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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. A Long-Term Care policy provides coverage for:

                                                                                                            A) hospital expenses
                                                                                                            B) medical expenses
                                                                                                            C) custodial care in a nursing home
                                                                                                            D) Medicare Supplement coverage


                                                                                                            2. Under federal law, a tax exempt Health Savings Account can only be opened for an individual who is:

                                                                                                            A) covered by a qualified High Deductible Health Plan
                                                                                                            B) entitled to Medicare benefits
                                                                                                            C) eligible to be claimed as a dependent on another person ' s tax return
                                                                                                            D) covered by Long Term Care Insurance


                                                                                                            3. A whole life policyowner stops paying premiums and chooses to use the policy's cash value to purchase the same face amount of insurance for as long as that cash value will buy. Which nonforfeiture option was selected?

                                                                                                            A) Automatic premium loan
                                                                                                            B) Cash surrender
                                                                                                            C) Extended term insurance
                                                                                                            D) Reduced paid-up insurance


                                                                                                            4. Basic cancer plans pay for all of the following EXCEPT:

                                                                                                            A) immunotherapy
                                                                                                            B) chemotherapy
                                                                                                            C) radiotherapy
                                                                                                            D) physical therapy


                                                                                                            5. An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may:

                                                                                                            A) increase the waiting period to adjust for the occupational difference
                                                                                                            B) increase the deductible to adjust for the occupational difference
                                                                                                            C) deny any claim on the basis of misrepresentation
                                                                                                            D) adjust benefits to the amount the premium provides for the new occupation


                                                                                                            Solutions:

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

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