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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

Insurance Licensing NV Accident and Health Sample Questions:

Question #1

Which of the following is NOT a preventive benefit for adults?

A. Mammograms
B. High blood pressure screening
C. Skin cancer screening
D. Physical therapy

Reveal Solution Discussion 0

Correct Answer: C 🗳️