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

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

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

                                                    1. When a producer engages in unfair practices, all of the following are true EXCEPT:

                                                    A) The Maryland Insurance Administration can issue a cease and desist order
                                                    B) The Maryland Insurance Administration can suspend the producer's license
                                                    C) The Maryland Insurance Administration's decision is final
                                                    D) The Maryland Insurance Administration can investigate the problem and hold a hearing


                                                    2. An accident and health insurance producer is most likely to become liable for professional errors and omissions as the result of:

                                                    A) Submitting a premium payment to an insurer in excess of the required amount
                                                    B) An accounting error discovered by the producer's accountant
                                                    C) Misleading a prospective insured in replacing accident and health insurance
                                                    D) Incorrect filing of federal income taxes


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

                                                    A) Experience rating
                                                    B) Pooled rating
                                                    C) Area rating
                                                    D) Occupational rating


                                                    4. The Maryland Insurance Administration is an agency of the:

                                                    A) State government
                                                    B) National Association of Insurance Commissioners
                                                    C) Federal government
                                                    D) Maryland General Assembly


                                                    5. An insured's statements on an accident and health insurance application are deemed to be:

                                                    A) General provisions
                                                    B) Categorical
                                                    C) Representations
                                                    D) Warranties


                                                    Solutions:

                                                    Question # 1
                                                    Answer: C
                                                    Question # 2
                                                    Answer: C
                                                    Question # 3
                                                    Answer: A
                                                    Question # 4
                                                    Answer: A
                                                    Question # 5
                                                    Answer: C

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