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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. In a cross-purchase buy-sell agreement funded by life insurance, who typically owns the policy on each business owner?

                                                                                                            A) The insured owner's children own the policy.
                                                                                                            B) Each owner owns policies on the other owners.
                                                                                                            C) The producer owns the policy until death occurs.
                                                                                                            D) The business entity owns every policy.


                                                                                                            2. Which feature most clearly distinguishes a health maintenance organization (HMO) from a traditional indemnity health insurance plan?

                                                                                                            A) The HMO provides only disability-income benefits.
                                                                                                            B) The HMO always reimburses any provider at the same level.
                                                                                                            C) The HMO pays only after the insured satisfies a cash-value requirement.
                                                                                                            D) The HMO commonly uses a provider network and coordinates care through managed-care rules.


                                                                                                            3. Which statement best describes a preferred provider organization (PPO)?

                                                                                                            A) It has no deductible, coinsurance, or utilization-management features.
                                                                                                            B) It generally provides greater benefits when members use participating providers but may allow nonnetwork care at a reduced benefit level.
                                                                                                            C) It pays only a fixed daily hospital benefit.
                                                                                                            D) It requires all care to be obtained only from government hospitals.


                                                                                                            4. Under a life insurance policy with a revocable beneficiary designation, who normally has the authority to change the beneficiary?

                                                                                                            A) The policyowner
                                                                                                            B) The insurer
                                                                                                            C) The beneficiary
                                                                                                            D) The insured, regardless of ownership


                                                                                                            5. 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) medical history
                                                                                                            C) marital status and occupation
                                                                                                            D) the spouse ' s occupation


                                                                                                            Solutions:

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

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