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

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

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

                                                    1. Disability income insurance premiums are a deductible expense when the premiums are paid by:

                                                    A) An insured for individual disability income coverage
                                                    B) A partnership for group disability income coverage for the partners
                                                    C) An employee for group disability income coverage
                                                    D) A corporation for group disability income coverage for the employees


                                                    2. 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) Health care services provided to members of the HMO
                                                    C) The dismemberment of an HMO member
                                                    D) The accidental death of an HMO member


                                                    3. A policy of life insurance may NOT be delivered unless the policy has a:

                                                    A) Notary seal
                                                    B) Financial statement of the life insurance company
                                                    C) Legible and brief description of the policy on the first page
                                                    D) Premium coupon book


                                                    4. In HMO coverage, all of the following services must be available 24 hours per day, 7 days per week EXCEPT:

                                                    A) In-patient hospital services
                                                    B) Primary care
                                                    C) Dental care
                                                    D) Emergency medical care


                                                    5. Which type of Medicare Supplement information can be used without prior state approval?

                                                    A) Government publications
                                                    B) Television advertisements approved by the insurer
                                                    C) Radio announcements approved by the insurer
                                                    D) Insurance company brochures


                                                    Solutions:

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

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