Quiz 2026 InsNV_Health02 Reliable Test Guide - Realistic NV Accident and Health Exam Cram Review

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q60-Q65):

NEW QUESTION # 60
Which of the following statements is generally CORRECT about a major medical policy?

A. It provides benefits for reasonable and necessary medical expenses, subject to policy limits.
B. It provides benefits for in-hospital expenses only, subject to policy limits.
C. It contains more limitations than a Basic Hospital, Medical, or Surgical policy.
D. It contains a 30-day Elimination period for losses due to sickness.

Answer: A

Explanation:
Major medical insurance is designed to provide broad protection against substantial medical expenses. It commonly covers hospital, surgical, physician, diagnostic, and other medically necessary services, subject to deductibles, coinsurance, exclusions, and stated policy limits. Therefore, choice D is correct. A major medical policy is not limited to in-hospital expenses; that description is more characteristic of basic hospital coverage.
It also is generally broader-not more limited-than a basic hospital, medical, or surgical policy. A 30-day elimination period is associated more closely with disability income insurance and does not define major medical coverage. The phrase "reasonable and necessary" is important because it allows the insurer to evaluate whether a service was medically appropriate and whether the charge falls within the policy's payment standard. Major medical policies are comprehensive, but they are not unlimited: coverage remains subject to deductibles, coinsurance, exclusions, maximum benefits, network terms, and utilization requirements. Study Guide References/Topics: Types of Health Insurance Policies; Major Medical Expense Insurance; Medical Expense Coverage.

NEW QUESTION # 61
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:

A. cancel the policy and return all premiums paid
B. reinstate the policy and then pay the claim
C. deny the claim
D. pay the claim but deduct the unpaid premium

Answer: D

Explanation:
The policy remains in force during its contractual grace period after a premium becomes due. For individual accident and health policies, the required grace period generally depends on premium mode: seven days for weekly premiums, ten days for monthly premiums, and 31 days for other premium modes. A claim occurring within the applicable grace period is not automatically denied simply because the premium has not yet been paid. Instead, the insurer may pay the covered claim and deduct the overdue premium from the amount otherwise payable. Therefore, choice B is the best answer. Reinstatement is unnecessary because the policy has not yet lapsed while the grace period is still running. Cancellation and return of all prior premiums would be inconsistent with the purpose of the grace-period provision. The question tests the difference between a late premium during grace and a lapsed policy after grace expires. Once grace expires without payment, coverage can lapse; if coverage later is reinstated, loss coverage may be subject to reinstatement provisions and limitations. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.

NEW QUESTION # 62
An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:

A. increase the deductible to adjust for the occupational difference
B. adjust benefits to the amount the premium provides for the new occupation
C. increase the waiting period to adjust for the occupational difference
D. deny any claim on the basis of misrepresentation

Answer: B

Explanation:
The Change of Occupation provision allows an insurer to adjust benefits when the insured changes to a more hazardous occupation after policy issue. Choice A is correct. If the same premium would have purchased a lower benefit amount for the new, more hazardous occupati on, the insurer may reduce the benefit to the amount that premium would have bought under the new occupational classification. The purpose is to preserve fairness between the risk assumed and the premium paid without automatically cancelling the policy.
The insurer does not simply increase the waiting period or deductible, because those are not the contractual adjustment method addressed by the provision. It also does not deny every claim for misrepresentation, because a later change in occupation is not necessarily a misrepresentation in the original application. If the insured changes to a less hazardous occupation, the provision may allow the insured to apply for an adjusted premium rate or greater benefit as appropriate under policy terms. The key examination rule is that occupational changes affect the amount of benefits or premium classification, not the basic validity of coverage. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Change of Occupation Provision; Individual Accident and Health Policies.

NEW QUESTION # 63
Which person is generally eligible to establish and contribute to a health savings account (HSA)?

A. A person covered by a qualified high-deductible health plan and meeting other eligibility requirements
B. A person enrolled in Medicare Part A
C. A person claimed as another taxpayer's dependent
D. A person enrolled in any health plan with no deductible

Answer: A

Explanation:
An HSA is generally available to an eligible individual who is covered by a qualified high-deductible health plan, commonly called an HDHP, and who meets the other federal eligibility requirements. The account is owned by the individual, not the employer or insurer. Contributions may be made by the individual, an employer, or another person, subject to annual contribution limits. Qualified distributions used for eligible medical expenses are generally tax advantaged under federal rules.
Eligibility is not based solely on having a high deductible. The health plan must meet the federal HDHP requirements for the applicable year. In addition, an individual generally cannot be enrolled in Medicare, cannot be claimed as another person's tax dependent, and cannot have disqualifying other health coverage.
Because federal limits and requirements can change, the producer should not provide individualized tax advice and should refer the consumer to current IRS guidance or a qualified tax professional.
An HSA differs from a flexible spending arrangement because unused HSA funds generally remain with the account owner and may carry forward. It also differs from health insurance itself; the HSA is a tax- advantaged account used alongside an eligible health plan.
References/topics from the Study Guide: Health Savings Accounts; High-Deductible Health Plans; Consumer- Directed Health Plans; Tax-Advantaged Medical Accounts.

NEW QUESTION # 64
What is the minimum age requirement for a natural person applying for a resident Nevada producer license?

A. 21 years old
B. 18 years old
C. 25 years old
D. 16 years old

Answer: B

Explanation:
A natural person applying for a resident Nevada producer license must be at least 18 years old. Age is only one part of the licensing standard. Before approving a resident producer application, the Commissioner must also find that the applicant has not committed an act that would justify refusal, suspension, or revocation of a license; has paid the applicable fees; and has passed the required examination for the requested line of authority unless an examination exemption applies.
A life and health producer must hold the appropriate line or lines of authority before selling, soliciting, or negotiating those classes of insurance. Nevada separately identifies life insurance and accident-and-health insurance as producer authorities. A producer must also comply with renewal, continuing education, appointment, recordkeeping, and reporting requirements as applicable.
A business organization may also be licensed as a producer, but it must designate a properly licensed natural person who is authorized to transact business on its behalf and is responsible for the organization's compliance with Nevada insurance laws and regulations. Licensing is therefore not merely a test-passing event; it is an ongoing regulatory responsibility.
For examination purposes, remember the basic resident-producer requirements: age 18 or older, proper application, fees, good character and eligibility, and examination success unless exempt.
References/topics from the Study Guide: Nevada Producer Licensing; Resident Producer Requirements; Lines of Authority; License Application; NRS 683A.251.

NEW QUESTION # 65
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