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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Definitions 1. Domestic, foreign, and alien 2. Transacting insurance 3. Premiums 4. Certificate of authority 5. Insurer 6. Authorized and unauthorized 7. Cost-sharing - Nevada Life and Health Insurance Guaranty Association - Insurance Commissioner 1. Notice and hearings and penalties 2. Examinations 3. General powers and duties - Marketing Practices 1. Fiduciary responsibilities 2. Commissions and payment restrictions 3. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation 4. Affordable Care Act 5. Required records and record retention 6. Silver State Health Insurance Exchange - Licensing 1. Name of licensee 2. Renewal and continuing education 3. Termination of license 4. Suspension, revocation, and refusal of license 5. Persons required to be licensed 6. Obtaining a license
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 - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Long Term Care - Hospice care - Mandatory policy clauses and provisions 1. Coverage for newborn children 2. Coverage for preventive healthcare services 3. Coverage for physical handicap or intellectual disability for dependent children
Accident & Health – General Knowledge	50%	- Social Insurance 1. Medicaid 2. Social Security benefits 3. Medicare Parts A, B, C, and D - Field Underwriting Procedures 1. Sources of insurability and HIPAA privacy information 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. Replacement 5. Submitting application and initial premium to company for underwriting 6. Explaining policy provisions, riders, exclusions, and ratings 7. Completing the application 8. Policy delivery - 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. Rights of renewability Noncancelable Cancelable Guaranteed renewable 3. 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 4. Riders Impairment and exclusions Guaranteed insurability Future increase option - Types of Policies 1. Accidental death and dismemberment 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. Medicare supplement policies 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. Individual and Group Long Term Care Eligibility Levels of care - Other Insurance Concepts 1. Cost containment 2. Nonduplication and coordination of benefits 3. Managed care 4. Workers Compensation 5. Total, partial, recurrent, and residual disability 6. Tax treatment of premiums and proceeds of insurance contracts 7. Primary and contingent beneficiaries 8. Dependent children benefits 9. Owner's rights 10. Modes of premium payments 11. Occupational vs. non-occupational 12. Subrogation
Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Advertising - Group life and health insurance 1. Eligible groups 2. Required provisions - Credit life and health insurance

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Insurance Licensing NV Accident and Health Sample Questions (Q85-Q90):

NEW QUESTION # 85
Which of the following statements is CORRECT about the Medicaid program?

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

Answer: D

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 # 86
Which of the following situations describes a representation?

A. An insurance company guarantees that premiums paid will be refunded within 30 days after the policy ' s effective date if an insured is dissatisfied with the policy
B. A prospect ' s statement on an application that is held to be absolutely true
C. A prospect ' s statement on an application that is held to be substantially true
D. An insurance company guarantees that policy benefits will be paid promptly on receipt of a Proof of Loss

Answer: C

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 # 87
A corporation purchases life insurance on a highly valuable executive and is named as owner, premium payer, and beneficiary. What is the primary purpose of this arrangement?

A. Viatical settlement insurance
B. Credit life insurance
C. Key person insurance
D. Family maintenance insurance

Answer: C

Explanation:
Key person insurance is life insurance purchased by a business on the life of an employee, owner, executive, or specialist whose death would create a significant financial loss for the business. The business is generally the owner, premium payer, and beneficiary. If the key person dies, the death proceeds can help the business offset lost revenue, recruit and train a replacement, protect credit relationships, reassure customers, or meet other financial obligations during the transition.
The key person must consent to the insurance, and the business must have a legitimate insurable interest at the time coverage is issued. Key person insurance is not designed to provide personal family protection to the employee. It protects the business against the financial consequences of losing an important contributor.
Credit life insurance is designed to help pay an outstanding debt upon the debtor's death. Family maintenance insurance is generally personal coverage intended to replace income or support dependents. A viatical settlement involves the sale of an existing life insurance policy to a third party, typically when the insured has a serious illness.
The producer should conduct a financial-needs analysis and coordinate with legal and tax advisers because ownership, consent, accounting treatment, and tax consequences require careful planning.
References/topics from the Study Guide: Key Person Insurance; Business Uses of Life Insurance; Insurable Interest; Business Continuation Planning; Executive Protection.

NEW QUESTION # 88
When must insurable interest generally exist in a life insurance transaction?

A. Only when the death benefit is paid
B. Only when the beneficiary is changed
C. At the time the policy is issued
D. Only after the policy has been in force for two years

Answer: C

Explanation:
Insurable interest must generally exist when a life insurance policy is issued. It is the lawful financial or personal interest that prevents life insurance from becoming a wagering arrangement. A person has an unlimited insurable interest in that person's own life and may name any lawful beneficiary. Insurable interest also commonly exists among close family members because of love and affection, and in certain business relationships where one person or entity would suffer a financial loss from another person's death.
Once a policy is validly issued with insurable interest, the interest does not generally need to continue until the insured's death. For example, a business may purchase life insurance on a key employee when a valid economic relationship exists. If the relationship later changes, the policy's continued validity is not automatically destroyed solely because the original financial relationship ended. However, ownership transfers, stranger-originated life insurance arrangements, and transactions designed to evade insurable- interest requirements raise significant legal and ethical concerns.
Insurable interest differs from beneficiary status. A beneficiary need not always have an insurable interest if the policyowner is insuring the policyowner's own life. The critical point is that the policy must be procured lawfully at inception.
References/topics from the Study Guide: Insurable Interest; Policy Ownership; Beneficiary Designations; Business Life Insurance; Contract Law.

NEW QUESTION # 89
Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?

A. The insurance company guarantees the premium rate for the life of the policy.
B. The insurance company must exchange the original policy for a new one at the insurability date.
C. The insured may periodically increase the amount of benefits payable under the policy.
D. The insured must periodically provide proof of insurability to the insurance company.

Answer: C

Explanation:
A Guaranteed Insurability rider gives the disability income policyowner the right to purchase additional disability income coverage at stated future option dates without furnishing evidence of insurability. The rider is valuable because an insured's income may increase over time while health may decline; the rider allows benefit amounts to be increased when the option is exercised, subject to the rider's conditions and insurer limits. Therefore, choice C is correct. The rider does not guarantee a premium rate for life. Premiums for the added coverage are based on the insured's attained age and the insurer's rates applicable when the additional coverage is purchased. It also does not require periodic proof of insurability; eliminating that requirement is the central purpose of the rider. The existing policy remains in force and normally does not have to be exchanged for a new policy. On an examination, distinguish guaranteed insurability from noncancellable and guaranteed renewable provisions: those provisions concern renewability and premiums, whereas the rider concerns the future purchase of additional benefits. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Optional Benefits Riders.

NEW QUESTION # 90
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