Exam Code: InsNV_Health02
Exam Name: NV Accident and Health
Certification Provider: Insurance Licensing
Corresponding Certification: Nevada Insurance

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

Section	Weight	Objectives
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance	20%	- Insurance Commissioner 1. Examinations 2. General powers and duties 3. Notice and hearings and penalties - Licensing 1. Suspension, revocation, and refusal of license 2. Name of licensee 3. Termination of license 4. Renewal and continuing education 5. Persons required to be licensed 6. Obtaining a license - Nevada Life and Health Insurance Guaranty Association - Definitions 1. Authorized and unauthorized 2. Insurer 3. Domestic, foreign, and alien 4. Cost-sharing 5. Certificate of authority 6. Premiums 7. Transacting insurance - Marketing Practices 1. Affordable Care Act 2. Fiduciary responsibilities 3. Commissions and payment restrictions 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. Required records and record retention
Accident & Health – General Knowledge	50%	- Field Underwriting Procedures 1. Submitting application and initial premium to company for underwriting 2. Contract law Elements of a contract Insurable interest Warranties and representations Unique aspects of the insurance contract 3. Completing the application 4. Replacement 5. Policy delivery 6. Initial premium payment and receipt 7. Sources of insurability and HIPAA privacy information 8. Explaining policy provisions, riders, exclusions, and ratings - Other Insurance Concepts 1. Primary and contingent beneficiaries 2. Workers Compensation 3. Modes of premium payments 4. Occupational vs. non-occupational 5. Managed care 6. Nonduplication and coordination of benefits 7. Owner's rights 8. Subrogation 9. Tax treatment of premiums and proceeds of insurance contracts 10. Cost containment 11. Total, partial, recurrent, and residual disability 12. Dependent children 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. Disability income Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policy 3. Individual and Group Long Term Care Eligibility Levels of care 4. Accidental death and dismemberment 5. Group insurance Differences between individual and group contracts General characteristics COBRA 6. Medicare supplement policies 7. 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 - Social Insurance 1. Medicare Parts A, B, C, and D 2. Social Security benefits 3. Medicaid - Policy Provisions, Clauses, and Riders 1. 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 2. Riders Impairment and exclusions Guaranteed insurability Future increase option 3. Rights of renewability Noncancelable Cancelable Guaranteed renewable 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
Nevada Statutes and Codes Pertinent to Health Insurance Only	14%	- Long Term Care - Coverage for reconstructive surgery - 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 - Medicare 1. Medicare supplement regulation 2. Medicare Advantage Plans 3. Prescription Drug Plan - Availability of coverage for mental health and treatment of alcohol abuse and drug abuse - Hospice care
Nevada Statutes and Codes Common to Life and Health Insurance Only	4%	- Credit life and health insurance - Group life and health insurance 1. Eligible groups 2. Required provisions - Advertising

Insurance Licensing NV Accident and Health Sample Questions:

Question #1

A long-term-care policy commonly becomes eligible to pay benefits when the insured is certified as chronically ill because the insured:

A. Cannot perform at least two activities of daily living without substantial assistance
B. Has missed one premium payment
C. Has reached age 65
D. Is unemployed for 30 days

Reveal Solution Discussion 0

Correct Answer: A 🗳️