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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Long Term Care
- Medicare
  • 1. Medicare Advantage Plans
    • 2. Prescription Drug Plan
      • 3. Medicare supplement regulation
        - 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 newborn children
            • 3. Coverage for physical handicap or intellectual disability for dependent children
              - Coverage for reconstructive surgery
              - Hospice care
              Topic 2: Accident & Health – General Knowledge50%- 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. Rights of renewability
                • Noncancelable
                • Cancelable
                • Guaranteed renewable
              • 3. 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
              • 4. Riders
                • Impairment and exclusions
                • Guaranteed insurability
                • Future increase option
              - Field Underwriting Procedures
              • 1. Sources of insurability and HIPAA privacy information
                • 2. Completing the application
                  • 3. Submitting application and initial premium to company for underwriting
                    • 4. Initial premium payment and receipt
                      • 5. Policy delivery
                        • 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. Replacement
                            - Other Insurance Concepts
                            • 1. Primary and contingent beneficiaries
                              • 2. Nonduplication and coordination of benefits
                                • 3. Dependent children benefits
                                  • 4. Occupational vs. non-occupational
                                    • 5. Owner's rights
                                      • 6. Cost containment
                                        • 7. Subrogation
                                          • 8. Tax treatment of premiums and proceeds of insurance contracts
                                            • 9. Total, partial, recurrent, and residual disability
                                              • 10. Managed care
                                                • 11. Workers Compensation
                                                  • 12. Modes of premium payments
                                                    - Types of Policies
                                                    • 1. Accidental death and dismemberment
                                                      • 2. Disability income
                                                        • Individual disability income policy
                                                        • Business overhead expense policy
                                                        • Business disability buyout policy
                                                        • Group disability income policy
                                                        • Key employee policy
                                                      • 3. Individual and Group Long Term Care
                                                        • Eligibility
                                                        • Levels of care
                                                      • 4. Medicare supplement policies
                                                        • 5. Other policies
                                                          • Dental
                                                          • Vision
                                                          • Cancer
                                                          • Critical illness or specified disease
                                                          • Worksite employer-sponsored
                                                          • Hospital indemnity
                                                          • Short-term medical
                                                          • Accident
                                                        • 6. Group insurance
                                                          • Differences between individual and group contracts
                                                          • General characteristics
                                                          • COBRA
                                                        • 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
                                                        - Social Insurance
                                                        • 1. Social Security benefits
                                                          • 2. Medicare Parts A, B, C, and D
                                                            • 3. Medicaid
                                                              Topic 3: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Licensing
                                                              • 1. Obtaining a license
                                                                • 2. Renewal and continuing education
                                                                  • 3. Name of licensee
                                                                    • 4. Suspension, revocation, and refusal of license
                                                                      • 5. Persons required to be licensed
                                                                        • 6. Termination of license
                                                                          - Nevada Life and Health Insurance Guaranty Association
                                                                          - Definitions
                                                                          • 1. Domestic, foreign, and alien
                                                                            • 2. Certificate of authority
                                                                              • 3. Cost-sharing
                                                                                • 4. Insurer
                                                                                  • 5. Authorized and unauthorized
                                                                                    • 6. Transacting insurance
                                                                                      • 7. Premiums
                                                                                        - Insurance Commissioner
                                                                                        • 1. Notice and hearings and penalties
                                                                                          • 2. Examinations
                                                                                            • 3. General powers and duties
                                                                                              - Marketing Practices
                                                                                              • 1. Unfair practices
                                                                                                • Unfair claims methods and practices and settlement of claims
                                                                                                • Rebating and inducement
                                                                                                • Twisting
                                                                                                • Misrepresentation
                                                                                                • Fraud
                                                                                                • Unfair discrimination
                                                                                                • Defamation
                                                                                              • 2. Required records and record retention
                                                                                                • 3. Silver State Health Insurance Exchange
                                                                                                  • 4. Fiduciary responsibilities
                                                                                                    • 5. Affordable Care Act
                                                                                                      • 6. Commissions and payment restrictions
                                                                                                        Topic 4: Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Credit life and health insurance
                                                                                                        - Group life and health insurance
                                                                                                        • 1. Required provisions
                                                                                                          • 2. Eligible groups
                                                                                                            - Advertising

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                                                                                                            Insurance Licensing NV Accident and Health Sample Questions (Q129-Q134):

                                                                                                            NEW QUESTION # 129
                                                                                                            An insured who wants to guarantee that an Accident and Health policy will remain in force even in the event of being disabled should purchase which of the following riders?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            The Waiver of Premium rider is designed to prevent a disability from causing the insured to lose coverage because premiums cannot be paid. When the rider's qualifying disability conditions are met, the insurer waives future premiums after the applicable waiting period while the disability continues. The policy therefore remains in force without premium payment during the qualifying period. Choice C is correct because it directly addresses continuation of coverage during disability. AD & D pays a benefit for accidental death or specified accidental losses; it does not waive premiums. Double indemnity generally increases the death benefit for a qualifying accidental death and likewise does not preserve health coverage during disability. Guaranteed insurability permits the future purchase of additional coverage without new evidence of insurability, but it does not relieve the policyowner of the duty to pay premiums on existing coverage. The rider's exact definition of disability, elimination period, age limitation, and proof-of-disability requirements are controlled by the policy. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Waiver of Premium.


                                                                                                            NEW QUESTION # 130
                                                                                                            A producer offers a prospective life insurance applicant a gift card that is not stated in the policy as an inducement to purchase coverage. Which prohibited practice is most directly implicated?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            Rebating occurs when a producer or insurer offers, gives, or allows an inducement not specified in the policy to persuade a person to purchase insurance. A gift card offered solely because the applicant buys a life or health policy is a classic example of a potentially prohibited rebate. Nevada trade-practice law restricts rebates and other improper inducements because they can create unfair competition, mislead consumers, and distort insurance pricing.
                                                                                                            The prohibition does not mean that every item of nominal value, educational material, or lawful consumer program is automatically illegal. The legality of a benefit depends on the statute, regulations, insurer programs, value, purpose, and whether it is tied improperly to the sale. Producers should follow current Nevada rules and insurer compliance guidance before offering anything of value in connection with a sale.
                                                                                                            Coinsurance is a health-policy cost-sharing method. Subrogation is an insurer's right to recover from a responsible third party after paying a loss. Assignment transfers some or all policy rights from one party to another. None of those terms describes an improper sales inducement.
                                                                                                            A producer should avoid promising gifts, refunds, premium reductions, or extra benefits unless specifically authorized and properly disclosed under applicable law and policy provisions.
                                                                                                            References/topics from the Study Guide: Unfair Trade Practices; Rebating; Inducements; Producer Ethics; NRS 686A.110.


                                                                                                            NEW QUESTION # 131
                                                                                                            Under a life insurance policy with a revocable beneficiary designation, who normally has the authority to change the beneficiary?

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            The policyowner normally holds the contractual rights known as incidents of ownership. When the beneficiary designation is revocable, the policyowner may generally change the beneficiary without obtaining that beneficiary's consent, provided the policy is in force and no assignment or court order restricts the right.
                                                                                                            The owner may also ordinarily exercise other ownership rights, such as selecting premium-payment modes, assigning the policy, taking a policy loan when available, surrendering the policy for cash value, and electing settlement options.
                                                                                                            The insured and the owner can be the same person, but they do not have to be. The insured is the person whose life is covered and whose death triggers payment of the death benefit. A beneficiary is the person or entity designated to receive policy proceeds. Those roles must be kept separate on examination questions. A revocable beneficiary has only an expectancy until the insured dies; by contrast, an irrevocable beneficiary usually has a vested interest that limits the owner's ability to change the designation or exercise certain policy rights without consent.
                                                                                                            Correctly identifying the owner is essential because ownership determines control of the policy during the insured's lifetime.
                                                                                                            References/topics from the Study Guide: Policyowners' Rights; Beneficiary Designations; Revocable and Irrevocable Beneficiaries; Assignments.


                                                                                                            NEW QUESTION # 132
                                                                                                            An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:

                                                                                                            Answer: D

                                                                                                            Explanation:
                                                                                                            The Change of Occupation provision allows an insurer to adjust benefits when the insured changes to a more hazardous occupation after policy issue. Choice A is correct. If the same premium would have purchased a lower benefit amount for the new, more hazardous occupati on, the insurer may reduce the benefit to the amount that premium would have bought under the new occupational classification. The purpose is to preserve fairness between the risk assumed and the premium paid without automatically cancelling the policy.
                                                                                                            The insurer does not simply increase the waiting period or deductible, because those are not the contractual adjustment method addressed by the provision. It also does not deny every claim for misrepresentation, because a later change in occupation is not necessarily a misrepresentation in the original application. If the insured changes to a less hazardous occupation, the provision may allow the insured to apply for an adjusted premium rate or greater benefit as appropriate under policy terms. The key examination rule is that occupational changes affect the amount of benefits or premium classification, not the basic validity of coverage. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Change of Occupation Provision; Individual Accident and Health Policies.


                                                                                                            NEW QUESTION # 133
                                                                                                            Which statement is true of a variable life insurance policy?

                                                                                                            Answer: C

                                                                                                            Explanation:
                                                                                                            Variable life insurance is permanent life insurance with cash values invested in separate-account investment options. Because the value of those investments can rise or fall, the policyowner bears the investment risk.
                                                                                                            The policy's cash value may fluctuate based on market performance, and the death benefit may vary above a guaranteed minimum amount, subject to policy provisions. The insurer does not guarantee the investment performance of the separate account.
                                                                                                            Variable life insurance differs from whole life, where the insurer's general account supports guaranteed cash values and fixed premiums. It also differs from universal life, which emphasizes flexible premiums and adjustable death-benefit structures. Variable universal life combines flexible-premium features with separate- account investment options. All such products must be described accurately because the potential for growth is accompanied by potential loss.
                                                                                                            Because variable life is a security as well as an insurance product, a producer generally needs appropriate securities registration and authorization in addition to life insurance licensing. Suitability is especially important. The product may be appropriate only for a consumer with a long time horizon, tolerance for market volatility, and a need for permanent life insurance. It should not be sold as a guaranteed investment or as equivalent to a fixed life policy.
                                                                                                            References/topics from the Study Guide: Variable Life Insurance; Separate Accounts; General Accounts; Securities Registration; Investment Risk; Suitability.


                                                                                                            NEW QUESTION # 134
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