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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

Insurance Licensing NV Accident and Health Sample Questions:

1. A group health policy that covers hospital expenses MUST also cover:

A) burial expenses
B) elective cosmetic surgery
C) travel expenses for caretakers
D) routine physical examinations

2. A producer who makes misleading policy comparisons for the purpose of inducing an insured to surrender an existing policy is guilty of:

A) defamation
B) coercion
C) twisting
D) rebating

3. An applicant unintentionally gives an incorrect answer about a material health condition on a life insurance application. This is best described as:

A) A representation that may be material to underwriting
B) A warranty that automatically voids the policy
C) A premium-payment mode
D) A rider

4. Which feature is most characteristic of universal life insurance?

A) A fixed premium and fixed death benefit with no flexibility
B) Coverage that can never build cash value
C) Investment risk borne entirely by the insurer in a separate account
D) Flexible premiums and adjustable death-benefit options, subject to policy requirements

5. Under a group health policy, which of the following coverages MUST be provided for newborn children?

A) Routine eye examinations
B) Genetic Testing
C) Congenital health defects
D) Transportation costs from the hospital to the child ' s residence

Solutions:

Question # 1
Answer: D

Question # 2
Answer: C

Question # 3
Answer: A

Question # 4
Answer: D

Question # 5
Answer: C

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