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

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Insurance Licensing NV Accident and Health Sample Questions (Q13-Q18):

NEW QUESTION # 13
A full-time employee who is suffering from chronic kidney failure and requires dialysis is eligible for medical coverage under which of the following plans?

A. Medicare
B. Medicaid
C. Social Security Disability benefits
D. Workers ' Compensation

Answer: A

Explanation:
The correct answer is B, Medicare. A person with end-stage renal disease-permanent kidney failure requiring regular dialysis or a kidney transplant-may qualify for Medicare regardless of age, provided the applicable work or family eligibility requirements are met. The employee's status as full-time does not prevent Medicare eligibility based on end-stage renal disease. Medicaid is a needs-based program and is not the best answer solely from the fact s given. Workers' compensation would apply only to a qualifying work- related injury or illness. Social Security Disability benefits can provide income support to qualifying disabled persons, but they are not the medical coverage program identified in the question. Medicare coverage for dialysis-related services is subject to eligibility and enrollment rules, and an employer group health plan may coordinate with Medicare during the ESRD coordination period. Medicare confirms that people with permanent kidney failure requiring regular dialysis or a transplant can qualify for coverage before age 65. See Medicare's ESRD eligibility guidance . Study Guide References/Topics: Social Insurance Programs; Medicare; End-Stage Renal Disease.

NEW QUESTION # 14
Which of the following statements is CORRECT about Business Overhead Expense insurance?

A. It reimburses the policyowner for loss of income.
B. It covers eligible expenses for staff, rent, and utilities.
C. It can be obtained only by corporations.
D. It covers eligible expenses for staff only.

Answer: B

Explanation:
Business Overhead Expense insurance reimburses a business for specified ongoing operating expenses when a business owner becomes disabled. Eligible expenses commonly include employee salaries, rent, utilities, office expenses, and other ordinary fixed costs identified in the policy. Accordingly, choice B is correct. The purpose is business continuity: it helps keep the office or practice operating during the owner's disability rather than replacing the owner's personal income. A disability income policy, not Business Overhead Expense insurance, is the product intended to replace an individual's lost earned income. The coverage is not restricted to corporations; it may be appropriate for sole proprietors, partners, and owners of closely held businesses, depending on underwriting and policy eligibility. It also is not limited to staff expenses alone, because rent, utilities, and other contractually covered overhead are central components of the protection.
Benefits are generally limited by the actual covered overhead incurred and the policy's monthly benefit amount. Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Disability Income Insurance; Business Overhead Expense Coverage.

NEW QUESTION # 15
Which person is the measuring life whose survival determines the timing and duration of annuity payments?

A. Annuitant
B. Beneficiary
C. Policyowner
D. Producer

Answer: A

Explanation:
The annuitant is the person whose life expectancy is used to determine the amount, timing, or duration of annuity payments. The annuitant is not necessarily the contract owner or the beneficiary. In many personally owned annuities, one person may occupy more than one role, but examination questions frequently separate them. The owner controls contractual rights, including premium payments, beneficiary changes, withdrawals when permitted, and surrender decisions. The annuitant is the measuring life. The beneficiary receives remaining contract value or death proceeds if the owner or annuitant dies, depending on the contract design.
During the accumulation period, the owner pays premiums or transfers funds into the annuity. During the annuitization period, the accumulated value is converted into a stream of income payments. The annuitant's age and selected payout option influence the payment calculation. A life-income option normally provides larger periodic payments for an older annuitant because the expected payment period is shorter.
Do not confuse the annuitant with the insured under life insurance. Life insurance is designed primarily to create a death benefit upon the insured's death. An annuity is designed primarily to provide income during life, although death-benefit provisions may apply before annuitization.
References/topics from the Study Guide: Annuities; Parties to an Annuity; Accumulation Period; Annuitization Period; Payout Options.

NEW QUESTION # 16
J and K are married and have several children. J is the primary beneficiary on K ' s Accidental Death and Dismemberment (AD & D) policy, and K ' s sibling, L, is the contingent beneficiary. J, K, and L are involved in a train accident, and K and L are killed instantly. The Accidental Death benefits will be paid to:

A. J only
B. L ' s estate
C. J and K ' s estate
D. K ' s estate

Answer: A

Explanation:
The correct answer is D, J only. A primary beneficiary has the first right to receive policy proceeds. J is named as K's primary beneficiary and survives the accident. Therefore, the AD & D benefit is paid directly to
J. The contingent beneficiary, L, would receive the proceeds only if the primary beneficiary had died before K or could not receive the benefit under the policy terms. Because J remains alive, L's death does not change the payment outcome. The proceeds do not pass to K's estate because a living named primary beneficiary exists.
They also do not pass to L's estate, because L never became entitled to the benefit; the contingency never occurred. Beneficiary designations control over general assumptions about family relationships or estates. The insured should keep beneficiary designations current after changes in family status, death, divorce, or estate- planning decisions. A simultaneous-death provision can alter outcomes if the beneficiary and insured die in the same event and survivorship cannot be determined, but the facts here identify K and L as deceased while J survives. Study Guide References/Topics: Group Health Insurance; Accidental Death and Dismemberment; Beneficiary Designations.

NEW QUESTION # 17
The maximum cost share for preventive screening from an in-network provider is:

A. 30%
B. 10%
C. 20%
D. 0%

Answer: D

Explanation:
The maximum cost share for a covered preventive screening received from an in-network provider is 0%. In practical terms, the insured generally pays no deductible, copayment, or coinsurance for qualifying preventive services delivered in-network. This rule is intended to encourage early detection of illness and promote preventive care before conditions become more serious and costly.
Examples of qualifying preventive care can include certain screenings, immunizations, counseling, and wellness services. The precise covered service and frequency may depend on age, sex, medical circumstances, and the applicable preventive-service recommendations. The in-network condition is important because services received outside the plan's network may be subject to different cost-sharing rules, except where other law or plan provisions apply.
The choices of 10%, 20%, and 30% reflect ordinary coinsurance levels that may apply to nonpreventive treatment or to services that do not qualify for first-dollar preventive coverage. They do not apply to an eligible preventive screening under the in-network preventive-care rule.
Always distinguish preventive screening from diagnostic care. A screening is generally performed when no symptom or suspected condition is being evaluated; a diagnostic service may generate cost sharing depending on the circumstances and plan terms.
Study Guide references/topics: preventive services; in-network providers; deductibles; copayments; coinsurance; HealthCare.gov preventive-care guidance .

NEW QUESTION # 18
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