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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

                                                      Insurance Licensing NV Accident and Health Sample Questions:

                                                      Question 1

                                                      Group coverage for a handicapped dependent child may be continued if the primary insured submits the required proof to the insurance company within what MAXIMUM period of time after the child reaches the limiting age?

                                                      A. 15 days
                                                      B. 31 days
                                                      C. 30 days
                                                      D. 45 days


                                                      Question 2

                                                      An employee's group life coverage terminates because employment ends. During the applicable conversion period, the former employee dies before applying for an individual policy. What protection does Nevada group-life law provide?

                                                      A. Only any accumulated cash value is payable.
                                                      B. No benefit is payable because the employee did not submit an application.
                                                      C. The amount that could have been converted is payable under the group policy.
                                                      D. The employer must personally pay the former employee's beneficiary.


                                                      Question 3

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

                                                      A. The HMO provides only disability-income benefits.
                                                      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 pays only after the insured satisfies a cash-value requirement.


                                                      Question 4

                                                      Nevada insurance laws define a domestic insurance company as one formed under the laws of:

                                                      A. any jurisdiction of the United States of America
                                                      B. the state of Nevada as well as any of its neighboring states
                                                      C. any territory of the United States of America
                                                      D. the state of Nevada only


                                                      Question 5

                                                      Which statement best describes a preferred provider organization (PPO)?

                                                      A. It has no deductible, coinsurance, or utilization-management features.
                                                      B. It requires all care to be obtained only from government hospitals.
                                                      C. It pays only a fixed daily hospital benefit.
                                                      D. It generally provides greater benefits when members use participating providers but may allow nonnetwork care at a reduced benefit level.


                                                      Solutions:

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

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