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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

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

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


                                                                                                            2. Under Nevada law, the definition of " insurer " includes:

                                                                                                            A) a financial planner
                                                                                                            B) a security dealer
                                                                                                            C) an indemnitor
                                                                                                            D) a syndicate


                                                                                                            3. Under a Disability policy, the Elimination period is:

                                                                                                            A) predetermined by the insurance company
                                                                                                            B) the same as a Probationary period
                                                                                                            C) similar to a deductible but expressed in terms of time rather than dollars
                                                                                                            D) usually longer for accidents than for sickness


                                                                                                            4. J and K are married and have several children. J is the primary beneficiary on K ' s Accidental Death and Dismemberment (AD & D) policy, and K ' s sibling, L, is the contingent beneficiary. J, K, and L are involved in a train accident, and K and L are killed instantly. The Accidental Death benefits will be paid to:

                                                                                                            A) J only
                                                                                                            B) J and K ' s estate
                                                                                                            C) L ' s estate
                                                                                                            D) K ' s estate


                                                                                                            5. Nevada insurance laws define a domestic insurance company as one formed under the laws of:

                                                                                                            A) any jurisdiction of the United States of America
                                                                                                            B) any territory of the United States of America
                                                                                                            C) the state of Nevada only
                                                                                                            D) the state of Nevada as well as any of its neighboring states


                                                                                                            Solutions:

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

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