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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q59-Q64):

NEW QUESTION # 59
Under an individual health policy issued in Nevada, a newborn is automatically covered for a MAXIMUM of how many days after birth?

A. Two
B. Thirty-one
C. Ten
D. Five

Answer: B

Explanation:
A newborn is automatically covered under the applicable Nevada health-policy rule for 31 days after birth.
Coverage begins from the moment of birth and includes necessary care and treatment for injury or sickness, including medically diagnosed congenital defects and birth abnormalities.
To continue coverage beyond the initial 31-day period, the policy may require timely notice of the birth and payment of any additional premium or fee required by the insurer. The notification and payment requirement must be satisfied within the 31-day period if the policy requires it. This rule protects newborns during the immediate post-birth period, when medical care may be urgently necessary.
The automatic coverage is not limited to routine newborn care. It includes necessary treatment of medical conditions identified at birth, subject to the policy's applicable limits. The law also prevents the policy from excluding premature births under the mandated newborn coverage.
Two, five, and ten days are incorrect because they would not provide the statutory protection required for newborn coverage. The exam point is that the initial automatic period is 31 days, while continuation beyond that period may require prompt enrollment action by the insured.
Study Guide references/topics: individual health insurance; newborn coverage; congenital defects; notification requirements; Nevada newborn-coverage requirements .

NEW QUESTION # 60
An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:

A. adjust benefits to the amount the premium provides for the new occupation
B. increase the waiting period to adjust for the occupational difference
C. deny any claim on the basis of misrepresentation
D. increase the deductible to adjust for the occupational difference

Answer: A

Explanation:
The Change of Occupation provision allows an insurer to adjust benefits when the insured changes to a more hazardous occupation after policy issue. Choice A is correct. If the same premium would have purchased a lower benefit amount for the new, more hazardous occupati on, the insurer may reduce the benefit to the amount that premium would have bought under the new occupational classification. The purpose is to preserve fairness between the risk assumed and the premium paid without automatically cancelling the policy.
The insurer does not simply increase the waiting period or deductible, because those are not the contractual adjustment method addressed by the provision. It also does not deny every claim for misrepresentation, because a later change in occupation is not necessarily a misrepresentation in the original application. If the insured changes to a less hazardous occupation, the provision may allow the insured to apply for an adjusted premium rate or greater benefit as appropriate under policy terms. The key examination rule is that occupational changes affect the amount of benefits or premium classification, not the basic validity of coverage. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Change of Occupation Provision; Individual Accident and Health Policies.

NEW QUESTION # 61
Under federal law, a tax exempt Health Savings Account can only be opened for an individual who is:

A. covered by a qualified High Deductible Health Plan
B. eligible to be claimed as a dependent on another person ' s tax return
C. entitled to Medicare benefits
D. covered by Long Term Care Insurance

Answer: A

Explanation:
A Health Savings Account is available only to an eligible individual, and a central eligibility requirement is coverage under a qualified High Deductible Health Plan. Therefore, choice A is correct. The individual also generally must not have disqualifying other health coverage, be enrolled in Medicare, or be claimable as another person's tax dependent. Long-term care insurance does not itself establish HSA eligibility. Medicare enrollment generally prevents new HSA contributions, although the account balance may still be used for qualified expenses under applicable tax rules. An HSA offers tax-favored contributions, tax-deferred growth, and tax-free distributions for qualified medical expenses when statutory requirements are met. The HDHP must satisfy annual federal deductible and out-of-pocket limits, which are adjusted periodically. The IRS states that eligible individuals must have HDHP coverage and no disqualifying health coverage to make HSA contributions. See IRS HSA guidance . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Health Savings Accounts; High Deductible Health Plans.

NEW QUESTION # 62
A policy pays a stated dollar amount for each day an insured is confined to a hospital, regardless of the actual hospital bill. What type of coverage is this?

A. Major medical insurance
B. Comprehensive dental insurance
C. Hospital indemnity insurance
D. Disability buy-sell insurance

Answer: C

Explanation:
Hospital indemnity insurance pays a fixed benefit for a covered hospital confinement, often expressed as a stated dollar amount per day. The payment is not based on the actual amount of the hospital bill. The insured may use the benefit for deductibles, transportation, household expenses, lost income, or other needs, subject to the policy terms. Because it pays a predetermined amount rather than reimbursing actual expenses, hospital indemnity coverage is generally considered limited-benefit or supplemental coverage.
Major medical insurance operates differently. It is designed to cover a broad range of medical expenses, subject to deductibles, coinsurance, network provisions, and out-of-pocket maximums. Major medical coverage generally reimburses or pays eligible expenses rather than merely paying a fixed daily hospital amount. The existence of hospital indemnity coverage does not replace the need for comprehensive health insurance.
The producer must clearly explain the limitations of indemnity products. It would be misleading to present a
$200-per-day hospital indemnity benefit as if it pays all hospital charges. Consumers should understand whether the policy is supplemental, what events trigger payment, whether preexisting-condition or waiting- period provisions apply, and whether benefits are payable in addition to other coverage.
References/topics from the Study Guide: Hospital Indemnity Insurance; Limited-Benefit Coverage; Supplemental Health Insurance; Major Medical; Fixed Indemnity Benefits.

NEW QUESTION # 63
Which of the following is NOT a preventive benefit for adults?

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

Answer: C

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 # 64
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