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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q71-Q76):

NEW QUESTION # 71
An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:

A. increase the waiting period to adjust for the occupational difference
B. increase the deductible to adjust for the occupational difference
C. adjust benefits to the amount the premium provides for the new occupation
D. deny any claim on the basis of misrepresentation

Answer: C

Explanation:
The Change of Occupation provision allows an insurer to adjust benefits when the insured changes to a more hazardous occupation after policy issue. Choice A is correct. If the same premium would have purchased a lower benefit amount for the new, more hazardous occupati on, the insurer may reduce the benefit to the amount that premium would have bought under the new occupational classification. The purpose is to preserve fairness between the risk assumed and the premium paid without automatically cancelling the policy.
The insurer does not simply increase the waiting period or deductible, because those are not the contractual adjustment method addressed by the provision. It also does not deny every claim for misrepresentation, because a later change in occupation is not necessarily a misrepresentation in the original application. If the insured changes to a less hazardous occupation, the provision may allow the insured to apply for an adjusted premium rate or greater benefit as appropriate under policy terms. The key examination rule is that occupational changes affect the amount of benefits or premium classification, not the basic validity of coverage. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Change of Occupation Provision; Individual Accident and Health Policies.

NEW QUESTION # 72
The Coinsurance clause in an individual Medical Expense policy refers to the:

A. insurance company ' s right to join with another company to carry excessive coverage on a particular individual
B. insurance company ' s right to share claim experience with another company
C. insured ' s rights to have another person, such as a spouse or child, insured on the same policy
D. insurance company ' s right to require the insured to share a certain percentage of the cost of each claim

Answer: D

Explanation:
Coinsurance is the contractual sharing of covered medical expenses between the insured and the insurer after any applicable deductible has been satisfied. Choice D is correc t. Under a common 80/20 coinsurance arrangement, for example, the insurer pays 80 percent of an eligible expense and the insured pays the remaining 20 percent, up to any out-of-pocket maximum or other plan limitation. Coinsurance reduces premium cost and encourages insureds to consider the cost of care, while preserving significant protection against major expenses. It does not refer to adding family members to a policy, which concerns eligibility or family coverage. It also does not describe insurers sharing risk with each other; that would involve reinsurance or other insurer-to-insurer arrangements. Coinsurance should be distinguished from a deductible, which is a specified dollar amount the insured pays before policy benefits begin. A copayment is instead a fixed dollar amount paid for a covered service. The exact coinsurance percentage, covered-charge definition, network rules, and annual out-of-pocket limit are determined by the policy. Study Guide References/Topics:
Policy Provisions, Clauses, and Riders; Medical Expense Insurance; Deductibles and Coinsurance.

NEW QUESTION # 73
A life insurance policy owner has paid $1,200 in premiums in six months for a $250,000 policy. The policyowner dies suddenly and the insurer pays the beneficiary $250,000. This exchange of unequal values reflects which of the following insurance contract features?

A. Unilateral
B. Personal
C. Aleatory
D. Conditional

Answer: C

Explanation:
An insurance contract is aleatory because the values exchanged by the parties may be unequal and depend on an uncertain event. Choice A is correct. In this example, the policyowner paid only $1,200 in premiums before death, while the insurer paid a $250,000 death benefit. The insurer's obligation was much greater than the premium amount received because the insured event occurred early in the policy period. If death had not occurred for many years, the total premiums paid could have been much closer to or greater than the eventual benefit value. That uncertainty is the defining aleatory feature. A personal contract is based on the insured's individual characteristics and insurable interest. A unilateral contract means only the insurer makes a legally enforceable promise to perform after the applicant accepts the contract and pays premium. A conditional contract requires stated conditions, such as premium payment and proof of loss, to be met before performance is due. None of those terms focuses on the unequal exchange demonstrated here. Study Guide References
/Topics: Policy Provisions, Clauses, and Riders; Insurance Contract Characteristics; Aleatory Contracts.

NEW QUESTION # 74
An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for:

A. medical history
B. marital status and occupation
C. other disability policies already in force
D. the spouse ' s occupation

Answer: D

Explanation:
The correct answer is D. Underwriting for an individual disability income policy focuses on facts that affect the proposed insured's probability of disability, ability to work, existing income protection, and potential for overinsurance. Marital status and occupation may be relevant to financial and occupational underwriting.
Medical history is directly relevant because past and current health conditions can affect eligibility, exclusions, ratings, or benefit limitations. Other disability policies already in force are important because insurers must evaluate the total amount of disability benefits relative to earned income and avoid excessive coverage. The spouse's occupation ordinarily does not determine the proposed insured's disability risk or benefit eligibility and is therefore the least relevant item. Insurers also may request information about income, employer, job duties, hazardous activities, tobacco use, prior claims, and other sources of disability income.
The producer must obtain complete and accurate answers from the applicant, explain questions when necessary, and avoid making assumptions or completing answers without the applicant's direction. Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Disability Income Underwriting; Application Information.

NEW QUESTION # 75
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 cash value may fluctuate with separate-account investment performance.
C. The policy is always a temporary term policy.
D. The policyowner bears no investment risk.

Answer: B

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 # 76
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