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Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer Exam Syllabus Topics:
| Section | Weight | Objectives |
| Maryland State-Specific Regulations | 20% | - Statutory Requirements
- 1. Claims handling and settlement rules
- 2. Disclosure and marketing requirements
- 3. Mandatory benefits and coverage mandates
- Compliance and Enforcement
- 1. Penalties and violations
- 2. Reporting and recordkeeping
|
| Insurance Regulation | 30% | - Regulation of Producers
- 1. Unfair trade practices
- 2. Privacy and confidentiality rules
- 3. Compensation and commissions
- Licensing
- 1. General provisions and definitions
- 2. Initial qualifications and examination
- 3. License issuance, renewal, and termination
- Providers and Markets
- 1. HMOs and managed care arrangements
- 2. Insurers and health service organizations
|
| General Insurance Concepts | 15% | - Policy Provisions
- 1. Mandatory and optional clauses
- 2. Exclusions and limitations
- Fundamental Principles
- 1. Contract law and policy structure
- 2. Insurable interest and indemnity
- 3. Risk and risk management
|
| Accident and Health Insurance Policies | 35% | - Policy Features
- 1. Benefit structures and limits
- 2. Pre-existing conditions and exclusions
- 3. Waiting periods and elimination periods
- Types of Coverage
- 1. Accident-only coverage
- 2. Disability income insurance
- 3. Medical expense insurance
- 4. Long-term care insurance
|
Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Sample Questions:
1. A health maintenance organization may issue a contract that provides benefits for the following:
A) Health care services provided to members of the HMO
B) Replacement of income lost by a member due to the member's disability
C) The accidental death of an HMO member
D) The dismemberment of an HMO member
2. Which of the following is NOT a mandated benefit in Maryland?
A) Treatment of mental illness
B) Treatment of substance abuse
C) Weight reduction programs
D) Hearing aids for children
3. An insurance producer provided several examples to the applicant persuasively demonstrating that the insurance coverage offered under his company's policy was superior to a competitor's product. The insurance producer knew he was misrepresenting or stretching the truth in order to induce the applicant to forfeit her current policy and purchase a similar but inferior insurance policy from him. The insurance producer is involved in which one of the following unfair trade practices?
A) Discrimination
B) Twisting
C) Rebating
D) Fraud
4. An insurance adviser's written contract with the client must include all of the following EXCEPT:
A) Disclosure as to whether commissions may be received
B) Expiration date of the consultant's license
C) Amount of the fee
D) Duration of the contract
5. Pat owns a small business and is interested in enrolling her son in the Maryland Children's Health Insurance Program. Which of the following is the MOST appropriate person for Pat to contact for enrollment?
A) An Insurance Producer authorized to work in the SHOP Exchange
B) The Maryland Insurance Commissioner
C) A SHOP Exchange Navigator
D) A certified Navigator or authorized Producer for the Individual Exchange
Solutions:
Question # 1 Answer: A | Question # 2 Answer: C | Question # 3 Answer: B | Question # 4 Answer: B | Question # 5 Answer: D |