Latest Insurance Licensing InsNV_Health02 Test Preparation | InsNV_Health02 Exam Prep

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Topic 1: Accident & Health – General Knowledge	50%	- Social Insurance 1. Medicare Parts A, B, C, and D 2. Medicaid 3. Social Security benefits - Other Insurance Concepts 1. Subrogation 2. Owner's rights 3. Occupational vs. non-occupational 4. Nonduplication and coordination of benefits 5. Modes of premium payments 6. Cost containment 7. Managed care 8. Dependent children benefits 9. Primary and contingent beneficiaries 10. Total, partial, recurrent, and residual disability 11. Tax treatment of premiums and proceeds of insurance contracts 12. Workers Compensation - Field Underwriting Procedures 1. Replacement 2. Explaining policy provisions, riders, exclusions, and ratings 3. Sources of insurability and HIPAA privacy information 4. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 5. Policy delivery 6. Submitting application and initial premium to company for underwriting 7. Initial premium payment and receipt 8. Completing the application - Policy Provisions, Clauses, and Riders 1. 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 2. Riders Impairment and exclusions Guaranteed insurability Future increase option 3. Rights of renewability Noncancelable Cancelable Guaranteed renewable 4. 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 - Types of Policies 1. Individual and Group Long Term Care Eligibility Levels of care 2. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident 3. Medicare supplement policies 4. Accidental death and dismemberment 5. Group insurance Differences between individual and group contracts General characteristics COBRA 6. 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 7. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy
Topic 2: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Marketing Practices 1. Fiduciary responsibilities 2. Required records and record retention 3. Commissions and payment restrictions 4. Silver State Health Insurance Exchange 5. Affordable Care Act 6. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation - Licensing 1. Suspension, revocation, and refusal of license 2. Persons required to be licensed 3. Obtaining a license 4. Renewal and continuing education 5. Name of licensee 6. Termination of license - Insurance Commissioner 1. Examinations 2. Notice and hearings and penalties 3. General powers and duties - Definitions 1. Domestic, foreign, and alien 2. Authorized and unauthorized 3. Premiums 4. Insurer 5. Transacting insurance 6. Certificate of authority 7. Cost-sharing - Nevada Life and Health Insurance Guaranty Association
Topic 3: Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Hospice care - Coverage for reconstructive surgery - Medicare 1. Medicare supplement regulation 2. Prescription Drug Plan 3. Medicare Advantage Plans - Mandatory policy clauses and provisions 1. Coverage for physical handicap or intellectual disability for dependent children 2. Coverage for preventive healthcare services 3. Coverage for newborn children - Long Term Care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
Topic 4: 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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Latest InsNV_Health02 Test Preparation and Insurance Licensing InsNV_Health02 Exam Prep: NV Accident and Health Latest Released

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Insurance Licensing NV Accident and Health Sample Questions (Q49-Q54):

NEW QUESTION # 49
Under a life insurance policy with a revocable beneficiary designation, who normally has the authority to change the beneficiary?

A. The insured, regardless of ownership
B. The insurer
C. The policyowner
D. The beneficiary

Answer: C

Explanation:
The policyowner normally holds the contractual rights known as incidents of ownership. When the beneficiary designation is revocable, the policyowner may generally change the beneficiary without obtaining that beneficiary's consent, provided the policy is in force and no assignment or court order restricts the right.
The owner may also ordinarily exercise other ownership rights, such as selecting premium-payment modes, assigning the policy, taking a policy loan when available, surrendering the policy for cash value, and electing settlement options.
The insured and the owner can be the same person, but they do not have to be. The insured is the person whose life is covered and whose death triggers payment of the death benefit. A beneficiary is the person or entity designated to receive policy proceeds. Those roles must be kept separate on examination questions. A revocable beneficiary has only an expectancy until the insured dies; by contrast, an irrevocable beneficiary usually has a vested interest that limits the owner's ability to change the designation or exercise certain policy rights without consent.
Correctly identifying the owner is essential because ownership determines control of the policy during the insured's lifetime.
References/topics from the Study Guide: Policyowners' Rights; Beneficiary Designations; Revocable and Irrevocable Beneficiaries; Assignments.

NEW QUESTION # 50
An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:

A. increase the waiting period to adjust for the occupational difference
B. increase the deductible to adjust for the occupational difference
C. adjust benefits to the amount the premium provides for the new occupation
D. deny any claim on the basis of misrepresentation

Answer: C

Explanation:
The Change of Occupation provision allows an insurer to adjust benefits when the insured changes to a more hazardous occupation after policy issue. Choice A is correct. If the same premium would have purchased a lower benefit amount for the new, more hazardous occupati on, the insurer may reduce the benefit to the amount that premium would have bought under the new occupational classification. The purpose is to preserve fairness between the risk assumed and the premium paid without automatically cancelling the policy.
The insurer does not simply increase the waiting period or deductible, because those are not the contractual adjustment method addressed by the provision. It also does not deny every claim for misrepresentation, because a later change in occupation is not necessarily a misrepresentation in the original application. If the insured changes to a less hazardous occupation, the provision may allow the insured to apply for an adjusted premium rate or greater benefit as appropriate under policy terms. The key examination rule is that occupational changes affect the amount of benefits or premium classification, not the basic validity of coverage. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Change of Occupation Provision; Individual Accident and Health Policies.

NEW QUESTION # 51
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?

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

Answer: D

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 # 52
For a group health plan subject to the federal waiting-period rule, the waiting period for otherwise eligible employees generally may not exceed:

A. 90 calendar days
B. 30 calendar days
C. 60 calendar days
D. 180 calendar days

Answer: A

Explanation:
A health plan's waiting period generally may not exceed 90 calendar days for an individual who is otherwise eligible to enroll. A waiting period is the period that must pass before coverage becomes effective for an employee or dependent who has met the plan's substantive eligibility conditions. The rule is intended to limit extended gaps in employer-sponsored health coverage for eligible individuals.
The 90-day limitation does not mean that every new employee must receive coverage immediately on the first day of work. An employer may use reasonable eligibility requirements, such as a bona fide job classification or an hours-of-service requirement, as long as the arrangement is structured and administered in compliance with applicable federal rules. The producer should not treat every orientation period or administrative condition as automatically permissible; plan documents and current legal guidance matter.
This issue is distinct from preexisting-condition exclusions. Modern health-insurance rules significantly restrict the use of preexisting-condition exclusions in major medical coverage. It is also distinct from an elimination period in disability insurance, which is a waiting period after a disability begins rather than a waiting period for plan eligibility.
References/topics from the Study Guide: Group Health Eligibility; Waiting Periods; Employer-Sponsored Coverage; Federal Health-Insurance Requirements; Nevada Group Health Rules.

NEW QUESTION # 53
One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:

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

Answer: B

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 # 54
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