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Nebraska Producer's Examination for Life, Accident and Health or Sickness Insurance Series 13-03 — Information & Free Practice

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Nebraska Producer's Examination for Life, Accident and Health or Sickness Insurance Series 13-03

Provider
PSI Services LLC
Format
Computer examination
Exam questions
150 scored questions plus 5 unscored items
Time limit
2.5 hours
Passing score
70%
Examination outline
  • 1.0 Insurance Regulation (15%)
    • 1.1 General
    • State specific licensing requirements
    • License issuance (44-4052, 44-4053)
    • License issuance (44-4052, 44-4053) > Application
    • License maintenance
    • License maintenance > Change of name/phone number/address/email address (44-4054(8))
    • License maintenance > Assumed business name (44-4057)
    • License maintenance > Reporting of actions (44-4065)
    • License maintenance > Continuing education including exemptions (44-3901 to 44-3908)
    • License maintenance > Penalties
    • License maintenance > Appointment and termination process
    • License duration
    • License duration > Renewal/nonrenewal (44-4054)
    • License duration > Reinstatement
    • License duration > Continuation
    • License duration > Termination (44-4062)
    • License duration > Surrender
    • License duration > Lapse
    • License duration > Inactivity due to military service
    • License duration > Inactivity due to extenuating circumstances
    • Disciplinary actions related to the license
    • Disciplinary actions related to the license > Denial
    • Disciplinary actions related to the license > Suspension (44-2633, 44-4059)
    • Disciplinary actions related to the license > Surrender
    • Disciplinary actions related to the license > Revocation or refusal to issue or renew (44-2633, 44-4059)
    • Penalties
    • Penalties > Civil
    • Penalties > Criminal (28-631)
    • Penalties > Hearings (44-4059(2))
    • Penalties > Fines (44-2634, 44-4059(4))
    • Penalties > Cease and desist order (44-1529, 44-1542)
    • 1.2 Licensing Types, Purposes, and Processes
    • License types (44-4054)
    • License types (44-4054) > Producer (44-4049, 44-4054)
    • License types (44-4054) > Consultant (44-2606 to 44-2635)
    • License types (44-4054) > Agency
    • License types (44-4054) > Resident (44-2625, 44-4055, 44-4063)
    • License types (44-4054) > Nonresident (44-2625, 44-4055, 44-4063)
    • License types (44-4054) > Temporary (44-4058)
    • Licensing requirements
    • Licensing requirements > Eligibility and qualification
    • Licensing requirements > Licensing exemptions (44-4051)
    • 1.3 State Regulation
    • Acts constituting insurance transaction
    • Acts constituting insurance transaction > Negotiate
    • Acts constituting insurance transaction > Sell
    • Acts constituting insurance transaction > Solicit
    • Director's general duties and powers (44-101.01, 44-2635)
    • Producer regulatory requirements
    • Producer regulatory requirements > Policy signatures
    • Producer regulatory requirements > Application signatures
    • Producer regulatory requirements > Premium payment
    • Producer regulatory requirements > Producer representation
    • Producer regulatory requirements > Commissions/compensation and fees (44-4060)
    • Producer regulatory requirements > Controlled business (44-361.01, 44-361.02)
    • Producer regulatory requirements > Appointment (44-4061)
    • Producer regulatory requirements > Fiduciary responsibility
    • Producer regulatory requirements > Impersonation
    • Producer regulatory requirements > Records maintenance (44-5905)
    • Producer regulatory requirements > Claims reporting
    • Company regulatory requirements
    • Company regulatory requirements > Solvency
    • Company regulatory requirements > Financial requirements
    • Company regulatory requirements > Certificate of authority (44-303)
    • Company regulatory requirements > State of domicile
    • Company regulatory requirements > Records maintenance
    • Company regulatory requirements > Policy forms/rates/exceptions
    • Company regulatory requirements > Appointment/termination
    • Company regulatory requirements > Capital and surplus requirements (44-214, 44-305)
    • Company regulatory requirements > Unfair trade practices complaint register (44-1525(9))
    • Difference between admitted, non-admitted, foreign, and domestic insurers
    • Unfair trade practices
    • Unfair trade practices > Unfair discrimination (44-1525(7))
    • Unfair trade practices > Misrepresentation (44-1525(1))
    • Unfair trade practices > False or deceptive advertising (44-1525(2))
    • Unfair trade practices > Claims settlement
    • Unfair trade practices > Boycott (44-1525(4))
    • Unfair trade practices > Coercion (44-1525(4))
    • Unfair trade practices > Intimidation (44-1525(4))
    • Unfair trade practices > Defamation (44-1525(3))
    • Unfair trade practices > False financial statements
    • Unfair trade practices > Fraud
    • Unfair trade practices > Illegal inducements including rebating and twisting (44-361, 44-1525(8))
    • Unfair trade practices > Misappropriation of funds
    • Unfair trade practices > Testimonials
    • Unfair trade practices > Comparisons
    • Unfair trade practices > Nondisclosure of fees or charges (44-354)
    • Other prohibited practices
    • Other prohibited practices > Commingling of funds
    • Other prohibited practices > Non-transparency
    • Other prohibited practices > STOLI/IOLI
    • Other prohibited practices > Prohibited fees/premiums/extra charges
    • Other prohibited practices > Larceny
    • Other prohibited practices > Acting without a license
    • Unfair claims settlement practices (44-1539, 44-1540)
    • Nonpublic personal information and privacy protection
    • Policy replacement (210 Nebraska Administrative Code Ch. 19)
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33)
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33) > Advertising (210 Nebraska Administrative Code Ch. 50)
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33) > Provisions/rules
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33) > Policy summary
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33) > Buyer's Guide (210 Nebraska Administrative Code Ch. 33 § 005, NAIC Current Model Buyer's Guide)
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33) > Illustrations (210 Nebraska Administrative Code Ch. 72)
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33) > Suitability (44-8101 to 44-8109)
    • Solicitation and sales (210 Nebraska Administrative Code Ch. 33) > Backdating
    • Selection criteria and unfair discrimination (44-1525(7)(a))
    • Insurance Fraud Act (44-6601 to 44-6608)
    • Privacy of Insurance Consumer Information Act (44-901 to 44-925) Neb. Rev. Stat. §44-902(1)(a)
    • 1.4 Federal Regulation
    • Federal Law (18 U.S. Code § 1033)
    • Fair Credit Reporting Act (15 USC 1681–1681d)
    • Fraud and false statements including 1033 and 1034 waiver
    • "Prohibited Persons" Waiver (Consent to Work) (18 U.S. Code § 1033-1034)
    • Other federal regulations
    • Other federal regulations > Do Not Call List (Telephone Consumer Protection Act)
    • Other federal regulations > Can-Spam Act
    • Other federal regulations > Sarbanes-Oxley Act
    • Other federal regulations > Consumer Data Privacy and Security Act
    • Other federal regulations > Gramm-Leach-Bliley Act
  • 2.0 General Insurance (10%)
    • 2.1 Risk management key terms
    • Risk
    • Exposure
    • Hazard
    • Peril
    • Loss
    • Insurance
    • 2.2 Methods of handling risk
    • Avoidance
    • Retention
    • Sharing
    • Reduction
    • Transfer
    • 2.3 Other risk concepts
    • Elements of insurable risks
    • Adverse selection
    • Law of large numbers
    • Reinsurance
    • 2.4 Types of insurers
    • Stock
    • Mutual
    • Fraternal benefit society
    • 2.5 Financial rating services
    • A.M. Best
    • Standard and Poor's
    • Moody's
    • 2.6 Distribution systems
    • Independent
    • Direct
    • Exclusive/captive agent
    • Exchanges
    • 2.7 Law of agency
    • Insurer as principal
    • Producer/agent/broker-insurer relationships
    • 2.8 Authority and powers of producers/agents/brokers
    • Express
    • Implied
    • Apparent
    • 2.9 Elements of a legal contract
    • Offer and acceptance
    • Consideration
    • Competent parties
    • Legal purpose
    • 2.10 Legal interpretations affecting contracts
    • Reasonable expectations
    • Indemnity
    • Utmost good faith
    • Concealment
    • Representations
    • Misrepresentations
    • Warranties
    • Fraud
  • 3.0 Life Insurance Basics (8%)
    • 3.1 Producer Authority and Powers
    • Insurable interest (44-704)
    • Personal uses of life insurance
    • Personal uses of life insurance > Survivor protection
    • Personal uses of life insurance > Estate creation/conservation
    • Personal uses of life insurance > Cash accumulation
    • Personal uses of life insurance > Security
    • Personal uses of life insurance > Exemption from creditor claims/probate
    • Needs approach to determining amount of personal life insurance
    • Needs approach to determining amount of personal life insurance > Types of information gathered
    • Needs approach to determining amount of personal life insurance > Determining lump-sum needs
    • Needs approach to determining amount of personal life insurance > Planning for income needs
    • Business uses of life insurance
    • Business uses of life insurance > Key person
    • Business uses of life insurance > Buy-sell
    • Factors in premium determination
    • Factors in premium determination > Mortality
    • Factors in premium determination > Interest
    • Factors in premium determination > Expense
    • Field underwriting
    • Field underwriting > Application procedures
    • Field underwriting > Required signatures
    • Field underwriting > Notice of information practices and premium collection
    • Field underwriting > Conditional receipt
    • Policy delivery
    • Policy delivery > Policy review
    • Policy delivery > Effective date of coverage
    • Policy delivery > Premium collection
    • Policy delivery > Statement of Good Health
    • Policy delivery > Delivery/electronic delivery requirements
    • Information sources and regulation
    • Information sources and regulation > Application
    • Information sources and regulation > Producer report
    • Information sources and regulation > Attending physician statement
    • Information sources and regulation > Investigative consumer report
    • Information sources and regulation > Medical Information Bureau (MIB)
    • Information sources and regulation > Medical examination and lab tests including HIV (RL 71-531)
    • Information sources and regulation > Financial information
    • Risk classifications
    • Risk classifications > Preferred
    • Risk classifications > Standard
    • Risk classifications > Substandard/rated
    • Risk classifications > Declined
  • 4.0 Life Insurance Policies (9%)
    • 4.1 Characteristics of Level Term
    • Renewability
    • Level premium
    • Convertibility
    • Term-to-65
    • 4.2 Decreasing Term
    • Credit/mortgage protection
    • 4.3 Whole Life
    • Ordinary
    • Limited pay
    • Single premium
    • 4.4 Characteristics of Whole Life
    • Cash value
    • Maturity
    • Guarantees
    • 4.5 Universal and Indexed Life
    • 4.6 Variable products
    • Regulation of variable products (44-2212, 44-2216; 210 Nebraska Administrative Code Ch. 15 § 006, § 011)
    • Qualifications of producers for the sale of variable products
    • General account versus separate account
    • 4.7 Specialized policies
    • Joint life/first-to-die
    • Survivorship life/second-to-die
    • 4.8 Characteristics of Group Life
    • Individual certificates
    • Eligibility
    • Plan sponsors
    • Underwriting requirements
    • Conversion (44- 1607(8–10), 44-1613, 44-1614)
    • Standard provisions
  • 5.0 Life Insurance Policy Provisions, Options and Riders (9%)
    • 5.1 Required Provisions (44-502)
    • Ownership
    • Assignment
    • Entire contract (44-502(3))
    • Right to examine (free look) (44- 502.05)
    • Payment of premiums (44-502(1))
    • Grace period (44-502(2))
    • Reinstatement (44-502(11))
    • Incontestability (44-502(5))
    • Misstatement of age or sex (44-502(6))
    • Exclusions (44-502(5))
    • Suicide
    • Consideration
    • Insuring clause
    • 5.2 Beneficiaries
    • Designation options
    • Designation options > Individuals
    • Designation options > Classes
    • Designation options > Estates
    • Designation options > Minors
    • Designation options > Trusts
    • Succession
    • Succession > Primary
    • Succession > Contingent
    • Revocable versus irrevocable
    • Common Disaster Clause
    • 5.3 Settlement Options
    • Types of settlement options
    • Types of settlement options > Cash payment
    • Types of settlement options > Interest only
    • Types of settlement options > Fixed-period installments
    • Types of settlement options > Fixed-amount installments
    • Types of settlement options > Life income
    • Types of settlement options > Single life
    • Types of settlement options > Joint and survivor
    • Retained asset account
    • Spendthrift clause
    • 5.4 Nonforfeiture Options
    • Types of nonforfeiture options
    • Types of nonforfeiture options > Cash surrender value
    • Types of nonforfeiture options > Extended term
    • Types of nonforfeiture options > Reduced paid-up insurance
    • 5.5 Policy Loan and Withdrawal Options
    • Types of loans and withdrawals
    • Types of loans and withdrawals > Policy loans
    • Types of loans and withdrawals > Automatic premium loans
    • Types of loans and withdrawals > Withdrawals or partial surrenders
    • 5.6 Dividend Options
    • Dividend options
    • Dividend options > Cash
    • Dividend options > Reduction of premium/loan
    • Dividend options > Accumulation at interest
    • Dividend options > One-year term
    • Dividend options > Paid-up additions
    • Dividend options > Paid-up insurance
    • 5.7 Policy Riders
    • Disability riders
    • Disability riders > Waiver of premium
    • Disability riders > Waiver of cost of insurance (Universal Life)
    • Disability riders > Disability income benefit
    • Disability riders > Guaranteed insurability
    • Accelerated (living) and long-term care benefits/riders
    • Accelerated (living) and long-term care benefits/riders > Conditions for payment
    • Accelerated (living) and long-term care benefits/riders > Effect on death benefit
    • Accelerated (living) and long-term care benefits/riders > Qualifying events
    • Accelerated (living) and long-term care benefits/riders > Disclosure
    • Accelerated (living) and long-term care benefits/riders > Exclusions and restrictions
    • Additional insureds
    • Additional insureds > Spouse/other-insured term
    • Additional insureds > Children's term
    • Additional insureds > Family term
    • Riders affecting death benefit
    • Riders affecting death benefit > Accidental death and dismemberment
    • Riders affecting death benefit > Cost of living
    • Riders affecting death benefit > Return of premium
  • 6.0 Annuities (6%)
    • 6.1 Annuity Basics
    • Annuity concepts and uses
    • Annuity concepts and uses > Accumulation/annuity periods
    • Annuity concepts and uses > Owner
    • Annuity concepts and uses > Annuitant
    • Annuity concepts and uses > Beneficiary
    • Annuity concepts and uses > Death of owner
    • Types of annuities
    • Types of annuities > Single premium
    • Types of annuities > Fixed premium
    • Types of annuities > Flexible premium
    • Types of annuities > Immediate
    • Types of annuities > Deferred
    • Features/aspects of annuities
    • Features/aspects of annuities > Nonforfeiture
    • Features/aspects of annuities > Surrender charges
    • Fixed versus variable annuities
    • Fixed versus variable annuities > Interest rate guarantees
    • Fixed versus variable annuities > Separate account
    • Fixed versus variable annuities > General account
    • 6.2 Payout Options
    • Life contingency benefit options
    • Life contingency benefit options > Pure life
    • Life contingency benefit options > Life with guaranteed minimum
    • Life contingency benefit options > Single life
    • Life contingency benefit options > Multiple life
    • Annuity certain payment options
    • Annuity certain payment options > Installments for a fixed period/amount
  • 7.0 Federal Taxation of Life Insurance and Annuities (4%)
    • 7.1 General
    • Taxation of amounts available to policyowner
    • Taxation of amounts available to policyowner > Cash value increases
    • Taxation of amounts available to policyowner > Dividends
    • Taxation of amounts available to policyowner > Loans
    • Taxation of amounts available to policyowner > Surrenders
    • Taxation of amounts available to policyowner > Accelerated benefits
    • Taxation of amounts available to policyowner > Death benefit
    • Taxation of amounts received by the beneficiary
    • Taxation of amounts received by the beneficiary > General rules and exceptions
    • Taxation of amounts received by the beneficiary > Settlement options
    • Taxation of amounts received by the beneficiary > Tax implications of estate as beneficiary
    • Section 1035 exchanges
    • Qualified versus nonqualified annuities
    • Qualified versus nonqualified annuities > General requirements
    • Qualified versus nonqualified annuities > Taxation of distributions/withdrawals/contributions
    • Qualified versus nonqualified annuities > Premature distributions
    • Qualified versus nonqualified annuities > During accumulation phase
    • Qualified versus nonqualified annuities > Annuity phase, exclusion ratio
    • Modified endowment contracts (MECs)
    • Modified endowment contracts (MECs) > Modified endowment versus life insurance
    • Modified endowment contracts (MECs) > Seven-pay test
    • Modified endowment contracts (MECs) > Distributions
  • 8.0 Customer Relations and Privacy (1%)
    • 8.1 Networking and Client Support
    • Product suitability
    • 8.2 Recording, Reporting, and Securing Client Information
    • HIPAA privacy and security (EDI) rules
    • Records maintenance and security
    • Required disclosures
    • Required disclosures > Buyer's/shopper's guide
    • Required disclosures > HIV consent
  • 9.0 Sickness and Accident Risk and Underwriting (8%)
    • 9.1 Risk Management
    • Risk management key terms
    • Risk management key terms > Risk
    • Risk management key terms > Exposure
    • Risk management key terms > Hazard
    • Risk management key terms > Peril
    • Risk management key terms > Loss
    • Methods of handling risk
    • Methods of handling risk > Avoidance
    • Methods of handling risk > Retention
    • Methods of handling risk > Sharing
    • Methods of handling risk > Reduction
    • Methods of handling risk > Transfer
    • Other concepts affecting risk
    • Other concepts affecting risk > Elements of insurable risks
    • Other concepts affecting risk > Adverse selection
    • Other concepts affecting risk > Law of large numbers
    • Other concepts affecting risk > Reinsurance
    • Other concepts affecting risk > Indemnity
    • Elements of insurable risk
    • Elements of insurable risk > Due to chance
    • Elements of insurable risk > Definite and measurable
    • Elements of insurable risk > Statistically predictable
    • Elements of insurable risk > Not catastrophic
    • Elements of insurable risk > Randomly selected
    • 9.2 Underwriting
    • Risk classifications
    • Risk classifications > Preferred
    • Risk classifications > Standard
    • Risk classifications > Substandard
    • Allowable sources of underwriting information
    • Allowable sources of underwriting information > Application
    • Allowable sources of underwriting information > Producer report
    • Allowable sources of underwriting information > Attending physicians’ statement
    • Allowable sources of underwriting information > Investigative consumer report
    • Allowable sources of underwriting information > Medical information bureau (MIB)
    • Allowable sources of underwriting information > Medical examinations and lab tests including HIV consent (RL 71-531)
    • Purpose and process of underwriting
    • Unfair discrimination (44-749)
    • Unfair discrimination (44-749) > Blindness
    • Unfair discrimination (44-749) > Genetic characteristics
    • Field underwriting
    • Field underwriting > Application process
    • Common errors or omissions related to underwriting
    • Common errors or omissions related to underwriting > Failing to give required disclosures
    • Common errors or omissions related to underwriting > Misrepresenting client information
    • 9.3 Replacement
    • Limitations and exclusions
    • Limitations and exclusions > Pre-existing conditions
    • Limitations and exclusions > Waiting periods
    • Replacement requirements
    • Replacement requirements > Notifications
    • Replacement requirements > Proof/certificate of creditable coverage
    • Replacement requirements > Suitability
    • 9.4 Policy Delivery Requirements
    • Statement of good health
    • Policy review
  • 10.0 Individual Accident and Sickness Insurance Policy General Provisions and Clauses (6%)
    • 10.1 Risk Management
    • Individual optional provisions (44-710.04)
    • Individual optional provisions (44-710.04) > Change of occupation (44-710.04(1))
    • Individual optional provisions (44-710.04) > Age/gender misstatement (44-710.04(2))
    • Individual optional provisions (44-710.04) > Insurance with other insurers (44-710.04(4))
    • Individual optional provisions (44-710.04) > Other insurance in this insurer (44-710.04(3))
    • Individual optional provisions (44-710.04) > Unpaid premiums (44-710.04(7))
    • Individual optional provisions (44-710.04) > Cancellation (44-710.04(8))
    • Individual optional provisions (44-710.04) > Conformity with state statutes (44-710.04(9))
    • Individual optional provisions (44-710.04) > Illegal occupation (44-710.04(10))
    • Individual optional provisions (44-710.04) > Intoxicants and narcotics (44-710.04(11))
    • Individual policy mandatory provisions (44-710.03)
    • Individual policy mandatory provisions (44-710.03) > Time limit on certain defenses (44-710.03(2))
    • Individual policy mandatory provisions (44-710.03) > Physical exam and autopsy (44-710.03(10))
    • Individual policy mandatory provisions (44-710.03) > Legal actions (44-710.03(11))
    • Individual policy mandatory provisions (44-710.03) > Change of beneficiary (44-710.03(12))
    • Individual policy mandatory provisions (44-710.03) > Entire contract (44-710.03(1), 44-710.12)
    • Individual policy mandatory provisions (44-710.03) > Grace period (44-710.03(3))
    • Individual policy mandatory provisions (44-710.03) > Reinstatement (44-710.03(4))
    • Individual policy mandatory provisions (44-710.03) > Claims forms (44-710.03(5–9))
    • Individual policy mandatory provisions (44-710.03) > Notice of claims (44-710.03(5–9))
    • Individual policy mandatory provisions (44-710.03) > Proof of loss
    • Individual policy mandatory provisions (44-710.03) > Time of payment of claims (44-710.03(5–9))
    • Individual policy mandatory provisions (44-710.03) > Payment of claims (44-710.03(5–9))
    • Other provisions
    • Other provisions > Free look period (44-710.18)
    • Other provisions > Insuring clause
    • Other provisions > Consideration clause
    • Other provisions > Coordination of benefits
    • Other provisions > Renewability clause
    • Renewability clauses (44-787)
    • Renewability clauses (44-787) > Noncancelable
    • Renewability clauses (44-787) > Guaranteed renewable
    • Renewability clauses (44-787) > Conditionally renewable at option of insurer
    • Renewability clauses (44-787) > Nonrenewable including cancelable and short-term health
    • Policy exclusions
    • Policy exclusions > Intentionally inflicted
    • Policy exclusions > War
    • Policy exclusions > Elective procedures
    • Policy exclusions > Workers' compensation
  • 11.0 Disability (3%)
    • 11.1 General
    • Total disability plans
    • Total disability plans > Indemnity policy versus loss of income
    • Social Security disability programs
    • Social Security disability programs > Coordination of benefits
    • Eligibility requirements
    • Characteristics of disability income insurance
    • Characteristics of disability income insurance > Occupational versus non occupational
    • Characteristics of disability income insurance > Definition of disability
    • Elimination period, waiting period, probationary period, and benefit period
    • 11.2 Types and Classes
    • Short-term versus long-term group disability income insurance
    • Business disability insurance
    • Business disability insurance > Key person
    • Business disability insurance > Buy-sell policy
    • Individual versus group policies
    • Total, partial, presumptive, and residual disability
    • Qualification for individual disability income insurance benefits
    • Qualification for individual disability income insurance benefits > Own occupation and any occupation
    • Effect of preexisting conditions on disability eligibility
  • 12.0 Medical Plans (6%)
    • 12.1 General
    • Difference between insureds and subscribers/participants
    • Methods by which insurers control health care costs
    • Methods by which insurers control health care costs > Coinsurance
    • Methods by which insurers control health care costs > Copayments
    • Methods by which insurers control health care costs > Deductibles
    • Characteristics of HMOs, PPOs, EPOs, and POS
    • Characteristics of HMOs, PPOs, EPOs, and POS > Provider network
    • Characteristics of HMOs, PPOs, EPOs, and POS > Out of network
    • Characteristics of HMOs, PPOs, EPOs, and POS > Primary care
    • Characteristics of HMOs, PPOs, EPOs, and POS > Specialist
    • Characteristics of HMOs, PPOs, EPOs, and POS > Utilization review
    • Characteristics of HMOs, PPOs, EPOs, and POS > Prepaid
    • Characteristics of HMOs, PPOs, EPOs, and POS > Fee for service
    • Characteristics of HMOs, PPOs, EPOs, and POS > Expense based
    • Methods of cost containment
    • Methods of cost containment > Utilization review (44-5416 to 44-5431)
    • Methods of cost containment > Preventive care
    • Methods of cost containment > Second opinion
    • Methods of cost containment > Hospital outpatient benefits
    • Methods of cost containment > Urgent care centers
    • Characteristics of major medical plans
    • Characteristics of excepted benefit plans
    • Marketplace to customize suitable insurance plans for businesses and individuals
    • Types of excepted (limited) benefit plans
    • Types of excepted (limited) benefit plans > Accident only
    • Types of excepted (limited) benefit plans > Accidental death and dismemberment
    • Types of excepted (limited) benefit plans > Critical illness
    • Types of excepted (limited) benefit plans > Hospital indemnity
    • Types of excepted (limited) benefit plans > Vision and hearing
    • Characteristics of Flexible savings accounts (FSAs), Health savings accounts (HSAs),
    • Health reimbursement accounts (HRAs), High Deductible Health Plans (HDHPs)
    • 12.2 Affordable Care Act (ACA)
    • Eligibility requirements
    • Patient protections
    • Patient protections > No lifetime limits/annual limits
    • Patient protections > Guaranteed issue
    • Patient protections > Pre-existing conditions
    • Patient protections > Preventive care without cost sharing
    • Patient protections > Dependent age
    • Patient protections > Appeal rights
    • Patient protections > Maternity coverage
    • Patient protections > Newborn coverage
    • Patient protections > No rescission
    • Patient protections > Emergency care
    • Enrollment periods
    • Definition of qualified health plan
    • Ten Essential Benefits
    • Ten Essential Benefits > 1. Ambulatory patient services
    • Ten Essential Benefits > 2. Emergency Services
    • Ten Essential Benefits > 3. Hospitalization
    • Ten Essential Benefits > 4. Pregnancy, maternity, and newborn care (both before and after birth)
    • Ten Essential Benefits > 5. Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
    • Ten Essential Benefits > 6. Prescription drugs
    • Ten Essential Benefits > 7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
    • Ten Essential Benefits > 8. Lab results
    • Ten Essential Benefits > 9. Preventive and wellness services and chronic disease management
    • Ten Essential Benefits > 10. Pediatric services, including oral and vision care
    • Rate setting factors
    • Rate setting factors > Geographic rating area
    • Rate setting factors > Family composition
    • Rate setting factors > Age
    • Rate setting factors > Tobacco use
    • Non-discrimination
    • Types of ACA plans
    • Types of ACA plans > Metal levels
    • Types of ACA plans > Catastrophic
    • Premium tax credits and subsidies
    • Federal versus state exchange/marketplace
    • Requirements for continuation of individual coverage, special enrollment period, and loss of minimum essential coverage
    • Events that lead to termination of coverage
    • 12.3 Mental Health Parity and Addiction Equity Act (MHPAEA)
    • Purpose of Mental Health Parity and Addiction Equity Act
  • 13.0 Group Plans (6%)
    • 13.1 General
    • Blanket policy
    • No loss/no gain statutes
    • Group underwriting (44-760)
    • General characteristics of group plans
    • General characteristics of group plans > Group contract, certificate of coverage
    • General characteristics of group plans > Experience versus community rating
    • General characteristics of group plans > Conversion (44-1613; 44-32, 44-130)
    • General characteristics of group plans > Contributory versus non-contributory
    • Types of eligible groups
    • Types of eligible groups > Individual employer groups
    • Types of eligible groups > Multiple-Employer Trusts/Welfare Arrangements
    • Types of eligible groups > Associations
    • Coverage eligibility
    • Coverage eligibility > Open enrollment
    • Coverage eligibility > Waiting periods
    • Coverage eligibility > Part-time employees
    • Coverage eligibility > Dependent/spousal coverage
    • Coverage eligibility > Disabled children
    • Small group and large group eligibility and renewability (44-5259, 44-5253)
    • Types of funding and administration
    • Types of funding and administration > Self-funded versus insured
    • Federal regulations of employer group insurance plans
    • Federal regulations of employer group insurance plans > Applicability
    • Federal regulations of employer group insurance plans > Fiduciary responsibilities
    • Federal regulations of employer group insurance plans > Effects on contributions
    • Federal regulations of employer group insurance plans > Reporting and disclosure requirements
    • Federal regulations of employer group insurance plans > ERISA
    • Eligibility and the benefits of continuation under COBRA (44-1640 to 44-1645)
    • Events that lead to termination of coverage
  • 14.0 Dental Insurance (2%)
    • 14.1 General
    • Indemnity plans, PPO/HMO dental plans, prepaid dental plans
    • Stand-alone dental plan (SADPs)
    • Types of dental treatment/service categories
    • Types of dental treatment/service categories > Endodontics
    • Types of dental treatment/service categories > Orthodontics
    • Types of dental treatment/service categories > Periodontics
    • Types of dental treatment/service categories > Prosthodontics
    • Types of dental treatment/service categories > Restorative care
    • Types of dental treatment/service categories > Oral surgery
    • Types of dental treatment/service categories > Diagnostic and preventive
    • Types of dental treatment/service categories > Basic and major
    • The role of the federal health insurance marketplace in dental insurance
    • Cost sharing
    • Cost sharing > Deductibles
    • Cost sharing > Coinsurance
    • Cost sharing > Copay
    • 14.2 Group Plans
    • Characteristics of employer group dental insurance
    • Minimizing adverse selection
    • Integrated deductibles
  • 15.0 Insurance for Senior Citizens and Individuals with Special Needs (5%)
    • 15.1 Long-Term Care
    • Continuing Education Requirements - Guidance Document F3
    • Coverage eligibility
    • Coverage eligibility > Underwriting
    • Coverage eligibility > Preexisting conditions
    • Coverage eligibility > Exclusions (210 Nebraska Administrative Code Ch. 46 § 006(006.02))
    • Coverage eligibility > Free look (44-3608; 210 Nebraska Administrative Code Ch. 36 § 017(017.01E))
    • Coverage eligibility > Guaranteed renewability
    • Elimination and benefit periods
    • Policy options
    • Policy options > Inflation protection
    • Policy options > Guarantee of insurability
    • Policy options > Return of premium
    • Policy options > Nonforfeiture options
    • Policy options > Waiver of premium
    • Benefit triggers
    • Benefit triggers > Activities of daily living
    • Benefit triggers > Cognitive impairment
    • Coverages
    • Coverages > Home healthcare (210 Nebraska Administrative Code Ch. 46 § 005(005.10), § 010)
    • Coverages > Hospice
    • Coverages > Assisted living (210 Nebraska Administrative Code Ch. 46 § 005(005.21))
    • Coverages > Adult daycare (210 Nebraska Administrative Code Ch. 46 § 005(005.02))
    • Coverages > Respite care
    • Purpose and levels of care
    • Purpose and levels of care > Skilled
    • Purpose and levels of care > Intermediate
    • Purpose and levels of care > Custodial
    • Cancellations or unintentional lapses
    • Required disclosures
    • Required disclosures > Outline of coverage (44-3607; 210 Nebraska Administrative Code Ch. 36 § 017(017.03))
    • Required disclosures > Shopper’s guide (210 Nebraska Administrative Code Ch. 46 § 027)
    • Trusted contacts (secondary addressee)
    • Potential future rate increases and cost of living adjustments
    • 15.2 Medicaid
    • Medicaid benefits
    • Medicaid eligibility requirements
    • The effects of the expansion of Medicaid benefits on long-term care and prescription drugs
    • 15.3 Medicare
    • Medicare eligibility requirements
    • Role of primary and secondary insurance
    • Effects of employer group health plans on employees with disabilities and employees over 65
    • Effects of employer group health plans on employees with disabilities and employees > Part A: Hospital Insurance eligibility, enrollment, coverage, and exclusions
    • Effects of employer group health plans on employees with disabilities and employees > Part B: Medical Insurance eligibility, enrollment, coverage, and exclusions
    • Effects of employer group health plans on employees with disabilities and employees > Part C: Medicare Advantage Plans eligibility, enrollment, coverage, and exclusions
    • Effects of employer group health plans on employees with disabilities and employees > Part D: Prescription Drug Plans eligibility, enrollment, coverage, and exclusions
    • 15.4 Medicare Supplements
    • Eligibility and enrollment (210 Nebraska Administrative Code Ch. 36 § 011)
    • The purpose of Medicare Supplement Insurance (210 Nebraska Administrative Code Ch. 36 § 001)
    • Standardized Medicare supplement plans and core benefits (210 Nebraska Administrative Code Ch. 36 § 009)
    • Policy requirements
    • Policy requirements > Free-look (44-3608; 210 Nebraska Administrative Code Ch. 36 § 017(017.01E))
    • Policy requirements > Pre-existing conditions (44-4513(2, 3))
    • Medicare Supplement Replacement
    • Medicare Supplement Replacement > Re-entry following Medicare Advantage
    • Medicare Supplement Replacement > Pre-existing conditions
    • Medicare Supplement Replacement > Waiting periods
  • 16.0 Federal Tax Considerations for Sickness and Accident Insurance (2%)
    • 16.1 Premiums and Benefits
    • Tax treatment of premiums and benefits for sole proprietors, partners, and limited liability corporations
    • Tax treatment of premiums and benefits for employer group insurance
    • Tax treatment of premiums and benefits for employer group insurance > Medical
    • Tax treatment of premiums and benefits for employer group insurance > Disability income
    • Tax treatment of premiums and benefits for individual coverages
    • Tax treatment of premiums and benefits for individual coverages > LTC
    • Tax treatment of premiums and benefits for individual coverages > Medical expense
    • Tax treatment of premiums and benefits for individual coverages > Health insurance
    • Tax consideration for Flexible spending accounts (FSAs), Health savings accounts (HSAs), and Health reimbursement accounts (HRAs)
    • 16.3 Disability
    • Tax considerations for disability insurance for personally-owned and employer/group health insurance
    • Tax considerations for Social Security Disability and Workers Compensation
    • Tax considerations for business disability insurance
    • Tax considerations for business disability insurance > Key person
    • Tax considerations for business disability insurance > Buy-sell policy
Examination sources

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