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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionObjectives
Topic 1: Government Health Insurance Programs- Medicare
  • 1. Medicare parts and eligibility
    • 2. Medicare supplement insurance
      - Medicaid and Other Programs
      • 1. Medicaid eligibility and coverage
        Topic 2: Insurance Basics- Risk Management and Insurance Concepts
        • 1. Insurance principles and contract characteristics
          • 2. Types of risk and methods of handling risk
            - Insurance Contracts
            • 1. Policy provisions, riders, and exclusions
              • 2. Contract elements
                Topic 3: Accident and Health Insurance Fundamentals- Disability Income Insurance
                • 1. Elimination periods and benefit periods
                  • 2. Disability definitions and benefits
                    - Types of Health Insurance Policies
                    • 1. Group health insurance
                      • 2. Individual health insurance
                        • 3. Managed care plans
                          - Medical Expense Insurance
                          • 1. Major medical plans
                            • 2. Hospital, surgical, and physician expense coverage
                              Topic 4: General Insurance Regulation- Licensing Requirements and Responsibilities
                              • 1. Continuing education and license maintenance
                                • 2. Producer licensing requirements
                                  - Nevada Insurance Department and Regulatory Authority
                                  • 1. Insurance laws, rules, and regulations
                                    • 2. Commissioner of Insurance powers and duties
                                      Topic 5: Producer Duties and Ethics- Sales Practices
                                      • 1. Unfair trade practices
                                        • 2. Advertising and marketing rules
                                          - Ethical Responsibilities
                                          • 1. Consumer protection requirements
                                            • 2. Fiduciary responsibilities
                                              Topic 6: Health Insurance Policy Provisions- Mandatory and Optional Provisions
                                              • 1. Renewability provisions
                                                • 2. Policy requirements and clauses
                                                  - Claims and Benefits
                                                  • 1. Benefit determination and payment
                                                    • 2. Claim procedures

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                                                      Insurance Licensing NV Accident and Health Sample Questions (Q95-Q100):

                                                      NEW QUESTION # 95
                                                      Under a group health policy, which of the following coverages MUST be provided for newborn children?

                                                      Answer: D

                                                      Explanation:
                                                      Nevada requires qualifying group health policies that cover family members to provide coverage for a newborn child from the moment of birth. Required newborn coverage includes injury or sickness and specifically includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Therefore, congenital health defects are the required coverage identified in this question.
                                                      The rule is important because congenital defects may be present at birth and can require immediate diagnostic, surgical, medical, or hospital treatment. Nevada law prevents a policy from excluding this necessary care simply because the condition existed at birth. The statute also prohibits exclusion of premature births under the applicable coverage requirement.
                                                      The transportation option is incorrect because the law addresses necessary transportation from the place of birth to the nearest specialized treatment center, within policy limits; it does not mandate transportation from the hospital to the child's residence. Routine eye examinations and genetic testing may be covered under a particular policy or health plan, but they are not the specific newborn mandate tested here. Continued coverage beyond the initial period may depend on timely notice and payment of required premium within 31 days.
                                                      Study Guide references/topics: group health insurance; newborn coverage; mandated benefits; NRS 689B.033
                                                      .


                                                      NEW QUESTION # 96
                                                      An applicant unintentionally gives an incorrect answer about a material health condition on a life insurance application. This is best described as:

                                                      Answer: A

                                                      Explanation:
                                                      An application statement is generally a representation rather than a warranty. A representation is a statement believed to be true to the best of the applicant's knowledge and belief. If a representation is false and material to the insurer's underwriting decision, it may create a basis for the insurer to investigate, contest, rescind, or adjust the policy according to applicable law and the policy's contestability provision. Materiality means the information would have influenced the insurer's decision to issue the policy, set the premium, determine the rating class, or limit coverage.
                                                      A warranty is a statement or promise that must be literally true or strictly complied with. Life and health insurance applications are not ordinarily treated as a collection of warranties because that result would be excessively harsh for innocent or immaterial errors. Nevada life insurance law states that, absent fraud, statements in an attached application are deemed representations rather than warranties.
                                                      Intent matters in distinguishing an innocent mistake from intentional fraud, but an unintentional error can still be material. Producers should read each question clearly, ensure the applicant understands it, record answers accurately, and allow the applicant to review the completed application before signing. The producer should never suggest that a medical condition, medication, or prior treatment can be omitted.
                                                      References/topics from the Study Guide: Representations and Warranties; Material Misrepresentation; Application Statements; Fraud; NRS 688A.070.


                                                      NEW QUESTION # 97
                                                      Which of the following statements is CORRECT about Business Overhead Expense insurance?

                                                      Answer: D

                                                      Explanation:
                                                      Business Overhead Expense insurance reimburses a business for specified ongoing operating expenses when a business owner becomes disabled. Eligible expenses commonly include employee salaries, rent, utilities, office expenses, and other ordinary fixed costs identified in the policy. Accordingly, choice B is correct. The purpose is business continuity: it helps keep the office or practice operating during the owner's disability rather than replacing the owner's personal income. A disability income policy, not Business Overhead Expense insurance, is the product intended to replace an individual's lost earned income. The coverage is not restricted to corporations; it may be appropriate for sole proprietors, partners, and owners of closely held businesses, depending on underwriting and policy eligibility. It also is not limited to staff expenses alone, because rent, utilities, and other contractually covered overhead are central components of the protection.
                                                      Benefits are generally limited by the actual covered overhead incurred and the policy's monthly benefit amount. Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Business Overhead Expense Coverage.


                                                      NEW QUESTION # 98
                                                      Which of the following situations describes a representation?

                                                      Answer: B

                                                      Explanation:
                                                      A representation is a statement made by an applicant on an insurance application that is believed to be true to the best of the applicant's knowledge and is required to be substantially true. Choice C correctly states that principle. A representation differs from a warranty. A warranty is a statement or promise that must be literally and absolutely true; choice D describes that stricter standard rather than a representation. Application answers help the insurer evaluate risk during underwriting, so material misrepresentations can affect coverage or the insurer's decision to issue the policy. However, not every immaterial or innocent inaccuracy has the same legal effect. The significance of a misstatement depends on its materiality and the applicable policy and insurance-law rules. Choices A and B describe potential policy promises or contract features, not statements made by a prospect in the application. For licensing purposes, remember that insurance applications are generally treated as containing representations, not warranties, unless the policy or law provides otherwise.
                                                      Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Representations and Warranties; Underwriting.


                                                      NEW QUESTION # 99
                                                      Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:

                                                      Answer: A

                                                      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 # 100
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