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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Advertising
- Group life and health insurance
  • 1. Required provisions
    • 2. Eligible groups
      - Credit life and health insurance
      Accident & Health – General Knowledge50%- Types of Policies
      • 1. Medicare supplement policies
        • 2. Group insurance
          • Differences between individual and group contracts
          • General characteristics
          • COBRA
        • 3. Individual and Group Long Term Care
          • Eligibility
          • Levels of care
        • 4. Disability income
          • Individual disability income policy
          • Business overhead expense policy
          • Business disability buyout policy
          • Group disability income policy
          • Key employee policy
        • 5. Accidental death and dismemberment
          • 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. Other policies
            • Dental
            • Vision
            • Cancer
            • Critical illness or specified disease
            • Worksite employer-sponsored
            • Hospital indemnity
            • Short-term medical
            • Accident
          - Field Underwriting Procedures
          • 1. Explaining policy provisions, riders, exclusions, and ratings
            • 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. Completing the application
                • 5. Policy delivery
                  • 6. Submitting application and initial premium to company for underwriting
                    • 7. Sources of insurability and HIPAA privacy information
                      • 8. Replacement
                        - Social Insurance
                        • 1. Medicare Parts A, B, C, and D
                          • 2. Social Security benefits
                            • 3. Medicaid
                              - Other Insurance Concepts
                              • 1. Primary and contingent beneficiaries
                                • 2. Dependent children benefits
                                  • 3. Workers Compensation
                                    • 4. Modes of premium payments
                                      • 5. Nonduplication and coordination of benefits
                                        • 6. Total, partial, recurrent, and residual disability
                                          • 7. Occupational vs. non-occupational
                                            • 8. Managed care
                                              • 9. Cost containment
                                                • 10. Owner's rights
                                                  • 11. Subrogation
                                                    • 12. Tax treatment of premiums and proceeds of insurance contracts
                                                      - 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
                                                      Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Long Term Care
                                                      - Coverage for reconstructive surgery
                                                      - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
                                                      - 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
                                                            - Medicare
                                                            • 1. Medicare supplement regulation
                                                              • 2. Prescription Drug Plan
                                                                • 3. Medicare Advantage Plans
                                                                  - Hospice care
                                                                  Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Licensing
                                                                  • 1. Persons required to be licensed
                                                                    • 2. Termination of license
                                                                      • 3. Name of licensee
                                                                        • 4. Obtaining a license
                                                                          • 5. Renewal and continuing education
                                                                            • 6. Suspension, revocation, and refusal of license
                                                                              - Insurance Commissioner
                                                                              • 1. General powers and duties
                                                                                • 2. Notice and hearings and penalties
                                                                                  • 3. Examinations
                                                                                    - Marketing Practices
                                                                                    • 1. Commissions and payment restrictions
                                                                                      • 2. Required records and record retention
                                                                                        • 3. Affordable Care Act
                                                                                          • 4. Unfair practices
                                                                                            • Unfair claims methods and practices and settlement of claims
                                                                                            • Rebating and inducement
                                                                                            • Twisting
                                                                                            • Misrepresentation
                                                                                            • Fraud
                                                                                            • Unfair discrimination
                                                                                            • Defamation
                                                                                          • 5. Fiduciary responsibilities
                                                                                            • 6. Silver State Health Insurance Exchange
                                                                                              - Definitions
                                                                                              • 1. Transacting insurance
                                                                                                • 2. Authorized and unauthorized
                                                                                                  • 3. Cost-sharing
                                                                                                    • 4. Insurer
                                                                                                      • 5. Domestic, foreign, and alien
                                                                                                        • 6. Certificate of authority
                                                                                                          • 7. Premiums
                                                                                                            - Nevada Life and Health Insurance Guaranty Association

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?

                                                                                                            A) 30 days
                                                                                                            B) 15 days
                                                                                                            C) 31 days
                                                                                                            D) 45 days


                                                                                                            2. J and K are married and have several children. J is the primary beneficiary on K ' s Accidental Death and Dismemberment (AD & D) policy, and K ' s sibling, L, is the contingent beneficiary. J, K, and L are involved in a train accident, and K and L are killed instantly. The Accidental Death benefits will be paid to:

                                                                                                            A) J and K ' s estate
                                                                                                            B) L ' s estate
                                                                                                            C) J only
                                                                                                            D) K ' s estate


                                                                                                            3. Group vision insurance plans typically provide insurance benefits that cover the cost of:

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


                                                                                                            4. A producer receives a phone call from an insured who already has health insurance and now wants to buy an Accidental Death and Dismemberment (AD & D) policy. In this situation, the producer should take which of the following actions?

                                                                                                            A) Fill out the application by phone interview with the prospect, and obtain the prospect ' s signature after the company approves the application.
                                                                                                            B) Meet with the prospect, ask the prospect to complete the application, and have the prospect sign the application.
                                                                                                            C) Mail the application to the prospect and request that the prospect complete it, sign it, and return it to the insurance company.
                                                                                                            D) Answer the routine application questions, meet with the prospect to obtain any additional information, and have the prospect sign the application.


                                                                                                            5. What is the primary purpose of a waiver-of-premium rider on a life insurance policy?

                                                                                                            A) It converts term insurance automatically into whole life insurance.
                                                                                                            B) It eliminates all future policy loans.
                                                                                                            C) It guarantees a higher death benefit every year.
                                                                                                            D) It waives required premiums if the insured becomes totally disabled as defined by the rider.


                                                                                                            Solutions:

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

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