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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Medicare
  • 1. Medicare Advantage Plans
    • 2. Medicare supplement regulation
      • 3. Prescription Drug Plan
        - Coverage for reconstructive surgery
        - Mandatory policy clauses and provisions
        • 1. Coverage for physical handicap or intellectual disability for dependent children
          • 2. Coverage for preventive healthcare services
            • 3. Coverage for newborn children
              - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
              - Hospice care
              - Long Term Care
              Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Definitions
              • 1. Domestic, foreign, and alien
                • 2. Transacting insurance
                  • 3. Certificate of authority
                    • 4. Premiums
                      • 5. Cost-sharing
                        • 6. Authorized and unauthorized
                          • 7. Insurer
                            - Marketing Practices
                            • 1. Affordable Care Act
                              • 2. Fiduciary responsibilities
                                • 3. Commissions and payment restrictions
                                  • 4. Required records and record retention
                                    • 5. Silver State Health Insurance Exchange
                                      • 6. Unfair practices
                                        • Unfair claims methods and practices and settlement of claims
                                        • Rebating and inducement
                                        • Twisting
                                        • Misrepresentation
                                        • Fraud
                                        • Unfair discrimination
                                        • Defamation
                                      - Insurance Commissioner
                                      • 1. Examinations
                                        • 2. General powers and duties
                                          • 3. Notice and hearings and penalties
                                            - Nevada Life and Health Insurance Guaranty Association
                                            - Licensing
                                            • 1. Name of licensee
                                              • 2. Renewal and continuing education
                                                • 3. Suspension, revocation, and refusal of license
                                                  • 4. Termination of license
                                                    • 5. Obtaining a license
                                                      • 6. Persons required to be licensed
                                                        Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Group life and health insurance
                                                        • 1. Required provisions
                                                          • 2. Eligible groups
                                                            - Advertising
                                                            - Credit life and health insurance
                                                            Accident & Health – General Knowledge50%- Other Insurance Concepts
                                                            • 1. Occupational vs. non-occupational
                                                              • 2. Modes of premium payments
                                                                • 3. Dependent children benefits
                                                                  • 4. Tax treatment of premiums and proceeds of insurance contracts
                                                                    • 5. Total, partial, recurrent, and residual disability
                                                                      • 6. Primary and contingent beneficiaries
                                                                        • 7. Subrogation
                                                                          • 8. Cost containment
                                                                            • 9. Managed care
                                                                              • 10. Owner's rights
                                                                                • 11. Nonduplication and coordination of benefits
                                                                                  • 12. Workers Compensation
                                                                                    - Social Insurance
                                                                                    • 1. Medicare Parts A, B, C, and D
                                                                                      • 2. Medicaid
                                                                                        • 3. Social Security benefits
                                                                                          - Policy Provisions, Clauses, and Riders
                                                                                          • 1. Riders
                                                                                            • Impairment and exclusions
                                                                                            • Guaranteed insurability
                                                                                            • Future increase option
                                                                                          • 2. 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
                                                                                          • 3. Rights of renewability
                                                                                            • Noncancelable
                                                                                            • Cancelable
                                                                                            • Guaranteed renewable
                                                                                          • 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. Submitting application and initial premium to company for underwriting
                                                                                            • 2. Policy delivery
                                                                                              • 3. Initial premium payment and receipt
                                                                                                • 4. Completing the application
                                                                                                  • 5. Explaining policy provisions, riders, exclusions, and ratings
                                                                                                    • 6. Contract law
                                                                                                      • Elements of a contract
                                                                                                      • Insurable interest
                                                                                                      • Warranties and representations
                                                                                                      • Unique aspects of the insurance contract
                                                                                                    • 7. Replacement
                                                                                                      • 8. Sources of insurability and HIPAA privacy information
                                                                                                        - Types of Policies
                                                                                                        • 1. Medicare supplement policies
                                                                                                          • 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. Group insurance
                                                                                                              • Differences between individual and group contracts
                                                                                                              • General characteristics
                                                                                                              • COBRA

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. Which person is the measuring life whose survival determines the timing and duration of annuity payments?

                                                                                                            A) Beneficiary
                                                                                                            B) Policyowner
                                                                                                            C) Producer
                                                                                                            D) Annuitant


                                                                                                            2. Which of the following information is included in the Consideration clause in an Accident and Health policy?

                                                                                                            A) Duration of the Grace Period
                                                                                                            B) Explanation of the Contestable periods
                                                                                                            C) Description of the coverage provided
                                                                                                            D) Schedule and amount of premium payments


                                                                                                            3. An applicant submits the first premium with a life insurance application and receives a conditional receipt.
                                                                                                            When does coverage generally become effective?

                                                                                                            A) When the conditions in the receipt are met, including required insurability
                                                                                                            B) Only when the producer promises that coverage exists
                                                                                                            C) Only after the policy has been in force for two years
                                                                                                            D) Immediately, regardless of the applicant's insurability


                                                                                                            4. Which premium-payment mode usually results in the lowest total annual premium cost for the policyowner?

                                                                                                            A) Semiannual
                                                                                                            B) Quarterly
                                                                                                            C) Annual
                                                                                                            D) Monthly


                                                                                                            5. Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member:

                                                                                                            A) ceases to be actively employed
                                                                                                            B) becomes disabled
                                                                                                            C) reaches the age specified in the policy
                                                                                                            D) ceases to fall within the eligible classification


                                                                                                            Solutions:

                                                                                                            Question # 1
                                                                                                            Answer: D
                                                                                                            Question # 2
                                                                                                            Answer: D
                                                                                                            Question # 3
                                                                                                            Answer: A
                                                                                                            Question # 4
                                                                                                            Answer: C
                                                                                                            Question # 5
                                                                                                            Answer: B

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