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

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Insurance Licensing InsNV_Health02 Questions PDF File

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Insurance Licensing NV Accident and Health Sample Questions (Q68-Q73):

NEW QUESTION # 68
A full-time employee who is suffering from chronic kidney failure and requires dialysis is eligible for medical coverage under which of the following plans?

A. Workers ' Compensation
B. Medicare
C. Social Security Disability benefits
D. Medicaid

Answer: B

Explanation:
The correct answer is B, Medicare. A person with end-stage renal disease-permanent kidney failure requiring regular dialysis or a kidney transplant-may qualify for Medicare regardless of age, provided the applicable work or family eligibility requirements are met. The employee's status as full-time does not prevent Medicare eligibility based on end-stage renal disease. Medicaid is a needs-based program and is not the best answer solely from the fact s given. Workers' compensation would apply only to a qualifying work- related injury or illness. Social Security Disability benefits can provide income support to qualifying disabled persons, but they are not the medical coverage program identified in the question. Medicare coverage for dialysis-related services is subject to eligibility and enrollment rules, and an employer group health plan may coordinate with Medicare during the ESRD coordination period. Medicare confirms that people with permanent kidney failure requiring regular dialysis or a transplant can qualify for coverage before age 65. See Medicare's ESRD eligibility guidance . Study Guide References/Topics: Social Insurance Programs; Medicare; End-Stage Renal Disease.

NEW QUESTION # 69
A producer receives a phone call from an insured who already has health insurance and now wants to buy an Accidental Death and Dismemberment (AD & D) policy. In this situation, the producer should take which of the following actions?

A. Mail the application to the prospect and request that the prospect complete it, sign it, and return it to the insurance company.
B. Fill out the application by phone interview with the prospect, and obtain the prospect ' s signature after the company approves the application.
C. Meet with the prospect, ask the prospect to complete the application, and have the prospect sign the application.
D. Answer the routine application questions, meet with the prospect to obtain any additional information, and have the prospect sign the application.

Answer: C

Explanation:
The application is a material underwriting document, so the producer must use a process that obtains accurate information and a valid applicant signature before submission. Choice D is correct because the producer should meet with the prospect, have the prospect complete the application, and obtain the prospect's signature. This confirms that the answers are the applicant's statements and that the applicant has reviewed the information before the insurer relies upon it. The producer may explain questions and assist with completion, but should not answer questions on the prospect's behalf. Choice B is improper because the applicant's signature should not be postponed until after insurer approval. Choice C is improper because the producer should not independently answer application questions; the applicant provides the information.
Choice A is less appropriate because it bypasses the producer's opportunity to review the application for completeness, explain disclosures, and verify that required signatures are obtained. The existing health coverage does not eliminate the need for a complete AD & D application. Study Guide References/Topics:
Completing the Application, Underwriting, and Delivering the Policy; Producer Responsibilities; Application Completion.

NEW QUESTION # 70
The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured ' s age on the policy application?

A. Increase the premium
B. Adjust the benefits
C. Cancel the policy
D. Lapse the coverage

Answer: B

Explanation:
A Misstatement of Age provision corrects the benefit amount when the insured's age was inaccurately stated at application. If the insured understated age, the premium paid was lower than the premium that should have been paid for the correct age. Rather than canceling coverage or retroactively demanding a different premium, the insurer adjusts the benefit to the amount the premium actually paid would have purchased at the correct age. Choice B is therefore correct. This approach preserves the policy while placing both parties in the financial position contemplated by the policy's age-based premium schedule. The provision does not automatically increase premiums, lapse coverage, or permit cancellation merely because the age was misstated. It is a standard uniform individual accident and health policy provision intended to resolve an administrative error fairly and predictably. The same principle applies in the opposite direction: if age was overstated and excess premium was paid, benefits may be adjusted upward to the amount the paid premium would have purchased at the actual age. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Uniform Individual Accident and Health Policy Provisions; Misstatement of Age.

NEW QUESTION # 71
In a disability income policy, the elimination period is best described as:

A. The period after disability during which benefits are payable
B. The waiting period after disability begins before benefits become payable
C. The period during which the policy cannot be cancelled
D. The maximum period for which premiums are waived

Answer: B

Explanation:
The elimination period is the waiting period that begins when a covered disability starts and ends before disability-income benefits become payable. It functions much like a time deductible. For example, if a policy has a 30-day elimination period, the insured must remain disabled for the required period before weekly or monthly benefits begin, subject to the policy's definition of disability and proof-of-loss requirements.
The elimination period is not the benefit period. The benefit period is the maximum length of time benefits may continue once the insured becomes eligible, such as two years, five years, or to a stated age. It is also not the probationary period, which may apply at the beginning of a policy before coverage for sickness becomes effective. Accident coverage is often effective immediately, while sickness coverage may have a probationary period depending on the contract.
A longer elimination period generally lowers the premium because the insured retains more of the initial loss.
A shorter elimination period generally increases the premium because the insurer begins paying sooner. When comparing disability policies, producers should evaluate the elimination period together with the monthly benefit amount, definition of disability, residual-benefit features, and benefit period.
References/topics from the Study Guide: Disability Income Insurance; Elimination Period; Benefit Period; Probationary Period; Time Deductible.

NEW QUESTION # 72
For Social Security disability benefits, which statement is generally correct?

A. Benefits are payable for any short-term illness that prevents work for one week.
B. Benefits are available only to persons age 65 or older.
C. The program is funded entirely by private insurance premiums.
D. The program uses a strict definition of disability involving inability to perform substantial work for a required duration.

Answer: D

Explanation:
Social Security disability benefits are based on a strict federal definition of disability. In general, the claimant must be unable to engage in substantial gainful activity because of a medically determinable physical or mental impairment that has lasted, or is expected to last, for at least 12 months or is expected to result in death. The program is not designed to insure every short-term illness, temporary injury, or partial loss of earnings.
Eligibility also depends on work history and Social Security credits in many cases. The Social Security Administration evaluates whether the person can perform past work or adjust to other substantial work, considering medical and vocational factors. A waiting period may apply before cash disability benefits begin.
Separate programs, such as Supplemental Security Income, have different eligibility and income-resource rules.
For insurance examination purposes, distinguish Social Security disability from private disability-income insurance. Private coverage is based on the policy definition of disability, elimination period, benefit amount, and benefit period. Social Security disability uses the federal program's statutory standard and administrative determination process. A producer should describe private coverage as a possible supplement to-not a replacement for-government disability benefits.
References/topics from the Study Guide: Social Security Disability; Definitions of Disability; Disability Income Insurance; Government Benefit Coordination.

NEW QUESTION # 73
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