InsNV_Health02 Latest Exam Guide | InsNV_Health02 Test Simulator

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Accident & Health – General Knowledge50%- Field Underwriting Procedures
  • 1. Contract law
    • Elements of a contract
    • Insurable interest
    • Warranties and representations
    • Unique aspects of the insurance contract
  • 2. Replacement
    • 3. Completing the application
      • 4. Policy delivery
        • 5. Submitting application and initial premium to company for underwriting
          • 6. Explaining policy provisions, riders, exclusions, and ratings
            • 7. Initial premium payment and receipt
              • 8. Sources of insurability and HIPAA privacy information
                - Types of Policies
                • 1. Other policies
                  • Dental
                  • Vision
                  • Cancer
                  • Critical illness or specified disease
                  • Worksite employer-sponsored
                  • Hospital indemnity
                  • Short-term medical
                  • Accident
                • 2. Medicare supplement policies
                  • 3. Accidental death and dismemberment
                    • 4. Group insurance
                      • Differences between individual and group contracts
                      • General characteristics
                      • COBRA
                    • 5. Individual and Group Long Term Care
                      • Eligibility
                      • Levels of care
                    • 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. Disability income
                      • Individual disability income policy
                      • Business overhead expense policy
                      • Business disability buyout policy
                      • Group disability income policy
                      • Key employee policy
                    - 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. Managed care
                      • 2. Modes of premium payments
                        • 3. Occupational vs. non-occupational
                          • 4. Total, partial, recurrent, and residual disability
                            • 5. Subrogation
                              • 6. Owner's rights
                                • 7. Primary and contingent beneficiaries
                                  • 8. Dependent children benefits
                                    • 9. Nonduplication and coordination of benefits
                                      • 10. Tax treatment of premiums and proceeds of insurance contracts
                                        • 11. Cost containment
                                          • 12. Workers Compensation
                                            - Social Insurance
                                            • 1. Medicaid
                                              • 2. Social Security benefits
                                                • 3. Medicare Parts A, B, C, and D
                                                  Topic 2: Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Long Term Care
                                                  - Medicare
                                                  • 1. Prescription Drug Plan
                                                    • 2. Medicare supplement regulation
                                                      • 3. Medicare Advantage Plans
                                                        - 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 preventive healthcare services
                                                          • 2. Coverage for newborn children
                                                            • 3. Coverage for physical handicap or intellectual disability for dependent children
                                                              Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Definitions
                                                              • 1. Certificate of authority
                                                                • 2. Domestic, foreign, and alien
                                                                  • 3. Transacting insurance
                                                                    • 4. Authorized and unauthorized
                                                                      • 5. Premiums
                                                                        • 6. Cost-sharing
                                                                          • 7. Insurer
                                                                            - Nevada Life and Health Insurance Guaranty Association
                                                                            - Marketing Practices
                                                                            • 1. Commissions and payment restrictions
                                                                              • 2. Required records and record retention
                                                                                • 3. Fiduciary responsibilities
                                                                                  • 4. Silver State Health Insurance Exchange
                                                                                    • 5. Unfair practices
                                                                                      • Unfair claims methods and practices and settlement of claims
                                                                                      • Rebating and inducement
                                                                                      • Twisting
                                                                                      • Misrepresentation
                                                                                      • Fraud
                                                                                      • Unfair discrimination
                                                                                      • Defamation
                                                                                    • 6. Affordable Care Act
                                                                                      - Licensing
                                                                                      • 1. Renewal and continuing education
                                                                                        • 2. Name of licensee
                                                                                          • 3. Persons required to be licensed
                                                                                            • 4. Obtaining a license
                                                                                              • 5. Termination of license
                                                                                                • 6. Suspension, revocation, and refusal of license
                                                                                                  - Insurance Commissioner
                                                                                                  • 1. Notice and hearings and penalties
                                                                                                    • 2. Examinations
                                                                                                      • 3. General powers and duties
                                                                                                        Topic 4: Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Credit life and health insurance
                                                                                                        - Advertising
                                                                                                        - Group life and health insurance
                                                                                                        • 1. Required provisions
                                                                                                          • 2. Eligible groups

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q128-Q133):

                                                                                                            NEW QUESTION # 128
                                                                                                            Under Nevada law, the definition of " insurer " includes:

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            Nevada law defines an insurer to include every person engaged as principal and as an indemnitor, surety, or contractor in the business of entering into insurance contracts. Therefore, an indemnitor is specifically included in the statutory definition of insurer.
                                                                                                            An indemnitor is a party that agrees to compensate another for specified loss or damage. That obligation is central to insurance: the insurer assumes a defined risk and promises to provide a benefit, payment, service, or indemnity when a covered loss occurs. A surety and a contractor entering insurance agreements can likewise fall within the statutory definition when operating in the insurance business.
                                                                                                            A security dealer sells or handles securities and is regulated under securities law rather than by the insurance definition in this question. A financial planner may provide financial advice but is not automatically an insurer. A syndicate may participate in insurance arrangements in certain contexts, but it is not the statutory term specifically identified in the definition.
                                                                                                            The exam point is to recognize the broad legal definition of insurer. It encompasses more than a company labeled "insurance company"; it includes persons acting as indemnitors, sureties, or insurance contractors.
                                                                                                            Study Guide references/topics: Nevada Insurance Code; definitions; insurer; indemnity; surety; NRS 679A.
                                                                                                            100 .


                                                                                                            NEW QUESTION # 129
                                                                                                            A policyowner borrows money from the insurer using the cash value of a whole life policy as security. If the loan and accrued interest are unpaid when the insured dies, what is the usual result?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            A policy loan is a loan made by the insurer to the policyowner and secured by the policy's available cash value. It is not a withdrawal that automatically terminates the coverage. However, the outstanding principal and accrued interest become indebtedness against the policy. If the insured dies before repayment, the insurer deducts that indebtedness from the amount otherwise payable to the beneficiary. Therefore, the usual result is a reduced death benefit.
                                                                                                            This concept is especially important with permanent life insurance, including whole life and certain universal- life policies, because cash value may support policy loans. Interest continues to accrue under the policy's loan provision. If the debt becomes large enough, it can threaten the policy's continuation because a lapse may occur if the cash value is insufficient to support the indebtedness and required charges. A producer should explain both the availability of loans and their consequences; presenting a loan as "free money" would be misleading.
                                                                                                            Nevada's life-insurance standards require a loan provision in policies to which the requirement applies. The contractual terms control such matters as interest, notice, repayment, and the effect of indebtedness on policy values and proceeds.
                                                                                                            References/topics from the Study Guide: Cash Value; Policy Loans; Nonforfeiture Values; NRS 688A.110- Loan Secured by Policy.


                                                                                                            NEW QUESTION # 130
                                                                                                            The Nevada Insurance Commissioner may revoke the license of any licensed producer who:

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            Misappropriating money belonging to policyholders is a direct and serious ground for license revocation. A producer commonly receives premiums, return premiums, claim funds, or other property in the course of insurance business. Those funds must be handled honestly, promptly, and in accordance with the producer's fiduciary responsibilities. Using, converting, improperly withholding, or diverting that money violates Nevada producer-licensing law.
                                                                                                            The Commissioner may refuse to issue, suspend, revoke, or refuse to renew a producer's license and may impose administrative fines or other disciplinary action for specified misconduct. Misappropriation is specifically identified as conduct warranting discipline because it threatens consumers and undermines the integrity of the insurance marketplace.
                                                                                                            A civil judgment alone does not automatically establish a licensing-revocation ground under the wording of this question. Likewise, reporting requirements and address-change obligations may lead to administrative consequences when violated, but the question asks for the clear statutory cause for revocation.
                                                                                                            Misappropriation of policyholder money is the most direct and legally significant answer.
                                                                                                            Producers should maintain accurate premium records, promptly remit funds, segregate money when required, and never treat policyholder or insurer funds as personal assets.
                                                                                                            Study Guide references/topics: producer fiduciary duties; prohibited practices; license denial, suspension, and revocation; NRS 683A.451 .


                                                                                                            NEW QUESTION # 131
                                                                                                            A life policy lapses because a premium was not paid. To reinstate the policy, the insurer will generally require all of the following EXCEPT:

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            Reinstatement restores a lapsed life insurance policy to active status if the policyowner satisfies the policy's requirements. Those requirements generally include applying for reinstatement within the permitted period, providing evidence of insurability satisfactory to the insurer, and paying overdue premiums plus interest. The exact reinstatement period and underwriting requirements are controlled by the policy and applicable law.
                                                                                                            A new medical examination is not required in every case. The insurer may request medical information or an examination when needed to evaluate the applicant's current insurability, but it is not an automatic universal requirement. The key examination principle is that evidence of insurability is required, not that a physical examination must always occur. Reinstatement is often preferable to purchasing a new policy because the existing policy may have more favorable premium rates, accumulated cash value, or a prior issue age.
                                                                                                            However, the policyowner must understand that contestability and certain exclusions may begin again with respect to the reinstatement.
                                                                                                            A producer should explain the difference between reinstatement and renewal. Reinstatement restores a policy that lapsed; renewal continues or extends a policy under its existing terms. Neither should be assumed available without reviewing the contract.
                                                                                                            References/topics from the Study Guide: Reinstatement Provision; Policy Lapse; Evidence of Insurability; Premium Payment; NRS 688A.130.


                                                                                                            NEW QUESTION # 132
                                                                                                            A Nevada producer wants to solicit an individual disability-income policy. Which license authority is required?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            A producer soliciting an individual disability-income policy must hold Nevada accident and health insurance authority. Nevada defines this line as insurance for sickness, bodily injury, or accidental death and permits it to include disability-income benefits. Disability-income insurance replaces a portion of earned income when an insured becomes disabled under the policy definition; it is therefore within the accident-and-health line rather than the property, casualty, or personal-lines authorities.
                                                                                                            Nevada requires a person to be licensed for the relevant class of insurance before selling, soliciting, or negotiating insurance in the state. The licensing distinction matters because a life authority and an accident- and-health authority are separately identified lines of authority. Although life insurance may include additional disability-income benefits when permitted as part of its statutory definition, a producer selling an individual health or disability-income policy should not assume that life authority alone authorizes the transaction.
                                                                                                            The producer must also comply with appointment requirements when acting as an insurer's agent, continuing education and renewal requirements, and all applicable trade-practice rules. Selling without the proper authority can result in administrative discipline and a monetary penalty. On examination questions, identify the coverage being sold first; then match it to the appropriate Nevada line of authority.
                                                                                                            References/topics from the Study Guide: Producer Licensing; Lines of Authority; Accident and Health Insurance; Disability Income; NRS 683A.201; NRS 683A.261.


                                                                                                            NEW QUESTION # 133
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