Exam Code: InsNV_Health02
Exam Name: NV Accident and Health
Certification Provider: Insurance Licensing
Corresponding Certification: Nevada Insurance

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

Insurance Licensing NV Accident and Health Sample Questions:

Question #1

Which of the following statements is CORRECT about the Medicaid program?

A. The program is administered at the federal level.
B. It provides medical assistance for participants who are blind.
C. It is supplemented by Medicare for persons 62 years of age or older.
D. Participants must be at least 55 years of age.

Reveal Solution Discussion 0

Correct Answer: B 🗳️