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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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新版Insurance Licensing InsNV_Health02題庫上線 & InsNV_Health02測試

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最新的 Nevada Insurance InsNV_Health02 免費考試真題 (Q17-Q22):

問題 #17
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:

A. not covered under the rules of ACA because mammograms are not considered preventative health care
B. covered under only health plans that offer mammogram coverage
C. not covered if a family member has been formally diagnosed with breast cancer
D. covered under preventative services annually at no cost

答案：D

解題說明：
For insured women age 40 or older, Nevada requires group health insurance coverage for an annual mammogram to screen for breast cancer. The required benefit must be available through an in-network provider, and the insurer generally may not impose a deductible, copayment, coinsurance, or another form of cost sharing for that mandated screening.
Mammography is preventive screening. It is intended to detect breast cancer early, often before symptoms appear. This differs from diagnostic imaging, which may be ordered after an abnormal screening result, a finding on examination, or another clinical concern. Nevada law also addresses medically necessary imaging and diagnostic testing when the insured's provider recommends them based on medical history, family history, risk factors, or an observed abnormality.
A family history of breast cancer does not eliminate coverage; instead, it may support the need for additional screening or imaging. The benefit is not restricted only to plans that voluntarily choose to offer mammography. It is a required coverage provision for applicable group health policies.
Study Guide references/topics: preventive care; breast-cancer screening; mandated benefits; deductibles and coinsurance; NRS 689B.0374 .

問題 #18
Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?

A. Two
B. Five
C. Ten
D. Thirty-one

答案：D

解題說明：
A newborn is automatically covered under the applicable Nevada health-policy rule for 31 days after birth.
Coverage begins from the moment of birth and includes necessary care and treatment for injury or sickness, including medically diagnosed congenital defects and birth abnormalities.
To continue coverage beyond the initial 31-day period, the policy may require timely notice of the birth and payment of any additional premium or fee required by the insurer. The notification and payment requirement must be satisfied within the 31-day period if the policy requires it. This rule protects newborns during the immediate post-birth period, when medical care may be urgently necessary.
The automatic coverage is not limited to routine newborn care. It includes necessary treatment of medical conditions identified at birth, subject to the policy's applicable limits. The law also prevents the policy from excluding premature births under the mandated newborn coverage.
Two, five, and ten days are incorrect because they would not provide the statutory protection required for newborn coverage. The exam point is that the initial automatic period is 31 days, while continuation beyond that period may require prompt enrollment action by the insured.
Study Guide references/topics: individual health insurance; newborn coverage; congenital defects; notification requirements; Nevada newborn-coverage requirements .

問題 #19
In a contributory group health insurance plan, which statement is correct?

A. The employer pays the entire premium.
B. Only executives may enroll.
C. Employees contribute part of the premium and participation requirements commonly apply.
D. No enrollment forms are necessary.

答案：C

解題說明：
A contributory group health plan is one in which covered employees pay a portion of the premium. Because employees must elect coverage and contribute financially, insurers commonly require a minimum percentage of eligible employees to participate. The participation requirement reduces adverse selection by helping ensure that enrollment includes a broad cross-section of the eligible group rather than only individuals who expect immediate medical expenses.
A noncontributory plan is one in which the employer pays the full premium for eligible employees. Because employees are not required to contribute, participation is generally expected to be much higher and may be mandatory for eligible employees under the employer's plan rules. The distinction is based on premium contribution, not on whether the coverage includes dependents, dental benefits, or a network.
Group insurance is characterized by a master policy issued to the policyholder, commonly an employer or association. Individual insureds receive certificates of coverage that describe the benefits and rights under the group contract. The employer's role, employee eligibility rules, waiting periods, and contribution structure must all be disclosed accurately.
On an examination question, remember the primary rule: contributory means employees contribute toward premium; noncontributory means the employer pays the entire premium for the covered employees.
References/topics from the Study Guide: Group Health Insurance; Contributory Plans; Noncontributory Plans; Participation Requirements; Certificates of Coverage.

問題 #20
Medicaid is best described as:

A. A Medicare supplement insurance plan
B. A private insurance policy sold by producers
C. A joint federal-state program that provides medical assistance to eligible individuals
D. A federal retirement program funded only by payroll taxes

答案：C

解題說明：
Medicaid is a joint federal-state medical-assistance program serving eligible individuals and families under income, resource, categorical, residency, and other program rules. The federal government establishes broad requirements and provides funding, while each state administers its program within federal parameters.
Nevada administers Medicaid through its state health and human-services structure and contracted delivery systems. Eligibility and benefits can vary by category and may change with law and program administration.
Medicaid is not the same as Medicare. Medicare is principally a federal social-insurance program associated with age 65 or older, certain disabilities, and end-stage renal disease or other qualifying conditions. Medicaid is generally means tested, although eligibility is determined by detailed program standards and should never be assumed from income alone. Some people may qualify for both Medicare and Medicaid; these individuals are often referred to as dual-eligible beneficiaries.
A producer should avoid giving legal or public-benefit eligibility advice beyond the scope of insurance licensing. The proper role is to identify the program accurately, explain how private coverage may coordinate where applicable, and direct a consumer to the appropriate state agency or benefits specialist for an eligibility determination.
References/topics from the Study Guide: Medicaid; Medicare; Dual Eligibility; Government-Sponsored Health Programs; Nevada Public Health Benefits.

問題 #21
Which statement best describes Medicare Part B?

A. It is Medicaid coverage for low-income individuals.
B. It provides only outpatient prescription-drug benefits.
C. It is medical insurance and generally requires enrollment and a monthly premium.
D. It is automatic for every person at age 55.

答案：C

解題說明：
Medicare Part B is the medical-insurance portion of Original Medicare. It generally helps cover physician services, outpatient care, diagnostic services, preventive care, durable medical equipment, and other covered medical services. Enrollment is generally voluntary, although it may be automatic for certain people who are already receiving Social Security benefits. Most individuals pay a monthly Part B premium, and higher- income beneficiaries may pay an income-related additional amount.
Part B should not be confused with Medicare Part D, which provides outpatient prescription-drug coverage, or with Medicaid, which is a joint federal-state program for eligible individuals with limited income and resources. Part B also differs from Part A, which is primarily hospital insurance. Delaying Part B enrollment without qualifying employer coverage can result in late-enrollment penalties and gaps in coverage, so producers should avoid casual advice and instead direct consumers to current Medicare enrollment guidance.
When discussing Medicare-related products, producers must accurately identify whether a client has Original Medicare, a Medicare Advantage plan, a Medicare supplement policy, and/or a Part D prescription-drug plan.
These arrangements have different rules, premiums, provider networks, and cost-sharing structures.
References/topics from the Study Guide: Medicare Part B; Original Medicare; Enrollment Periods; Medicare Premiums; Medicare Supplement Products.

問題 #22
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