Insurance Licensing InsNV_Health02 Valid Real Test & Latest Braindumps InsNV_Health02 Ppt

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

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Insurance Licensing NV Accident and Health Sample Questions (Q23-Q28):

NEW QUESTION # 23
Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?

A. A church
B. A newspaper corporation
C. A volunteer fire department
D. A family

Answer: D

Explanation:
A family is not an eligible blanket-health-insurance group under Nevada law. Blanket accident and health insurance is designed for defined groups connected by a common activity, organization, occupation, event, or exposure to a specified hazard. It is not designed as a substitute for ordinary individual or family health insurance.
Nevada specifically recognizes various groups that may be covered under a blanket policy. These include religious, charitable, recreational, educational, and civic organizations; newspaper publishers covering their carriers; and volunteer fire departments or similar emergency organizations covering members or participants.
The organization acts as the policyholder, and the covered persons are defined by their relationship to the group activity or specified hazard.
A church is eligible as a religious organization. A newspaper corporation may qualify when covering its carriers. A volunteer fire department is specifically listed as an eligible organization. A family, however, is a private household relationship rather than a qualifying blanket group formed around an authorized organizational purpose or activity.
Study Guide references/topics: blanket accident and health insurance; eligible groups; policyholder; specified hazards; NRS 689B.070 .

NEW QUESTION # 24
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:

A. covered under preventative services annually at no cost
B. covered under only health plans that offer mammogram coverage
C. not covered if a family member has been formally diagnosed with breast cancer
D. not covered under the rules of ACA because mammograms are not considered preventative health care

Answer: A

Explanation:
For insured women age 40 or older, Nevada requires group health insurance coverage for an annual mammogram to screen for breast cancer. The required benefit must be available through an in-network provider, and the insurer generally may not impose a deductible, copayment, coinsurance, or another form of cost sharing for that mandated screening.
Mammography is preventive screening. It is intended to detect breast cancer early, often before symptoms appear. This differs from diagnostic imaging, which may be ordered after an abnormal screening result, a finding on examination, or another clinical concern. Nevada law also addresses medically necessary imaging and diagnostic testing when the insured's provider recommends them based on medical history, family history, risk factors, or an observed abnormality.
A family history of breast cancer does not eliminate coverage; instead, it may support the need for additional screening or imaging. The benefit is not restricted only to plans that voluntarily choose to offer mammography. It is a required coverage provision for applicable group health policies.
Study Guide references/topics: preventive care; breast-cancer screening; mandated benefits; deductibles and coinsurance; NRS 689B.0374 .

NEW QUESTION # 25
The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured ' s age on the policy application?

A. Increase the premium
B. Cancel the policy
C. Adjust the benefits
D. Lapse the coverage

Answer: C

Explanation:
A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.

NEW QUESTION # 26
An insurance company MUST take which of the following actions to terminate a producer ' s appointment?

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

Answer: A

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 # 27
A $100,000 group Accidental Death and Dismemberment policy will pay double indemnity if the insured dies in a commercial airplane crash. If the insured is killed when flying to a business meeting on a commercial flight, the policy will pay a MAXIMUM of:

A. $100,000
B. $200,000
C. $300,000
D. $0

Answer: B

Explanation:
The correct answer is C, $200,000. The policy's principal sum is $100,000, and the double-indemnity provision pays twice that amount when death results from the stated qualifying accident: a commercial airplane crash. Because the insured was flying on a commercial flight and was killed in the crash, the maximum payable benefit is two times $100,000, or $200,000. The fact that the trip was to a business meeting does not reduce the benefit under the facts given. Choice A would be appropriate only if an exclusion applied, such as an excluded type of aviation activity. Choice B states only the policy's base amount and ignores the double-indemnity provision. Choice D incorrectly adds an additional amount beyond the stated double benefit. AD & D coverage pays only when the loss falls within the policy's accidental-loss definition and occurs within any stated loss period. Aviation wording matters: commercial passenger travel is commonly covered, while piloting, crew duties, private aircraft, or military aviation may be treated differently under the contract. Study Guide References/Topics: Group Health Insurance; Accidental Death and Dismemberment; Double Indemnity.

NEW QUESTION # 28
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