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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q61-Q66):

NEW QUESTION # 61
According to Nevada law, an authorized insurer is BEST defined as:

A. an insurer with a certificate of authority issued by the Insurance Commissioner of Nevada
B. an insurer authorized under a certificate of authority issued by the Governor of Nevada
C. any insurer with minimum assets as required by this state
D. an insurer with a certificate of authority issued by the National Association of Insurance Commissioners (NAIC)

Answer: A

Explanation:
An authorized insurer is an insurer that holds a certificate of authority issued by the Nevada Insurance Commissioner and remains authorized to transact insurance in the state. The certificate of authority is the formal approval allowing the insurer to conduct the kinds of insurance business for which it has been approved.
Having sufficient assets may be one consideration in an insurer's application and ongoing financial regulation, but assets alone do not make an insurer authorized. The National Association of Insurance Commissioners develops model laws, standards, and regulatory resources; it does not issue Nevada certificates of authority. The Governor of Nevada likewise does not issue insurance certificates of authority.
This distinction is central to Nevada insurance regulation. Authorized, or admitted, insurers are subject to Nevada's ongoing solvency oversight, market-conduct regulation, rate and form requirements where applicable, examinations, and other statutory obligations. Nonadmitted insurers may be used only through the surplus-lines process or another applicable statutory exception.
A producer must understand whether an insurer is authorized before placing ordinary insurance business.
Selling or placing insurance with an unauthorized insurer outside a lawful exception can create serious regulatory consequences.
Study Guide references/topics: authorized insurers; admitted insurers; certificates of authority; insurer regulation; NRS 680A.020 .

NEW QUESTION # 62
Which of the following is permitted by a licensee?

A. Buying the client a nominal gift at Christmas
B. Returning the commission to the client to ensure policy renewal
C. Altering the client ' s application information to lower the premium rate
D. Lowering the premium by rebating the commission

Answer: A

Explanation:
A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada's statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.
Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.
Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant's information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.
The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.
Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .

NEW QUESTION # 63
The Nevada Life and Health Insurance Guaranty Association is financed by which of the following methods?

A. Assessing insureds
B. Assessing member insurance companies
C. Assessing agent association members
D. Assessing a premium tax

Answer: B

Explanation:
The Nevada Life and Health Insurance Guaranty Association is financed through assessments on member insurance companies. Insurers authorized to transact covered life, health, or annuity business in Nevada are members of the Association as a condition of their authority to operate in the state. When an assessment is necessary, the Association assesses member insurers according to the statutory assessment system.
The Association exists to provide limited protection when a member insurer becomes impaired or insolvent and cannot meet covered contractual obligations. It is not financed by direct assessments against insureds, policyowners, agents, or association members. It is also not simply funded through a general premium tax imposed on consumers.
Nevada law establishes assessment classes, including assessments for administrative and legal expenses and assessments needed to carry out the Association's obligations regarding an impaired or insolvent insurer.
Member insurers may consider the cost of assessments when establishing rates and dividends, but that does not change the source of the Association's direct funding: the member insurers themselves.
The Guaranty Association is a safety mechanism with statutory limits. It is not a substitute for evaluating an insurer's financial strength, and insurers and producers may not use its existence as a sales inducement.
Study Guide references/topics: insurer insolvency; guaranty associations; member insurer assessments; NRS Chapter 686C .

NEW QUESTION # 64
Under a Disability policy, the Elimination period is:

A. the same as a Probationary period
B. usually longer for accidents than for sickness
C. similar to a deductible but expressed in terms of time rather than dollars
D. predetermined by the insurance company

Answer: C

Explanation:
The elimination period is the waiting period that must pass after disability begins before disability income benefits become payable. Choice C is correct because it performs a function similar to a deductible, but it is measured in time rather than dollars. For example, a policy may require an insured to remain disabled for 30,
60, 90, or 180 days before benefits begin. The insured bears the financial impact of the disability during that initial period, just as an insured bears a deductible before medical expense benefits apply. A longer elimination period generally reduces the policy premium because the insurer begins payments later and may avoid paying shorter-duration claims. The elimination period is not necessarily longer for accidents than sickness; many policies use the same waiting period for both. It is selected under the policy terms, rather than being an undefined period solely controlled by the insurer. It is also not the same as a probationary period, which is a period at the beginning of a policy during which sickness losses may be excluded. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Elimination Period.

NEW QUESTION # 65
Under federal law, a tax exempt Health Savings Account can only be opened for an individual who is:

A. covered by a qualified High Deductible Health Plan
B. covered by Long Term Care Insurance
C. eligible to be claimed as a dependent on another person ' s tax return
D. entitled to Medicare benefits

Answer: A

Explanation:
A Health Savings Account is available only to an eligible individual, and a central eligibility requirement is coverage under a qualified High Deductible Health Plan. Therefore, choice A is correct. The individual also generally must not have disqualifying other health coverage, be enrolled in Medicare, or be claimable as another person's tax dependent. Long-term care insurance does not itself establish HSA eligibility. Medicare enrollment generally prevents new HSA contributions, although the account balance may still be used for qualified expenses under applicable tax rules. An HSA offers tax-favored contributions, tax-deferred growth, and tax-free distributions for qualified medical expenses when statutory requirements are met. The HDHP must satisfy annual federal deductible and out-of-pocket limits, which are adjusted periodically. The IRS states that eligible individuals must have HDHP coverage and no disqualifying health coverage to make HSA contributions. See IRS HSA guidance . Study Guide References/Topics: Taxation and Business Uses of Health Insurance; Health Savings Accounts; High Deductible Health Plans.

NEW QUESTION # 66
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