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Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Policy Provisions and Clauses | 18-22% | - Waiting periods - Deductibles and copayments - Benefit periods - Exclusions and limitations - Coverage terms and conditions - Preexisting condition clauses |
| Marketing Practices | 8-12% | - Advertising guidelines - Marketing regulations - Producer responsibilities - Prohibited practices |
| Social Insurance Programs | 8-12% | - CHIP (Children's Health Insurance Program) - Medicaid programs - Social Security disability benefits - Medicare Part A, B, C, D |
| Maryland Insurance Laws and Regulations | 20-25% | - Maryland Insurance Code - Producer licensing requirements - Privacy and confidentiality requirements - Violations and penalty provisions - Consumer protection regulations - Unfair claim settlement practices |
| Field Underwriting and Application Process | 8-12% | - Medical underwriting - Agent responsibilities in enrollment - Application procedures - Risk classification |
| Types of Health Insurance Policies | 20-25% | - Individual health insurance - Medicare and Medicaid - Group health insurance - Dental and vision insurance - Disability income insurance - 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) Replacement of income lost by a member due to the member's disability
B) The dismemberment of an HMO member
C) The accidental death of an HMO member
D) Health care services provided to members of the HMO
2. All of the following are typical health maintenance organization (HMO) preventive care services provided by a primary care physician EXCEPT:
A) Well-baby checkups
B) Immunizations for children
C) Physical examinations
D) Experimental surgery
3. Under Maryland law, the agreement between an insurance producer and insurer under which the insurance producer, for compensation, may sell, solicit, or negotiate policies issued by the insurer is defined as:
A) A license
B) An appointment
C) A certificate of authority
D) A binding agreement
4. An accident and health insurance producer is most likely to become liable for professional errors and omissions as the result of:
A) An accounting error discovered by the producer's accountant
B) Misleading a prospective insured in replacing accident and health insurance
C) Submitting a premium payment to an insurer in excess of the required amount
D) Incorrect filing of federal income taxes
5. Medical expense insurance typically EXCLUDES coverage for treatment of:
A) Intentionally self-inflicted injuries
B) Undiagnosed diseases
C) Eating disorders
D) Chronic back pain
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: D | Question # 3 Answer: B | Question # 4 Answer: B | Question # 5 Answer: A |
