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Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Types of Health Insurance Policies | 20-25% | - Individual health insurance - Group health insurance - Dental and vision insurance - Long-term care insurance - Disability income insurance - Medicare and Medicaid |
| Maryland Insurance Laws and Regulations | 20-25% | - Unfair claim settlement practices - Consumer protection regulations - Producer licensing requirements - Violations and penalty provisions - Maryland Insurance Code - Privacy and confidentiality requirements |
| Policy Provisions and Clauses | 18-22% | - Benefit periods - Deductibles and copayments - Coverage terms and conditions - Preexisting condition clauses - Exclusions and limitations - Waiting periods |
| Social Insurance Programs | 8-12% | - Social Security disability benefits - CHIP (Children's Health Insurance Program) - Medicaid programs - Medicare Part A, B, C, D |
| Field Underwriting and Application Process | 8-12% | - Medical underwriting - Application procedures - Agent responsibilities in enrollment - Risk classification |
| Marketing Practices | 8-12% | - Producer responsibilities - Advertising guidelines - Marketing regulations - Prohibited practices |
Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Sample Questions:
If an insurer pays an individual accident and health insurance claim during a policy's grace period:
- A. The deductible is waived
- B. A 10% service fee is charged
- C. The amount of unpaid premium may be subtracted from the reimbursement
- D. The policy is canceled automatically at the end of the grace period
Correct Answer: C 🗳️
Explanation: Only visible for ActualPDF members. You can sign-up / login (it's free).
A nonprofit health service plan may NOT issue a contract that covers which of the following types of benefits?
- A. Vision benefits
- B. Dental benefits
- C. Medical expense benefits
- D. Disability income benefits
Correct Answer: D 🗳️
Explanation: Only visible for ActualPDF members. You can sign-up / login (it's free).
Medical expense insurance typically EXCLUDES coverage for treatment of:
- A. Chronic back pain
- B. Intentionally self-inflicted injuries
- C. Undiagnosed diseases
- D. Eating disorders
Correct Answer: B 🗳️
Explanation: Only visible for ActualPDF members. You can sign-up / login (it's free).
Reasonable and customary charges for health care are based primarily on:
- A. National physician surveys
- B. Actuarial tables
- C. Insurance industry studies
- D. Average charges within a geographic area
Correct Answer: D 🗳️
Explanation: Only visible for ActualPDF members. You can sign-up / login (it's free).
If an employer with 200 employees wants to offer health insurance and calls a SHOP Exchange Navigator, what should the navigator do?
- A. Refer the employer to a licensed insurance producer
- B. Refer the employer to the carrier where a friend works
- C. Help the employer sign-up through the SHOP Exchange
- D. Refer the employer to the Maryland Insurance Administration
Correct Answer: A 🗳️
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