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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. What is the principal purpose of Medicare supplement insurance?

                                                                                                            A) To pay only long-term custodial care
                                                                                                            B) To provide Medicaid eligibility
                                                                                                            C) To help pay certain deductibles, coinsurance, and other gaps in Original Medicare
                                                                                                            D) To replace Medicare Part A and Part B entirely


                                                                                                            2. A producer who makes misleading policy comparisons for the purpose of inducing an insured to surrender an existing policy is guilty of:

                                                                                                            A) coercion
                                                                                                            B) twisting
                                                                                                            C) rebating
                                                                                                            D) defamation


                                                                                                            3. For a group health plan subject to the federal waiting-period rule, the waiting period for otherwise eligible employees generally may not exceed:

                                                                                                            A) 60 calendar days
                                                                                                            B) 30 calendar days
                                                                                                            C) 90 calendar days
                                                                                                            D) 180 calendar days


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


                                                                                                            5. If coverage has stayed in force with the same insurance company, what is the maximum number of years for which reconstructive surgery (mastectomy) benefits must be provided?

                                                                                                            A) 5
                                                                                                            B) 3
                                                                                                            C) 1
                                                                                                            D) 7


                                                                                                            Solutions:

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

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