InsNV_Health02 Sure-Pass Torrent: NV Accident and Health & InsNV_Health02 Exam Bootcamp & InsNV_Health02 Exam Guide

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Medicare
  • 1. Medicare supplement regulation
    • 2. Prescription Drug Plan
      • 3. Medicare Advantage Plans
        - Long Term Care
        - Mandatory policy clauses and provisions
        • 1. Coverage for physical handicap or intellectual disability for dependent children
          • 2. Coverage for preventive healthcare services
            • 3. Coverage for newborn children
              - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
              - Hospice care
              - Coverage for reconstructive surgery
              Topic 2: Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Advertising
              - Credit life and health insurance
              - Group life and health insurance
              • 1. Required provisions
                • 2. Eligible groups
                  Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Insurance Commissioner
                  • 1. Examinations
                    • 2. General powers and duties
                      • 3. Notice and hearings and penalties
                        - Definitions
                        • 1. Certificate of authority
                          • 2. Authorized and unauthorized
                            • 3. Premiums
                              • 4. Cost-sharing
                                • 5. Transacting insurance
                                  • 6. Domestic, foreign, and alien
                                    • 7. Insurer
                                      - Nevada Life and Health Insurance Guaranty Association
                                      - Marketing Practices
                                      • 1. Required records and record retention
                                        • 2. Fiduciary responsibilities
                                          • 3. Silver State Health Insurance Exchange
                                            • 4. Affordable Care Act
                                              • 5. Unfair practices
                                                • Unfair claims methods and practices and settlement of claims
                                                • Rebating and inducement
                                                • Twisting
                                                • Misrepresentation
                                                • Fraud
                                                • Unfair discrimination
                                                • Defamation
                                              • 6. Commissions and payment restrictions
                                                - Licensing
                                                • 1. Suspension, revocation, and refusal of license
                                                  • 2. Name of licensee
                                                    • 3. Obtaining a license
                                                      • 4. Renewal and continuing education
                                                        • 5. Persons required to be licensed
                                                          • 6. Termination of license
                                                            Topic 4: Accident & Health – General Knowledge50%- Policy Provisions, Clauses, and Riders
                                                            • 1. Riders
                                                              • Impairment and exclusions
                                                              • Guaranteed insurability
                                                              • Future increase option
                                                            • 2. Rights of renewability
                                                              • Noncancelable
                                                              • Cancelable
                                                              • Guaranteed renewable
                                                            • 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
                                                            - Other Insurance Concepts
                                                            • 1. Modes of premium payments
                                                              • 2. Dependent children benefits
                                                                • 3. Workers Compensation
                                                                  • 4. Cost containment
                                                                    • 5. Nonduplication and coordination of benefits
                                                                      • 6. Managed care
                                                                        • 7. Primary and contingent beneficiaries
                                                                          • 8. Total, partial, recurrent, and residual disability
                                                                            • 9. Subrogation
                                                                              • 10. Occupational vs. non-occupational
                                                                                • 11. Tax treatment of premiums and proceeds of insurance contracts
                                                                                  • 12. Owner's rights
                                                                                    - Types of Policies
                                                                                    • 1. Medicare supplement policies
                                                                                      • 2. Accidental death and dismemberment
                                                                                        • 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. Individual and Group Long Term Care
                                                                                          • Eligibility
                                                                                          • Levels of care
                                                                                        • 5. Other policies
                                                                                          • Dental
                                                                                          • Vision
                                                                                          • Cancer
                                                                                          • Critical illness or specified disease
                                                                                          • Worksite employer-sponsored
                                                                                          • Hospital indemnity
                                                                                          • Short-term medical
                                                                                          • Accident
                                                                                        • 6. Disability income
                                                                                          • Individual disability income policy
                                                                                          • Business overhead expense policy
                                                                                          • Business disability buyout policy
                                                                                          • Group disability income policy
                                                                                          • Key employee policy
                                                                                        • 7. Group insurance
                                                                                          • Differences between individual and group contracts
                                                                                          • General characteristics
                                                                                          • COBRA
                                                                                        - Social Insurance
                                                                                        • 1. Social Security benefits
                                                                                          • 2. Medicaid
                                                                                            • 3. Medicare Parts A, B, C, and D
                                                                                              - Field Underwriting Procedures
                                                                                              • 1. Initial premium payment and receipt
                                                                                                • 2. Sources of insurability and HIPAA privacy information
                                                                                                  • 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. Completing the application
                                                                                                        • 7. Explaining policy provisions, riders, exclusions, and ratings
                                                                                                          • 8. Replacement

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q131-Q136):

                                                                                                            NEW QUESTION # 131
                                                                                                            A Nevada producer wants to solicit an individual disability-income policy. Which license authority is required?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            A producer soliciting an individual disability-income policy must hold Nevada accident and health insurance authority. Nevada defines this line as insurance for sickness, bodily injury, or accidental death and permits it to include disability-income benefits. Disability-income insurance replaces a portion of earned income when an insured becomes disabled under the policy definition; it is therefore within the accident-and-health line rather than the property, casualty, or personal-lines authorities.
                                                                                                            Nevada requires a person to be licensed for the relevant class of insurance before selling, soliciting, or negotiating insurance in the state. The licensing distinction matters because a life authority and an accident- and-health authority are separately identified lines of authority. Although life insurance may include additional disability-income benefits when permitted as part of its statutory definition, a producer selling an individual health or disability-income policy should not assume that life authority alone authorizes the transaction.
                                                                                                            The producer must also comply with appointment requirements when acting as an insurer's agent, continuing education and renewal requirements, and all applicable trade-practice rules. Selling without the proper authority can result in administrative discipline and a monetary penalty. On examination questions, identify the coverage being sold first; then match it to the appropriate Nevada line of authority.
                                                                                                            References/topics from the Study Guide: Producer Licensing; Lines of Authority; Accident and Health Insurance; Disability Income; NRS 683A.201; NRS 683A.261.


                                                                                                            NEW QUESTION # 132
                                                                                                            The Nevada Life and Health Insurance Guaranty Association is financed by which of the following methods?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            The Nevada Life and Health Insurance Guaranty Association is financed through assessments on member insurance companies. Insurers authorized to transact covered life, health, or annuity business in Nevada are members of the Association as a condition of their authority to operate in the state. When an assessment is necessary, the Association assesses member insurers according to the statutory assessment system.
                                                                                                            The Association exists to provide limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not financed by direct assessments against insureds, policyowners, agents, or association members. It is also not simply funded through a general premium tax imposed on consumers.
                                                                                                            Nevada law establishes assessment classes, including assessments for administrative and legal expenses and assessments needed to carry out the Association's obligations regarding an impaired or insolvent insurer.
                                                                                                            Member insurers may consider the cost of assessments when establishing rates and dividends, but that does not change the source of the Association's direct funding: the member insurers themselves.
                                                                                                            The Guaranty Association is a safety mechanism with statutory limits. It is not a substitute for evaluating an insurer's financial strength, and insurers and producers may not use its existence as a sales inducement.
                                                                                                            Study Guide references/topics: insurer insolvency; guaranty associations; member insurer assessments; NRS Chapter 686C .


                                                                                                            NEW QUESTION # 133
                                                                                                            In a cross-purchase buy-sell agreement funded by life insurance, who typically owns the policy on each business owner?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            In a cross-purchase buy-sell agreement, each business owner purchases, owns, and is beneficiary of life insurance on the other owner or owners. If one owner dies, the surviving owner receives the policy proceeds and uses them to purchase the deceased owner's business interest from the estate or designated successor. The arrangement provides liquidity and a predetermined method for transferring ownership, helping the business continue without forcing a sale of assets or requiring the surviving owner to obtain financing at a difficult time.
                                                                                                            An entity-purchase agreement differs because the business itself owns policies on each owner and uses the proceeds to redeem the deceased owner's interest. The number of policies can be an important distinction.
                                                                                                            With two owners, a cross-purchase arrangement usually requires two policies. With several owners, each may need policies on all other owners, which can become administratively complex.
                                                                                                            The agreement should be drafted and reviewed by qualified legal and tax professionals. The insurance policy alone does not create the buy-sell obligation; the written agreement establishes the purchase terms, valuation method, triggering events, and funding mechanism. The producer's role is to help identify appropriate funding, not to draft legal agreements.
                                                                                                            References/topics from the Study Guide: Buy-Sell Agreements; Cross-Purchase Plans; Entity-Purchase Plans; Business Continuation; Life Insurance Funding.


                                                                                                            NEW QUESTION # 134
                                                                                                            Which of the following information is included in the Consideration clause in an Accident and Health policy?

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            The consideration clause identifies the exchange of value that creates the insurance contract. The insurer's consideration is its promise to provide the stated coverage and pay covered claims. The applicant's consideration consists of the application statements and payment of the required premium. Therefore, choice D is correct because the policy identifies the schedule and amount of premium payments as part of that contractual consideration. The coverage description is found in the insuring clause and benefit provisions.
                                                                                                            Contestability is addressed in the time-limit or incontestability provisions. The grace period is stated in a separate mandatory policy provision dealing with late premium payments and continuation of coverage. The consideration clause is important because it establishes that insurance is a reciprocal exchange: the insurer assumes risk in return for the applicant's premium and representations. If the premium is not paid as required, the policy can lapse after the grace period unless another provision applies. The clause also connects the policy and attached application as part of the entire contract, subject to applicable individual accident and health insurance requirements. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Consideration Clause; Entire Contract.


                                                                                                            NEW QUESTION # 135
                                                                                                            A corporation purchases life insurance on a highly valuable executive and is named as owner, premium payer, and beneficiary. What is the primary purpose of this arrangement?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            Key person insurance is life insurance purchased by a business on the life of an employee, owner, executive, or specialist whose death would create a significant financial loss for the business. The business is generally the owner, premium payer, and beneficiary. If the key person dies, the death proceeds can help the business offset lost revenue, recruit and train a replacement, protect credit relationships, reassure customers, or meet other financial obligations during the transition.
                                                                                                            The key person must consent to the insurance, and the business must have a legitimate insurable interest at the time coverage is issued. Key person insurance is not designed to provide personal family protection to the employee. It protects the business against the financial consequences of losing an important contributor.
                                                                                                            Credit life insurance is designed to help pay an outstanding debt upon the debtor's death. Family maintenance insurance is generally personal coverage intended to replace income or support dependents. A viatical settlement involves the sale of an existing life insurance policy to a third party, typically when the insured has a serious illness.
                                                                                                            The producer should conduct a financial-needs analysis and coordinate with legal and tax advisers because ownership, consent, accounting treatment, and tax consequences require careful planning.
                                                                                                            References/topics from the Study Guide: Key Person Insurance; Business Uses of Life Insurance; Insurable Interest; Business Continuation Planning; Executive Protection.


                                                                                                            NEW QUESTION # 136
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