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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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

NEW QUESTION # 117
Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:

A. not covered under the rules of ACA because mammograms are not considered preventative health care
B. covered under preventative services annually at no cost
C. covered under only health plans that offer mammogram coverage
D. not covered if a family member has been formally diagnosed with breast cancer

Answer: B

Explanation:
For insured women age 40 or older, Nevada requires group health insurance coverage for an annual mammogram to screen for breast cancer. The required benefit must be available through an in-network provider, and the insurer generally may not impose a deductible, copayment, coinsurance, or another form of cost sharing for that mandated screening.
Mammography is preventive screening. It is intended to detect breast cancer early, often before symptoms appear. This differs from diagnostic imaging, which may be ordered after an abnormal screening result, a finding on examination, or another clinical concern. Nevada law also addresses medically necessary imaging and diagnostic testing when the insured's provider recommends them based on medical history, family history, risk factors, or an observed abnormality.
A family history of breast cancer does not eliminate coverage; instead, it may support the need for additional screening or imaging. The benefit is not restricted only to plans that voluntarily choose to offer mammography. It is a required coverage provision for applicable group health policies.
Study Guide references/topics: preventive care; breast-cancer screening; mandated benefits; deductibles and coinsurance; NRS 689B.0374 .

NEW QUESTION # 118
Which of the following situations describes a representation?

A. An insurance company guarantees that premiums paid will be refunded within 30 days after the policy ' s effective date if an insured is dissatisfied with the policy
B. An insurance company guarantees that policy benefits will be paid promptly on receipt of a Proof of Loss
C. A prospect ' s statement on an application that is held to be substantially true
D. A prospect ' s statement on an application that is held to be absolutely true

Answer: C

Explanation:
A representation is a statement made by an applicant on an insurance application that is believed to be true to the best of the applicant's knowledge and is required to be substantially true. Choice C correctly states that principle. A representation differs from a warranty. A warranty is a statement or promise that must be literally and absolutely true; choice D describes that stricter standard rather than a representation. Application answers help the insurer evaluate risk during underwriting, so material misrepresentations can affect coverage or the insurer's decision to issue the policy. However, not every immaterial or innocent inaccuracy has the same legal effect. The significance of a misstatement depends on its materiality and the applicable policy and insurance-law rules. Choices A and B describe potential policy promises or contract features, not statements made by a prospect in the application. For licensing purposes, remember that insurance applications are generally treated as containing representations, not warranties, unless the policy or law provides otherwise.
Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Representations and Warranties; Underwriting.

NEW QUESTION # 119
An insurer shall not issue an individual long-term care insurance contract in Nevada unless the insurer has received from the applicant:

A. a notarized waiver dated and signed by the applicant stating that the applicant has chosen not to designate another person to receive notice of any lapse or termination of coverage for nonpayment of premium
B. a written designation by the applicant to pay premium for long-term care insurance through either a payroll or pension deduction plan
C. a designation by at least one person, in addition to the applicant, to accept liability for services provided to the applicant
D. a written designation of at least one person, in addition to the applicant, who must receive notice of any lapse or termination of coverage under the policy for nonpayment of premium

Answer: D

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 # 120
For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?

A. Loss of life due to a heart attack
B. Partial paralysis due to a stroke
C. Loss of eyesight due to an accidental injury
D. Loss of the spleen due to an accidental injury

Answer: C

Explanation:
Choice B is correct because accidental loss of eyesight is a standard covered dismemberment loss under most AD & D policies. These policies pay benefits for accidental death and for specifically listed losses, often including loss of life, both hands, both feet, one h and and one foot, sight in one or both eyes, hearing, speech, or specified paralysis. The loss must result directly from accidental bodily injury and occur within the policy's required loss period. Death from a heart attack is generally illness-related rather than accidental. Loss of the spleen, even when caused by an accident, is not usually one of the specifically scheduled losses in a basic AD
& D policy. Partial paralysis due to a stroke is caused by illness rather than accidental injury. AD & D policies are limited-benefit contracts, so the policy does not pay merely because an injury is serious; the loss must match the policy's defined covered loss. The benefit amount varies according to the loss, with full principal sums often payable for death or loss of both eyes and smaller percentages for certain partial losses.
Study Guide References/Topics: Types of Health Insurance Policies; Accidental Death and Dismemberment; Covered Losses.

NEW QUESTION # 121
Under a Medicare Supplement policy that is issued in response to a direct solicitation, a policyowner may return the policy to the insurance company for a full premium refund within a MAXIMUM of how many days?

A. Ten
B. Sixty
C. Forty-five
D. Thirty

Answer: D

Explanation:
A Medicare Supplement policy issued in response to direct solicitation may be returned for a full premium refund within 30 days. This is commonly called a free-look or right-to-return period. It gives the policyowner time to examine the policy after delivery and decide whether the coverage is suitable.
Direct solicitation presents a heightened consumer-protection concern because the purchaser may not have received the same personal explanation and comparison assistance available in a face-to-face sale. The 30-day period allows the consumer to review benefits, exclusions, premiums, Medicare coordination, replacement implications, and suitability without financial penalty.
The policyowner should return the policy within the required period and follow the insurer's return instructions. Once timely returned, the insurer must refund the premium in accordance with the applicable rule. The free-look right does not mean that every policy can be cancelled at any time for a complete refund; it is a specific statutory or regulatory rescission period following delivery.
Ten, 45, and 60 days are common distractors because various insurance rules use different deadlines. For Medicare Supplement direct-solicitation policies, the tested maximum period is 30 days.
Study Guide references/topics: Medicare Supplement insurance; direct solicitation; free-look period; consumer protections; Nevada Medicare Supplement regulations .

NEW QUESTION # 122
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