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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            Question 1

                                                                                                            In a disability income policy, the elimination period is best described as:

                                                                                                            A. The maximum period for which premiums are waived
                                                                                                            B. The period after disability during which benefits are payable
                                                                                                            C. The waiting period after disability begins before benefits become payable
                                                                                                            D. The period during which the policy cannot be cancelled


                                                                                                            Question 2

                                                                                                            The Nevada Insurance Commissioner may revoke the license of any licensed producer who:

                                                                                                            A. fails to file an annual financial report with the Division of Insurance
                                                                                                            B. fails to notify the Commissioner of a change of address within forty-eight hours
                                                                                                            C. misappropriates monies belonging to policyholders
                                                                                                            D. is found liable by final judgment in a civil case


                                                                                                            Question 3

                                                                                                            After appointing a producer as its agent, when must an insurer generally file its notice of appointment with the Nevada Commissioner?

                                                                                                            A. Before the producer completes any insurance training
                                                                                                            B. Within 90 days after the first premium is collected
                                                                                                            C. Only at the producer's next license renewal
                                                                                                            D. Within 15 days after the contract is executed or the first application is submitted


                                                                                                            Question 4

                                                                                                            For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?

                                                                                                            A. Loss of the spleen due to an accidental injury
                                                                                                            B. Partial paralysis due to a stroke
                                                                                                            C. Loss of life due to a heart attack
                                                                                                            D. Loss of eyesight due to an accidental injury


                                                                                                            Question 5

                                                                                                            A life policy has been in force during the insured's lifetime for more than two years. Which circumstance may still permit the insurer to deny a claim under the policy's incontestability provision?

                                                                                                            A. A change in the insured's occupation after issue
                                                                                                            B. A material misrepresentation unrelated to the policy
                                                                                                            C. An innocent misstatement on the original application
                                                                                                            D. Nonpayment of premium


                                                                                                            Solutions:

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

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