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

SectionWeightObjectives
Topic 1: 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 2: 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 3: General Insurance Concepts15%- Policy Provisions
                          • 1. Exclusions and limitations
                            • 2. Mandatory and optional clauses
                              - Fundamental Principles
                              • 1. Insurable interest and indemnity
                                • 2. Risk and risk management
                                  • 3. Contract law and policy structure
                                    Topic 4: Insurance Regulation30%- Regulation of Producers
                                    • 1. Unfair trade practices
                                      • 2. Privacy and confidentiality rules
                                        • 3. Compensation and commissions
                                          - Licensing
                                          • 1. General provisions and definitions
                                            • 2. License issuance, renewal, and termination
                                              • 3. Initial qualifications and examination
                                                - Providers and Markets
                                                • 1. Insurers and health service organizations
                                                  • 2. HMOs and managed care arrangements

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

                                                    Question #1

                                                    The primary purpose of disability income insurance is to:

                                                    • A. Provide indemnity for loss of life
                                                    • B. Pay any physicians' fees resulting from a disabling injury
                                                    • C. Pay necessary hospital expenses when the insured is unable to work
                                                    • D. Provide benefit payments for a period of time when the insured is unable to work
                                                    Answer: D

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                                                    Question #2

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

                                                    • A. Experience rating
                                                    • B. Occupational rating
                                                    • C. Pooled rating
                                                    • D. Area rating
                                                    Answer: A

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                                                    Question #3

                                                    All advertisements for health insurance shall make clear the identity of the:

                                                    • A. Insurance Commissioner
                                                    • B. Beneficiary
                                                    • C. Insured
                                                    • D. Insurer
                                                    Answer: D

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                                                    Question #4

                                                    In dental insurance coverage, which one of the following typically is EXCLUDED?

                                                    • A. Preventive care
                                                    • B. Treatment started prior to the eligibility date
                                                    • C. Root canal therapy
                                                    • D. Dental X-rays
                                                    Answer: B

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                                                    Question #5

                                                    The Maryland State Benchmark Plan applies to which of the following?

                                                    • A. Medicare supplement plans sold outside the Exchange prior to January 1, 2014
                                                    • B. Individual Health Benefit Plans sold outside the Exchange prior to January 1, 2014
                                                    • C. Medicaid plans sold through the Exchange
                                                    • D. Individual Health Benefit Plans sold through the Exchange
                                                    Answer: D

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