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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Topic 1: Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Marketing Practices 1. Required records and record retention 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. Affordable Care Act 5. Commissions and payment restrictions 6. Fiduciary responsibilities - Nevada Life and Health Insurance Guaranty Association - Definitions 1. Cost-sharing 2. Certificate of authority 3. Authorized and unauthorized 4. Insurer 5. Domestic, foreign, and alien 6. Transacting insurance 7. Premiums - Insurance Commissioner 1. Notice and hearings and penalties 2. General powers and duties 3. Examinations - Licensing 1. Persons required to be licensed 2. Obtaining a license 3. Termination of license 4. Name of licensee 5. Suspension, revocation, and refusal of license 6. Renewal and continuing education
Topic 2: Accident & Health – General Knowledge	50%	- 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. 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. Rights of renewability Noncancelable Cancelable Guaranteed renewable 4. Riders Impairment and exclusions Guaranteed insurability Future increase option - Field Underwriting Procedures 1. Explaining policy provisions, riders, exclusions, and ratings 2. Replacement 3. Policy delivery 4. Initial premium payment and receipt 5. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 6. Completing the application 7. Submitting application and initial premium to company for underwriting 8. Sources of insurability and HIPAA privacy information - Social Insurance 1. Social Security benefits 2. Medicaid 3. Medicare Parts A, B, C, and D - Other Insurance Concepts 1. Workers Compensation 2. Occupational vs. non-occupational 3. Primary and contingent beneficiaries 4. Nonduplication and coordination of benefits 5. Cost containment 6. Managed care 7. Dependent children benefits 8. Owner's rights 9. Total, partial, recurrent, and residual disability 10. Modes of premium payments 11. Tax treatment of premiums and proceeds of insurance contracts 12. Subrogation - 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. Accidental death and dismemberment 3. Individual and Group Long Term Care Eligibility Levels of care 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
Topic 3: Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Credit life and health insurance - Group life and health insurance 1. Required provisions 2. Eligible groups - Advertising
Topic 4: Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Medicare 1. Medicare Advantage Plans 2. Medicare supplement regulation 3. Prescription Drug Plan - 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 preventive healthcare services 2. Coverage for newborn children 3. Coverage for physical handicap or intellectual disability for dependent children - Hospice care - Long Term Care

Insurance Licensing NV Accident and Health Sample Questions:

1. An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for:

A) other disability policies already in force
B) the spouse ' s occupation
C) marital status and occupation
D) medical history

2. Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?

A) A newspaper corporation
B) A church
C) A volunteer fire department
D) A family

3. When must insurable interest generally exist in a life insurance transaction?

A) At the time the policy is issued
B) Only when the death benefit is paid
C) Only after the policy has been in force for two years
D) Only when the beneficiary is changed

4. 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) 1
B) 5
C) 7
D) 3

5. Which of the following information is included in the Consideration clause in an Accident and Health policy?

A) Description of the coverage provided
B) Explanation of the Contestable periods
C) Duration of the Grace Period
D) Schedule and amount of premium payments

Solutions:

Question # 1
Answer: B

Question # 2
Answer: D

Question # 3
Answer: A

Question # 4
Answer: D

Question # 5
Answer: D

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