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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Long Term Care - Coverage for reconstructive surgery - Mandatory policy clauses and provisions 1. Coverage for physical handicap or intellectual disability for dependent children 2. Coverage for preventive healthcare services 3. Coverage for newborn children - 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 - Hospice care
Accident & Health – General Knowledge	50%	- Other Insurance Concepts 1. Subrogation 2. Cost containment 3. Dependent children benefits 4. Workers Compensation 5. Primary and contingent beneficiaries 6. Nonduplication and coordination of benefits 7. Occupational vs. non-occupational 8. Managed care 9. Owner's rights 10. Total, partial, recurrent, and residual disability 11. Modes of premium payments 12. Tax treatment of premiums and proceeds of insurance contracts - Field Underwriting Procedures 1. Sources of insurability and HIPAA privacy information 2. Submitting application and initial premium to company for underwriting 3. Explaining policy provisions, riders, exclusions, and ratings 4. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 5. Initial premium payment and receipt 6. Replacement 7. Policy delivery 8. Completing the application - Social Insurance 1. Medicare Parts A, B, C, and D 2. Social Security benefits 3. Medicaid - Types of Policies 1. Medicare supplement policies 2. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident 3. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy 4. Group insurance Differences between individual and group contracts General characteristics COBRA 5. Accidental death and dismemberment 6. Individual and Group Long Term Care Eligibility Levels of care 7. 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 - 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
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Definitions 1. Premiums 2. Certificate of authority 3. Cost-sharing 4. Insurer 5. Authorized and unauthorized 6. Domestic, foreign, and alien 7. Transacting insurance - Nevada Life and Health Insurance Guaranty Association - Insurance Commissioner 1. General powers and duties 2. Examinations 3. Notice and hearings and penalties - Marketing Practices 1. Required records and record retention 2. Silver State Health Insurance Exchange 3. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation 4. Commissions and payment restrictions 5. Affordable Care Act 6. Fiduciary responsibilities - Licensing 1. Name of licensee 2. Suspension, revocation, and refusal of license 3. Persons required to be licensed 4. Renewal and continuing education 5. Termination of license 6. Obtaining a license
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 (Q113-Q118):

NEW QUESTION # 113
The maximum cost share for preventive screening from an in-network provider is:

A. 0%
B. 30%
C. 20%
D. 10%

Answer: A

Explanation:
The maximum cost share for a covered preventive screening received from an in-network provider is 0%. In practical terms, the insured generally pays no deductible, copayment, or coinsurance for qualifying preventive services delivered in-network. This rule is intended to encourage early detection of illness and promote preventive care before conditions become more serious and costly.
Examples of qualifying preventive care can include certain screenings, immunizations, counseling, and wellness services. The precise covered service and frequency may depend on age, sex, medical circumstances, and the applicable preventive-service recommendations. The in-network condition is important because services received outside the plan's network may be subject to different cost-sharing rules, except where other law or plan provisions apply.
The choices of 10%, 20%, and 30% reflect ordinary coinsurance levels that may apply to nonpreventive treatment or to services that do not qualify for first-dollar preventive coverage. They do not apply to an eligible preventive screening under the in-network preventive-care rule.
Always distinguish preventive screening from diagnostic care. A screening is generally performed when no symptom or suspected condition is being evaluated; a diagnostic service may generate cost sharing depending on the circumstances and plan terms.
Study Guide references/topics: preventive services; in-network providers; deductibles; copayments; coinsurance; HealthCare.gov preventive-care guidance .

NEW QUESTION # 114
Which statement best describes a group life conversion privilege?

A. It allows the employer to convert all employees into beneficiaries.
B. It guarantees that the group premium will never increase.
C. It transfers the employee's group policy cash value to a retirement account.
D. It allows an insured leaving the group to obtain individual coverage without evidence of insurability, subject to the policy terms.

Answer: D

Explanation:
A group life conversion privilege allows an insured whose group coverage terminates to obtain an individual life insurance policy without providing new evidence of insurability, provided the person applies and pays the required premium within the conversion period. The privilege is valuable because a person leaving employment may have become less insurable since original enrollment. Conversion allows continued life coverage despite a change in health, although the individual policy's premium is generally based on the insurer's conversion rates and may be higher than the group rate.
The group master policy and applicable law control the conversion period, maximum conversion amount, and type of individual policy available. The individual policy may not be identical to the group coverage. A producer should explain that the former employee has a limited window to act and should review alternative coverage options promptly.
Conversion differs from portability. Portability allows an insured to continue group-style coverage under certain terms, while conversion results in a new individual policy. The protection during the conversion period is also significant: Nevada group-life law provides a death benefit if the insured dies during the conversion period before the individual policy becomes effective, in the amount that could have been converted.
References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Portability; Termination of Group Coverage; NRS 688B.120-688B.130.

NEW QUESTION # 115
Which of the following statements is CORRECT about Medicare?

A. It is a medical assistance program.
B. It provides benefits to totally disabled persons only.
C. Its Part A provides payment for physicians ' bills.
D. It is a hospital and medical expense insurance program.

Answer: D

Explanation:
Medicare is a federal social insurance program that provides hospital and medical expense coverage to eligible persons. Therefore, choice B is correct. Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services.
Medicare Part B primarily covers physician services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Choice A describes Medicaid, which is a needs-based medical assistance program jointly administered by federal and state governments. Choice C is incorrect because Medicare also serves people age 65 or older and individuals with qualifying end-stage renal disease or ALS; it is not limited to totally disabled persons. Choice D is incorrect because physician bills are generally associated with Part B, not Part A. Medicare beneficiaries may also choose Medicare Advantage plans, which provide Medicare-covered benefits through private plans, and may obtain prescription drug coverage under Part D. Study Guide References/Topics: Social Insurance Programs; Medicare Parts A and B; Federal Health Programs.

NEW QUESTION # 116
The Nevada Life and Health Insurance Guaranty Association becomes involved in an insurance company ' s affairs when the company:

A. becomes insolvent
B. denies a claim
C. withdraws as an Association member
D. enters a lawsuit against a claimant

Answer: A

Explanation:
The Nevada Life and Health Insurance Guaranty Association becomes involved when a covered member insurer becomes impaired or insolvent. Its statutory purpose is to provide limited protection to eligible policyowners, certificate holders, enrollees, beneficiaries, and other covered persons when a member insurer cannot perform its contractual obligations because of financial failure.
An ordinary lawsuit, claim denial, or membership withdrawal does not by itself trigger Guaranty Association protection. Claim disputes are normally handled through the insurer's claims process, internal appeals, administrative complaint procedures, or litigation. The Guaranty Association is not a general claims-review agency.
When a member insurer is impaired or insolvent, the Association may guarantee, assume, reissue, or reinsure covered policies and contracts, or provide other support necessary to meet covered obligations. Coverage is subject to statutory limits, eligibility requirements, exclusions, and residency rules. It does not protect every type of policy or every amount of loss.
Insurers must not use the Association as a sales inducement. Consumers should evaluate an insurer's financial strength and coverage terms rather than assume that all benefits are fully guaranteed.
Study Guide references/topics: insurer insolvency; impaired insurer; Guaranty Association; member insurers; NRS Chapter 686C .

NEW QUESTION # 117
Under a Medicare Supplement policy that is issued in response to a direct solicitation, a policyowner may return the policy to the insurance company for a full premium refund within a MAXIMUM of how many days?

A. Thirty
B. Ten
C. Sixty
D. Forty-five

Answer: A

Explanation:
A Medicare Supplement policy issued in response to direct solicitation may be returned for a full premium refund within 30 days. This is commonly called a free-look or right-to-return period. It gives the policyowner time to examine the policy after delivery and decide whether the coverage is suitable.
Direct solicitation presents a heightened consumer-protection concern because the purchaser may not have received the same personal explanation and comparison assistance available in a face-to-face sale. The 30-day period allows the consumer to review benefits, exclusions, premiums, Medicare coordination, replacement implications, and suitability without financial penalty.
The policyowner should return the policy within the required period and follow the insurer's return instructions. Once timely returned, the insurer must refund the premium in accordance with the applicable rule. The free-look right does not mean that every policy can be cancelled at any time for a complete refund; it is a specific statutory or regulatory rescission period following delivery.
Ten, 45, and 60 days are common distractors because various insurance rules use different deadlines. For Medicare Supplement direct-solicitation policies, the tested maximum period is 30 days.
Study Guide references/topics: Medicare Supplement insurance; direct solicitation; free-look period; consumer protections; Nevada Medicare Supplement regulations .

NEW QUESTION # 118
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