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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                                                                            Insurance Licensing NV Accident and Health Sample Questions:

                                                                                                            1. A person insured under a policy of Long Term Care insurance issued pursuant to a direct response solicitation has how many days after delivery to return the policy for a full refund?

                                                                                                            A) Forty-five days
                                                                                                            B) Sixty days
                                                                                                            C) Ten days
                                                                                                            D) Thirty days


                                                                                                            2. The Nevada Life and Health Insurance Guaranty Association is financed by which of the following methods?

                                                                                                            A) Assessing a premium tax
                                                                                                            B) Assessing insureds
                                                                                                            C) Assessing agent association members
                                                                                                            D) Assessing member insurance companies


                                                                                                            3. In a cross-purchase buy-sell agreement funded by life insurance, who typically owns the policy on each business owner?

                                                                                                            A) Each owner owns policies on the other owners.
                                                                                                            B) The producer owns the policy until death occurs.
                                                                                                            C) The insured owner's children own the policy.
                                                                                                            D) The business entity owns every policy.


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

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


                                                                                                            5. A client needs a $250,000 death benefit for exactly 20 years to protect a home mortgage. The client wants the lowest practical initial premium and does not need cash-value accumulation. Which policy is most appropriate?

                                                                                                            A) Whole life insurance
                                                                                                            B) Level term life insurance
                                                                                                            C) Variable life insurance
                                                                                                            D) Universal life insurance


                                                                                                            Solutions:

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

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