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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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InsNV_Health02最新試験情報 & InsNV_Health02資格専門知識

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Insurance Licensing NV Accident and Health 認定 InsNV_Health02 試験問題 (Q107-Q112):

質問 # 107
A prospect submits an Accident and Health application with the premium and receives a conditional receipt.
The insurance company issues a policy and mails it to the insured, but the insured never receives it. Which of the following statements is CORRECT about this situation?

A. The policy is in force.
B. The policy will be in force five business days after the prospect notifies the company that the prospect has not received the policy.
C. The policy will be in force as soon as the company issues a replacement policy.
D. The policy is not in force because delivery was not completed.

正解：A

解説：
The correct answer is D. A conditional receipt may provide temporary or conditional coverage when the application and required premium are submitted, subject to the receipt's terms and the applicant meeting underwriting requirements. Once the insurer approves the application, issues the policy, and mails it to the insured, the policy is generally considered delivered through constructive delivery. Physical receipt by the insured is not required when the insurer has completed issuance and mailing without retaining control over the policy. Accordingly, failure of the insured to receive the mailed policy does not, by itself, prevent the policy from being in force. Choice A incorrectly assumes that personal delivery is always essential. Choices B and C introduce conditions that are not part of the usual delivery rule. The policy's effective date remains governed by the application, conditional receipt, policy provisions, and underwriting approval. This question tests the distinction between actual delivery, where the insured personally receives the policy, and constructive delivery, where the insurer's completed mailing is sufficient to establish delivery. Study Guide References
/Topics: Completing the Application, Underwriting, and Delivering the Policy; Conditional Receipts; Policy Delivery.

質問 # 108
A corporation purchases life insurance on a highly valuable executive and is named as owner, premium payer, and beneficiary. What is the primary purpose of this arrangement?

A. Credit life insurance
B. Key person insurance
C. Family maintenance insurance
D. Viatical settlement insurance

正解：B

解説：
Key person insurance is life insurance purchased by a business on the life of an employee, owner, executive, or specialist whose death would create a significant financial loss for the business. The business is generally the owner, premium payer, and beneficiary. If the key person dies, the death proceeds can help the business offset lost revenue, recruit and train a replacement, protect credit relationships, reassure customers, or meet other financial obligations during the transition.
The key person must consent to the insurance, and the business must have a legitimate insurable interest at the time coverage is issued. Key person insurance is not designed to provide personal family protection to the employee. It protects the business against the financial consequences of losing an important contributor.
Credit life insurance is designed to help pay an outstanding debt upon the debtor's death. Family maintenance insurance is generally personal coverage intended to replace income or support dependents. A viatical settlement involves the sale of an existing life insurance policy to a third party, typically when the insured has a serious illness.
The producer should conduct a financial-needs analysis and coordinate with legal and tax advisers because ownership, consent, accounting treatment, and tax consequences require careful planning.
References/topics from the Study Guide: Key Person Insurance; Business Uses of Life Insurance; Insurable Interest; Business Continuation Planning; Executive Protection.

質問 # 109
A Long-Term Care policy provides coverage for:

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

正解：C

解説：
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 .

質問 # 110
Which of the following statements is CORRECT about the Medicaid program?

A. Participants must be at least 55 years of age.
B. It provides medical assistance for participants who are blind.
C. It is supplemented by Medicare for persons 62 years of age or older.
D. The program is administered at the federal level.

正解：B

解説：
Medicaid is a means-tested public medical assistance program for eligible low-income individuals and families. Eligibility may include persons who are blind, disabled, aged, pregnant, children, or otherwise within an eligible category under federal and state rules. Therefore, choice A is correct. There is no universal minimum age of 55 for Medicaid eligibility; eligibility is based principally on financial and categorical requirements. Medicaid is also not simply a program supplemented by Medicare at age 62. Medicare eligibility is generally associated with age 65 or qualifying disability or disease status, while Medicaid may assist certain eligible persons with limited income and resources, including some Medicare beneficiaries.
Medicaid is jointly financed by federal and state governments but is administered by the states within federal standards. In Nevada, the state administers the program through its designated health and human-services structure. Examination questions commonly test the distinction between Medicare as social insurance and Medicaid as needs-based medical assistance. Study Guide References/Topics: Social Insurance Programs; Medicaid; Federal-State Health Programs.

質問 # 111
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. Only any accumulated cash value is payable.
B. The employer must personally pay the former employee's beneficiary.
C. No benefit is payable because the employee did not submit an application.
D. The amount that could have been converted is payable under the group policy.

正解：D

解説：
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.

質問 # 112
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