High Quality Of NV Accident and Health Exam

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

Insurance Licensing NV Accident and Health Sample Questions:

Question #1
A life policy lapses because a premium was not paid. To reinstate the policy, the insurer will generally require all of the following EXCEPT:

A. Evidence of insurability
B. A new medical examination in every case
C. Reinstatement within the policy's permitted time limit
D. Payment of overdue premiums with interest

Question #2
The Affordable Care Act (ACA) requires every individual policy to provide minimum coverages known as:

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

Question #3
The Nevada Life and Health Insurance Guaranty Association becomes involved in an insurance company ' s affairs when the company:

A. enters a lawsuit against a claimant
B. withdraws as an Association member
C. denies a claim
D. becomes insolvent

Question #4
Which feature most clearly distinguishes a health maintenance organization (HMO) from a traditional indemnity health insurance plan?

A. The HMO pays only after the insured satisfies a cash-value requirement.
B. The HMO commonly uses a provider network and coordinates care through managed-care rules.
C. The HMO always reimburses any provider at the same level.
D. The HMO provides only disability-income benefits.

Question #5
Which of the following groups is NOT eligible to purchase blanket health insurance to cover its members for a specific event or activity?

A. A family
B. A volunteer fire department
C. A newspaper corporation
D. A church

Solutions:

Question #1
Correct Answer: B

Question #2
Correct Answer: C

Question #3
Correct Answer: D

Question #4
Correct Answer: B

Question #5
Correct Answer: A

Insurance Licensing NV Accident and Health : InsNV_Health02

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