100%パスレートInsNV_Health02日本語版と英語版 &資格試験におけるリーダーオファー &初段のInsurance Licensing NV Accident and Health

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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                                                                                                            InsNV_Health02ミシュレーション問題 & InsNV_Health02試験番号

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                                                                                                            Insurance Licensing NV Accident and Health 認定 InsNV_Health02 試験問題 (Q81-Q86):

                                                                                                            質問 # 81
                                                                                                            When a nonqualified annuity is surrendered for more than the owner's investment in the contract, how is the gain generally treated for federal income-tax purposes?

                                                                                                            正解:A

                                                                                                            解説:
                                                                                                            Gain from a nonqualified annuity is generally taxed as ordinary income when distributed. The owner's investment in the contract, often called the cost basis, is not taxed again because it was paid with after-tax dollars. However, the growth above that basis is tax-deferred only while it remains inside the annuity. When the owner surrenders the contract or receives a taxable distribution, the gain is subject to ordinary-income treatment rather than the preferential capital-gains treatment that may apply to certain investments.
                                                                                                            A nonqualified annuity is funded with after-tax money and is not held inside a qualified retirement arrangement such as an IRA or employer plan. The contract's tax deferral can be valuable for long-term planning, but it does not mean that every distribution is tax free. In addition, distributions before age 59½ may be subject to an additional federal tax penalty unless an exception applies. A full surrender may also trigger a surrender charge under the contract if it occurs during the surrender-charge period.
                                                                                                            The producer should never present an annuity as tax avoidance. The accurate explanation is tax deferral, possible ordinary-income taxation of gain upon distribution, potential penalties for early distributions, and the importance of consulting a qualified tax adviser for individual circumstances.
                                                                                                            References/topics from the Study Guide: Annuity Taxation; Nonqualified Annuities; Cost Basis; Tax Deferral; Surrender Charges.


                                                                                                            質問 # 82
                                                                                                            What is the minimum age requirement for a natural person applying for a resident Nevada producer license?

                                                                                                            正解:C

                                                                                                            解説:
                                                                                                            A natural person applying for a resident Nevada producer license must be at least 18 years old. Age is only one part of the licensing standard. Before approving a resident producer application, the Commissioner must also find that the applicant has not committed an act that would justify refusal, suspension, or revocation of a license; has paid the applicable fees; and has passed the required examination for the requested line of authority unless an examination exemption applies.
                                                                                                            A life and health producer must hold the appropriate line or lines of authority before selling, soliciting, or negotiating those classes of insurance. Nevada separately identifies life insurance and accident-and-health insurance as producer authorities. A producer must also comply with renewal, continuing education, appointment, recordkeeping, and reporting requirements as applicable.
                                                                                                            A business organization may also be licensed as a producer, but it must designate a properly licensed natural person who is authorized to transact business on its behalf and is responsible for the organization's compliance with Nevada insurance laws and regulations. Licensing is therefore not merely a test-passing event; it is an ongoing regulatory responsibility.
                                                                                                            For examination purposes, remember the basic resident-producer requirements: age 18 or older, proper application, fees, good character and eligibility, and examination success unless exempt.
                                                                                                            References/topics from the Study Guide: Nevada Producer Licensing; Resident Producer Requirements; Lines of Authority; License Application; NRS 683A.251.


                                                                                                            質問 # 83
                                                                                                            Under a Gold health insurance plan, an insurer would be expected to pay which percentage of medical costs?

                                                                                                            正解:A

                                                                                                            解説:
                                                                                                            A Gold Marketplace health plan has an actuarial value of approximately 80%. Therefore, the insurer is expected to pay about 80% of covered medical costs for a standard population, while enrollees as a group pay approximately 20% through deductibles, copayments, and coinsurance.
                                                                                                            Actuarial value does not mean that the insurer pays exactly 80% of every individual's bills. A particular insured may pay more or less than 20% in a year depending on the services used, the plan's deductible, copayment structure, provider network, prescription-drug costs, and whether the annual out-of-pocket maximum has been reached. It is an overall measure of expected cost sharing for covered benefits.
                                                                                                            The standard metal levels are Bronze at 60%, Silver at 70%, Gold at 80%, and Platinum at 90%. Gold plans generally have higher monthly premiums than Bronze or Silver plans but lower cost sharing when health care is received. Platinum plans generally have the highest premiums and the lowest cost sharing.
                                                                                                            Study Guide references/topics: Affordable Care Act; Marketplace plans; metal levels; actuarial value; deductibles; copayments; HealthCare.gov plan categories .


                                                                                                            質問 # 84
                                                                                                            In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:

                                                                                                            正解:D

                                                                                                            解説:
                                                                                                            A person may not concurrently hold a Nevada producer license and an Exchange Enrollment Facilitator certificate. Therefore, a health insurance producer who wishes to become an EEF must surrender the producer authority and apply for certification as an Exchange Enrollment Facilitator.
                                                                                                            An EEF assists consumers with enrollment in qualified health plans offered through the Exchange. The role is designed to provide objective enrollment help, application assistance, and general information. An EEF may not sell, solicit, or negotiate insurance. The EEF also may not receive consideration from a health insurance issuer or insurer in connection with enrollment and may not receive remuneration arising from EEF activities from a licensed producer, insurance consultant, surplus lines broker, or insurer.
                                                                                                            For that reason, a producer cannot receive commissions while acting as an EEF, cannot collect both commission and EEF compensation in the manner described, and cannot steer a consumer toward a particular coverage choice. Producers and EEFs have different legal roles, compensation structures, and consumer- protection limitations.
                                                                                                            Study Guide references/topics: Exchange Enrollment Facilitators; producer licensing; prohibited acts; compensation; NRS 695J.210 .


                                                                                                            質問 # 85
                                                                                                            A consumer wishes to purchase an insurance policy that covers pre-existing illnesses. The consumer contacted the producer who informed the consumer:

                                                                                                            正解:D

                                                                                                            解説:
                                                                                                            A consumer's pre-existing condition does not prevent enrollment in a Qualified Health Plan offered through the Exchange. Marketplace plans must cover treatment for pre-existing medical conditions and cannot reject an applicant, charge a higher premium, or refuse to pay Essential Health Benefits solely because of the applicant's health history.
                                                                                                            The producer should accurately explain that coverage is subject to the plan's normal terms, provider network, formulary, deductibles, copayments, coinsurance, and out-of-pocket maximum. The prohibition against pre- existing-condition discrimination does not mean the consumer has no out-of-pocket costs. The insured may still have ordinary cost sharing for covered medical services, just as other enrollees do.
                                                                                                            Option A is incorrect because Qualified Health Plans do cover pre-existing conditions. Option B is incorrect because a QHP may not impose a surcharge based on health status or medical history. Option C is incorrect because the Affordable Care Act's protection against discrimination does not eliminate all deductibles, copayments, coinsurance, or other permitted cost sharing.
                                                                                                            For exam purposes, remember the core rule: health status cannot be used to deny enrollment in a QHP or set a higher premium based solely on a pre-existing condition.
                                                                                                            Study Guide references/topics: Affordable Care Act; Qualified Health Plans; guaranteed issue; pre-existing conditions; HealthCare.gov pre-existing-condition coverage .


                                                                                                            質問 # 86
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