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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. As a condition to granting a loan, a creditor can:

                                                                                                            A) require insurance in an amount greater than the debt
                                                                                                            B) accept assignment from an existing policy
                                                                                                            C) assess a higher interest rate if insurance is not purchased
                                                                                                            D) require insurance coverage through a specific insurer


                                                                                                            2. Which of the following statements is generally CORRECT about a major medical policy?

                                                                                                            A) It provides benefits for in-hospital expenses only, subject to policy limits.
                                                                                                            B) It contains more limitations than a Basic Hospital, Medical, or Surgical policy.
                                                                                                            C) It provides benefits for reasonable and necessary medical expenses, subject to policy limits.
                                                                                                            D) It contains a 30-day Elimination period for losses due to sickness.


                                                                                                            3. Which of the following statements is correct about the Coordination of Benefits provision?

                                                                                                            A) It prevents an insured covered by two health plans from making a profit on a covered loss.
                                                                                                            B) It allows an insured to change insurers without losing benefits.
                                                                                                            C) It prohibits an insurer from selling a health policy to an applicant who already has similar coverage.
                                                                                                            D) It permits an insurer to defer paying a claim for a work-related injury until Workers ' Compensation Benefits have expired.


                                                                                                            4. Under a Disability policy, the Elimination period is:

                                                                                                            A) usually longer for accidents than for sickness
                                                                                                            B) similar to a deductible but expressed in terms of time rather than dollars
                                                                                                            C) the same as a Probationary period
                                                                                                            D) predetermined by the insurance company


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

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


                                                                                                            Solutions:

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

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