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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q88-Q93):

NEW QUESTION # 88
Which statement is true of a variable life insurance policy?

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

Answer: D

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 # 89
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:

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

Answer: C

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 # 90
Which rider allows a terminally ill insured to receive part of the death benefit while still alive, subject to the policy terms?

A. Accelerated death benefit rider
B. Guaranteed insurability rider
C. Payor benefit rider
D. Accidental death rider

Answer: A

Explanation:
An accelerated death benefit rider permits an insured who meets the rider's qualifying conditions to receive a portion of the policy's death benefit while alive. Qualifying conditions commonly include terminal illness and may include chronic illness or other severe conditions, depending on the contract. The advance is not additional insurance. It is an acceleration of part of the death benefit otherwise payable at death. As a result, the remaining death benefit available to beneficiaries is reduced by the amount paid, together with any applicable charges or adjustments under the policy.
This rider can provide funds for medical care, home modifications, long-term care, living expenses, or other needs created by a serious illness. However, the producer must explain that eligibility is determined by the contract and supporting medical documentation. The rider should not be described as a replacement for comprehensive health insurance, disability income protection, or long-term-care insurance.
The other choices serve different purposes. A guaranteed-insurability rider allows future purchases of coverage without evidence of insurability at stated times or events. A payor-benefit rider waives premiums if a designated payor becomes disabled or dies. An accidental-death rider pays an additional benefit for qualifying accidental death.
References/topics from the Study Guide: Living Benefits; Accelerated Death Benefit Rider; Terminal Illness; Policy Riders; Beneficiary Considerations.

NEW QUESTION # 91
An applicant submits the first premium with a life insurance application and receives a conditional receipt.
When does coverage generally become effective?

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

Answer: D

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 # 92
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 volunteer fire department
B. A church
C. A newspaper corporation
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 # 93
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