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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q55-Q60):

NEW QUESTION # 55
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 a long-term capital gain in all cases
B. As a tax-free return of principal only
C. As a deductible business loss
D. As ordinary income

Answer: D

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 # 56
Which feature is most characteristic of universal life insurance?

A. Coverage that can never build cash value
B. Flexible premiums and adjustable death-benefit options, subject to policy requirements
C. A fixed premium and fixed death benefit with no flexibility
D. Investment risk borne entirely by the insurer in a separate account

Answer: B

Explanation:
Universal life insurance is a flexible-premium permanent life insurance policy. It generally provides a cash- value account, interest crediting, mortality charges, expense charges, and flexible premium-payment options within policy limits. The owner may often adjust the amount and timing of premiums and may have death- benefit options, subject to minimum funding requirements, underwriting rules for increases, and the policy's terms. The flexibility does not mean the owner can stop paying indefinitely without consequence. If cash value is insufficient to cover monthly deductions and charges, the policy can lapse.
Universal life differs from traditional whole life, which typically has fixed premiums, a guaranteed cash-value schedule, and a fixed death benefit. It also differs from variable life, in which cash value and death benefit are linked to separate-account investments and market performance. Universal life typically uses the insurer's general account for interest crediting, although variable universal life is a separate product combining flexibility with separate-account investment risk.
A producer must explain that illustrated values are not guaranteed unless identified as such. Policyowners should receive in-force illustrations and review funding adequacy periodically, particularly after taking loans, withdrawals, or reducing premium payments.
References/topics from the Study Guide: Universal Life Insurance; Flexible Premiums; Adjustable Death Benefit; Cash Value; Policy Lapse Risk.

NEW QUESTION # 57
When must insurable interest generally exist in a life insurance transaction?

A. At the time the policy is issued
B. Only when the beneficiary is changed
C. Only after the policy has been in force for two years
D. Only when the death benefit is paid

Answer: A

Explanation:
Insurable interest must generally exist when a life insurance policy is issued. It is the lawful financial or personal interest that prevents life insurance from becoming a wagering arrangement. A person has an unlimited insurable interest in that person's own life and may name any lawful beneficiary. Insurable interest also commonly exists among close family members because of love and affection, and in certain business relationships where one person or entity would suffer a financial loss from another person's death.
Once a policy is validly issued with insurable interest, the interest does not generally need to continue until the insured's death. For example, a business may purchase life insurance on a key employee when a valid economic relationship exists. If the relationship later changes, the policy's continued validity is not automatically destroyed solely because the original financial relationship ended. However, ownership transfers, stranger-originated life insurance arrangements, and transactions designed to evade insurable- interest requirements raise significant legal and ethical concerns.
Insurable interest differs from beneficiary status. A beneficiary need not always have an insurable interest if the policyowner is insuring the policyowner's own life. The critical point is that the policy must be procured lawfully at inception.
References/topics from the Study Guide: Insurable Interest; Policy Ownership; Beneficiary Designations; Business Life Insurance; Contract Law.

NEW QUESTION # 58
An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?

A. Only any accumulated cash value is payable.
B. The amount that could have been converted is payable under the group policy.
C. The employer must personally pay the former employee's beneficiary.
D. No benefit is payable because the employee did not submit an application.

Answer: B

Explanation:
Nevada group-life law protects an insured person during the conversion interval. If a person covered under a group life policy dies during the period in which the person was entitled to obtain an individual conversion policy-and before that individual policy becomes effective-the amount of life insurance the person could have converted is payable as a claim under the group policy. This protection applies whether or not the person submitted the individual-policy application or paid the first premium before death.
The conversion privilege is important because group coverage is usually tied to employment or membership.
When eligibility ends, the individual may lose the group policy's protection. Conversion gives the former insured an opportunity to obtain individual life insurance without new evidence of insurability, subject to the statute and policy terms. The converted amount may be limited by the group policy and applicable law, and the individual policy's premium is based on the insurer's conversion rates.
This rule should not be confused with portability. Portability allows continuation of group-style coverage under certain conditions, whereas conversion replaces group coverage with an individual policy. The producer should explain notice requirements, the available conversion amount, deadlines, and premium differences whenever group coverage terminates.
References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Termination of Employment; NRS 688B.120-688B.130.

NEW QUESTION # 59
Which of the following benefits are usually EXCLUDED or limited under a Long Term Care policy?

A. Addictive behavior rehabilitation
B. Home health care
C. Hospice care
D. Skilled nursing

Answer: A

Explanation:
Long-term care insurance is intended to provide benefits for qualified services needed because of chronic illness, cognitive impairment, or inability to perform activities of daily living. Typical covered settings and services include skilled nursing facilities, home health care, and hospice care, subject to the policy's benefit triggers, elimination period, daily or monthly limits, and plan of care requirements. Therefore, choice D is correct. Treatment or rehabilitation for addictive behavior is commonly excluded or restricted because it is not ordinarily a qualifying l ong-term care service under the policy's chronic-care purpose. Long-term care insurance is not the same as comprehensive medical insurance, disability income insurance, or substance-use treatment coverage. Before benefits become payable, the insured usually must be certified as chronically ill, often based on inability to perform at least two activities of daily living or severe cognitive impairment.
Policies may cover institutional care, assisted living, adult day care, respite care, and home-based services, but each benefit is subject to contractual definitions and limits. Study Guide References/Topics: Types of Health Insurance Policies; Long-Term Care Insurance; Long-Term Care Exclusions and Benefit Triggers.

NEW QUESTION # 60
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