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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q111-Q116):

NEW QUESTION # 111
Which of the following is true regarding Medicare Advantage Plans?

A. The enrollee may opt out of a preventative health care program and receive a reduced premium
B. For many enrollee ' s deductible or coinsurance payments are reduced or eliminated
C. Prescription drug coverage mandates generics only
D. Vision and dental coverage is mandated.

Answer: B

Explanation:
Medicare Advantage, also called Medicare Part C, is private-plan coverage approved by Medicare. These plans must provide at least the services covered by Original Medicare, subject to Medicare rules, but they may structure deductibles, copayments, and coinsurance differently. For many enrollees, a plan's benefit design can reduce or eliminate certain cost-sharing amounts that would otherwise apply under Original Medicare.
Medicare Advantage plans also include a yearly maximum out-of-pocket limit for covered Medicare services.
Vision, hearing, and dental benefits may be offered as supplemental benefits by many Medicare Advantage plans, but they are not universally mandated as a standard benefit in every plan. Drug coverage is commonly included, but it is not restricted to generic medications only. Part D formularies can include both generic and brand-name drugs, subject to plan rules and Medicare requirements.
The final option is incorrect because an enrollee does not receive a reduced premium merely by opting out of preventive care. Preventive benefits and plan premiums are governed by Medicare and plan design rules rather than by an individual's decision to decline a preventive program.
Study Guide references/topics: Medicare Part C; Medicare Advantage; deductibles; coinsurance; out-of- pocket limits; Medicare Advantage cost rules .

NEW QUESTION # 112
When a nonqualified annuity is surrendered for more than the owner's investment in the contract, how is the gain generally treated for federal income-tax purposes?

A. As a tax-free return of principal only
B. As a deductible business loss
C. As a long-term capital gain in all cases
D. As ordinary income

Answer: D

Explanation:
Gain from a nonqualified annuity is generally taxed as ordinary income when distributed. The owner's investment in the contract, often called the cost basis, is not taxed again because it was paid with after-tax dollars. However, the growth above that basis is tax-deferred only while it remains inside the annuity. When the owner surrenders the contract or receives a taxable distribution, the gain is subject to ordinary-income treatment rather than the preferential capital-gains treatment that may apply to certain investments.
A nonqualified annuity is funded with after-tax money and is not held inside a qualified retirement arrangement such as an IRA or employer plan. The contract's tax deferral can be valuable for long-term planning, but it does not mean that every distribution is tax free. In addition, distributions before age 59½ may be subject to an additional federal tax penalty unless an exception applies. A full surrender may also trigger a surrender charge under the contract if it occurs during the surrender-charge period.
The producer should never present an annuity as tax avoidance. The accurate explanation is tax deferral, possible ordinary-income taxation of gain upon distribution, potential penalties for early distributions, and the importance of consulting a qualified tax adviser for individual circumstances.
References/topics from the Study Guide: Annuity Taxation; Nonqualified Annuities; Cost Basis; Tax Deferral; Surrender Charges.

NEW QUESTION # 113
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. entitled to Medicare benefits
C. eligible to be claimed as a dependent on another person ' s tax return
D. covered by Long Term Care Insurance

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 # 114
For a group health plan subject to the federal waiting-period rule, the waiting period for otherwise eligible employees generally may not exceed:

A. 180 calendar days
B. 90 calendar days
C. 60 calendar days
D. 30 calendar days

Answer: B

Explanation:
A health plan's waiting period generally may not exceed 90 calendar days for an individual who is otherwise eligible to enroll. A waiting period is the period that must pass before coverage becomes effective for an employee or dependent who has met the plan's substantive eligibility conditions. The rule is intended to limit extended gaps in employer-sponsored health coverage for eligible individuals.
The 90-day limitation does not mean that every new employee must receive coverage immediately on the first day of work. An employer may use reasonable eligibility requirements, such as a bona fide job classification or an hours-of-service requirement, as long as the arrangement is structured and administered in compliance with applicable federal rules. The producer should not treat every orientation period or administrative condition as automatically permissible; plan documents and current legal guidance matter.
This issue is distinct from preexisting-condition exclusions. Modern health-insurance rules significantly restrict the use of preexisting-condition exclusions in major medical coverage. It is also distinct from an elimination period in disability insurance, which is a waiting period after a disability begins rather than a waiting period for plan eligibility.
References/topics from the Study Guide: Group Health Eligibility; Waiting Periods; Employer-Sponsored Coverage; Federal Health-Insurance Requirements; Nevada Group Health Rules.

NEW QUESTION # 115
What is the primary purpose of a waiver-of-premium rider on a life insurance policy?

A. It guarantees a higher death benefit every year.
B. It converts term insurance automatically into whole life insurance.
C. It waives required premiums if the insured becomes totally disabled as defined by the rider.
D. It eliminates all future policy loans.

Answer: C

Explanation:
A waiver-of-premium rider keeps qualifying life insurance coverage in force by waiving required premiums when the insured becomes totally disabled as defined in the rider. The rider protects against the risk that disability will interrupt income and make premium payments unaffordable. Once the rider's requirements are satisfied, the insurer pays or waives the premium according to the policy terms, allowing the coverage and any applicable cash-value features to continue.
The definition of total disability, the waiting period, the age limitation, proof-of-disability requirements, and the duration of the waiver are contractual matters. The rider does not usually mean that premiums are waived for every illness, injury, or temporary work interruption. The insured must meet the stated definition and provide required evidence. Some riders also require that disability begin before a specified age.
This rider should not be confused with disability-income insurance. Disability income pays a periodic benefit to replace a portion of income. Waiver of premium does not provide an income payment; it protects the life policy from lapse due to qualifying disability. It also differs from a payor-benefit rider, which is commonly used with juvenile policies and protects the policy when the premium-paying adult dies or becomes disabled.
References/topics from the Study Guide: Waiver of Premium Rider; Total Disability; Disability Income; Payor Benefit Rider; Policy Continuation.

NEW QUESTION # 116
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