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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Coverage for reconstructive surgery
- Long Term Care
- Hospice care
- Medicare
  • 1. Medicare Advantage Plans
    • 2. Medicare supplement regulation
      • 3. Prescription Drug Plan
        - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
        - Mandatory policy clauses and provisions
        • 1. Coverage for newborn children
          • 2. Coverage for preventive healthcare services
            • 3. Coverage for physical handicap or intellectual disability for dependent children
              Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Nevada Life and Health Insurance Guaranty Association
              - Insurance Commissioner
              • 1. Notice and hearings and penalties
                • 2. Examinations
                  • 3. General powers and duties
                    - Definitions
                    • 1. Transacting insurance
                      • 2. Certificate of authority
                        • 3. Authorized and unauthorized
                          • 4. Domestic, foreign, and alien
                            • 5. Cost-sharing
                              • 6. Premiums
                                • 7. Insurer
                                  - Licensing
                                  • 1. Persons required to be licensed
                                    • 2. Obtaining a license
                                      • 3. Termination of license
                                        • 4. Name of licensee
                                          • 5. Renewal and continuing education
                                            • 6. Suspension, revocation, and refusal of license
                                              - Marketing Practices
                                              • 1. Required records and record retention
                                                • 2. Unfair practices
                                                  • Unfair claims methods and practices and settlement of claims
                                                  • Rebating and inducement
                                                  • Twisting
                                                  • Misrepresentation
                                                  • Fraud
                                                  • Unfair discrimination
                                                  • Defamation
                                                • 3. Silver State Health Insurance Exchange
                                                  • 4. Fiduciary responsibilities
                                                    • 5. Commissions and payment restrictions
                                                      • 6. Affordable Care Act
                                                        Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Credit life and health insurance
                                                        - Group life and health insurance
                                                        • 1. Eligible groups
                                                          • 2. Required provisions
                                                            - Advertising
                                                            Accident & Health – General Knowledge50%- 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. 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
                                                            • 4. Rights of renewability
                                                              • Noncancelable
                                                              • Cancelable
                                                              • Guaranteed renewable
                                                            - Social Insurance
                                                            • 1. Medicaid
                                                              • 2. Social Security benefits
                                                                • 3. Medicare Parts A, B, C, and D
                                                                  - Other Insurance Concepts
                                                                  • 1. Nonduplication and coordination of benefits
                                                                    • 2. Cost containment
                                                                      • 3. Subrogation
                                                                        • 4. Managed care
                                                                          • 5. Workers Compensation
                                                                            • 6. Modes of premium payments
                                                                              • 7. Dependent children benefits
                                                                                • 8. Total, partial, recurrent, and residual disability
                                                                                  • 9. Occupational vs. non-occupational
                                                                                    • 10. Primary and contingent beneficiaries
                                                                                      • 11. Owner's rights
                                                                                        • 12. Tax treatment of premiums and proceeds of insurance contracts
                                                                                          - Types of Policies
                                                                                          • 1. Group insurance
                                                                                            • Differences between individual and group contracts
                                                                                            • General characteristics
                                                                                            • COBRA
                                                                                          • 2. Disability income
                                                                                            • Individual disability income policy
                                                                                            • Business overhead expense policy
                                                                                            • Business disability buyout policy
                                                                                            • Group disability income policy
                                                                                            • Key employee policy
                                                                                          • 3. Medicare supplement policies
                                                                                            • 4. Individual and Group Long Term Care
                                                                                              • Eligibility
                                                                                              • Levels of care
                                                                                            • 5. Other policies
                                                                                              • Dental
                                                                                              • Vision
                                                                                              • Cancer
                                                                                              • Critical illness or specified disease
                                                                                              • Worksite employer-sponsored
                                                                                              • Hospital indemnity
                                                                                              • Short-term medical
                                                                                              • Accident
                                                                                            • 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. Accidental death and dismemberment
                                                                                              - Field Underwriting Procedures
                                                                                              • 1. Policy delivery
                                                                                                • 2. Submitting application and initial premium to company for underwriting
                                                                                                  • 3. Initial premium payment and receipt
                                                                                                    • 4. Completing the application
                                                                                                      • 5. Contract law
                                                                                                        • Elements of a contract
                                                                                                        • Insurable interest
                                                                                                        • Warranties and representations
                                                                                                        • Unique aspects of the insurance contract
                                                                                                      • 6. Replacement
                                                                                                        • 7. Explaining policy provisions, riders, exclusions, and ratings
                                                                                                          • 8. Sources of insurability and HIPAA privacy information

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                                                                                                            InsNV_Health02 Real Question & Certification InsNV_Health02 Cost

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

                                                                                                            NEW QUESTION # 49
                                                                                                            Under federal law, a tax exempt Health Savings Account can only be opened for an individual who is:

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            A Health Savings Account is available only to an eligible individual, and a central eligibility requirement is coverage under a qualified High Deductible Health Plan. Therefore, choice A is correct. The individual also generally must not have disqualifying other health coverage, be enrolled in Medicare, or be claimable as another person's tax dependent. Long-term care insurance does not itself establish HSA eligibility. Medicare enrollment generally prevents new HSA contributions, although the account balance may still be used for qualified expenses under applicable tax rules. An HSA offers tax-favored contributions, tax-deferred growth, and tax-free distributions for qualified medical expenses when statutory requirements are met. The HDHP must satisfy annual federal deductible and out-of-pocket limits, which are adjusted periodically. The IRS states that eligible individuals must have HDHP coverage and no disqualifying health coverage to make HSA contributions. See IRS HSA guidance . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Health Savings Accounts; High Deductible Health Plans.


                                                                                                            NEW QUESTION # 50
                                                                                                            Which of the following statements is CORRECT about Business Overhead Expense insurance?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            Business Overhead Expense insurance reimburses a business for specified ongoing operating expenses when a business owner becomes disabled. Eligible expenses commonly include employee salaries, rent, utilities, office expenses, and other ordinary fixed costs identified in the policy. Accordingly, choice B is correct. The purpose is business continuity: it helps keep the office or practice operating during the owner's disability rather than replacing the owner's personal income. A disability income policy, not Business Overhead Expense insurance, is the product intended to replace an individual's lost earned income. The coverage is not restricted to corporations; it may be appropriate for sole proprietors, partners, and owners of closely held businesses, depending on underwriting and policy eligibility. It also is not limited to staff expenses alone, because rent, utilities, and other contractually covered overhead are central components of the protection.
                                                                                                            Benefits are generally limited by the actual covered overhead incurred and the policy's monthly benefit amount. Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Business Overhead Expense Coverage.


                                                                                                            NEW QUESTION # 51
                                                                                                            For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            Choice B is correct because accidental loss of eyesight is a standard covered dismemberment loss under most AD & D policies. These policies pay benefits for accidental death and for specifically listed losses, often including loss of life, both hands, both feet, one h and and one foot, sight in one or both eyes, hearing, speech, or specified paralysis. The loss must result directly from accidental bodily injury and occur within the policy's required loss period. Death from a heart attack is generally illness-related rather than accidental. Loss of the spleen, even when caused by an accident, is not usually one of the specifically scheduled losses in a basic AD
                                                                                                            & D policy. Partial paralysis due to a stroke is caused by illness rather than accidental injury. AD & D policies are limited-benefit contracts, so the policy does not pay merely because an injury is serious; the loss must match the policy's defined covered loss. The benefit amount varies according to the loss, with full principal sums often payable for death or loss of both eyes and smaller percentages for certain partial losses.
                                                                                                            Study Guide References/Topics: Types of Health Insurance Policies; Accidental Death and Dismemberment; Covered Losses.


                                                                                                            NEW QUESTION # 52
                                                                                                            Under federal COBRA continuation rules, an employee who loses group health coverage because of termination of employment or reduction in hours will generally be offered continuation coverage for up to:

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            COBRA generally gives qualified beneficiaries the right to continue employer-sponsored group health coverage after certain qualifying events. For termination of employment, other than gross misconduct, or a reduction in work hours, the standard maximum continuation period is generally 18 months. Other qualifying events, such as death of the covered employee, divorce, legal separation, or a dependent child's loss of dependent status, may result in a longer maximum continuation period, commonly 36 months.
                                                                                                            Continuation coverage is not free coverage. The qualified beneficiary typically pays the full group premium plus a permitted administrative charge. COBRA can preserve the same group coverage and provider access for a limited time, but it may be expensive because the employer is no longer subsidizing premiums.
                                                                                                            Enrollment deadlines, election notices, payment rules, and employer-plan size requirements are important.
                                                                                                            COBRA should not be confused with conversion coverage or an Affordable Care Act marketplace plan.
                                                                                                            Conversion coverage is an individual policy issued after group coverage ends under stated conditions.
                                                                                                            Marketplace coverage is a separate individual-market option that may be available following loss of employer- sponsored coverage. Producers should explain options carefully and avoid presenting one continuation route as automatically best for every consumer.
                                                                                                            References/topics from the Study Guide: COBRA; Group Health Continuation; Qualifying Events; Conversion Privilege; Employer-Sponsored Health Insurance.


                                                                                                            NEW QUESTION # 53
                                                                                                            An insurance company MUST take which of the following actions to terminate a producer ' s appointment?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            When an insurer terminates the appointment, employment, or other relationship of a producer, it must notify the Nevada Insurance Commissioner. The notice must be made in the form prescribed by the Commissioner within 30 days after the effective date of termination.
                                                                                                            An appointment is the insurer's authorization for a licensed producer to act as its agent. Ending an appointment does not automatically cancel the producer's underlying license. A producer may remain properly licensed and may be appointed by another insurer or operate as a broker when permitted by law.
                                                                                                            Therefore, option B is incorrect.
                                                                                                            The insurer must provide the required notice to the Commissioner; it is not required to obtain a hearing before ending the appointment. The producer is sent a copy of the insurer's notification after the Commissioner is notified, but the statute does not require the insurer to provide 30 days' advance notice to the producer. The producer has an opportunity to file written comments concerning the report with the Commissioner.
                                                                                                            The reporting rule supports regulatory oversight and helps the Division identify whether a termination involved conduct that may warrant disciplinary action.
                                                                                                            Study Guide references/topics: producer appointments; appointment termination; insurer reporting duties; NRS 683A.331 .


                                                                                                            NEW QUESTION # 54
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