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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Detailed InsNV_Health02 Study Dumps | InsNV_Health02 Test Study Guide

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Insurance Licensing NV Accident and Health Sample Questions (Q118-Q123):

NEW QUESTION # 118
Which of the following is NOT a preventive benefit for adults?

A. Mammograms
B. Physical therapy
C. High blood pressure screening
D. Skin cancer screening

Answer: D

Explanation:
Skin cancer screening is the correct answer because it is not included as a broadly required preventive benefit for adults in the same manner as the other listed services. Preventive-service requirements are tied to specified recommended services and may vary by population, risk status, and recommendation level. A service may be medically useful or covered by a particular policy without being a universally required no-cost preventive benefit.
High blood pressure screening is a standard adult preventive screening. Mammography is a recognized preventive screening benefit for eligible women. Physical therapy can be included in preventive fall- intervention services for certain adults, particularly older adults at risk of falls, when the preventive-service criteria are met. Thus, the question is testing the distinction between services commonly covered in some circumstances and services specifically identified as preventive benefits.
Skin examinations or skin cancer evaluations may be medically necessary when a lesion, symptom, prior diagnosis, or risk factor is present. In that circumstance, the service may be classified as diagnostic rather than preventive and can be subject to policy terms and cost sharing.
For examination purposes, remember that preventive-benefit questions focus on the mandated screening list and preventive-care criteria, not merely on whether a service can be medically valuable.
Study Guide references/topics: preventive care; adult screenings; in-network preventive benefits; adult preventive-care benefits .

NEW QUESTION # 119
An applicant unintentionally gives an incorrect answer about a material health condition on a life insurance application. This is best described as:

A. A representation that may be material to underwriting
B. A rider
C. A warranty that automatically voids the policy
D. A premium-payment mode

Answer: A

Explanation:
An application statement is generally a representation rather than a warranty. A representation is a statement believed to be true to the best of the applicant's knowledge and belief. If a representation is false and material to the insurer's underwriting decision, it may create a basis for the insurer to investigate, contest, rescind, or adjust the policy according to applicable law and the policy's contestability provision. Materiality means the information would have influenced the insurer's decision to issue the policy, set the premium, determine the rating class, or limit coverage.
A warranty is a statement or promise that must be literally true or strictly complied with. Life and health insurance applications are not ordinarily treated as a collection of warranties because that result would be excessively harsh for innocent or immaterial errors. Nevada life insurance law states that, absent fraud, statements in an attached application are deemed representations rather than warranties.
Intent matters in distinguishing an innocent mistake from intentional fraud, but an unintentional error can still be material. Producers should read each question clearly, ensure the applicant understands it, record answers accurately, and allow the applicant to review the completed application before signing. The producer should never suggest that a medical condition, medication, or prior treatment can be omitted.
References/topics from the Study Guide: Representations and Warranties; Material Misrepresentation; Application Statements; Fraud; NRS 688A.070.

NEW QUESTION # 120
In Nevada, which life insurance policy is subject to a 30-day right to surrender for a premium refund after delivery?

A. A standard nonreplacement life insurance policy
B. A replacement life insurance policy
C. An industrial life policy
D. A group life certificate

Answer: B

Explanation:
A replacement life insurance policy delivered in Nevada must provide a 30-day period during which the policyowner may surrender the policy to the insurer with a written request for cancellation and receive a refund of premiums paid, including policy fees or other charges. This longer review period recognizes the special risks associated with replacement transactions. Replacing existing coverage can cause the consumer to lose favorable values, restart contestability or suicide periods, incur surrender charges, or exchange a policy that better serves the client's long-term needs.
For a nonreplacement life policy, annuity contract, or pure endowment contract, Nevada generally requires a
10-day right of surrender after delivery. The applicable statute excludes industrial life insurance from this requirement. The producer must therefore identify whether a proposed transaction is a replacement and follow the related disclosure and recordkeeping requirements. The free-look period is a consumer-protection right; it does not excuse a producer from determining suitability or accurately comparing existing and proposed coverage before the sale.
On an examination question, the key distinction is not whether the policy is whole life, term life, or universal life. The key is whether it is a replacement contract or policy.
References/topics from the Study Guide: Replacement; Free-Look Provision; Nevada Consumer Protections; NRS 688A.165.

NEW QUESTION # 121
Basic cancer plans pay for all of the following EXCEPT:

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

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 # 122
For an individual health insurance policy, which document is generally part of the entire contract when a copy is attached to or endorsed on the policy?

A. An advertisement used during the sale
B. A producer's personal notes
C. A verbal statement made by the applicant
D. The application

Answer: D

Explanation:
The application is generally part of the entire contract only when a copy is attached to or endorsed on the policy. The entire-contract provision identifies the documents that form the binding agreement between the insurer and the insured. In an individual health policy, the policy itself and the attached application are the principal contract documents. Material statements made in the application are treated according to the policy and governing law, but outside papers, advertisements, and verbal discussions ordinarily do not become policy terms merely because they were used in the sales process.
This rule protects both parties. The insured can review the documents that govern coverage, while the insurer can rely on the written application it used for underwriting. A producer's notes, informal assurances, or advertising language cannot expand benefits, remove exclusions, or alter policy conditions unless formally incorporated into the contract. Producers must avoid statements that conflict with the issued policy and should deliver the policy promptly so the applicant can examine it during any applicable free-look period.
Nevada's individual health-insurance law requires specified policy provisions and permits approved substitutions only when they are not less favorable to the insured or beneficiary. The exact wording and placement of the application therefore matter.
References/topics from the Study Guide: Entire Contract; Application; Policy Delivery; Individual Health Policy Provisions; NRS 689A.040.

NEW QUESTION # 123
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