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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. The commission for the placement of nonadmitted insurance is paid by the insurer to the:

                                                                                                            A) surplus lines broker
                                                                                                            B) Division of Insurance
                                                                                                            C) third-party claimant
                                                                                                            D) policyholder


                                                                                                            2. Which of the following situations describes a representation?

                                                                                                            A) A prospect ' s statement on an application that is held to be absolutely true
                                                                                                            B) A prospect ' s statement on an application that is held to be substantially true
                                                                                                            C) An insurance company guarantees that policy benefits will be paid promptly on receipt of a Proof of Loss
                                                                                                            D) An insurance company guarantees that premiums paid will be refunded within 30 days after the policy ' s effective date if an insured is dissatisfied with the policy


                                                                                                            3. A client needs a $250,000 death benefit for exactly 20 years to protect a home mortgage. The client wants the lowest practical initial premium and does not need cash-value accumulation. Which policy is most appropriate?

                                                                                                            A) Whole life insurance
                                                                                                            B) Level term life insurance
                                                                                                            C) Variable life insurance
                                                                                                            D) Universal life insurance


                                                                                                            4. Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?

                                                                                                            A) 15 days
                                                                                                            B) 30 days
                                                                                                            C) 31 days
                                                                                                            D) 45 days


                                                                                                            5. J and K are married and have several children. J is the primary beneficiary on K ' s Accidental Death and Dismemberment (AD & D) policy, and K ' s sibling, L, is the contingent beneficiary. J, K, and L are involved in a train accident, and K and L are killed instantly. The Accidental Death benefits will be paid to:

                                                                                                            A) K ' s estate
                                                                                                            B) L ' s estate
                                                                                                            C) J and K ' s estate
                                                                                                            D) J only


                                                                                                            Solutions:

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

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