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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Accident & Health – General Knowledge50%- Other Insurance Concepts
  • 1. Nonduplication and coordination of benefits
    • 2. Primary and contingent beneficiaries
      • 3. Subrogation
        • 4. Owner's rights
          • 5. Cost containment
            • 6. Occupational vs. non-occupational
              • 7. Total, partial, recurrent, and residual disability
                • 8. Managed care
                  • 9. Dependent children benefits
                    • 10. Workers Compensation
                      • 11. Modes of premium payments
                        • 12. Tax treatment of premiums and proceeds of insurance contracts
                          - 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. Rights of renewability
                            • Noncancelable
                            • Cancelable
                            • Guaranteed renewable
                          • 3. Riders
                            • Impairment and exclusions
                            • Guaranteed insurability
                            • Future increase option
                          • 4. 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
                          - Field Underwriting Procedures
                          • 1. Replacement
                            • 2. Initial premium payment and receipt
                              • 3. Explaining policy provisions, riders, exclusions, and ratings
                                • 4. Contract law
                                  • Elements of a contract
                                  • Insurable interest
                                  • Warranties and representations
                                  • Unique aspects of the insurance contract
                                • 5. Completing the application
                                  • 6. Policy delivery
                                    • 7. Submitting application and initial premium to company for underwriting
                                      • 8. Sources of insurability and HIPAA privacy information
                                        - Types of Policies
                                        • 1. Group insurance
                                          • Differences between individual and group contracts
                                          • General characteristics
                                          • COBRA
                                        • 2. Medicare supplement policies
                                          • 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. 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. Other policies
                                              • Dental
                                              • Vision
                                              • Cancer
                                              • Critical illness or specified disease
                                              • Worksite employer-sponsored
                                              • Hospital indemnity
                                              • Short-term medical
                                              • Accident
                                            - Social Insurance
                                            • 1. Social Security benefits
                                              • 2. Medicare Parts A, B, C, and D
                                                • 3. Medicaid
                                                  Nevada Statutes and Codes Common to Life and Health Insurance Only4%- Credit life and health insurance
                                                  - Advertising
                                                  - Group life and health insurance
                                                  • 1. Required provisions
                                                    • 2. Eligible groups
                                                      Nevada Statutes and Codes Pertinent to Health Insurance Only14%- Coverage for reconstructive surgery
                                                      - Long Term Care
                                                      - Hospice care
                                                      - Medicare
                                                      • 1. Medicare Advantage Plans
                                                        • 2. Prescription Drug Plan
                                                          • 3. Medicare supplement regulation
                                                            - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse
                                                            - Mandatory policy clauses and provisions
                                                            • 1. Coverage for newborn children
                                                              • 2. Coverage for physical handicap or intellectual disability for dependent children
                                                                • 3. Coverage for preventive healthcare services
                                                                  Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- Marketing Practices
                                                                  • 1. Commissions and payment restrictions
                                                                    • 2. Required records and record retention
                                                                      • 3. Unfair practices
                                                                        • Unfair claims methods and practices and settlement of claims
                                                                        • Rebating and inducement
                                                                        • Twisting
                                                                        • Misrepresentation
                                                                        • Fraud
                                                                        • Unfair discrimination
                                                                        • Defamation
                                                                      • 4. Fiduciary responsibilities
                                                                        • 5. Affordable Care Act
                                                                          • 6. Silver State Health Insurance Exchange
                                                                            - Nevada Life and Health Insurance Guaranty Association
                                                                            - Insurance Commissioner
                                                                            • 1. Notice and hearings and penalties
                                                                              • 2. Examinations
                                                                                • 3. General powers and duties
                                                                                  - Definitions
                                                                                  • 1. Certificate of authority
                                                                                    • 2. Authorized and unauthorized
                                                                                      • 3. Cost-sharing
                                                                                        • 4. Transacting insurance
                                                                                          • 5. Domestic, foreign, and alien
                                                                                            • 6. Premiums
                                                                                              • 7. Insurer
                                                                                                - Licensing
                                                                                                • 1. Persons required to be licensed
                                                                                                  • 2. Obtaining a license
                                                                                                    • 3. Renewal and continuing education
                                                                                                      • 4. Termination of license
                                                                                                        • 5. Name of licensee
                                                                                                          • 6. Suspension, revocation, and refusal of license

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. Which statement best describes a group life conversion privilege?

                                                                                                            A) It allows the employer to convert all employees into beneficiaries.
                                                                                                            B) It transfers the employee's group policy cash value to a retirement account.
                                                                                                            C) It allows an insured leaving the group to obtain individual coverage without evidence of insurability, subject to the policy terms.
                                                                                                            D) It guarantees that the group premium will never increase.


                                                                                                            2. What is the principal purpose of Medicare supplement insurance?

                                                                                                            A) To pay only long-term custodial care
                                                                                                            B) To provide Medicaid eligibility
                                                                                                            C) To help pay certain deductibles, coinsurance, and other gaps in Original Medicare
                                                                                                            D) To replace Medicare Part A and Part B entirely


                                                                                                            3. Which statement is true of a variable life insurance policy?

                                                                                                            A) The cash value is held only in the insurer's general account.
                                                                                                            B) The policy is always a temporary term policy.
                                                                                                            C) The policyowner bears no investment risk.
                                                                                                            D) The cash value may fluctuate with separate-account investment performance.


                                                                                                            4. Life insurance death proceeds paid to a named beneficiary are generally:

                                                                                                            A) Subject to ordinary federal income tax in every case
                                                                                                            B) Received free of federal income tax, subject to exceptions and special circumstances
                                                                                                            C) Taxed as capital gains
                                                                                                            D) Treated as a deductible premium refund


                                                                                                            5. What is the primary purpose of a waiver-of-premium rider on a life insurance policy?

                                                                                                            A) It guarantees a higher death benefit every year.
                                                                                                            B) It waives required premiums if the insured becomes totally disabled as defined by the rider.
                                                                                                            C) It eliminates all future policy loans.
                                                                                                            D) It converts term insurance automatically into whole life insurance.


                                                                                                            Solutions:

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

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