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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q47-Q52):

NEW QUESTION # 47
Which of the following persons is NOT required to be licensed by the Nevada Insurance Commissioner?

A. A salaried insurance agency clerk who also receives commissions on applications the clerk processes
B. A person who procures insurance for an insured
C. An adjuster's employee who assists in the investigation and settlement of insurance claims
D. A salaried insurance company employee who performs clerical and administrative work

Answer: D

Explanation:
A salaried insurance company employee performing only clerical and administrative work is not required to hold an insurance producer license. The exemption applies when the employee does not sell, solicit, or negotiate insurance and is not compensated by commission based on insurance transactions.
Licensing is required for persons whose activities bring them into the regulated functions of insurance production, brokering, adjusting, or other licensed insurance activity. A person who procures insurance for an insured is acting in a producer or broker capacity and requires appropriate authority. An individual involved in investigating and settling claims may require an adjuster license depending on the duties performed.
Likewise, an agency clerk who receives commissions related to processed applications is no longer functioning solely as a clerical employee; commission-based activity indicates involvement in the insurance transaction.
The distinction is based on the actual work performed, not merely the person's job title. A company may call someone an assistant, representative, clerk, or customer-service employee, but the individual must be licensed if the person sells, solicits, negotiates, or otherwise performs regulated insurance functions.
Study Guide references/topics: producer licensing; licensing exemptions; clerical employees; sales, solicitation, and negotiation; NRS 683A.117 .

NEW QUESTION # 48
Which of the following statements is CORRECT about Medicare?

A. It is a medical assistance program.
B. Its Part A provides payment for physicians ' bills.
C. It is a hospital and medical expense insurance program.
D. It provides benefits to totally disabled persons only.

Answer: C

Explanation:
Medicare is a federal social insurance program that provides hospital and medical expense coverage to eligible persons. Therefore, choice B is correct. Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services.
Medicare Part B primarily covers physician services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Choice A describes Medicaid, which is a needs-based medical assistance program jointly administered by federal and state governments. Choice C is incorrect because Medicare also serves people age 65 or older and individuals with qualifying end-stage renal disease or ALS; it is not limited to totally disabled persons. Choice D is incorrect because physician bills are generally associated with Part B, not Part A. Medicare beneficiaries may also choose Medicare Advantage plans, which provide Medicare-covered benefits through private plans, and may obtain prescription drug coverage under Part D. Study Guide References/Topics: Social Insurance Programs; Medicare Parts A and B; Federal Health Programs.

NEW QUESTION # 49
R, a self-employed stockbroker, becomes totally disabled on January 1 and receives $1,500 a month for the next twelve months from her own Individual Disability Income policy, for which she had paid the premium.
How much of this income is subject to federal income tax?

A. $0
B. $9,000
C. $12,800
D. $18,000

Answer: A

Explanation:
The correct answer is D, $0. Disability income benefits generally are not taxable to the insured when the insured personally paid the premiums with after-tax dollars. R paid the premium for her own individual disability income policy, so the $1,500 monthly benefit is excluded from federal taxable income. The total annual benefit is $18,000, but the fact that it totals $18,000 does not make it taxable. Tax treatment changes when an employer pays the premium and does not include that premium amount in the employee's taxable income; in that case, disability benefits are generally taxable. Similarly, benefits can be taxable when premiums were paid through certain pre-tax arrangements. The central exam rule is: personally paid, after-tax disability premiums normally produce income-tax-free disability benefits. The Internal Revenue Service confirms that benefits from an accident or health policy are not taxable when the taxpayer paid the premiums.
See IRS Publication 525 . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Tax Treatment of Disability Benefits.

NEW QUESTION # 50
Basic cancer plans pay for all of the following EXCEPT:

A. radiotherapy
B. immunotherapy
C. physical therapy
D. chemotherapy

Answer: C

Explanation:
Basic cancer policies are limited-benefit plans intended to supplement, rather than replace, comprehensive medical coverage. They commonly provide benefits for cancer-specific treatment such as chemotherapy, radiotherapy, and immunotherapy, subject to the policy's definitions, schedules, and limits. Therefore, choice C is correct because physical therapy is not ordinarily a core cancer-treatment benefit under a basic cancer policy. Physical therapy may be covered under a comprehensive medical plan or under a more expansive supplemental policy if expressly included, but it is not a standard basic cancer-plan benefit. Cancer policies can pay specified amounts for surgery, hospital confinement, physician services, diagnostic testing, drugs, radiation, chemotherapy, or other treatment tied directly to a covered cancer diagnosis. The insured should not assume that every medical expense arising during cancer treatment is covered. Benefits may be subject to waiting periods, preexisting-condition restrictions, recurrence rules, benefit schedules, and exclusions. The appropriate exam distinction is between benefits directly associated with treatment of cancer and general rehabilitative or medical services that are not expressly included in the cancer policy. Study Guide References
/Topics: Types of Health Insurance Policies; Limited-Coverage Health Policies; Cancer Insurance.

NEW QUESTION # 51
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. cancel the policy and return all premiums paid
B. deny the claim
C. reinstate the policy and then pay the claim
D. pay the claim but deduct the unpaid premium

Answer: D

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 # 52
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