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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q113-Q118):

NEW QUESTION # 113
Which statement is true of a variable life insurance policy?

A. The policyowner bears no investment risk.
B. The cash value is held only in the insurer's general account.
C. The cash value may fluctuate with separate-account investment performance.
D. The policy is always a temporary term policy.

Answer: C

Explanation:
Variable life insurance is permanent life insurance with cash values invested in separate-account investment options. Because the value of those investments can rise or fall, the policyowner bears the investment risk.
The policy's cash value may fluctuate based on market performance, and the death benefit may vary above a guaranteed minimum amount, subject to policy provisions. The insurer does not guarantee the investment performance of the separate account.
Variable life insurance differs from whole life, where the insurer's general account supports guaranteed cash values and fixed premiums. It also differs from universal life, which emphasizes flexible premiums and adjustable death-benefit structures. Variable universal life combines flexible-premium features with separate- account investment options. All such products must be described accurately because the potential for growth is accompanied by potential loss.
Because variable life is a security as well as an insurance product, a producer generally needs appropriate securities registration and authorization in addition to life insurance licensing. Suitability is especially important. The product may be appropriate only for a consumer with a long time horizon, tolerance for market volatility, and a need for permanent life insurance. It should not be sold as a guaranteed investment or as equivalent to a fixed life policy.
References/topics from the Study Guide: Variable Life Insurance; Separate Accounts; General Accounts; Securities Registration; Investment Risk; Suitability.

NEW QUESTION # 114
According to Nevada law, an authorized insurer is BEST defined as:

A. any insurer with minimum assets as required by this state
B. an insurer with a certificate of authority issued by the Insurance Commissioner of Nevada
C. an insurer authorized under a certificate of authority issued by the Governor of Nevada
D. an insurer with a certificate of authority issued by the National Association of Insurance Commissioners (NAIC)

Answer: B

Explanation:
An authorized insurer is an insurer that holds a certificate of authority issued by the Nevada Insurance Commissioner and remains authorized to transact insurance in the state. The certificate of authority is the formal approval allowing the insurer to conduct the kinds of insurance business for which it has been approved.
Having sufficient assets may be one consideration in an insurer's application and ongoing financial regulation, but assets alone do not make an insurer authorized. The National Association of Insurance Commissioners develops model laws, standards, and regulatory resources; it does not issue Nevada certificates of authority. The Governor of Nevada likewise does not issue insurance certificates of authority.
This distinction is central to Nevada insurance regulation. Authorized, or admitted, insurers are subject to Nevada's ongoing solvency oversight, market-conduct regulation, rate and form requirements where applicable, examinations, and other statutory obligations. Nonadmitted insurers may be used only through the surplus-lines process or another applicable statutory exception.
A producer must understand whether an insurer is authorized before placing ordinary insurance business.
Selling or placing insurance with an unauthorized insurer outside a lawful exception can create serious regulatory consequences.
Study Guide references/topics: authorized insurers; admitted insurers; certificates of authority; insurer regulation; NRS 680A.020 .

NEW QUESTION # 115
What is the primary purpose of a waiver-of-premium rider on a life insurance policy?

A. It eliminates all future policy loans.
B. It converts term insurance automatically into whole life insurance.
C. It guarantees a higher death benefit every year.
D. It waives required premiums if the insured becomes totally disabled as defined by the rider.

Answer: D

Explanation:
A waiver-of-premium rider keeps qualifying life insurance coverage in force by waiving required premiums when the insured becomes totally disabled as defined in the rider. The rider protects against the risk that disability will interrupt income and make premium payments unaffordable. Once the rider's requirements are satisfied, the insurer pays or waives the premium according to the policy terms, allowing the coverage and any applicable cash-value features to continue.
The definition of total disability, the waiting period, the age limitation, proof-of-disability requirements, and the duration of the waiver are contractual matters. The rider does not usually mean that premiums are waived for every illness, injury, or temporary work interruption. The insured must meet the stated definition and provide required evidence. Some riders also require that disability begin before a specified age.
This rider should not be confused with disability-income insurance. Disability income pays a periodic benefit to replace a portion of income. Waiver of premium does not provide an income payment; it protects the life policy from lapse due to qualifying disability. It also differs from a payor-benefit rider, which is commonly used with juvenile policies and protects the policy when the premium-paying adult dies or becomes disabled.
References/topics from the Study Guide: Waiver of Premium Rider; Total Disability; Disability Income; Payor Benefit Rider; Policy Continuation.

NEW QUESTION # 116
Which statement best describes a preferred provider organization (PPO)?

A. It pays only a fixed daily hospital benefit.
B. It requires all care to be obtained only from government hospitals.
C. It has no deductible, coinsurance, or utilization-management features.
D. It generally provides greater benefits when members use participating providers but may allow nonnetwork care at a reduced benefit level.

Answer: D

Explanation:
A preferred provider organization, or PPO, contracts with a network of preferred providers who agree to provide services under negotiated payment arrangements. Members generally receive the highest level of benefit and lowest out-of-pocket cost when they use participating providers. Many PPOs also permit use of nonnetwork providers, but the member normally pays more through a higher deductible, higher coinsurance, balance billing exposure, or reduced reimbursement.
A PPO differs from a traditional HMO because it commonly provides more flexibility in choosing providers and may not require a primary-care referral for specialist care. However, the tradeoff may be higher premiums, higher cost sharing, and more complex reimbursement rules. A PPO is still managed care; it may use prior authorization, utilization review, formularies, and network rules.
A producer should explain provider-network access, emergency-care rules, deductible and coinsurance amounts, out-of-network payment limitations, and whether a provider is actually participating at the time of enrollment. The phrase "you can see any doctor" can be misleading if nonnetwork care is covered at a lower level or exposes the insured to significant unpaid charges.
References/topics from the Study Guide: PPO; Managed Care; Provider Networks; In-Network and Out-of- Network Benefits; Cost Sharing.

NEW QUESTION # 117
An applicant submits the first premium with a life insurance application and receives a conditional receipt.
When does coverage generally become effective?

A. When the conditions in the receipt are met, including required insurability
B. Immediately, regardless of the applicant's insurability
C. Only after the policy has been in force for two years
D. Only when the producer promises that coverage exists

Answer: A

Explanation:
A conditional receipt may provide temporary coverage from the application date or medical-examination date, but only if the conditions stated in the receipt are satisfied. A common condition is that the insurer, applying its normal underwriting standards, would have issued the policy to the applicant as applied for or at the requested rating. The receipt does not guarantee coverage for every applicant merely because the first premium was submitted.
The exact effect of a conditional receipt depends on its language. Some receipts use an "approval" approach, under which coverage begins only when the insurer approves the application. Others use an "insurability" approach, under which coverage may relate back to an earlier date if the applicant was insurable under the insurer's standards. A producer must not describe a conditional receipt as an unconditional binder or promise that the policy has been issued.
The producer should collect and transmit premium funds according to insurer instructions, deliver the receipt, explain its limited nature, and avoid making coverage representations outside the receipt's terms. If the insurer declines the application, the premium is ordinarily returned according to the applicable procedure.
Proper explanation is especially important because applicants may assume that payment alone creates permanent insurance.
References/topics from the Study Guide: Conditional Receipt; Premium with Application; Temporary Insurance; Underwriting Approval; Policy Delivery.

NEW QUESTION # 118
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