2026 Pass4sure InsNV_Health02 Exam Prep | Useful 100% Free NV Accident and Health Online Training Materials

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Accident & Health – General Knowledge	50%	- Types of Policies 1. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident 2. Group insurance Differences between individual and group contracts General characteristics COBRA 3. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy 4. Individual and Group Long Term Care Eligibility Levels of care 5. Medicare supplement policies 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. Accidental death and dismemberment - Policy Provisions, Clauses, and Riders 1. Mandatory and optional provisions Entire contract Time limit on certain defenses Grace period Reinstatement Notice of claim Claim forms Proof of loss Time of payment of claims Payment of claims Physical examination and autopsy Legal actions Change of beneficiary Misstatement of age or gender Change of occupation Illegal occupation Relation of earnings to insurance 2. 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. Riders Impairment and exclusions Guaranteed insurability Future increase option - Field Underwriting Procedures 1. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 2. Sources of insurability and HIPAA privacy information 3. Explaining policy provisions, riders, exclusions, and ratings 4. Initial premium payment and receipt 5. Replacement 6. Submitting application and initial premium to company for underwriting 7. Policy delivery 8. Completing the application - Social Insurance 1. Social Security benefits 2. Medicare Parts A, B, C, and D 3. Medicaid - Other Insurance Concepts 1. Managed care 2. Owner's rights 3. Modes of premium payments 4. Total, partial, recurrent, and residual disability 5. Occupational vs. non-occupational 6. Nonduplication and coordination of benefits 7. Tax treatment of premiums and proceeds of insurance contracts 8. Workers Compensation 9. Subrogation 10. Dependent children benefits 11. Primary and contingent beneficiaries 12. Cost containment
Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Long Term Care - Coverage for reconstructive surgery - Hospice 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 - Medicare 1. Medicare supplement regulation 2. Medicare Advantage Plans 3. Prescription Drug Plan - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Definitions 1. Certificate of authority 2. Insurer 3. Domestic, foreign, and alien 4. Premiums 5. Authorized and unauthorized 6. Cost-sharing 7. Transacting insurance - Insurance Commissioner 1. General powers and duties 2. Notice and hearings and penalties 3. Examinations - Nevada Life and Health Insurance Guaranty Association - Marketing Practices 1. Commissions and payment restrictions 2. Affordable Care Act 3. Silver State Health Insurance Exchange 4. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation 5. Fiduciary responsibilities 6. Required records and record retention - Licensing 1. Obtaining a license 2. Termination of license 3. Name of licensee 4. Renewal and continuing education 5. Persons required to be licensed 6. Suspension, revocation, and refusal of license
Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Credit life and health insurance - Advertising - Group life and health insurance 1. Eligible groups 2. Required provisions

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Quiz InsNV_Health02 - NV Accident and Health Authoritative Pass4sure Exam Prep

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Insurance Licensing NV Accident and Health Sample Questions (Q117-Q122):

NEW QUESTION # 117
In order for a health insurance producer to be an Exchange Enrollment Facilitator (EEF), the producer:

A. can receive both commission and compensation as a facilitator
B. can receive commissions from the company in addition to the compensation as a facilitator
C. must surrender the producer ' s license and apply for an Exchange Enrollment Facilitator license
D. can offer advice to consumers resulting in the " steering " of the selection of coverage

Answer: C

Explanation:
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 .

NEW QUESTION # 118
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?

A. Sue the insurance company for not paying a claim within 30 days after submission of Proof of Loss
B. Reinstate the policy within 3 years after it lapses
C. Add a newborn child to the policy without providing proof of insurability
D. Demand binding arbitration if there is disagreement over a claim

Answer: C

Explanation:
Choice D is correct. A family health policy must provide coverage for a newborn child without requiring evidence of insurability at birth, subject to the policy's notice and premium requirements for continuation of coverage. This protects the child during the period when medical needs can arise immediately after birth and prevents underwriting from becoming a barrier to initial coverage. Nevada law recognizes family coverage for dependent children from birth and establishes rules governing newborn coverage. The policy may require notice and any additional premium within the specified period to continue coverage beyond the initial statutory protection. The other choices do not state standard rights under an individual major medical policy.
Arbitration is not automatically available merely because an insured disagrees with a claim decision. A proof of loss does not create an automatic right to sue precisely 30 days after submission. Reinstatement rights also operate under the policy's reinstatement provision and are not a universal three-year right. Nevada's statutory framework specifically addresses dependent and newborn coverage under individual health insurance. See NRS Chapter 689A . Study Guide References/Topics: Nevada-Specific Health Insurance Mandates and Rules; Individual Major Medical; Newborn Coverage.

NEW QUESTION # 119
Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member:

A. ceases to fall within the eligible classification
B. ceases to be actively employed
C. reaches the age specified in the policy
D. becomes disabled

Answer: D

Explanation:
The correct answer is D. A guaranteed renewable provision protects an insured against termination based solely on health deterioration or disability, provided the premium is paid and the insured continues to meet the policy's stated conditions. Therefore, the insurer may not terminate coverage merely because the member becomes disabled. The insurer may, however, terminate or end coverage when a member no longer meets an eligibility requirement, such as leaving the eligible occupational classification, ceasing active employment, or reaching a policy-specified terminating age. Those conditions concern the member's contractual eligibility for the group coverage rather than the member's health status. Guaranteed renewable does not necessarily mean that premiums can never change. The insurer may generally change premiums on a class basis, but it cannot single out one insured for an individual premium increase or cancellation because that person became ill or disabled. This concept should be distinguished from noncancellable coverage, which provides stronger protection by preventing the insurer from changing either premiums or benefits during the stated period.
Study Guide References/Topics: Group Health Insurance; Renewability Provisions; Guaranteed Renewable Coverage.

NEW QUESTION # 120
Under a group health policy, which of the following coverages MUST be provided for newborn children?

A. Routine eye examinations
B. Transportation costs from the hospital to the child ' s residence
C. Genetic Testing
D. Congenital health defects

Answer: D

Explanation:
Nevada requires qualifying group health policies that cover family members to provide coverage for a newborn child from the moment of birth. Required newborn coverage includes injury or sickness and specifically includes the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Therefore, congenital health defects are the required coverage identified in this question.
The rule is important because congenital defects may be present at birth and can require immediate diagnostic, surgical, medical, or hospital treatment. Nevada law prevents a policy from excluding this necessary care simply because the condition existed at birth. The statute also prohibits exclusion of premature births under the applicable coverage requirement.
The transportation option is incorrect because the law addresses necessary transportation from the place of birth to the nearest specialized treatment center, within policy limits; it does not mandate transportation from the hospital to the child's residence. Routine eye examinations and genetic testing may be covered under a particular policy or health plan, but they are not the specific newborn mandate tested here. Continued coverage beyond the initial period may depend on timely notice and payment of required premium within 31 days.
Study Guide references/topics: group health insurance; newborn coverage; mandated benefits; NRS 689B.033
.

NEW QUESTION # 121
Medicaid is best described as:

A. A federal retirement program funded only by payroll taxes
B. A Medicare supplement insurance plan
C. A private insurance policy sold by producers
D. A joint federal-state program that provides medical assistance to eligible individuals

Answer: D

Explanation:
Medicaid is a joint federal-state medical-assistance program serving eligible individuals and families under income, resource, categorical, residency, and other program rules. The federal government establishes broad requirements and provides funding, while each state administers its program within federal parameters.
Nevada administers Medicaid through its state health and human-services structure and contracted delivery systems. Eligibility and benefits can vary by category and may change with law and program administration.
Medicaid is not the same as Medicare. Medicare is principally a federal social-insurance program associated with age 65 or older, certain disabilities, and end-stage renal disease or other qualifying conditions. Medicaid is generally means tested, although eligibility is determined by detailed program standards and should never be assumed from income alone. Some people may qualify for both Medicare and Medicaid; these individuals are often referred to as dual-eligible beneficiaries.
A producer should avoid giving legal or public-benefit eligibility advice beyond the scope of insurance licensing. The proper role is to identify the program accurately, explain how private coverage may coordinate where applicable, and direct a consumer to the appropriate state agency or benefits specialist for an eligibility determination.
References/topics from the Study Guide: Medicaid; Medicare; Dual Eligibility; Government-Sponsored Health Programs; Nevada Public Health Benefits.

NEW QUESTION # 122
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