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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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Insurance Licensing NV Accident and Health Sample Questions (Q68-Q73):

NEW QUESTION # 68
Which of the following statements is generally CORRECT about a major medical policy?

A. It contains a 30-day Elimination period for losses due to sickness.
B. It provides benefits for in-hospital expenses only, subject to policy limits.
C. It provides benefits for reasonable and necessary medical expenses, subject to policy limits.
D. It contains more limitations than a Basic Hospital, Medical, or Surgical policy.

Answer: C

Explanation:
Major medical insurance is designed to provide broad protection against substantial medical expenses. It commonly covers hospital, surgical, physician, diagnostic, and other medically necessary services, subject to deductibles, coinsurance, exclusions, and stated policy limits. Therefore, choice D is correct. A major medical policy is not limited to in-hospital expenses; that description is more characteristic of basic hospital coverage.
It also is generally broader-not more limited-than a basic hospital, medical, or surgical policy. A 30-day elimination period is associated more closely with disability income insurance and does not define major medical coverage. The phrase "reasonable and necessary" is important because it allows the insurer to evaluate whether a service was medically appropriate and whether the charge falls within the policy's payment standard. Major medical policies are comprehensive, but they are not unlimited: coverage remains subject to deductibles, coinsurance, exclusions, maximum benefits, network terms, and utilization requirements. Study Guide References/Topics: Types of Health Insurance Policies; Major Medical Expense Insurance; Medical Expense Coverage.

NEW QUESTION # 69
A client needs a $250,000 death benefit for exactly 20 years to protect a home mortgage. The client wants the lowest practical initial premium and does not need cash-value accumulation. Which policy is most appropriate?

A. Level term life insurance
B. Universal life insurance
C. Variable life insurance
D. Whole life insurance

Answer: A

Explanation:
Level term life insurance is the appropriate recommendation because it provides a stated death benefit for a stated period, such as 20 years. It is designed for temporary protection where the financial need has a known end date-for example, the remaining duration of a mortgage, a child's dependency period, or a short-to- medium-term income-replacement need. The premium is generally level for the selected term period, while the death benefit remains level if the policy stays in force.
Whole life insurance provides permanent protection and cash-value accumulation, but its premium is ordinarily higher because the insurer expects coverage to continue for the insured's lifetime. Universal life offers flexible premiums and adjustable death-benefit structures, but it is not the simplest match when the client's purpose is fixed, time-limited mortgage protection. Variable life has investment risk because policy values depend on separate-account performance and is not selected merely to obtain low-cost temporary coverage.
The producer should confirm that the term period aligns with the mortgage obligation and explain that coverage normally ends at the term's expiration unless the policy is renewed, converted, or otherwise continued under its provisions.
References/topics from the Study Guide: Types of Life Insurance; Term Life Insurance; Needs Analysis; Mortgage Protection.

NEW QUESTION # 70
If coverage has stayed in force with the same insurance company, what is the maximum number of years for which reconstructive surgery (mastectomy) benefits must be provided?

A. 0
B. 1
C. 2
D. 3

Answer: C

Explanation:
If reconstructive surgery is begun within three years after a mastectomy, the amount of benefits for that surgery must equal the amount provided by the policy at the time of the mastectomy. Therefore, the tested maximum period is three years.
Nevada requires a policy that covers mastectomy to provide commensurate coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to create symmetry, prostheses, and treatment of physical complications of all stages of mastectomy, including lymphedema. The attending physician and patient determine the appropriate care.
The three-year rule protects an insured from losing the original level of reconstruction benefits merely because reconstruction is delayed. If surgery begins more than three years after the mastectomy, benefits are governed by the policy terms, conditions, and exclusions in effect at the time reconstructive surgery begins.
This question does not ask how long all reconstruction coverage disappears. It tests the period during which the policy must preserve the benefit amount available at the time of mastectomy.
Study Guide references/topics: mastectomy coverage; reconstructive surgery; breast reconstruction; mandated health benefits; NRS 689B.0375 .

NEW QUESTION # 71
Which statement best describes Medicare Part B?

A. It is automatic for every person at age 55.
B. It is Medicaid coverage for low-income individuals.
C. It provides only outpatient prescription-drug benefits.
D. It is medical insurance and generally requires enrollment and a monthly premium.

Answer: D

Explanation:
Medicare Part B is the medical-insurance portion of Original Medicare. It generally helps cover physician services, outpatient care, diagnostic services, preventive care, durable medical equipment, and other covered medical services. Enrollment is generally voluntary, although it may be automatic for certain people who are already receiving Social Security benefits. Most individuals pay a monthly Part B premium, and higher- income beneficiaries may pay an income-related additional amount.
Part B should not be confused with Medicare Part D, which provides outpatient prescription-drug coverage, or with Medicaid, which is a joint federal-state program for eligible individuals with limited income and resources. Part B also differs from Part A, which is primarily hospital insurance. Delaying Part B enrollment without qualifying employer coverage can result in late-enrollment penalties and gaps in coverage, so producers should avoid casual advice and instead direct consumers to current Medicare enrollment guidance.
When discussing Medicare-related products, producers must accurately identify whether a client has Original Medicare, a Medicare Advantage plan, a Medicare supplement policy, and/or a Part D prescription-drug plan.
These arrangements have different rules, premiums, provider networks, and cost-sharing structures.
References/topics from the Study Guide: Medicare Part B; Original Medicare; Enrollment Periods; Medicare Premiums; Medicare Supplement Products.

NEW QUESTION # 72
A prospect submits an Accident and Health application with the premium and receives a conditional receipt.
The insurance company issues a policy and mails it to the insured, but the insured never receives it. Which of the following statements is CORRECT about this situation?

A. The policy will be in force as soon as the company issues a replacement policy.
B. The policy will be in force five business days after the prospect notifies the company that the prospect has not received the policy.
C. The policy is in force.
D. The policy is not in force because delivery was not completed.

Answer: C

Explanation:
The correct answer is D. A conditional receipt may provide temporary or conditional coverage when the application and required premium are submitted, subject to the receipt's terms and the applicant meeting underwriting requirements. Once the insurer approves the application, issues the policy, and mails it to the insured, the policy is generally considered delivered through constructive delivery. Physical receipt by the insured is not required when the insurer has completed issuance and mailing without retaining control over the policy. Accordingly, failure of the insured to receive the mailed policy does not, by itself, prevent the policy from being in force. Choice A incorrectly assumes that personal delivery is always essential. Choices B and C introduce conditions that are not part of the usual delivery rule. The policy's effective date remains governed by the application, conditional receipt, policy provisions, and underwriting approval. This question tests the distinction between actual delivery, where the insured personally receives the policy, and constructive delivery, where the insurer's completed mailing is sufficient to establish delivery. Study Guide References
/Topics: Completing the Application, Underwriting, and Delivering the Policy; Conditional Receipts; Policy Delivery.

NEW QUESTION # 73
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