Insurance Licensing InsNV_Health02 Guide - InsNV_Health02 Study Guides

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

>> Insurance Licensing InsNV_Health02 Guide <<

NV Accident and Health Exam Training Guide Improve Your Efficiency - EduDump

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Insurance Licensing NV Accident and Health Sample Questions (Q83-Q88):

NEW QUESTION # 83
Which feature most clearly distinguishes a health maintenance organization (HMO) from a traditional indemnity health insurance plan?

A. The HMO commonly uses a provider network and coordinates care through managed-care rules.
B. The HMO always reimburses any provider at the same level.
C. The HMO provides only disability-income benefits.
D. The HMO pays only after the insured satisfies a cash-value requirement.

Answer: A

Explanation:
An HMO is a managed-care arrangement that commonly delivers and finances health-care services through a defined network of providers. Covered persons typically select or are assigned a primary care provider who coordinates routine care and, depending on the plan design, provides referrals for specialist services. Services received outside the network may be limited or not covered except for emergencies or specifically authorized care.
Traditional indemnity insurance operates differently. It generally reimburses covered medical expenses subject to policy limits, deductibles, coinsurance, and usual-and-customary or other payment standards. The insured may have broader provider choice, but that flexibility is often paired with less managed coordination and potentially greater out-of-pocket exposure. A preferred provider organization, or PPO, also uses a network but typically allows nonnetwork care at reduced benefit levels rather than requiring the same referral structure associated with many HMOs.
The exam distinction is based on delivery of care and network control, not merely on whether a policy has a deductible. Managed-care plans seek to control cost and improve coordination by negotiating with providers and establishing coverage procedures. Nevada recognizes network plans as policies in which financing and delivery of medical care are provided, at least in part, through defined providers under contract with the insurer.
References/topics from the Study Guide: Managed Care; HMO; PPO; Network Plans; NRS 689A-Network Plan Definition.

NEW QUESTION # 84
A life policy lapses because a premium was not paid. To reinstate the policy, the insurer will generally require all of the following EXCEPT:

A. Reinstatement within the policy's permitted time limit
B. A new medical examination in every case
C. Payment of overdue premiums with interest
D. Evidence of insurability

Answer: B

Explanation:
Reinstatement restores a lapsed life insurance policy to active status if the policyowner satisfies the policy's requirements. Those requirements generally include applying for reinstatement within the permitted period, providing evidence of insurability satisfactory to the insurer, and paying overdue premiums plus interest. The exact reinstatement period and underwriting requirements are controlled by the policy and applicable law.
A new medical examination is not required in every case. The insurer may request medical information or an examination when needed to evaluate the applicant's current insurability, but it is not an automatic universal requirement. The key examination principle is that evidence of insurability is required, not that a physical examination must always occur. Reinstatement is often preferable to purchasing a new policy because the existing policy may have more favorable premium rates, accumulated cash value, or a prior issue age.
However, the policyowner must understand that contestability and certain exclusions may begin again with respect to the reinstatement.
A producer should explain the difference between reinstatement and renewal. Reinstatement restores a policy that lapsed; renewal continues or extends a policy under its existing terms. Neither should be assumed available without reviewing the contract.
References/topics from the Study Guide: Reinstatement Provision; Policy Lapse; Evidence of Insurability; Premium Payment; NRS 688A.130.

NEW QUESTION # 85
The Nevada Life and Health Insurance Guaranty Association becomes involved in an insurance company ' s affairs when the company:

A. enters a lawsuit against a claimant
B. becomes insolvent
C. withdraws as an Association member
D. denies a claim

Answer: B

Explanation:
The Nevada Life and Health Insurance Guaranty Association becomes involved when a covered member insurer becomes impaired or insolvent. Its statutory purpose is to provide limited protection to eligible policyowners, certificate holders, enrollees, beneficiaries, and other covered persons when a member insurer cannot perform its contractual obligations because of financial failure.
An ordinary lawsuit, claim denial, or membership withdrawal does not by itself trigger Guaranty Association protection. Claim disputes are normally handled through the insurer's claims process, internal appeals, administrative complaint procedures, or litigation. The Guaranty Association is not a general claims-review agency.
When a member insurer is impaired or insolvent, the Association may guarantee, assume, reissue, or reinsure covered policies and contracts, or provide other support necessary to meet covered obligations. Coverage is subject to statutory limits, eligibility requirements, exclusions, and residency rules. It does not protect every type of policy or every amount of loss.
Insurers must not use the Association as a sales inducement. Consumers should evaluate an insurer's financial strength and coverage terms rather than assume that all benefits are fully guaranteed.
Study Guide references/topics: insurer insolvency; impaired insurer; Guaranty Association; member insurers; NRS Chapter 686C .

NEW QUESTION # 86
For a group health plan subject to the federal waiting-period rule, the waiting period for otherwise eligible employees generally may not exceed:

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

Answer: D

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 # 87
A group health insurance policy MUST include coverage for which of the following expenses?

A. Hospice
B. Adult dental
C. Over-the-counter dietary supplements
D. Adult vision

Answer: A

Explanation:
A group health insurance policy in Nevada must include coverage for expenses arising from hospice care.
Hospice care is intended for patients with terminal illness and emphasizes comfort, pain control, symptom management, supportive services, and assistance for the patient and family rather than curative treatment.
Nevada's group-policy required-provisions statute specifically identifies benefits for expenses arising from hospice care. This makes hospice the correct answer. Adult dental and adult vision benefits may be offered by separate policies, riders, employer plans, or benefit arrangements, but they are not universally required in every group health policy. Over-the-counter dietary supplements are not a standard mandated group health benefit and are generally covered only when specifically provided by a policy or health plan.
Hospice coverage should be distinguished from ordinary inpatient hospital coverage. Hospice care may be delivered in a home, residential setting, hospice facility, or other appropriate location, depending on the patient's needs and the terms of coverage. It frequently involves an interdisciplinary team and includes both patient care and family-support services.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; supportive services; NRS 689B.030 .

NEW QUESTION # 88
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