InsNV_Health02 Test Passing Score, New InsNV_Health02 Real Exam

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Topic 1: Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Advertising - Group life and health insurance 1. Required provisions 2. Eligible groups - Credit life and health insurance
Topic 2: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Definitions 1. Authorized and unauthorized 2. Cost-sharing 3. Certificate of authority 4. Transacting insurance 5. Insurer 6. Domestic, foreign, and alien 7. Premiums - Marketing Practices 1. Required records and record retention 2. Silver State Health Insurance Exchange 3. Affordable Care Act 4. Commissions and payment restrictions 5. Fiduciary responsibilities 6. Unfair practices Unfair claims methods and practices and settlement of claims Rebating and inducement Twisting Misrepresentation Fraud Unfair discrimination Defamation - Insurance Commissioner 1. General powers and duties 2. Notice and hearings and penalties 3. Examinations - Nevada Life and Health Insurance Guaranty Association - 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
Topic 3: Accident & Health – General Knowledge	50%	- 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. 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. Accidental death and dismemberment 5. Other policies Dental Vision Cancer Critical illness or specified disease Worksite employer-sponsored Hospital indemnity Short-term medical Accident 6. 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 7. Medicare supplement policies - Other Insurance Concepts 1. Total, partial, recurrent, and residual disability 2. Modes of premium payments 3. Managed care 4. Tax treatment of premiums and proceeds of insurance contracts 5. Nonduplication and coordination of benefits 6. Workers Compensation 7. Cost containment 8. Dependent children benefits 9. Occupational vs. non-occupational 10. Primary and contingent beneficiaries 11. Subrogation 12. Owner's rights - 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. 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. Rights of renewability Noncancelable Cancelable Guaranteed renewable - 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. Completing the application 4. Initial premium payment and receipt 5. Replacement 6. Explaining policy provisions, riders, exclusions, and ratings 7. Sources of insurability and HIPAA privacy information 8. Policy delivery
Topic 4: Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Medicare 1. Medicare Advantage Plans 2. Medicare supplement regulation 3. Prescription Drug Plan - Mandatory policy clauses and provisions 1. Coverage for newborn children 2. Coverage for preventive healthcare services 3. Coverage for physical handicap or intellectual disability for dependent children - Coverage for reconstructive surgery - Hospice care - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Long Term Care

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Insurance Licensing NV Accident and Health Sample Questions (Q49-Q54):

NEW QUESTION # 49
A person insured under a policy of Long Term Care insurance issued pursuant to a direct response solicitation has how many days after delivery to return the policy for a full refund?

A. Forty-five days
B. Thirty days
C. Sixty days
D. Ten days

Answer: B

Explanation:
A long-term care insurance policy may be returned within 30 days after delivery for a full premium refund if the applicant is dissatisfied for any reason. This is known as a free-look or right-to-return provision. It gives the insured time to examine the contract after delivery and determine whether the coverage is appropriate.
The right is especially important in a direct-response sale, where the consumer may not have met face-to-face with a producer. Long-term care policies can contain detailed provisions concerning benefit triggers, elimination periods, activities of daily living, cognitive impairment, benefit periods, inflation protection, exclusions, premium changes, and nonforfeiture benefits. The 30-day review period allows a buyer to examine those terms without forfeiting premium.
The policy must prominently disclose the right to return the contract and receive a refund. The insurer must make the refund within the required period after the policy is returned. This rule differs from other health- insurance free-look, cancellation, grace-period, and reinstatement provisions, which can use different deadlines.
Study Guide references/topics: long-term care insurance; direct response solicitation; free-look provision; return of policy; NAC 687B.060 .

NEW QUESTION # 50
Which of the following persons is NOT required to be licensed by the Nevada Insurance Commissioner?

A. A salaried insurance company employee who performs clerical and administrative work
B. A salaried insurance agency clerk who also receives commissions on applications the clerk processes
C. A person who procures insurance for an insured
D. An adjuster's employee who assists in the investigation and settlement of insurance claims

Answer: A

Explanation:
A salaried insurance company employee performing only clerical and administrative work is not required to hold an insurance producer license. The exemption applies when the employee does not sell, solicit, or negotiate insurance and is not compensated by commission based on insurance transactions.
Licensing is required for persons whose activities bring them into the regulated functions of insurance production, brokering, adjusting, or other licensed insurance activity. A person who procures insurance for an insured is acting in a producer or broker capacity and requires appropriate authority. An individual involved in investigating and settling claims may require an adjuster license depending on the duties performed.
Likewise, an agency clerk who receives commissions related to processed applications is no longer functioning solely as a clerical employee; commission-based activity indicates involvement in the insurance transaction.
The distinction is based on the actual work performed, not merely the person's job title. A company may call someone an assistant, representative, clerk, or customer-service employee, but the individual must be licensed if the person sells, solicits, negotiates, or otherwise performs regulated insurance functions.
Study Guide references/topics: producer licensing; licensing exemptions; clerical employees; sales, solicitation, and negotiation; NRS 683A.117 .

NEW QUESTION # 51
Which statement best describes a group life conversion privilege?

A. It guarantees that the group premium will never increase.
B. It transfers the employee's group policy cash value to a retirement account.
C. It allows an insured leaving the group to obtain individual coverage without evidence of insurability, subject to the policy terms.
D. It allows the employer to convert all employees into beneficiaries.

Answer: C

Explanation:
A group life conversion privilege allows an insured whose group coverage terminates to obtain an individual life insurance policy without providing new evidence of insurability, provided the person applies and pays the required premium within the conversion period. The privilege is valuable because a person leaving employment may have become less insurable since original enrollment. Conversion allows continued life coverage despite a change in health, although the individual policy's premium is generally based on the insurer's conversion rates and may be higher than the group rate.
The group master policy and applicable law control the conversion period, maximum conversion amount, and type of individual policy available. The individual policy may not be identical to the group coverage. A producer should explain that the former employee has a limited window to act and should review alternative coverage options promptly.
Conversion differs from portability. Portability allows an insured to continue group-style coverage under certain terms, while conversion results in a new individual policy. The protection during the conversion period is also significant: Nevada group-life law provides a death benefit if the insured dies during the conversion period before the individual policy becomes effective, in the amount that could have been converted.
References/topics from the Study Guide: Group Life Insurance; Conversion Privilege; Portability; Termination of Group Coverage; NRS 688B.120-688B.130.

NEW QUESTION # 52
Which feature most clearly distinguishes a health maintenance organization (HMO) from a traditional indemnity health insurance plan?

A. The HMO provides only disability-income benefits.
B. The HMO pays only after the insured satisfies a cash-value requirement.
C. The HMO commonly uses a provider network and coordinates care through managed-care rules.
D. The HMO always reimburses any provider at the same level.

Answer: C

Explanation:
An HMO is a managed-care arrangement that commonly delivers and finances health-care services through a defined network of providers. Covered persons typically select or are assigned a primary care provider who coordinates routine care and, depending on the plan design, provides referrals for specialist services. Services received outside the network may be limited or not covered except for emergencies or specifically authorized care.
Traditional indemnity insurance operates differently. It generally reimburses covered medical expenses subject to policy limits, deductibles, coinsurance, and usual-and-customary or other payment standards. The insured may have broader provider choice, but that flexibility is often paired with less managed coordination and potentially greater out-of-pocket exposure. A preferred provider organization, or PPO, also uses a network but typically allows nonnetwork care at reduced benefit levels rather than requiring the same referral structure associated with many HMOs.
The exam distinction is based on delivery of care and network control, not merely on whether a policy has a deductible. Managed-care plans seek to control cost and improve coordination by negotiating with providers and establishing coverage procedures. Nevada recognizes network plans as policies in which financing and delivery of medical care are provided, at least in part, through defined providers under contract with the insurer.
References/topics from the Study Guide: Managed Care; HMO; PPO; Network Plans; NRS 689A-Network Plan Definition.

NEW QUESTION # 53
Which of the following situations describes a representation?

A. An insurance company guarantees that premiums paid will be refunded within 30 days after the policy ' s effective date if an insured is dissatisfied with the policy
B. An insurance company guarantees that policy benefits will be paid promptly on receipt of a Proof of Loss
C. A prospect ' s statement on an application that is held to be substantially true
D. A prospect ' s statement on an application that is held to be absolutely true

Answer: C

Explanation:
A representation is a statement made by an applicant on an insurance application that is believed to be true to the best of the applicant's knowledge and is required to be substantially true. Choice C correctly states that principle. A representation differs from a warranty. A warranty is a statement or promise that must be literally and absolutely true; choice D describes that stricter standard rather than a representation. Application answers help the insurer evaluate risk during underwriting, so material misrepresentations can affect coverage or the insurer's decision to issue the policy. However, not every immaterial or innocent inaccuracy has the same legal effect. The significance of a misstatement depends on its materiality and the applicable policy and insurance-law rules. Choices A and B describe potential policy promises or contract features, not statements made by a prospect in the application. For licensing purposes, remember that insurance applications are generally treated as containing representations, not warranties, unless the policy or law provides otherwise.
Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Representations and Warranties; Underwriting.

NEW QUESTION # 54
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