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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q73-Q78):

NEW QUESTION # 73
Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?

A. The insurance company guarantees the premium rate for the life of the policy.
B. The insurance company must exchange the original policy for a new one at the insurability date.
C. The insured may periodically increase the amount of benefits payable under the policy.
D. The insured must periodically provide proof of insurability to the insurance company.

Answer: C

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 # 74
In order to be covered under the Nevada Life and Health Insurance Guaranty Association, an insurance company MUST be:

A. admitted
B. alien
C. rated by AM Best
D. a fraternal benefit society

Answer: A

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 # 75
An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?

A. The employer must personally pay the former employee's beneficiary.
B. No benefit is payable because the employee did not submit an application.
C. Only any accumulated cash value is payable.
D. The amount that could have been converted is payable under the group policy.

Answer: D

Explanation:
Nevada group-life law protects an insured person during the conversion interval. If a person covered under a group life policy dies during the period in which the person was entitled to obtain an individual conversion policy-and before that individual policy becomes effective-the amount of life insurance the person could have converted is payable as a claim under the group policy. This protection applies whether or not the person submitted the individual-policy application or paid the first premium before death.
The conversion privilege is important because group coverage is usually tied to employment or membership.
When eligibility ends, the individual may lose the group policy's protection. Conversion gives the former insured an opportunity to obtain individual life insurance without new evidence of insurability, subject to the statute and policy terms. The converted amount may be limited by the group policy and applicable law, and the individual policy's premium is based on the insurer's conversion rates.
This rule should not be confused with portability. Portability allows continuation of group-style coverage under certain conditions, whereas conversion replaces group coverage with an individual policy. The producer should explain notice requirements, the available conversion amount, deadlines, and premium differences whenever group coverage terminates.
References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Termination of Employment; NRS 688B.120-688B.130.

NEW QUESTION # 76
Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?

A. A family
B. A newspaper corporation
C. A volunteer fire department
D. A church

Answer: A

Explanation:
A family is not an eligible blanket-health-insurance group under Nevada law. Blanket accident and health insurance is designed for defined groups connected by a common activity, organization, occupation, event, or exposure to a specified hazard. It is not designed as a substitute for ordinary individual or family health insurance.
Nevada specifically recognizes various groups that may be covered under a blanket policy. These include religious, charitable, recreational, educational, and civic organizations; newspaper publishers covering their carriers; and volunteer fire departments or similar emergency organizations covering members or participants.
The organization acts as the policyholder, and the covered persons are defined by their relationship to the group activity or specified hazard.
A church is eligible as a religious organization. A newspaper corporation may qualify when covering its carriers. A volunteer fire department is specifically listed as an eligible organization. A family, however, is a private household relationship rather than a qualifying blanket group formed around an authorized organizational purpose or activity.
Study Guide references/topics: blanket accident and health insurance; eligible groups; policyholder; specified hazards; NRS 689B.070 .

NEW QUESTION # 77
A Long-Term Care policy provides coverage for:

A. custodial care in a nursing home
B. medical expenses
C. hospital expenses
D. Medicare Supplement coverage

Answer: A

Explanation:
Long-term care insurance is designed primarily to cover services required when an insured cannot perform activities of daily living independently or has a severe cognitive impairment. Custodial care in a nursing home is a core example of long-term care coverage. Custodial care involves assistance with everyday personal needs, such as bathing, dressing, eating, transferring, toileting, and continence, rather than acute medical treatment.
Long-term care benefits may be provided in a nursing home, assisted-living setting, adult day-care setting, or the insured's home, depending on the policy. Coverage can include skilled nursing care, intermediate care, custodial care, home health care, hospice care, respite care, and care-management services, subject to policy conditions and benefit triggers.
Hospital-expense and medical-expense policies generally focus on acute treatment, physician services, surgery, hospitalization, and related medical costs. Medicare Supplement insurance is designed to help pay certain Medicare deductibles, coinsurance, and copayments; it is not long-term care insurance.
The distinction is crucial: long-term care insurance addresses prolonged assistance and supervision resulting from chronic illness, disability, frailty, or cognitive impairment, whereas major medical insurance focuses principally on acute medical treatment.
Study Guide references/topics: long-term care insurance; custodial care; skilled care; activities of daily living; nursing-home benefits; Nevada long-term-care regulations .

NEW QUESTION # 78
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