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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            Which of the following policies provides a specified income benefit when the insured person becomes unable to work because of illness or accident?

                                                                                                            • A. Temporary Income
                                                                                                            • B. Disability Income
                                                                                                            • C. Emergency Income
                                                                                                            • D. Supplemental Income
                                                                                                            Reveal Solution  Discussion  0

                                                                                                            Correct Answer: B  🗳️

                                                                                                            Explanation: Only visible for ActualVCE members. You can sign-up / login (it's free).

                                                                                                            Under the Affordable Care Act (ACA), for a woman 40 years or older, mammograms are:

                                                                                                            • A. covered under preventative services annually at no cost
                                                                                                            • B. covered under only health plans that offer mammogram coverage
                                                                                                            • C. not covered if a family member has been formally diagnosed with breast cancer
                                                                                                            • D. not covered under the rules of ACA because mammograms are not considered preventative health care
                                                                                                            Reveal Solution  Discussion  0

                                                                                                            Correct Answer: A  🗳️

                                                                                                            Explanation: Only visible for ActualVCE members. You can sign-up / login (it's free).

                                                                                                            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
                                                                                                            Reveal Solution  Discussion  0

                                                                                                            Correct Answer: B  🗳️

                                                                                                            Explanation: Only visible for ActualVCE members. You can sign-up / login (it's free).

                                                                                                            A Major Medical policy insured is injured in an auto collision during a police chase. The occupants in the police car are killed. The insured is convicted of reckless driving and manslaughter. If the insured files a claim, the insurance company will MOST likely take which of the following actions?

                                                                                                            • A. Pay full benefits
                                                                                                            • B. Deny the claim and return the premiums paid
                                                                                                            • C. Pay partial benefits
                                                                                                            • D. Deny the claim only
                                                                                                            Reveal Solution  Discussion  0

                                                                                                            Correct Answer: A  🗳️

                                                                                                            Explanation: Only visible for ActualVCE members. You can sign-up / login (it's free).

                                                                                                            An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:

                                                                                                            • A. reinstate the policy and then pay the claim
                                                                                                            • B. pay the claim but deduct the unpaid premium
                                                                                                            • C. deny the claim
                                                                                                            • D. cancel the policy and return all premiums paid
                                                                                                            Reveal Solution  Discussion  0

                                                                                                            Correct Answer: B  🗳️

                                                                                                            Explanation: Only visible for ActualVCE members. You can sign-up / login (it's free).

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