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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

Insurance Licensing NV Accident and Health Sample Questions:

1. All insurance companies and producers who sell Group Life or Accident and Health policies in Nevada MUST:

A) obtain a receipt when delivering individual certificates to insureds
B) notify the Commissioner when individual certificates have been issued
C) deliver to the policyholder individual certificates for all insureds
D) deliver a policy to each insured member of a group

2. A full-time employee who is suffering from chronic kidney failure and requires dialysis is eligible for medical coverage under which of the following plans?

A) Workers ' Compensation
B) Medicaid
C) Social Security Disability benefits
D) Medicare

3. Which of the following is true regarding Medicare Advantage Plans?

A) Prescription drug coverage mandates generics only
B) Vision and dental coverage is mandated.
C) For many enrollee ' s deductible or coinsurance payments are reduced or eliminated
D) The enrollee may opt out of a preventative health care program and receive a reduced premium

4. An Outline of Coverage for Medicare Supplement policies must be provided to a prospective insured at which of the following times?

A) When the premium is paid
B) When the policy is delivered
C) At the time a claim is submitted
D) At the time of application

5. An incorporated licensee who seeks to do business under a fictitious name is required to file a document about the name with the:

A) Nevada Insurance Commissioner
B) National Association of Insurance and Financial Advisors
C) Nevada Attorney General ' s office
D) National Association of Health Underwriters

Solutions:

Question # 1
Answer: C

Question # 2
Answer: D

Question # 3
Answer: C

Question # 4
Answer: D

Question # 5
Answer: A