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

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

NEW QUESTION # 129
For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?

A. Loss of life due to a heart attack
B. Partial paralysis due to a stroke
C. Loss of eyesight due to an accidental injury
D. Loss of the spleen due to an accidental injury

Answer: C

Explanation:
Choice B is correct because accidental loss of eyesight is a standard covered dismemberment loss under most AD & D policies. These policies pay benefits for accidental death and for specifically listed losses, often including loss of life, both hands, both feet, one h and and one foot, sight in one or both eyes, hearing, speech, or specified paralysis. The loss must result directly from accidental bodily injury and occur within the policy's required loss period. Death from a heart attack is generally illness-related rather than accidental. Loss of the spleen, even when caused by an accident, is not usually one of the specifically scheduled losses in a basic AD
& D policy. Partial paralysis due to a stroke is caused by illness rather than accidental injury. AD & D policies are limited-benefit contracts, so the policy does not pay merely because an injury is serious; the loss must match the policy's defined covered loss. The benefit amount varies according to the loss, with full principal sums often payable for death or loss of both eyes and smaller percentages for certain partial losses.
Study Guide References/Topics: Types of Health Insurance Policies; Accidental Death and Dismemberment; Covered Losses.

NEW QUESTION # 130
A whole life policyowner stops paying premiums and chooses to use the policy's cash value to purchase the same face amount of insurance for as long as that cash value will buy. Which nonforfeiture option was selected?

A. Reduced paid-up insurance
B. Cash surrender
C. Extended term insurance
D. Automatic premium loan

Answer: C

Explanation:
Extended term insurance uses the policy's accumulated cash value to purchase term insurance for the original face amount. Because the cash value is limited, the coverage lasts only for a stated period. During that period, the death benefit remains equal to the original policy's face amount, but no additional cash value normally accumulates. When the extended term period ends, coverage terminates unless another policy provision applies.
Reduced paid-up insurance works differently. It uses the cash value to purchase a smaller amount of permanent, paid-up life insurance. The face amount is reduced, but the coverage continues for the insured's lifetime without further premium payments. Cash surrender ends the policy and pays the available cash value to the owner, less any indebtedness and applicable charges. An automatic premium loan provision uses available cash value to pay overdue premiums temporarily, thereby attempting to prevent lapse.
Nonforfeiture options are designed to preserve some policy value when a cash-value life policy is discontinued. They are not typically available in pure term insurance because term policies ordinarily do not accumulate cash value. The correct option depends on whether the owner values the original death benefit for a limited period or a smaller death benefit permanently.
References/topics from the Study Guide: Nonforfeiture Options; Extended Term Insurance; Reduced Paid-Up Insurance; Cash Surrender; Automatic Premium Loan.

NEW QUESTION # 131
Under federal law, a tax exempt Health Savings Account can only be opened for an individual who is:

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

Answer: D

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 # 132
Group vision insurance plans typically provide insurance benefits that cover the cost of:

A. eye exams, lenses, retinal corrective surgery
B. eye exams, lenses, frames, and contact lenses
C. cataract removal, frames, lenses
D. laser surgery, eye exams, lenses

Answer: B

Explanation:
Group vision coverage is an ancillary group health benefit designed primarily for routine vision care and corrective eyewear. Its usual covered services include periodic eye examinations, lenses, frames, and-in plans that provide the option-contact lenses. The key distinction is between routine vision expenses and medical or surgical eye treatment. Choice C contains the customary routine vision benefits and is therefore correct. Laser refractive surgery is commonly elective and is not a standard core group vision benefit. Cataract removal and retinal corrective surgery are medical or surgical procedures ordinarily addressed through medical expense coverage, subject to that policy's provisions, rather than through a routine vision plan.
Vision plans often apply a stated allowance, benefit schedule, copayment, provider-network requirement, or frequency limit to exams, frames, lenses, and contacts. The insured should therefore recognize that the plan does not provide unlimited eye-care coverage; it covers specified routine corrective services under the contract's schedule of benefits. Study Guide References/Topics: Group Health Insurance; Types of Health Insurance Policies; Limited-Coverage Health Plans.

NEW QUESTION # 133
Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?

A. The insurance company guarantees the premium rate for the life of the policy.
B. The insured may periodically increase the amount of benefits payable under the policy.
C. The insured must periodically provide proof of insurability to the insurance company.
D. The insurance company must exchange the original policy for a new one at the insurability date.

Answer: B

Explanation:
A Guaranteed Insurability rider gives the disability income policyowner the right to purchase additional disability income coverage at stated future option dates without furnishing evidence of insurability. The rider is valuable because an insured's income may increase over time while health may decline; the rider allows benefit amounts to be increased when the option is exercised, subject to the rider's conditions and insurer limits. Therefore, choice C is correct. The rider does not guarantee a premium rate for life. Premiums for the added coverage are based on the insured's attained age and the insurer's rates applicable when the additional coverage is purchased. It also does not require periodic proof of insurability; eliminating that requirement is the central purpose of the rider. The existing policy remains in force and normally does not have to be exchanged for a new policy. On an examination, distinguish guaranteed insurability from noncancellable and guaranteed renewable provisions: those provisions concern renewability and premiums, whereas the rider concerns the future purchase of additional benefits. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Optional Benefits Riders.

NEW QUESTION # 134
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