InsNV_Health02勉強資料 & InsNV_Health02受験資料更新版

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health 認定 InsNV_Health02 試験問題 (Q77-Q82):

質問 # 77
A group health insurance policy MUST include coverage for which of the following expenses?

A. Hospice
B. Adult dental
C. Adult vision
D. Over-the-counter dietary supplements

正解：A

解説：
A group health insurance policy in Nevada must include coverage for expenses arising from hospice care.
Hospice care is intended for patients with terminal illness and emphasizes comfort, pain control, symptom management, supportive services, and assistance for the patient and family rather than curative treatment.
Nevada's group-policy required-provisions statute specifically identifies benefits for expenses arising from hospice care. This makes hospice the correct answer. Adult dental and adult vision benefits may be offered by separate policies, riders, employer plans, or benefit arrangements, but they are not universally required in every group health policy. Over-the-counter dietary supplements are not a standard mandated group health benefit and are generally covered only when specifically provided by a policy or health plan.
Hospice coverage should be distinguished from ordinary inpatient hospital coverage. Hospice care may be delivered in a home, residential setting, hospice facility, or other appropriate location, depending on the patient's needs and the terms of coverage. It frequently involves an interdisciplinary team and includes both patient care and family-support services.
Study Guide references/topics: group health required provisions; hospice care; mandated benefits; supportive services; NRS 689B.030 .

質問 # 78
Which of the following is NOT a preventive benefit for adults?

A. High blood pressure screening
B. Skin cancer screening
C. Mammograms
D. Physical therapy

正解：B

解説：
Skin cancer screening is the correct answer because it is not included as a broadly required preventive benefit for adults in the same manner as the other listed services. Preventive-service requirements are tied to specified recommended services and may vary by population, risk status, and recommendation level. A service may be medically useful or covered by a particular policy without being a universally required no-cost preventive benefit.
High blood pressure screening is a standard adult preventive screening. Mammography is a recognized preventive screening benefit for eligible women. Physical therapy can be included in preventive fall- intervention services for certain adults, particularly older adults at risk of falls, when the preventive-service criteria are met. Thus, the question is testing the distinction between services commonly covered in some circumstances and services specifically identified as preventive benefits.
Skin examinations or skin cancer evaluations may be medically necessary when a lesion, symptom, prior diagnosis, or risk factor is present. In that circumstance, the service may be classified as diagnostic rather than preventive and can be subject to policy terms and cost sharing.
For examination purposes, remember that preventive-benefit questions focus on the mandated screening list and preventive-care criteria, not merely on whether a service can be medically valuable.
Study Guide references/topics: preventive care; adult screenings; in-network preventive benefits; adult preventive-care benefits .

質問 # 79
One key distinction between producers and Exchange Enrollment Facilitator (EEF) is producers:

A. can explain insurance terms like copayments and deductibles
B. can recommend a health plan for a consumer
C. can answer questions regarding program eligibility
D. are compensated monetarily

正解：B

解説：
A licensed producer may recommend a health plan for a consumer because the producer is authorized to sell, solicit, and negotiate insurance. That authority permits the producer to discuss coverage choices in a personalized manner, explain how plan provisions apply to the consumer's situation, and recommend a particular policy or plan when appropriate.
An Exchange Enrollment Facilitator is certified to help consumers enroll in qualified health plans through the Exchange. The EEF role is designed to provide impartial enrollment assistance, application support, and general program information. However, an EEF may not sell, solicit, or negotiate insurance. That restriction prevents an EEF from functioning as an insurance producer or steering a consumer toward a particular carrier or plan.
Explaining general terminology, such as deductibles, copayments, and eligibility rules, can be part of enrollment assistance and is not the defining distinction. Compensation is also not the key answer because the legal distinction turns on insurance authority, not simply whether a person receives payment. A Nevada EEF also may not concurrently hold a producer license.
Study Guide references/topics: Exchange Enrollment Facilitators; producer authority; solicitation and negotiation; NRS Chapter 695J .

質問 # 80
Which policy is designed to pay benefits upon diagnosis or treatment of a specifically named illness, such as cancer?

A. Major medical insurance
B. Specified disease insurance
C. Group term life insurance
D. Credit disability insurance

正解：B

解説：
Specified disease insurance provides limited benefits for a condition or group of conditions specifically named in the policy, such as cancer, heart disease, or stroke. The benefits may be paid as reimbursement for certain covered expenses, as fixed cash amounts for treatment events, or through a schedule of benefits. The scope of coverage is controlled by the policy and is substantially narrower than comprehensive major medical insurance.
A producer must not represent specified disease coverage as complete health insurance. It may help with deductibles, travel, household costs, experimental-treatment expenses not covered elsewhere, or income disruption, but it is not a substitute for comprehensive coverage that addresses a broad range of illnesses and injuries. The client should understand covered conditions, waiting periods, recurrence provisions, preexisting- condition limitations where permitted, benefit schedules, exclusions, and whether the policy pays in addition to other coverage.
Major medical insurance is intended to cover a broad spectrum of medically necessary expenses. Credit disability insurance is connected to repayment of a debt if the debtor becomes disabled. Group term life insurance pays a death benefit and does not provide medical-expense coverage. The examination point is to identify the limited, condition-specific purpose of specified disease insurance.
References/topics from the Study Guide: Specified Disease Insurance; Cancer Insurance; Critical Illness Coverage; Limited-Benefit Health Insurance; Major Medical.

質問 # 81
Which of the following persons is NOT required to be licensed by the Nevada Insurance Commissioner?

A. A salaried insurance company employee who performs clerical and administrative work
B. A salaried insurance agency clerk who also receives commissions on applications the clerk processes
C. An adjuster's employee who assists in the investigation and settlement of insurance claims
D. A person who procures insurance for an insured

正解：A

解説：
A salaried insurance company employee performing only clerical and administrative work is not required to hold an insurance producer license. The exemption applies when the employee does not sell, solicit, or negotiate insurance and is not compensated by commission based on insurance transactions.
Licensing is required for persons whose activities bring them into the regulated functions of insurance production, brokering, adjusting, or other licensed insurance activity. A person who procures insurance for an insured is acting in a producer or broker capacity and requires appropriate authority. An individual involved in investigating and settling claims may require an adjuster license depending on the duties performed.
Likewise, an agency clerk who receives commissions related to processed applications is no longer functioning solely as a clerical employee; commission-based activity indicates involvement in the insurance transaction.
The distinction is based on the actual work performed, not merely the person's job title. A company may call someone an assistant, representative, clerk, or customer-service employee, but the individual must be licensed if the person sells, solicits, negotiates, or otherwise performs regulated insurance functions.
Study Guide references/topics: producer licensing; licensing exemptions; clerical employees; sales, solicitation, and negotiation; NRS 683A.117 .

質問 # 82
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