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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. Which feature is most characteristic of universal life insurance?

                                                                                                            A) Coverage that can never build cash value
                                                                                                            B) Investment risk borne entirely by the insurer in a separate account
                                                                                                            C) A fixed premium and fixed death benefit with no flexibility
                                                                                                            D) Flexible premiums and adjustable death-benefit options, subject to policy requirements


                                                                                                            2. Which policy is designed to pay benefits upon diagnosis or treatment of a specifically named illness, such as cancer?

                                                                                                            A) Major medical insurance
                                                                                                            B) Group term life insurance
                                                                                                            C) Credit disability insurance
                                                                                                            D) Specified disease insurance


                                                                                                            3. An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:

                                                                                                            A) increase the deductible to adjust for the occupational difference
                                                                                                            B) increase the waiting period to adjust for the occupational difference
                                                                                                            C) deny any claim on the basis of misrepresentation
                                                                                                            D) adjust benefits to the amount the premium provides for the new occupation


                                                                                                            4. Under a Medicare Supplement policy that is issued in response to a direct solicitation, a policyowner may return the policy to the insurance company for a full premium refund within a MAXIMUM of how many days?

                                                                                                            A) Thirty
                                                                                                            B) Ten
                                                                                                            C) Forty-five
                                                                                                            D) Sixty


                                                                                                            5. An insured purchases a rider that pays an additional amount only if death results from a covered accident.
                                                                                                            This rider is best described as:

                                                                                                            A) A return-of-premium rider
                                                                                                            B) A cost-of-living rider
                                                                                                            C) An accidental death benefit rider
                                                                                                            D) A guaranteed-insurability rider


                                                                                                            Solutions:

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

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