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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q33-Q38):

NEW QUESTION # 33
Which type of health insurance is designed primarily to reimburse medical expenses such as hospital, surgical, and physician charges?

A. Credit life insurance
B. Disability income insurance
C. Accidental death insurance
D. Medical expense insurance

Answer: D

Explanation:
Medical expense insurance is designed to reimburse or pay covered health-care expenses arising from illness or injury. These expenses may include hospital room and board, surgical services, physician services, diagnostic testing, outpatient treatment, prescription drugs, and other covered medical care. Benefits are subject to the policy's deductible, copayment, coinsurance, network rules, exclusions, benefit limits, and medical-necessity standards.
Disability income insurance serves a different purpose. It replaces a portion of the insured's earned income when the insured becomes disabled under the policy definition. It does not ordinarily reimburse hospital or physician bills. Accidental death insurance pays a benefit upon qualifying accidental death and does not serve as general medical coverage. Credit life insurance is designed to help satisfy a debt when the debtor dies.
An examination question may describe a policy as basic hospital, surgical, physician expense, major medical, comprehensive major medical, or managed care. Each is within the broader medical-expense category, although benefits and delivery systems differ. The producer should help clients understand the distinction between coverage for medical bills and coverage for lost income. A client can need both forms of protection because medical expenses and inability to earn income are separate financial risks.
References/topics from the Study Guide: Medical Expense Insurance; Hospital Expense; Surgical Expense; Major Medical; Disability Income Insurance.

NEW QUESTION # 34
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:

A. deny the claim
B. pay the claim but deduct the unpaid premium
C. cancel the policy and return all premiums paid
D. reinstate the policy and then pay the claim

Answer: B

Explanation:
The policy remains in force during its contractual grace period after a premium becomes due. For individual accident and health policies, the required grace period generally depends on premium mode: seven days for weekly premiums, ten days for monthly premiums, and 31 days for other premium modes. A claim occurring within the applicable grace period is not automatically denied simply because the premium has not yet been paid. Instead, the insurer may pay the covered claim and deduct the overdue premium from the amount otherwise payable. Therefore, choice B is the best answer. Reinstatement is unnecessary because the policy has not yet lapsed while the grace period is still running. Cancellation and return of all prior premiums would be inconsistent with the purpose of the grace-period provision. The question tests the difference between a late premium during grace and a lapsed policy after grace expires. Once grace expires without payment, coverage can lapse; if coverage later is reinstated, loss coverage may be subject to reinstatement provisions and limitations. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.

NEW QUESTION # 35
In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:

A. can receive both commission and compensation as a facilitator
B. can receive commissions from the company in addition to the compensation as a facilitator
C. can offer advice to consumers resulting in the " steering " of the selection of coverage
D. must surrender the producer ' s license and apply for an Exchange Enrollment Facilitator license

Answer: D

Explanation:
A person may not concurrently hold a Nevada producer license and an Exchange Enrollment Facilitator certificate. Therefore, a health insurance producer who wishes to become an EEF must surrender the producer authority and apply for certification as an Exchange Enrollment Facilitator.
An EEF assists consumers with enrollment in qualified health plans offered through the Exchange. The role is designed to provide objective enrollment help, application assistance, and general information. An EEF may not sell, solicit, or negotiate insurance. The EEF also may not receive consideration from a health insurance issuer or insurer in connection with enrollment and may not receive remuneration arising from EEF activities from a licensed producer, insurance consultant, surplus lines broker, or insurer.
For that reason, a producer cannot receive commissions while acting as an EEF, cannot collect both commission and EEF compensation in the manner described, and cannot steer a consumer toward a particular coverage choice. Producers and EEFs have different legal roles, compensation structures, and consumer- protection limitations.
Study Guide references/topics: Exchange Enrollment Facilitators; producer licensing; prohibited acts; compensation; NRS 695J.210 .

NEW QUESTION # 36
Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?

A. A volunteer fire department
B. A family
C. A church
D. A newspaper corporation

Answer: B

Explanation:
A family is not an eligible blanket-health-insurance group under Nevada law. Blanket accident and health insurance is designed for defined groups connected by a common activity, organization, occupation, event, or exposure to a specified hazard. It is not designed as a substitute for ordinary individual or family health insurance.
Nevada specifically recognizes various groups that may be covered under a blanket policy. These include religious, charitable, recreational, educational, and civic organizations; newspaper publishers covering their carriers; and volunteer fire departments or similar emergency organizations covering members or participants.
The organization acts as the policyholder, and the covered persons are defined by their relationship to the group activity or specified hazard.
A church is eligible as a religious organization. A newspaper corporation may qualify when covering its carriers. A volunteer fire department is specifically listed as an eligible organization. A family, however, is a private household relationship rather than a qualifying blanket group formed around an authorized organizational purpose or activity.
Study Guide references/topics: blanket accident and health insurance; eligible groups; policyholder; specified hazards; NRS 689B.070 .

NEW QUESTION # 37
Which of the following statements is CORRECT about the Medicaid program?

A. Participants must be at least 55 years of age.
B. It provides medical assistance for participants who are blind.
C. It is supplemented by Medicare for persons 62 years of age or older.
D. The program is administered at the federal level.

Answer: B

Explanation:
Medicaid is a means-tested public medical assistance program for eligible low-income individuals and families. Eligibility may include persons who are blind, disabled, aged, pregnant, children, or otherwise within an eligible category under federal and state rules. Therefore, choice A is correct. There is no universal minimum age of 55 for Medicaid eligibility; eligibility is based principally on financial and categorical requirements. Medicaid is also not simply a program supplemented by Medicare at age 62. Medicare eligibility is generally associated with age 65 or qualifying disability or disease status, while Medicaid may assist certain eligible persons with limited income and resources, including some Medicare beneficiaries.
Medicaid is jointly financed by federal and state governments but is administered by the states within federal standards. In Nevada, the state administers the program through its designated health and human-services structure. Examination questions commonly test the distinction between Medicare as social insurance and Medicaid as needs-based medical assistance. Study Guide References/Topics: Social Insurance Programs; Medicaid; Federal-State Health Programs.

NEW QUESTION # 38
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