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

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Insurance Licensing NV Accident and Health Sample Questions (Q62-Q67):

NEW QUESTION # 62
What is the primary purpose of a waiver-of-premium rider on a life insurance policy?

A. It waives required premiums if the insured becomes totally disabled as defined by the rider.
B. It guarantees a higher death benefit every year.
C. It eliminates all future policy loans.
D. It converts term insurance automatically into whole life insurance.

Answer: A

Explanation:
A waiver-of-premium rider keeps qualifying life insurance coverage in force by waiving required premiums when the insured becomes totally disabled as defined in the rider. The rider protects against the risk that disability will interrupt income and make premium payments unaffordable. Once the rider's requirements are satisfied, the insurer pays or waives the premium according to the policy terms, allowing the coverage and any applicable cash-value features to continue.
The definition of total disability, the waiting period, the age limitation, proof-of-disability requirements, and the duration of the waiver are contractual matters. The rider does not usually mean that premiums are waived for every illness, injury, or temporary work interruption. The insured must meet the stated definition and provide required evidence. Some riders also require that disability begin before a specified age.
This rider should not be confused with disability-income insurance. Disability income pays a periodic benefit to replace a portion of income. Waiver of premium does not provide an income payment; it protects the life policy from lapse due to qualifying disability. It also differs from a payor-benefit rider, which is commonly used with juvenile policies and protects the policy when the premium-paying adult dies or becomes disabled.
References/topics from the Study Guide: Waiver of Premium Rider; Total Disability; Disability Income; Payor Benefit Rider; Policy Continuation.

NEW QUESTION # 63
Which feature is most characteristic of universal life insurance?

A. Investment risk borne entirely by the insurer in a separate account
B. Coverage that can never build cash value
C. A fixed premium and fixed death benefit with no flexibility
D. Flexible premiums and adjustable death-benefit options, subject to policy requirements

Answer: D

Explanation:
Universal life insurance is a flexible-premium permanent life insurance policy. It generally provides a cash- value account, interest crediting, mortality charges, expense charges, and flexible premium-payment options within policy limits. The owner may often adjust the amount and timing of premiums and may have death- benefit options, subject to minimum funding requirements, underwriting rules for increases, and the policy's terms. The flexibility does not mean the owner can stop paying indefinitely without consequence. If cash value is insufficient to cover monthly deductions and charges, the policy can lapse.
Universal life differs from traditional whole life, which typically has fixed premiums, a guaranteed cash-value schedule, and a fixed death benefit. It also differs from variable life, in which cash value and death benefit are linked to separate-account investments and market performance. Universal life typically uses the insurer's general account for interest crediting, although variable universal life is a separate product combining flexibility with separate-account investment risk.
A producer must explain that illustrated values are not guaranteed unless identified as such. Policyowners should receive in-force illustrations and review funding adequacy periodically, particularly after taking loans, withdrawals, or reducing premium payments.
References/topics from the Study Guide: Universal Life Insurance; Flexible Premiums; Adjustable Death Benefit; Cash Value; Policy Lapse Risk.

NEW QUESTION # 64
An insurer shall not issue an individual long-term care insurance contract in Nevada unless the insurer has received from the applicant:

A. a written designation of at least one person, in addition to the applicant, who must receive notice of any lapse or termination of coverage under the policy for nonpayment of premium
B. a written designation by the applicant to pay premium for long-term care insurance through either a payroll or pension deduction plan
C. a designation by at least one person, in addition to the applicant, to accept liability for services provided to the applicant
D. a notarized waiver dated and signed by the applicant stating that the applicant has chosen not to designate another person to receive notice of any lapse or termination of coverage for nonpayment of premium

Answer: A

Explanation:
Nevada requires an individual long-term care insurer to obtain a written designation of at least one additional person who will receive notice if coverage is about to lapse or terminate for nonpayment of premium. This protection is intended to reduce unintended lapses, particularly when an insured experiences cognitive decline, illness, disability, or another circumstance that interferes with managing premiums.
The applicant may instead submit a written waiver, dated and signed, stating that the applicant chooses not to designate another person. The waiver is not required to be notarized. Because option B incorrectly adds a notarization requirement, option A is the best answer as written.
The designated person does not become responsible for paying premiums and does not assume liability for the applicant's care. The person's role is simply to receive notice, allowing the person an opportunity to alert the insured or help address an overlooked payment. Payroll or pension deduction is not a required payment method.
Before an individual long-term care policy can lapse for nonpayment, notice requirements apply to both the policyholder and the designated person. This is a key long-term-care consumer-protection provision.
Study Guide references/topics: long-term care insurance; lapse protection; nonpayment of premium; designation of another person; NAC 687B.0681 .

NEW QUESTION # 65
The Affordable Care Act (ACA) requires every individual policy to provide minimum coverages known as:

A. Essential Health Benefits
B. Medicaid Buy-Back coverage
C. Silver Saver Value coverages
D. Gold Value coverages

Answer: A

Explanation:
The Affordable Care Act established Essential Health Benefits as the minimum categories of benefits that qualifying individual and small-group health plans must cover. These required benefit categories create a baseline of comprehensive coverage rather than allowing a major medical plan to omit fundamental types of care.
Essential Health Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance-use-disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic-disease management, and pediatric services, including oral and vision care.
Gold and Silver are metal-level plan categories. They describe the general actuarial value of a plan-the approximate division of covered health-care costs between the insurer and enrollees-not a separate legal list of mandatory minimum benefits. A Gold plan generally pays a larger share of covered costs than a Silver plan, but both must include the applicable Essential Health Benefits. "Silver Saver Value" and "Medicaid Buy- Back" are not the ACA's required minimum-coverage terminology.
For examination purposes, distinguish the benefit package itself-Essential Health Benefits-from plan metal levels and from public programs such as Medicaid.
Study Guide references/topics: Affordable Care Act; individual health insurance; qualified health plans; Essential Health Benefits; HealthCare.gov coverage protections .

NEW QUESTION # 66
A producer aggrieved by any regulation or order of the Insurance Commissioner may request:

A. legislative review of the case
B. injunctive relief through the Secretary of State
C. an administrative hearing
D. peer review of the case

Answer: C

Explanation:
A producer who is aggrieved by a regulation or order of the Nevada Insurance Commissioner may request an administrative hearing. Nevada law requires the Commissioner to hold a hearing upon a proper written application from a person aggrieved by an act, failure to act, report, rule, regulation, or order related to the business of insurance, subject to statutory timing and procedural requirements.
The request is a due-process mechanism. It gives the affected producer an opportunity to state the grounds for relief, present evidence, challenge the factual or legal basis of the regulatory action, and create an administrative record. The application must generally be filed with the Division within 60 days after the person knew or reasonably should have known of the action, unless another law establishes a different period.
The Secretary of State does not provide the administrative remedy described in this question. Legislative review and peer review are not the standard appeal mechanisms for an individual Commissioner action.
Judicial review may become available after the administrative process, but the immediate remedy tested here is the request for an administrative hearing.
Study Guide references/topics: Commissioner authority; hearings; producer rights; administrative due process; NRS 679B.310 .

NEW QUESTION # 67
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