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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing InsNV_Health02 Reliable Test Tips: NV Accident and Health - DumpsQuestion High-Efficient Test Dumps for your preparing

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Insurance Licensing NV Accident and Health Sample Questions (Q70-Q75):

NEW QUESTION # 70
A life policy has been in force during the insured's lifetime for more than two years. Which circumstance may still permit the insurer to deny a claim under the policy's incontestability provision?

A. An innocent misstatement on the original application
B. A change in the insured's occupation after issue
C. Nonpayment of premium
D. A material misrepresentation unrelated to the policy

Answer: C

Explanation:
The incontestability provision limits the insurer's ability to contest the validity of a life insurance policy after it has been in force during the insured's lifetime for the stated period, which Nevada law permits to be no longer than two years from issue. Once that period has passed, an insurer ordinarily cannot avoid the policy because of misstatements in the application, except as provided by the policy and law. The rule promotes certainty for beneficiaries and prevents an insurer from indefinitely reopening underwriting issues after accepting premiums for years.
Nonpayment of premiums remains an exception. Incontestability does not require an insurer to pay a claim on a policy that lapsed because required premiums were not paid. A policy can also contain provisions concerning total and permanent disability benefits or additional accidental-death benefits that are treated separately under the applicable statutory rule. In addition, an incontestability clause concerns contesting the policy's validity; it does not automatically override every policy exclusion or restriction on coverage.
The producer should distinguish contestability from the grace period, reinstatement, and exclusions. Each provision serves a different function. For test purposes, the durable rule is that incontestability does not eliminate the insurer's defense of nonpayment of premium.
References/topics from the Study Guide: Incontestability Clause; Premium Payment; Policy Lapse; NRS
688A.080.

NEW QUESTION # 71
An insured purchases a rider that pays an additional amount only if death results from a covered accident.
This rider is best described as:

A. A return-of-premium rider
B. A cost-of-living rider
C. An accidental death benefit rider
D. A guaranteed-insurability rider

Answer: C

Explanation:
An accidental death benefit rider provides an additional death benefit when the insured dies as the direct result of a covered accident. It is often described as "double indemnity" when the additional benefit equals the policy's face amount, although the actual amount and conditions depend on the rider. The rider supplements the base life policy; it does not replace the base death benefit. If the insured dies from a covered accident, the beneficiary may receive the base policy amount plus the rider benefit. If death results from illness or a noncovered cause, only the base policy benefit is generally payable.
Accidental-death riders contain important limitations. They typically require death to occur within a stated time after the accident and may exclude deaths resulting from specified causes, such as war, suicide, certain hazardous activities, intoxication, or illegal acts, depending on the contract. The producer must explain that the benefit is conditional and is not the same as comprehensive life insurance.
A guaranteed-insurability rider permits future coverage increases without new evidence of insurability. A cost- of-living rider increases coverage under specified inflation-related terms. A return-of-premium feature returns qualifying premiums under stated conditions, usually at the end of a term period.
References/topics from the Study Guide: Accidental Death Benefit Rider; Double Indemnity; Exclusions; Supplementary Benefits; Policy Riders.

NEW QUESTION # 72
The Nevada Life and Health Insurance Guaranty Association is financed by which of the following methods?

A. Assessing a premium tax
B. Assessing member insurance companies
C. Assessing agent association members
D. Assessing insureds

Answer: B

Explanation:
The Nevada Life and Health Insurance Guaranty Association is financed through assessments on member insurance companies. Insurers authorized to transact covered life, health, or annuity business in Nevada are members of the Association as a condition of their authority to operate in the state. When an assessment is necessary, the Association assesses member insurers according to the statutory assessment system.
The Association exists to provide limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not financed by direct assessments against insureds, policyowners, agents, or association members. It is also not simply funded through a general premium tax imposed on consumers.
Nevada law establishes assessment classes, including assessments for administrative and legal expenses and assessments needed to carry out the Association's obligations regarding an impaired or insolvent insurer.
Member insurers may consider the cost of assessments when establishing rates and dividends, but that does not change the source of the Association's direct funding: the member insurers themselves.
The Guaranty Association is a safety mechanism with statutory limits. It is not a substitute for evaluating an insurer's financial strength, and insurers and producers may not use its existence as a sales inducement.
Study Guide references/topics: insurer insolvency; guaranty associations; member insurer assessments; NRS Chapter 686C .

NEW QUESTION # 73
A client needs a $250,000 death benefit for exactly 20 years to protect a home mortgage. The client wants the lowest practical initial premium and does not need cash-value accumulation. Which policy is most appropriate?

A. Variable life insurance
B. Level term life insurance
C. Whole life insurance
D. Universal life insurance

Answer: B

Explanation:
Level term life insurance is the appropriate recommendation because it provides a stated death benefit for a stated period, such as 20 years. It is designed for temporary protection where the financial need has a known end date-for example, the remaining duration of a mortgage, a child's dependency period, or a short-to- medium-term income-replacement need. The premium is generally level for the selected term period, while the death benefit remains level if the policy stays in force.
Whole life insurance provides permanent protection and cash-value accumulation, but its premium is ordinarily higher because the insurer expects coverage to continue for the insured's lifetime. Universal life offers flexible premiums and adjustable death-benefit structures, but it is not the simplest match when the client's purpose is fixed, time-limited mortgage protection. Variable life has investment risk because policy values depend on separate-account performance and is not selected merely to obtain low-cost temporary coverage.
The producer should confirm that the term period aligns with the mortgage obligation and explain that coverage normally ends at the term's expiration unless the policy is renewed, converted, or otherwise continued under its provisions.
References/topics from the Study Guide: Types of Life Insurance; Term Life Insurance; Needs Analysis; Mortgage Protection.

NEW QUESTION # 74
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a:

A. Loss form
B. Inspection report
C. Notice of Claim
D. Proof of Loss

Answer: D

Explanation:
The correct answer is C, Proof of Loss. Proof of loss is the written documentation supplied to the insurer to establish that a covered loss occurred and to provide the facts needed to evaluate the claim. It may include claim forms, medical records, bills, physician statements, dates of treatment, disability information, and other evidence required under the policy. Notice of claim is different: it simply informs the insurer that a loss has occurred or that a claim may be made. After receiving notice, the insurer ordinarily provides claim forms or instructions. A loss form may be one document used in the proof-of-loss process, but it is not the complete legal concept. An inspection report may be used by an insurer in some lines of insurance but is not the insured' s required statement establishing a health or disability claim. Timely proof of loss is important because it triggers the insurer's claim-review duties and helps determine when payment is due. Policy provisions specify the timing and form of proof required. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Notice of Claim; Proof of Loss; Claim Procedures.

NEW QUESTION # 75
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