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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

Insurance Licensing NV Accident and Health Sample Questions:

Question 1

Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member:

A. becomes disabled
B. ceases to fall within the eligible classification
C. ceases to be actively employed
D. reaches the age specified in the policy

Question 2

Under a Disability policy, the Elimination period is:

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

Question 3

Most insurance companies use the usual, customary, and reasonable (UCR) charges to:

A. reimburse the employee for expenses charged by the medical facilities
B. limit the insurance company claims liability
C. reimburse physicians for excess expense
D. pay dollars direct to the employers for health insurance

Question 4

Insurance for the primary purpose of repaying a loan in the event of disability is referred to as:

A. Credit Life and Major Medical policy
B. Loan Repayment policy
C. Guaranteed Asset Protection policy
D. Credit Accident and Health policy

Question 5

A producer aggrieved by any regulation or order of the Insurance Commissioner may request:

A. legislative review of the case
B. an administrative hearing
C. injunctive relief through the Secretary of State
D. peer review of the case

Solutions:

Question 1
Answer: A

Question 2
Answer: B

Question 3
Answer: B

Question 4
Answer: D

Question 5
Answer: B