birth and prevents underwriting from becoming a barrier to initial coverage. Nevada law recognizes family coverage for dependent children from birth and establishes rules governing newborn coverage. The policy may require notice and any additional premium within the specified period to continue coverage beyond the initial statutory protection. The other choices do not state standard rights under an individual major medical policy.
Arbitration is not automatically available merely because an insured disagrees with a claim decision. A proof of loss does not create an automatic right to sue precisely 30 days after submission. Reinstatement rights also operate under the policy's reinstatement provision and are not a universal three-year right. Nevada's statutory framework specifically addresses dependent and newborn coverage under individual health insurance. See NRS Chapter 689A . Study Guide References/Topics: Nevada-Specific Health Insurance Mandates and Rules; Individual Major Medical; Newborn Coverage.

NEW QUESTION # 113
Which of the following is NOT a preventive benefit for adults?

A. High blood pressure screening
B. Mammograms
C. Physical therapy
D. Skin cancer screening

Answer: D

Explanation:
Skin cancer screening is the correct answer because it is not included as a broadly required preventive benefit for adults in the same manner as the other listed services. Preventive-service requirements are tied to specified recommended services and may vary by population, risk status, and recommendation level. A service may be medically useful or covered by a particular policy without being a universally required no-cost preventive benefit.
High blood pressure screening is a standard adult preventive screening. Mammography is a recognized preventive screening benefit for eligible women. Physical therapy can be included in preventive fall- intervention services for certain adults, particularly older adults at risk of falls, when the preventive-service criteria are met. Thus, the question is testing the distinction between services commonly covered in some circumstances and services specifically identified as preventive benefits.
Skin examinations or skin cancer evaluations may be medically necessary when a lesion, symptom, prior diagnosis, or risk factor is present. In that circumstance, the service may be classified as diagnostic rather than preventive and can be subject to policy terms and cost sharing.
For examination purposes, remember that preventive-benefit questions focus on the mandated screening list and preventive-care criteria, not merely on whether a service can be medically valuable.
Study Guide references/topics: preventive care; adult screenings; in-network preventive benefits; adult preventive-care benefits .

NEW QUESTION # 114
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:

A. L ' s estate
B. J only
C. K ' s estate
D. J and K ' s estate

Answer: B

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 # 115
The Nevada Insurance Commissioner may revoke the license of any licensed producer who:

A. is found liable by final judgment in a civil case
B. misappropriates monies belonging to policyholders
C. fails to notify the Commissioner of a change of address within forty-eight hours
D. fails to file an annual financial report with the Division of Insurance

Answer: B

Explanation:
Misappropriating money belonging to policyholders is a direct and serious ground for license revocation. A producer commonly receives premiums, return premiums, claim funds, or other property in the course of insurance business. Those funds must be handled honestly, promptly, and in accordance with the producer's fiduciary responsibilities. Using, converting, improperly withholding, or diverting that money violates Nevada producer-licensing law.
The Commissioner may refuse to issue, suspend, revoke, or refuse to renew a producer's license and may impose administrative fines or other disciplinary action for specified misconduct. Misappropriation is specifically identified as conduct warranting discipline because it threatens consumers and undermines the integrity of the insurance marketplace.
A civil judgment alone does not automatically establish a licensing-revocation ground under the wording of this question. Likewise, reporting requirements and address-change obligations may lead to administrative consequences when violated, but the question asks for the clear statutory cause for revocation.
Misappropriation of policyholder money is the most direct and legally significant answer.
Producers should maintain accurate premium records, promptly remit funds, segregate money when required, and never treat policyholder or insurer funds as personal assets.
Study Guide references/topics: producer fiduciary duties; prohibited practices; license denial, suspension, and revocation; NRS 683A.451 .

NEW QUESTION # 116
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:

A. Inspection report
B. Notice of Claim
C. Loss form
D. Proof of Loss

Answer: D

Explanation:
The correct answer is C, Proof of Loss. Proof of loss is the written documentation supplied to the insurer to establish that a covered loss occurred and to provide the facts needed to evaluate the claim. It may include claim forms, medical records, bills, physician statements, dates of treatment, disability information, and other evidence required under the policy. Notice of claim is different: it simply informs the insurer that a loss has occurred or that a claim may be made. After receiving notice, the insurer ordinarily provides claim forms or instructions. A loss form may be one document used in the proof-of-loss process, but it is not the complete legal concept. An inspection report may be used by an insurer in some lines of insurance but is not the insured' s required statement establishing a health or disability claim. Timely proof of loss is important because it triggers the insurer's claim-review duties and helps determine when payment is due. Policy provisions specify the timing and form of proof required. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Notice of Claim; Proof of Loss; Claim Procedures.

NEW QUESTION # 117
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