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

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

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

                                                    Question 1

                                                    Which benefit is usually excluded from major medical expense plan coverage?

                                                    A. Physical therapy
                                                    B. Hospice care
                                                    C. Prescription drugs
                                                    D. Routine dental care


                                                    Question 2

                                                    To be deemed a "qualified employer" under the Maryland Health Benefit Exchange Act, anemployer MUST:

                                                    A. Have at least 50% of its employees work in the state of Maryland
                                                    B. Contribute to employee premiums
                                                    C. Have its principal place of business in the state of Maryland
                                                    D. Have at least 50% of its employees reside in the state of Maryland


                                                    Question 3

                                                    An elimination period in a disability income insurance policy is the:

                                                    A. Period between the start of a disability and the beginning of benefits
                                                    B. Time during which benefits are paid under the policy
                                                    C. Time period the policy is in force
                                                    D. Same as the probationary period


                                                    Question 4

                                                    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 through the Exchange
                                                    C. Individual Health Benefit Plans sold outside the Exchange prior to January 1, 2014
                                                    D. Medicaid plans sold through the Exchange


                                                    Question 5

                                                    All of the following services are covered under the Medicare Supplement preventive care benefit EXCEPT:

                                                    A. Hearing tests
                                                    B. Outpatient prescription vitamins
                                                    C. Routine physical examinations
                                                    D. Immunizations


                                                    Solutions:

                                                    Question 1
                                                    Answer: D
                                                    Question 2
                                                    Answer: C
                                                    Question 3
                                                    Answer: A
                                                    Question 4
                                                    Answer: B
                                                    Question 5
                                                    Answer: B

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