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InsNV_Health02 Pass Test Guide & New Study InsNV_Health02 Questions

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

>> InsNV_Health02 Pass Test Guide <<

Quiz 2026 First-grade Insurance Licensing InsNV_Health02: NV Accident and Health Pass Test Guide

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Insurance Licensing NV Accident and Health Sample Questions (Q77-Q82):

NEW QUESTION # 77
Most insurance companies use the usual, customary, and reasonable (UCR) charges to:

A. pay dollars direct to the employers for health insurance
B. reimburse physicians for excess expense
C. limit the insurance company claims liability
D. reimburse the employee for expenses charged by the medical facilities

Answer: C

Explanation:
Usual, customary, and reasonable charges are payment standards used to determine the portion of a medical charge that a health insurer recognizes as eligible for reimbursement. Choice D is correct because UCR standards limit the insurer's claim liability to an amount considered appropriate for the service in the relevant geographic area. "Usual" refers to the fee commonly charged by a particular provider; "customary" refers to fees generally charged by comparable providers in the area; and "reasonable" considers the circumstances and complexity of the service. If a provider's charge exceeds the plan's allowed amount, the insurer may pay only the UCR amount, and the patient may remain responsible for the difference unless a network agreement or other policy provision prevents balance billing. UCR does not mean that insurers reimburse excess charges, pay funds to employers, or reimburse every amount billed by a medical facility. This concept is tested as a cost-control mechanism within medical expense coverage and should be distinguished from deductibles, coinsurance, copayments, and maximum benefit limits. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Medical Expense Insurance; Usual, Customary, and Reasonable Charges.

NEW QUESTION # 78
Which Medicare part generally helps cover inpatient hospital care, skilled nursing facility care following a qualifying hospital stay, hospice care, and certain home health services?

A. Medicare Part A
B. Medicare Part B
C. Medicare Part D
D. Medicare Part C

Answer: A

Explanation:
Medicare Part A is commonly called hospital insurance. It generally helps cover inpatient hospital care, limited skilled nursing facility care following a qualifying hospital stay, hospice care, and certain home health services. Part A benefits are subject to program rules, benefit periods, deductibles, coinsurance, eligibility conditions, and coverage limitations. It does not mean that every hospital-related service is fully paid.
Medicare Part B is medical insurance. It generally covers physicians' services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Part C, Medicare Advantage, is an alternative way for eligible beneficiaries to receive Medicare-covered benefits through approved private plans. Part D provides outpatient prescription-drug coverage through private plans approved by Medicare.
A producer must understand that Medicare supplements and Medicare Advantage plans coordinate differently with Original Medicare. A Medicare supplement policy is designed to help pay certain deductibles, coinsurance, and other gaps in Original Medicare. A Medicare Advantage plan generally replaces the method of receiving Parts A and B services through a private managed plan rather than functioning as a standard supplement.
The examination focus is the basic division: Part A is primarily hospital-related coverage; Part B is primarily medical and outpatient coverage.
References/topics from the Study Guide: Medicare; Medicare Part A; Medicare Part B; Medicare Advantage; Medicare Supplement Insurance.

NEW QUESTION # 79
A doctor who is receiving Disability Income benefits is not able to return to work full-time but continues practicing on a part-time basis. Which of the following policy features would allow the doctor to continue receiving benefits?

A. A Concurrent Benefit clause
B. A Guaranteed Insurability rider
C. A Residual Benefit clause
D. A Contingent Benefit clause

Answer: C

Explanation:
The correct answer is A. A residual benefit clause permits an insured who has returned to work on a limited basis, but still suffers a loss of income because of disability, to receive partial disability benefits. The doctor is able to practice part-time but cannot resume full-time work, so the disability continues to cause an earnings loss. Residual benefits are intended to encourage rehabilitation and return to productive work without forcing the insured to lose all benefits immediately. The benefit amount is usually tied to the percentage of income lost compared with pre-disability earnings, subject to policy requirements. A contingent benefit clause and concurrent benefit clause are not the standard disability-income provisions that address partial return to work.
A guaranteed insurability rider permits future increases in coverage without proof of insurability; it does not pay benefits for a continuing partial disability. Residual disability should be distinguished from total disability, which generally requires inability to perform the duties defined in the policy. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Disability Income Insurance; Residual Disability Benefits.

NEW QUESTION # 80
An insured has a $1,000 deductible and then pays 20% of covered medical expenses, while the insurer pays
80%. What is the insured's 20% share called?

A. Elimination period
B. Copayment
C. Coinsurance
D. Stop-loss benefit

Answer: C

Explanation:
Coinsurance is the percentage of covered expenses that the insured shares with the insurer after the deductible has been satisfied. In this question, the insured pays 20% and the insurer pays 80%; this is commonly described as 80/20 coinsurance. The deductible is separate. It is the amount the insured must pay before the insurer begins sharing covered expenses, subject to any services that the policy covers before the deductible.
A copayment is a fixed dollar amount paid for a covered service, such as a stated amount for a physician visit or prescription. It is not normally expressed as a percentage. An elimination period is a waiting period in disability-income insurance before benefits begin. A stop-loss feature, also called an out-of-pocket maximum in many plans, limits the insured's covered cost sharing after a stated maximum has been reached, subject to plan rules.
Understanding these terms is essential when comparing health plans. A plan may have a lower premium but a higher deductible, greater coinsurance, or a larger out-of-pocket maximum. Producers must clearly explain the consumer's potential financial responsibility and must not imply that the insurer pays every medical expense once a policy is issued.
References/topics from the Study Guide: Major Medical Insurance; Deductibles; Coinsurance; Copayments; Out-of-Pocket Maximums.

NEW QUESTION # 81
According to Nevada law, an authorized insurer is BEST defined as:

A. an insurer authorized under a certificate of authority issued by the Governor of Nevada
B. an insurer with a certificate of authority issued by the National Association of Insurance Commissioners (NAIC)
C. any insurer with minimum assets as required by this state
D. an insurer with a certificate of authority issued by the Insurance Commissioner of Nevada

Answer: D

Explanation:
An authorized insurer is an insurer that holds a certificate of authority issued by the Nevada Insurance Commissioner and remains authorized to transact insurance in the state. The certificate of authority is the formal approval allowing the insurer to conduct the kinds of insurance business for which it has been approved.
Having sufficient assets may be one consideration in an insurer's application and ongoing financial regulation, but assets alone do not make an insurer authorized. The National Association of Insurance Commissioners develops model laws, standards, and regulatory resources; it does not issue Nevada certificates of authority. The Governor of Nevada likewise does not issue insurance certificates of authority.
This distinction is central to Nevada insurance regulation. Authorized, or admitted, insurers are subject to Nevada's ongoing solvency oversight, market-conduct regulation, rate and form requirements where applicable, examinations, and other statutory obligations. Nonadmitted insurers may be used only through the surplus-lines process or another applicable statutory exception.
A producer must understand whether an insurer is authorized before placing ordinary insurance business.
Selling or placing insurance with an unauthorized insurer outside a lawful exception can create serious regulatory consequences.
Study Guide references/topics: authorized insurers; admitted insurers; certificates of authority; insurer regulation; NRS 680A.020 .

NEW QUESTION # 82
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