Insurance Licensing InsNV_Health02 Pass Exam - InsNV_Health02 Training Materials

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q76-Q81):

NEW QUESTION # 76
An insurer shall not issue an individual long-term care insurance contract in Nevada unless the insurer has received from the applicant:

A. a written designation of at least one person, in addition to the applicant, who must receive notice of any lapse or termination of coverage under the policy for nonpayment of premium
B. a written designation by the applicant to pay premium for long-term care insurance through either a payroll or pension deduction plan
C. a designation by at least one person, in addition to the applicant, to accept liability for services provided to the applicant
D. a notarized waiver dated and signed by the applicant stating that the applicant has chosen not to designate another person to receive notice of any lapse or termination of coverage for nonpayment of premium

Answer: A

Explanation:
Nevada requires an individual long-term care insurer to obtain a written designation of at least one additional person who will receive notice if coverage is about to lapse or terminate for nonpayment of premium. This protection is intended to reduce unintended lapses, particularly when an insured experiences cognitive decline, illness, disability, or another circumstance that interferes with managing premiums.
The applicant may instead submit a written waiver, dated and signed, stating that the applicant chooses not to designate another person. The waiver is not required to be notarized. Because option B incorrectly adds a notarization requirement, option A is the best answer as written.
The designated person does not become responsible for paying premiums and does not assume liability for the applicant's care. The person's role is simply to receive notice, allowing the person an opportunity to alert the insured or help address an overlooked payment. Payroll or pension deduction is not a required payment method.
Before an individual long-term care policy can lapse for nonpayment, notice requirements apply to both the policyholder and the designated person. This is a key long-term-care consumer-protection provision.
Study Guide references/topics: long-term care insurance; lapse protection; nonpayment of premium; designation of another person; NAC 687B.0681 .

NEW QUESTION # 77
In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:

A. must surrender the producer ' s license and apply for an Exchange Enrollment Facilitator license
B. can receive commissions from the company in addition to the compensation as a facilitator
C. can offer advice to consumers resulting in the " steering " of the selection of coverage
D. can receive both commission and compensation as a facilitator

Answer: A

Explanation:
A person may not concurrently hold a Nevada producer license and an Exchange Enrollment Facilitator certificate. Therefore, a health insurance producer who wishes to become an EEF must surrender the producer authority and apply for certification as an Exchange Enrollment Facilitator.
An EEF assists consumers with enrollment in qualified health plans offered through the Exchange. The role is designed to provide objective enrollment help, application assistance, and general information. An EEF may not sell, solicit, or negotiate insurance. The EEF also may not receive consideration from a health insurance issuer or insurer in connection with enrollment and may not receive remuneration arising from EEF activities from a licensed producer, insurance consultant, surplus lines broker, or insurer.
For that reason, a producer cannot receive commissions while acting as an EEF, cannot collect both commission and EEF compensation in the manner described, and cannot steer a consumer toward a particular coverage choice. Producers and EEFs have different legal roles, compensation structures, and consumer- protection limitations.
Study Guide references/topics: Exchange Enrollment Facilitators; producer licensing; prohibited acts; compensation; NRS 695J.210 .

NEW QUESTION # 78
A whole life policyowner stops paying premiums and chooses to use the policy's cash value to purchase the same face amount of insurance for as long as that cash value will buy. Which nonforfeiture option was selected?

A. Reduced paid-up insurance
B. Extended term insurance
C. Cash surrender
D. Automatic premium loan

Answer: B

Explanation:
Extended term insurance uses the policy's accumulated cash value to purchase term insurance for the original face amount. Because the cash value is limited, the coverage lasts only for a stated period. During that period, the death benefit remains equal to the original policy's face amount, but no additional cash value normally accumulates. When the extended term period ends, coverage terminates unless another policy provision applies.
Reduced paid-up insurance works differently. It uses the cash value to purchase a smaller amount of permanent, paid-up life insurance. The face amount is reduced, but the coverage continues for the insured's lifetime without further premium payments. Cash surrender ends the policy and pays the available cash value to the owner, less any indebtedness and applicable charges. An automatic premium loan provision uses available cash value to pay overdue premiums temporarily, thereby attempting to prevent lapse.
Nonforfeiture options are designed to preserve some policy value when a cash-value life policy is discontinued. They are not typically available in pure term insurance because term policies ordinarily do not accumulate cash value. The correct option depends on whether the owner values the original death benefit for a limited period or a smaller death benefit permanently.
References/topics from the Study Guide: Nonforfeiture Options; Extended Term Insurance; Reduced Paid-Up Insurance; Cash Surrender; Automatic Premium Loan.

NEW QUESTION # 79
Group health policies MUST provide which of the following benefits?

A. Hospice care
B. Cosmetic surgery
C. Adult vision care
D. Adult dental care

Answer: A

Explanation:
Nevada requires group health insurance policies to include benefits for expenses arising from hospice care.
Hospice care is designed for individuals facing terminal illness and focuses on comfort, pain and symptom management, emotional support, and assistance for the patient and family rather than curative treatment.
The group-policy required-provisions statute specifically includes hospice-care benefits. It also recognizes benefits for care at home or health supportive services when prescribed by a physician and otherwise covered if provided in a medical facility. This reflects the policy goal of allowing appropriate end-of-life care in a setting suited to the patient's needs.
Adult vision care and adult dental care are not universally required benefits under every group health policy.
They may be offered through separate policies, riders, employer benefit arrangements, or plan designs.
Cosmetic surgery is generally not a mandatory health insurance benefit and may be excluded unless medically necessary or required because of injury, congenital condition, reconstruction, or another covered circumstance.
The key examination point is that hospice care is a specifically required group-policy benefit in Nevada, while the other choices may be optional, limited, or excluded depending on the plan.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; NRS 689B.
030 .

NEW QUESTION # 80
After appointing a producer as its agent, when must an insurer generally file its notice of appointment with the Nevada Commissioner?

A. Within 15 days after the contract is executed or the first application is submitted
B. Before the producer completes any insurance training
C. Only at the producer's next license renewal
D. Within 90 days after the first premium is collected

Answer: A

Explanation:
In Nevada, an insurer appointing a producer as its agent must generally file a notice of appointment with the Commissioner within 15 days after the agency contract is executed or the first application for insurance is submitted, whichever event triggers the statutory timing. The appointment establishes the producer's authority to act as the insurer's agent for the applicable business. An agent is a producer compensated by the insurer who sells, solicits, or negotiates insurance for that insurer.
A producer who is not acting as an insurer's agent may act as a broker, subject to the statutory definition and applicable requirements. The distinction matters because an agent represents the insurer in the agency relationship, while a broker acts on behalf of the insured or prospective insured and lacks authority to bind an insurer through the broker's own actions.
The appointment requirement does not replace the producer-license requirement. Before selling, soliciting, or negotiating a class of insurance in Nevada, the person must hold the appropriate line of authority. A life or health producer must therefore have the relevant licensing authority and, when acting as an insurer's agent, be properly appointed.
Examination questions often test both the 15-day filing timeline and the difference between an agent and a broker.
References/topics from the Study Guide: Producer Appointments; Agent and Broker Distinction; Insurer Appointments; Nevada Producer Licensing; NRS 683A.321.

NEW QUESTION # 81
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