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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

SectionObjectives
Health Insurance Policy Provisions- Mandatory and Optional Provisions
  • 1. Renewability provisions
    • 2. Policy requirements and clauses
      - Claims and Benefits
      • 1. Claim procedures
        • 2. Benefit determination and payment
          Insurance Basics- Risk Management and Insurance Concepts
          • 1. Types of risk and methods of handling risk
            • 2. Insurance principles and contract characteristics
              - Insurance Contracts
              • 1. Contract elements
                • 2. Policy provisions, riders, and exclusions
                  Government Health Insurance Programs- Medicaid and Other Programs
                  • 1. Medicaid eligibility and coverage
                    - Medicare
                    • 1. Medicare supplement insurance
                      • 2. Medicare parts and eligibility
                        General Insurance Regulation- Licensing Requirements and Responsibilities
                        • 1. Producer licensing requirements
                          • 2. Continuing education and license maintenance
                            - Nevada Insurance Department and Regulatory Authority
                            • 1. Commissioner of Insurance powers and duties
                              • 2. Insurance laws, rules, and regulations
                                Accident and Health Insurance Fundamentals- Types of Health Insurance Policies
                                • 1. Managed care plans
                                  • 2. Individual health insurance
                                    • 3. Group health insurance
                                      - Disability Income Insurance
                                      • 1. Disability definitions and benefits
                                        • 2. Elimination periods and benefit periods
                                          - Medical Expense Insurance
                                          • 1. Hospital, surgical, and physician expense coverage
                                            • 2. Major medical plans
                                              Producer Duties and Ethics- Ethical Responsibilities
                                              • 1. Consumer protection requirements
                                                • 2. Fiduciary responsibilities
                                                  - Sales Practices
                                                  • 1. Unfair trade practices
                                                    • 2. Advertising and marketing rules

                                                      Insurance Licensing NV Accident and Health Sample Questions:

                                                      1. Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?

                                                      A) Sue the insurance company for not paying a claim within 30 days after submission of Proof of Loss
                                                      B) Demand binding arbitration if there is disagreement over a claim
                                                      C) Reinstate the policy within 3 years after it lapses
                                                      D) Add a newborn child to the policy without providing proof of insurability


                                                      2. An insurer shall not issue an individual long-term care insurance contract in Nevada unless the insurer has received from the applicant:

                                                      A) a written designation of at least one person, in addition to the applicant, who must receive notice of any lapse or termination of coverage under the policy for nonpayment of premium
                                                      B) a written designation by the applicant to pay premium for long-term care insurance through either a payroll or pension deduction plan
                                                      C) a designation by at least one person, in addition to the applicant, to accept liability for services provided to the applicant
                                                      D) a notarized waiver dated and signed by the applicant stating that the applicant has chosen not to designate another person to receive notice of any lapse or termination of coverage for nonpayment of premium


                                                      3. A life insurance policy owner has paid $1,200 in premiums in six months for a $250,000 policy. The policyowner dies suddenly and the insurer pays the beneficiary $250,000. This exchange of unequal values reflects which of the following insurance contract features?

                                                      A) Unilateral
                                                      B) Aleatory
                                                      C) Personal
                                                      D) Conditional


                                                      4. The Affordable Care Act (ACA) requires every individual policy to provide minimum coverages known as:

                                                      A) Medicaid Buy-Back coverage
                                                      B) Silver Saver Value coverages
                                                      C) Gold Value coverages
                                                      D) Essential Health Benefits


                                                      5. A producer who makes misleading policy comparisons for the purpose of inducing an insured to surrender an existing policy is guilty of:

                                                      A) rebating
                                                      B) defamation
                                                      C) twisting
                                                      D) coercion


                                                      Solutions:

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

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