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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q27-Q32):

NEW QUESTION # 27
As a condition to granting a loan, a creditor can:

A. require insurance in an amount greater than the debt
B. require insurance coverage through a specific insurer
C. accept assignment from an existing policy
D. assess a higher interest rate if insurance is not purchased

Answer: C

Explanation:
A creditor may accept an assignment from an existing policy as security for a loan. When consumer credit insurance is required as additional security for debt, Nevada law allows the debtor to furnish the required insurance through existing policies owned or controlled by the debtor, or through any insurer authorized to transact insurance in Nevada.
A creditor may not require the borrower to purchase insurance from a particular insurer. That would improperly limit the borrower's freedom of choice. The creditor also may not require coverage in an amount greater than the debt being secured. Credit insurance is intended to protect the creditor against the unpaid obligation, not to create excess insurance for the creditor's benefit.
Similarly, a creditor may not impose a higher interest rate merely because the borrower declines to purchase credit insurance. Credit insurance must not be represented as a mandatory condition of loan approval when it is optional.
Assignment allows the borrower's existing coverage to be used as collateral or security without forcing the borrower to buy duplicative insurance. The creditor may require proof that the existing insurance is adequate for the risk and debt involved.
Study Guide references/topics: credit insurance; creditor-debtor relationship; assignment; consumer protections; NRS 690A.140 .

NEW QUESTION # 28
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:

A. pay the claim but deduct the unpaid premium
B. deny the claim
C. reinstate the policy and then pay the claim
D. cancel the policy and return all premiums paid

Answer: A

Explanation:
The policy remains in force during its contractual grace period after a premium becomes due. For individual accident and health policies, the required grace period generally depends on premium mode: seven days for weekly premiums, ten days for monthly premiums, and 31 days for other premium modes. A claim occurring within the applicable grace period is not automatically denied simply because the premium has not yet been paid. Instead, the insurer may pay the covered claim and deduct the overdue premium from the amount otherwise payable. Therefore, choice B is the best answer. Reinstatement is unnecessary because the policy has not yet lapsed while the grace period is still running. Cancellation and return of all prior premiums would be inconsistent with the purpose of the grace-period provision. The question tests the difference between a late premium during grace and a lapsed policy after grace expires. Once grace expires without payment, coverage can lapse; if coverage later is reinstated, loss coverage may be subject to reinstatement provisions and limitations. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.

NEW QUESTION # 29
Which type of health insurance is designed primarily to reimburse medical expenses such as hospital, surgical, and physician charges?

A. Credit life insurance
B. Medical expense insurance
C. Accidental death insurance
D. Disability income insurance

Answer: B

Explanation:
Medical expense insurance is designed to reimburse or pay covered health-care expenses arising from illness or injury. These expenses may include hospital room and board, surgical services, physician services, diagnostic testing, outpatient treatment, prescription drugs, and other covered medical care. Benefits are subject to the policy's deductible, copayment, coinsurance, network rules, exclusions, benefit limits, and medical-necessity standards.
Disability income insurance serves a different purpose. It replaces a portion of the insured's earned income when the insured becomes disabled under the policy definition. It does not ordinarily reimburse hospital or physician bills. Accidental death insurance pays a benefit upon qualifying accidental death and does not serve as general medical coverage. Credit life insurance is designed to help satisfy a debt when the debtor dies.
An examination question may describe a policy as basic hospital, surgical, physician expense, major medical, comprehensive major medical, or managed care. Each is within the broader medical-expense category, although benefits and delivery systems differ. The producer should help clients understand the distinction between coverage for medical bills and coverage for lost income. A client can need both forms of protection because medical expenses and inability to earn income are separate financial risks.
References/topics from the Study Guide: Medical Expense Insurance; Hospital Expense; Surgical Expense; Major Medical; Disability Income Insurance.

NEW QUESTION # 30
An insurance company MUST take which of the following actions to terminate a producer ' s appointment?

A. Notify the producer of the termination at least thirty days before the effective date of termination
B. Request a hearing before the Insurance Commissioner
C. Request that the Division of Insurance cancel the producer ' s license
D. Send notice of the termination to the Insurance Commissioner

Answer: D

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 # 31
Under federal law, a tax exempt Health Savings Account can only be opened for an individual who is:

A. eligible to be claimed as a dependent on another person ' s tax return
B. covered by Long Term Care Insurance
C. covered by a qualified High Deductible Health Plan
D. entitled to Medicare benefits

Answer: C

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 # 32
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