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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionWeightObjectives
Nevada Statutes and Codes Common to Life, Health, Property, and Casualty Insurance20%- 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 Knowledge50%- 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 Common to Life and Health Insurance Only4%- Credit life and health insurance
                                                                                            - Group life and health insurance
                                                                                            • 1. Eligible groups
                                                                                              • 2. Required provisions
                                                                                                - Advertising
                                                                                                Nevada Statutes and Codes Pertinent to Health Insurance Only14%- 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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            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


                                                                                                            2. Under a life insurance policy with a revocable beneficiary designation, who normally has the authority to change the beneficiary?

                                                                                                            A) The beneficiary
                                                                                                            B) The insured, regardless of ownership
                                                                                                            C) The insurer
                                                                                                            D) The policyowner


                                                                                                            3. Which of the following statements is CORRECT about Business Overhead Expense insurance?

                                                                                                            A) It covers eligible expenses for staff only.
                                                                                                            B) It can be obtained only by corporations.
                                                                                                            C) It reimburses the policyowner for loss of income.
                                                                                                            D) It covers eligible expenses for staff, rent, and utilities.


                                                                                                            4. Which statement best describes Medicare Part B?

                                                                                                            A) It is automatic for every person at age 55.
                                                                                                            B) It is Medicaid coverage for low-income individuals.
                                                                                                            C) It is medical insurance and generally requires enrollment and a monthly premium.
                                                                                                            D) It provides only outpatient prescription-drug benefits.


                                                                                                            5. What is the minimum age requirement for a natural person applying for a resident Nevada producer license?

                                                                                                            A) 25 years old
                                                                                                            B) 21 years old
                                                                                                            C) 16 years old
                                                                                                            D) 18 years old


                                                                                                            Solutions:

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

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