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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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

NEW QUESTION # 23
In Nevada, which life insurance policy is subject to a 30-day right to surrender for a premium refund after delivery?

A. A standard nonreplacement life insurance policy
B. A replacement life insurance policy
C. An industrial life policy
D. A group life certificate

Answer: B

Explanation:
A replacement life insurance policy delivered in Nevada must provide a 30-day period during which the policyowner may surrender the policy to the insurer with a written request for cancellation and receive a refund of premiums paid, including policy fees or other charges. This longer review period recognizes the special risks associated with replacement transactions. Replacing existing coverage can cause the consumer to lose favorable values, restart contestability or suicide periods, incur surrender charges, or exchange a policy that better serves the client's long-term needs.
For a nonreplacement life policy, annuity contract, or pure endowment contract, Nevada generally requires a
10-day right of surrender after delivery. The applicable statute excludes industrial life insurance from this requirement. The producer must therefore identify whether a proposed transaction is a replacement and follow the related disclosure and recordkeeping requirements. The free-look period is a consumer-protection right; it does not excuse a producer from determining suitability or accurately comparing existing and proposed coverage before the sale.
On an examination question, the key distinction is not whether the policy is whole life, term life, or universal life. The key is whether it is a replacement contract or policy.
References/topics from the Study Guide: Replacement; Free-Look Provision; Nevada Consumer Protections; NRS 688A.165.

NEW QUESTION # 24
The Affordable Care Act (ACA) requires every individual policy to provide minimum coverages known as:

A. Gold Value coverages
B. Medicaid Buy-Back coverage
C. Silver Saver Value coverages
D. Essential Health Benefits

Answer: D

Explanation:
The Affordable Care Act established Essential Health Benefits as the minimum categories of benefits that qualifying individual and small-group health plans must cover. These required benefit categories create a baseline of comprehensive coverage rather than allowing a major medical plan to omit fundamental types of care.
Essential Health Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance-use-disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic-disease management, and pediatric services, including oral and vision care.
Gold and Silver are metal-level plan categories. They describe the general actuarial value of a plan-the approximate division of covered health-care costs between the insurer and enrollees-not a separate legal list of mandatory minimum benefits. A Gold plan generally pays a larger share of covered costs than a Silver plan, but both must include the applicable Essential Health Benefits. "Silver Saver Value" and "Medicaid Buy- Back" are not the ACA's required minimum-coverage terminology.
For examination purposes, distinguish the benefit package itself-Essential Health Benefits-from plan metal levels and from public programs such as Medicaid.
Study Guide references/topics: Affordable Care Act; individual health insurance; qualified health plans; Essential Health Benefits; HealthCare.gov coverage protections .

NEW QUESTION # 25
Under a typical coordination-of-benefits rule, a child is covered under both parents' group health plans.
Which plan is generally primary when the parents are married and neither plan contains an exception?

A. The plan of the parent whose birthday falls earlier in the calendar year
B. The plan that began most recently
C. The plan with the highest deductible
D. The plan selected by the child each year

Answer: A

Explanation:
Coordination of benefits, or COB, establishes the order in which multiple health plans pay when an insured is covered by more than one plan. For a dependent child covered by both married parents' group health plans, the common "birthday rule" generally makes primary the plan of the parent whose birthday occurs earlier in the calendar year. The rule compares the month and day of birth, not the year. If both birthdays are the same, the plan that has covered the parent longer is generally primary.
The primary plan pays first according to its own policy terms. The secondary plan then considers the remaining eligible expense and may pay an additional amount, subject to its coordination-of-benefits provision. COB is intended to prevent duplicate recovery exceeding the actual covered expense while still allowing the insured to receive the benefit of multiple coverages.
Special rules can apply in divorce, custody, court-order, active-versus-retired employee, Medicare, and other situations. The producer should never assume that one generic rule governs every family arrangement. Plan documents and applicable law control. For examination purposes, the birthday rule is the standard answer when the parents are married and no special circumstance is stated.
References/topics from the Study Guide: Coordination of Benefits; Primary and Secondary Coverage; Birthday Rule; Group Health Insurance; Dependent Coverage.

NEW QUESTION # 26
A person insured under a policy of Long Term Care insurance issued pursuant to a direct response solicitation has how many days after delivery to return the policy for a full refund?

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

Answer: C

Explanation:
A long-term care insurance policy may be returned within 30 days after delivery for a full premium refund if the applicant is dissatisfied for any reason. This is known as a free-look or right-to-return provision. It gives the insured time to examine the contract after delivery and determine whether the coverage is appropriate.
The right is especially important in a direct-response sale, where the consumer may not have met face-to-face with a producer. Long-term care policies can contain detailed provisions concerning benefit triggers, elimination periods, activities of daily living, cognitive impairment, benefit periods, inflation protection, exclusions, premium changes, and nonforfeiture benefits. The 30-day review period allows a buyer to examine those terms without forfeiting premium.
The policy must prominently disclose the right to return the contract and receive a refund. The insurer must make the refund within the required period after the policy is returned. This rule differs from other health- insurance free-look, cancellation, grace-period, and reinstatement provisions, which can use different deadlines.
Study Guide references/topics: long-term care insurance; direct response solicitation; free-look provision; return of policy; NAC 687B.060 .

NEW QUESTION # 27
Which statement best describes Medicare Part B?

A. It provides only outpatient prescription-drug benefits.
B. It is automatic for every person at age 55.
C. It is Medicaid coverage for low-income individuals.
D. It is medical insurance and generally requires enrollment and a monthly premium.

Answer: D

Explanation:
Medicare Part B is the medical-insurance portion of Original Medicare. It generally helps cover physician services, outpatient care, diagnostic services, preventive care, durable medical equipment, and other covered medical services. Enrollment is generally voluntary, although it may be automatic for certain people who are already receiving Social Security benefits. Most individuals pay a monthly Part B premium, and higher- income beneficiaries may pay an income-related additional amount.
Part B should not be confused with Medicare Part D, which provides outpatient prescription-drug coverage, or with Medicaid, which is a joint federal-state program for eligible individuals with limited income and resources. Part B also differs from Part A, which is primarily hospital insurance. Delaying Part B enrollment without qualifying employer coverage can result in late-enrollment penalties and gaps in coverage, so producers should avoid casual advice and instead direct consumers to current Medicare enrollment guidance.
When discussing Medicare-related products, producers must accurately identify whether a client has Original Medicare, a Medicare Advantage plan, a Medicare supplement policy, and/or a Part D prescription-drug plan.
These arrangements have different rules, premiums, provider networks, and cost-sharing structures.
References/topics from the Study Guide: Medicare Part B; Original Medicare; Enrollment Periods; Medicare Premiums; Medicare Supplement Products.

NEW QUESTION # 28
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