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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionObjectives
Accident and Health Insurance Fundamentals- Medical Expense Insurance
  • 1. Major medical plans
    • 2. Hospital, surgical, and physician expense coverage
      - Types of Health Insurance Policies
      • 1. Group health insurance
        • 2. Managed care plans
          • 3. Individual health insurance
            - Disability Income Insurance
            • 1. Elimination periods and benefit periods
              • 2. Disability definitions and benefits
                Health Insurance Policy Provisions- Mandatory and Optional Provisions
                • 1. Renewability provisions
                  • 2. Policy requirements and clauses
                    - Claims and Benefits
                    • 1. Claim procedures
                      • 2. Benefit determination and payment
                        Insurance Basics- Risk Management and Insurance Concepts
                        • 1. Types of risk and methods of handling risk
                          • 2. Insurance principles and contract characteristics
                            - Insurance Contracts
                            • 1. Contract elements
                              • 2. Policy provisions, riders, and exclusions
                                Producer Duties and Ethics- Sales Practices
                                • 1. Advertising and marketing rules
                                  • 2. Unfair trade practices
                                    - Ethical Responsibilities
                                    • 1. Fiduciary responsibilities
                                      • 2. Consumer protection requirements
                                        Government Health Insurance Programs- Medicaid and Other Programs
                                        • 1. Medicaid eligibility and coverage
                                          - Medicare
                                          • 1. Medicare parts and eligibility
                                            • 2. Medicare supplement insurance
                                              General Insurance Regulation- Licensing Requirements and Responsibilities
                                              • 1. Producer licensing requirements
                                                • 2. Continuing education and license maintenance
                                                  - Nevada Insurance Department and Regulatory Authority
                                                  • 1. Commissioner of Insurance powers and duties
                                                    • 2. Insurance laws, rules, and regulations

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                                                      Insurance Licensing NV Accident and Health Sample Questions (Q21-Q26):

                                                      NEW QUESTION # 21
                                                      A Nevada producer wants to solicit an individual disability-income policy. Which license authority is required?

                                                      Answer: C

                                                      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 # 22
                                                      All insurance companies and producers who sell Group Life or Accident and Health policies in Nevada MUST:

                                                      Answer: A

                                                      Explanation:
                                                      Group insurance is generally issued through a master policy. The policyholder-often an employer, association, trustee, or creditor-receives the master contract. Individual insured members do not receive a separate master policy; instead, they receive certificates describing the coverage, benefits, limitations, and applicable rights.
                                                      Nevada requires companies, resident agents, and nonresident agents or brokers conducting group life or group accident and health business to provide for delivery of the required individual certificates to the policyholder.
                                                      They must also use their best efforts to ensure that the policyholder distributes the certificates to covered debtors, members, or employees. Accordingly, option B correctly states the required delivery process.
                                                      Option C is incorrect because each group member is not entitled to receive the full group policy. Option A adds a receipt requirement that is not the applicable rule. Option D is also incorrect because the regulation does not require notice to the Commissioner each time certificates are issued.
                                                      This requirement ensures that insured individuals receive understandable evidence of their group coverage even though the policyholder owns the master policy. Certificates are central to informing members of benefits, exclusions, and conversion rights.
                                                      Study Guide references/topics: group life insurance; group accident and health insurance; certificates of coverage; NAC 687B.405 .


                                                      NEW QUESTION # 23
                                                      The commission for the placement of nonadmitted insurance is paid by the insurer to the:

                                                      Answer: D

                                                      Explanation:
                                                      The commission for the placement of nonadmitted insurance is paid to the surplus lines broker. A surplus lines broker is specially licensed to place eligible insurance with a nonadmitted insurer when coverage cannot be procured from authorized insurers under the conditions required by Nevada's Nonadmitted Insurance Law.
                                                      A nonadmitted insurer is not licensed or authorized to transact insurance generally in Nevada, but it may provide qualifying surplus-lines coverage through a properly licensed surplus lines broker. The broker performs the regulated placement function, documents the effort to obtain coverage from the admitted market when required, handles applicable filings, and ensures that statutory taxes and disclosures are addressed.
                                                      The policyholder purchases the insurance and pays the premium; the policyholder is not paid the placement commission. The Division of Insurance regulates the transaction and may receive taxes, fees, and reports as provided by law, but it is not the recipient of the insurer's commission. A third-party claimant is someone asserting a claim against an insured and has no role in the placement commission.
                                                      Study Guide references/topics: nonadmitted insurance; surplus lines; broker licensing; commissions; Nevada Nonadmitted Insurance Law .


                                                      NEW QUESTION # 24
                                                      Which of the following is permitted by a licensee?

                                                      Answer: B

                                                      Explanation:
                                                      A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada's statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.
                                                      Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.
                                                      Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant's information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.
                                                      The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.
                                                      Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .


                                                      NEW QUESTION # 25
                                                      An insurer shall not issue an individual long-term care insurance contract in Nevada unless the insurer has received from the applicant:

                                                      Answer: C

                                                      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 # 26
                                                      ......

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