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Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Insurance Regulation30%- Providers and Markets
  • 1. Insurers and health service organizations
    • 2. HMOs and managed care arrangements
      - Licensing
      • 1. General provisions and definitions
        • 2. License issuance, renewal, and termination
          • 3. Initial qualifications and examination
            - Regulation of Producers
            • 1. Compensation and commissions
              • 2. Unfair trade practices
                • 3. Privacy and confidentiality rules
                  Topic 2: Maryland State-Specific Regulations20%- Statutory Requirements
                  • 1. Claims handling and settlement rules
                    • 2. Mandatory benefits and coverage mandates
                      • 3. Disclosure and marketing requirements
                        - Compliance and Enforcement
                        • 1. Penalties and violations
                          • 2. Reporting and recordkeeping
                            Topic 3: Accident and Health Insurance Policies35%- Types of Coverage
                            • 1. Accident-only coverage
                              • 2. Medical expense insurance
                                • 3. Long-term care insurance
                                  • 4. Disability income insurance
                                    - Policy Features
                                    • 1. Pre-existing conditions and exclusions
                                      • 2. Waiting periods and elimination periods
                                        • 3. Benefit structures and limits
                                          Topic 4: General Insurance Concepts15%- Fundamental Principles
                                          • 1. Insurable interest and indemnity
                                            • 2. Risk and risk management
                                              • 3. Contract law and policy structure
                                                - Policy Provisions
                                                • 1. Exclusions and limitations
                                                  • 2. Mandatory and optional clauses

                                                    Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Sample Questions:

                                                    When determining the premiums for large groups, most insurance companies use:

                                                    • A. Occupational rating
                                                    • B. Experience rating
                                                    • C. Area rating
                                                    • D. Pooled rating
                                                    Reveal Solution  Discussion  0

                                                    Correct Answer: B  🗳️

                                                    Explanation: Only visible for ExamPrepAway members. You can sign-up / login (it's free).

                                                    In Maryland, a group accident and health certificate of insurance must contain:

                                                    • A. A list of all participating physicians
                                                    • B. A summary of policy features and benefits
                                                    • C. The insurer's financial statement
                                                    • D. A copy of the group contract
                                                    Reveal Solution  Discussion  0

                                                    Correct Answer: B  🗳️

                                                    Explanation: Only visible for ExamPrepAway members. You can sign-up / login (it's free).

                                                    An insured incurs a covered accident and health insurance loss on May 30, which is submitted to the insurer on June 8. If the insured terminated coverage on June 1, the insurer:

                                                    • A. Must pay the claim within one year of termination of coverage
                                                    • B. Must pay the claim upon receipt of the proof of loss
                                                    • C. Can refuse to pay the claim because coverage has been terminated
                                                    • D. Can refuse to pay the claim under the pre-existing conditions exclusion
                                                    Reveal Solution  Discussion  0

                                                    Correct Answer: B  🗳️

                                                    Explanation: Only visible for ExamPrepAway members. You can sign-up / login (it's free).

                                                    It is unlawful for a person to provide an advertisement that:

                                                    • A. Points out coverage advantages of a policy
                                                    • B. Uses a policy title to misrepresent a coverage
                                                    • C. Makes a comparison of benefits between policies
                                                    • D. Refers to the insurer's financial rating
                                                    Reveal Solution  Discussion  0

                                                    Correct Answer: B  🗳️

                                                    Explanation: Only visible for ExamPrepAway members. You can sign-up / login (it's free).

                                                    Which one of the following causes of loss typically is EXCLUDED under a disability income insurance policy?

                                                    • A. Auto accidents
                                                    • B. Intentionally self-inflicted injuries
                                                    • C. Tropical disease
                                                    • D. Cancer
                                                    Reveal Solution  Discussion  0

                                                    Correct Answer: B  🗳️

                                                    Explanation: Only visible for ExamPrepAway members. You can sign-up / login (it's free).

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