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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            Question 1

                                                                                                            Group health policies MUST provide which of the following benefits?

                                                                                                            A. Adult dental care
                                                                                                            B. Hospice care
                                                                                                            C. Cosmetic surgery
                                                                                                            D. Adult vision care


                                                                                                            Question 2

                                                                                                            Basic cancer plans pay for all of the following EXCEPT:

                                                                                                            A. physical therapy
                                                                                                            B. chemotherapy
                                                                                                            C. radiotherapy
                                                                                                            D. immunotherapy


                                                                                                            Question 3

                                                                                                            An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?

                                                                                                            A. The employer must personally pay the former employee's beneficiary.
                                                                                                            B. The amount that could have been converted is payable under the group policy.
                                                                                                            C. No benefit is payable because the employee did not submit an application.
                                                                                                            D. Only any accumulated cash value is payable.


                                                                                                            Question 4

                                                                                                            Which Medicare part generally helps cover inpatient hospital care, skilled nursing facility care following a qualifying hospital stay, hospice care, and certain home health services?

                                                                                                            A. Medicare Part D
                                                                                                            B. Medicare Part B
                                                                                                            C. Medicare Part C
                                                                                                            D. Medicare Part A


                                                                                                            Question 5

                                                                                                            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. rebating
                                                                                                            C. coercion
                                                                                                            D. twisting


                                                                                                            Solutions:

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

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