Valid InsNV_Health02 Test Pattern - InsNV_Health02 Exam Learning

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q101-Q106):

                                                                                                            NEW QUESTION # 101
                                                                                                            In Nevada, which life insurance policy is subject to a 30-day right to surrender for a premium refund after delivery?

                                                                                                            Answer: A

                                                                                                            Explanation:
                                                                                                            A replacement life insurance policy delivered in Nevada must provide a 30-day period during which the policyowner may surrender the policy to the insurer with a written request for cancellation and receive a refund of premiums paid, including policy fees or other charges. This longer review period recognizes the special risks associated with replacement transactions. Replacing existing coverage can cause the consumer to lose favorable values, restart contestability or suicide periods, incur surrender charges, or exchange a policy that better serves the client's long-term needs.
                                                                                                            For a nonreplacement life policy, annuity contract, or pure endowment contract, Nevada generally requires a
                                                                                                            10-day right of surrender after delivery. The applicable statute excludes industrial life insurance from this requirement. The producer must therefore identify whether a proposed transaction is a replacement and follow the related disclosure and recordkeeping requirements. The free-look period is a consumer-protection right; it does not excuse a producer from determining suitability or accurately comparing existing and proposed coverage before the sale.
                                                                                                            On an examination question, the key distinction is not whether the policy is whole life, term life, or universal life. The key is whether it is a replacement contract or policy.
                                                                                                            References/topics from the Study Guide: Replacement; Free-Look Provision; Nevada Consumer Protections; NRS 688A.165.


                                                                                                            NEW QUESTION # 102
                                                                                                            In order to be covered under the Nevada Life and Health Insurance Guaranty Association, an insurance company MUST be:

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            An insurer must be admitted in Nevada-meaning authorized to transact the applicable insurance business in the state-to be a member of the Nevada Life and Health Insurance Guaranty Association. Membership is a condition of authority for insurers and health maintenance organizations writing the kinds of coverage protected by the Guaranty Association Act.
                                                                                                            The Association provides limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not a general guarantee of every insurance company or every policy. Coverage is governed by statute, subject to eligibility requirements, benefit limits, exclusions, and residency provisions.
                                                                                                            An AM Best rating is an independent financial-strength opinion. It may be useful to consumers and producers evaluating an insurer, but it does not determine membership in the Guaranty Association. A fraternal benefit society is specifically excluded from the definition of a member insurer for this purpose. "Alien" refers to an insurer organized under the laws of another country and does not, by itself, establish Association membership; the key consideration is whether the insurer is authorized to transact covered insurance in Nevada.
                                                                                                            Study Guide references/topics: admitted versus nonadmitted insurers; guaranty associations; insurer insolvency; NRS Chapter 686C .


                                                                                                            NEW QUESTION # 103
                                                                                                            The Coinsurance clause in an individual Medical Expense policy refers to the:

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            Coinsurance is the contractual sharing of covered medical expenses between the insured and the insurer after any applicable deductible has been satisfied. Choice D is correc t. Under a common 80/20 coinsurance arrangement, for example, the insurer pays 80 percent of an eligible expense and the insured pays the remaining 20 percent, up to any out-of-pocket maximum or other plan limitation. Coinsurance reduces premium cost and encourages insureds to consider the cost of care, while preserving significant protection against major expenses. It does not refer to adding family members to a policy, which concerns eligibility or family coverage. It also does not describe insurers sharing risk with each other; that would involve reinsurance or other insurer-to-insurer arrangements. Coinsurance should be distinguished from a deductible, which is a specified dollar amount the insured pays before policy benefits begin. A copayment is instead a fixed dollar amount paid for a covered service. The exact coinsurance percentage, covered-charge definition, network rules, and annual out-of-pocket limit are determined by the policy. Study Guide References/Topics:
                                                                                                            Policy Provisions, Clauses, and Riders; Medical Expense Insurance; Deductibles and Coinsurance.


                                                                                                            NEW QUESTION # 104
                                                                                                            Which premium-payment mode usually results in the lowest total annual premium cost for the policyowner?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            Annual premium payment generally produces the lowest total cost over the policy year because the insurer receives the full annual premium at the beginning of the coverage period. Monthly, quarterly, and semiannual payment modes are convenient for budgeting, but they commonly include an additional charge or produce a higher total annual premium. The difference reflects the insurer's additional administrative expense and the fact that the insurer receives portions of the premium later.
                                                                                                            Premium mode does not change the policy's face amount, underwriting classification, or contractual benefits.
                                                                                                            It changes only the schedule and total cost of paying the premium. A producer should present all available modes clearly and explain the actual amount due under each option. A consumer with predictable annual cash flow may prefer annual mode to reduce total cost, while a consumer who needs more frequent payments may choose a higher-cost mode to preserve affordability and avoid lapse.
                                                                                                            This issue is distinct from the grace period. The grace period protects the policyowner after a premium due date by allowing a limited time to make payment before coverage lapses. Premium mode establishes how frequently the regular premium is due; it does not eliminate the policyowner's obligation to pay.
                                                                                                            References/topics from the Study Guide: Premium Payment; Premium Modes; Grace Period; Policy Lapse; Life Insurance Contract Provisions.


                                                                                                            NEW QUESTION # 105
                                                                                                            Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?

                                                                                                            Answer: B

                                                                                                            Explanation:
                                                                                                            A Guaranteed Insurability rider gives the disability income policyowner the right to purchase additional disability income coverage at stated future option dates without furnishing evidence of insurability. The rider is valuable because an insured's income may increase over time while health may decline; the rider allows benefit amounts to be increased when the option is exercised, subject to the rider's conditions and insurer limits. Therefore, choice C is correct. The rider does not guarantee a premium rate for life. Premiums for the added coverage are based on the insured's attained age and the insurer's rates applicable when the additional coverage is purchased. It also does not require periodic proof of insurability; eliminating that requirement is the central purpose of the rider. The existing policy remains in force and normally does not have to be exchanged for a new policy. On an examination, distinguish guaranteed insurability from noncancellable and guaranteed renewable provisions: those provisions concern renewability and premiums, whereas the rider concerns the future purchase of additional benefits. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Optional Benefits Riders.


                                                                                                            NEW QUESTION # 106
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