InsNV_Health02證照指南 - InsNV_Health02考試資料

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Insurance Licensing InsNV_Health02 Exam Syllabus Topics:

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

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                                                                                                            最新的 Nevada Insurance InsNV_Health02 免費考試真題 (Q22-Q27):

                                                                                                            問題 #22
                                                                                                            Under Nevada law, the definition of " insurer " includes:

                                                                                                            • A. a security dealer
                                                                                                            • B. an indemnitor
                                                                                                            • C. a financial planner
                                                                                                            • D. a syndicate

                                                                                                            答案:B

                                                                                                            解題說明:
                                                                                                            Nevada law defines an insurer to include every person engaged as principal and as an indemnitor, surety, or contractor in the business of entering into insurance contracts. Therefore, an indemnitor is specifically included in the statutory definition of insurer.
                                                                                                            An indemnitor is a party that agrees to compensate another for specified loss or damage. That obligation is central to insurance: the insurer assumes a defined risk and promises to provide a benefit, payment, service, or indemnity when a covered loss occurs. A surety and a contractor entering insurance agreements can likewise fall within the statutory definition when operating in the insurance business.
                                                                                                            A security dealer sells or handles securities and is regulated under securities law rather than by the insurance definition in this question. A financial planner may provide financial advice but is not automatically an insurer. A syndicate may participate in insurance arrangements in certain contexts, but it is not the statutory term specifically identified in the definition.
                                                                                                            The exam point is to recognize the broad legal definition of insurer. It encompasses more than a company labeled "insurance company"; it includes persons acting as indemnitors, sureties, or insurance contractors.
                                                                                                            Study Guide references/topics: Nevada Insurance Code; definitions; insurer; indemnity; surety; NRS 679A.
                                                                                                            100 .


                                                                                                            問題 #23
                                                                                                            All insurance companies and producers who sell Group Life or Accident and Health policies in Nevada MUST:

                                                                                                            • A. deliver to the policyholder individual certificates for all insureds
                                                                                                            • B. deliver a policy to each insured member of a group
                                                                                                            • C. obtain a receipt when delivering individual certificates to insureds
                                                                                                            • D. notify the Commissioner when individual certificates have been issued

                                                                                                            答案:A

                                                                                                            解題說明:
                                                                                                            Group insurance is generally issued through a master policy. The policyholder-often an employer, association, trustee, or creditor-receives the master contract. Individual insured members do not receive a separate master policy; instead, they receive certificates describing the coverage, benefits, limitations, and applicable rights.
                                                                                                            Nevada requires companies, resident agents, and nonresident agents or brokers conducting group life or group accident and health business to provide for delivery of the required individual certificates to the policyholder.
                                                                                                            They must also use their best efforts to ensure that the policyholder distributes the certificates to covered debtors, members, or employees. Accordingly, option B correctly states the required delivery process.
                                                                                                            Option C is incorrect because each group member is not entitled to receive the full group policy. Option A adds a receipt requirement that is not the applicable rule. Option D is also incorrect because the regulation does not require notice to the Commissioner each time certificates are issued.
                                                                                                            This requirement ensures that insured individuals receive understandable evidence of their group coverage even though the policyholder owns the master policy. Certificates are central to informing members of benefits, exclusions, and conversion rights.
                                                                                                            Study Guide references/topics: group life insurance; group accident and health insurance; certificates of coverage; NAC 687B.405 .


                                                                                                            問題 #24
                                                                                                            What is the principal purpose of Medicare supplement insurance?

                                                                                                            • A. To replace Medicare Part A and Part B entirely
                                                                                                            • B. To pay only long-term custodial care
                                                                                                            • C. To provide Medicaid eligibility
                                                                                                            • D. To help pay certain deductibles, coinsurance, and other gaps in Original Medicare

                                                                                                            答案:D

                                                                                                            解題說明:
                                                                                                            Medicare supplement insurance, often called Medigap, is designed to help pay certain out-of-pocket costs left by Original Medicare, such as deductibles, coinsurance, copayments, and other covered gaps, depending on the standardized policy type and current rules. It supplements Original Medicare Parts A and B; it does not replace Medicare coverage. The insured must generally remain enrolled in Original Medicare to use a Medicare supplement policy.
                                                                                                            Medigap differs from Medicare Advantage. A Medicare Advantage plan is a private plan through which an eligible beneficiary receives Medicare-covered services, usually with plan networks, plan rules, and an annual out-of-pocket maximum. A consumer generally does not use a Medicare supplement policy to supplement a Medicare Advantage plan. Medigap also differs from stand-alone Part D prescription-drug coverage, which is separately arranged for many Original Medicare beneficiaries.
                                                                                                            Producers selling Medicare-related products must make accurate comparisons, use required disclosures, and avoid misleading consumers about benefits, provider access, premiums, or enrollment rights. A client's health needs, travel patterns, provider preferences, prescription needs, affordability, and enrollment timing are important factors. No single Medicare arrangement is automatically best for every beneficiary.
                                                                                                            References/topics from the Study Guide: Medicare Supplement Insurance; Original Medicare; Medicare Advantage; Medicare Part D; Medicare Cost Sharing.


                                                                                                            問題 #25
                                                                                                            Which of the following statements is CORRECT about Medicare?

                                                                                                            • A. It is a hospital and medical expense insurance program.
                                                                                                            • B. It provides benefits to totally disabled persons only.
                                                                                                            • C. It is a medical assistance program.
                                                                                                            • D. Its Part A provides payment for physicians ' bills.

                                                                                                            答案:A

                                                                                                            解題說明:
                                                                                                            Medicare is a federal social insurance program that provides hospital and medical expense coverage to eligible persons. Therefore, choice B is correct. Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice care, and certain home health services.
                                                                                                            Medicare Part B primarily covers physician services, outpatient care, preventive services, durable medical equipment, and other medically necessary services. Choice A describes Medicaid, which is a needs-based medical assistance program jointly administered by federal and state governments. Choice C is incorrect because Medicare also serves people age 65 or older and individuals with qualifying end-stage renal disease or ALS; it is not limited to totally disabled persons. Choice D is incorrect because physician bills are generally associated with Part B, not Part A. Medicare beneficiaries may also choose Medicare Advantage plans, which provide Medicare-covered benefits through private plans, and may obtain prescription drug coverage under Part D. Study Guide References/Topics: Social Insurance Programs; Medicare Parts A and B; Federal Health Programs.


                                                                                                            問題 #26
                                                                                                            Which of the following is permitted by a licensee?

                                                                                                            • A. Altering the client ' s application information to lower the premium rate
                                                                                                            • B. Buying the client a nominal gift at Christmas
                                                                                                            • C. Returning the commission to the client to ensure policy renewal
                                                                                                            • D. Lowering the premium by rebating the commission

                                                                                                            答案:B

                                                                                                            解題說明:
                                                                                                            A licensee may give a client a nominal gift, such as an ordinary Christmas gift, so long as the gift complies with Nevada's statutory limits and is not used as an unlawful inducement. Nevada permits producers and insurers to provide certain gifts, goods, gift certificates, meals, event tickets, and similar items to a policyholder or prospective policyholder up to an aggregate value of $100 in a calendar year.
                                                                                                            Rebating is prohibited. A producer may not reduce the premium by giving back all or part of a commission, nor may the producer return a commission to induce the client to buy, retain, or renew insurance. The prohibition protects consumers and preserves fair competition by requiring premiums and policy benefits to be applied consistently.
                                                                                                            Altering an application to obtain a lower premium is also prohibited. Application answers must accurately reflect the applicant's information. Knowingly changing material information can constitute misrepresentation, fraud, and grounds for producer discipline.
                                                                                                            The exam distinction is straightforward: a modest, permitted gift is lawful; a rebate, commission return, or falsification of application information is not.
                                                                                                            Study Guide references/topics: rebating; inducements; producer ethics; application accuracy; NRS 686A.110 .


                                                                                                            問題 #27
                                                                                                            ......

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