UpdateDumps Accident-and-Health-or-Sickness-Producer Dumps Real Exam Questions Test Engine Dumps Training
Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer exam dumps and online Test Engine
NEW QUESTION # 50
An insurance producer's license may be suspended or revoked by:
- A. The Maryland Insurance Administration
- B. The continuing education course provider
- C. The appointing insurer
- D. The Attorney General
Answer: A
Explanation:
Comprehensive and Detailed Step by Step Explanation:The Maryland Insurance Administration (MIA) has sole authority to regulate, suspend, or revoke an insurance producer's license for violations of state insurance laws:
Maryland Insurance Administration (C):Correct. The MIA oversees producer licensing, compliance, and disciplinary actions.
Appointing insurer (A):Can terminate an appointment but cannot revoke a license.
Continuing education provider (B):Only offers training and has no regulatory authority.
Attorney General (D):Handles legal actions but does not directly manage licensing.
References:Maryland Insurance Article §10-126, Producer Regulation Guidelines, COMAR 31.03.13.
NEW QUESTION # 51
Group health insurance contracts providing coverage for employees in more than one state are usually controlled by the laws of the state where:
- A. The majority of employees reside
- B. The application is signed
- C. The producer resides
- D. The master contract is issued
Answer: D
Explanation:
Multi-state group plans (Insurance Article, § 15-1202) are governed by the state where the master contract is issued, typically the employer's home state, ensuring consistent legal oversight regardless of employee location or producer residence.
References:Maryland Insurance Article, § 15-1202; MIA multi-state group rules.
NEW QUESTION # 52
Which one of the following causes of loss typically is EXCLUDED under a disability income insurance policy?
- A. Cancer
- B. Intentionally self-inflicted injuries
- C. Tropical disease
- D. Auto accidents
Answer: B
Explanation:
Disability income policies (Insurance Article, § 15-201) cover accidents, cancer, and diseases, but exclude intentionally self-inflicted injuries as non-accidental, aligning with standard exclusions to prevent abuse.
References:Maryland Insurance Article, § 15-201; MIA disability insurance standards.
NEW QUESTION # 53
A nonprofit health service plan may NOT issue a contract that covers which of the following types of benefits?
- A. Dental benefits
- B. Disability income benefits
- C. Vision benefits
- D. Medical expense benefits
Answer: B
Explanation:
Nonprofit health service plans (Insurance Article, § 14-102), like HMOs, provide medical, vision, and dental benefits, but disability income-replacing lost wages-is outside their scope and belongs to separate insurance types.
References:Maryland Insurance Article, § 14-102; MIA nonprofit plan rules.
NEW QUESTION # 54
Which benefit is usually excluded from accident and health plan coverage?
- A. Custodial care
- B. Physicians' visits
- C. Hospital expense
- D. Surgical expense
Answer: A
Explanation:
Accident and health plans (Insurance Article, § 15-201) cover acute needs like hospital, physician, and surgical expenses. Custodial care-non-medical daily assistance-is excluded, typically covered by long-term care insurance.
References:Maryland Insurance Article, § 15-201; MIA health insurance standards.
NEW QUESTION # 55
To be eligible for major medical extended care benefits, a patient must:
- A. Have had surgery
- B. Be terminally ill
- C. Require continuous skilled nursing care
- D. Require physical therapy
Answer: C
Explanation:
Extended care under major medical (Insurance Article, § 15-201) requires continuous skilled nursing care (e.
g., nursing home), not just terminal illness, surgery, or therapy, which have broadercriteria.
References:Maryland Insurance Article, § 15-201; MIA major medical standards.
NEW QUESTION # 56
A producer may be guilty of misrepresentation if the producer:
- A. Denied a claim for failure of the policyholder to prove damages
- B. Required timely written notice of loss for all claims
- C. Issued a full settlement check expressly releasing the insurer
- D. Failed to disclose exclusions of the policy
Answer: D
Explanation:
Comprehensive and Detailed Step by Step Explanation:Misrepresentation involves providing false, misleading, or incomplete information about a policy:
Failed to disclose exclusions of the policy (A):Correct. Not informing the insured about policy exclusions misrepresents the coverage and violates Maryland law.
Denied a claim for failure to prove damages (B):This relates to claims handling and is not misrepresentation.
Required written notice of loss (C):This is a legitimate policy requirement, not misrepresentation.
Issued a full settlement check (D):Standard claims settlement practice when agreed upon; not related to misrepresentation.
References:Maryland Insurance Article §27-303, Misrepresentation and False Advertising Standards, COMAR 31.15.03.
NEW QUESTION # 57
All of the following services are covered under the Medicare Supplement preventive care benefit EXCEPT:
- A. Routine physical examinations
- B. Outpatient prescription vitamins
- C. Immunizations
- D. Hearing tests
Answer: B
Explanation:
Medicare Supplement (Medigap, Insurance Article, § 15-901) covers preventive services like immunizations, hearing tests (if Medicare-eligible), and physicals, but outpatient prescription vitamins aren't a standard benefit under Medicare or Medigap.
References:Maryland Insurance Article, § 15-901; CMS Medigap guidelines.
NEW QUESTION # 58
Giving policyholders some part of the agent's commission as an inducement to purchase insurance is an unfair trade practice known as:
- A. Replacement
- B. Rebating
- C. Twisting
- D. Retention
Answer: B
Explanation:
Rebating (Insurance Article, § 27-212) involves offering part of a commission to entice a purchase, an illegal practice in Maryland unless part of an approved plan. Twisting misrepresentspolicies, replacement swaps coverage, and retention isn't a trade practice term. This protects fair competition.
References:Maryland Insurance Article, § 27-212; MIA trade practice rules.
NEW QUESTION # 59
When a producer sells an individual accident and health insurance policy, how is the initial premium usually paid?
- A. The producer collects and forwards it to the insurer
- B. The applicant sends it directly to the insurer with the application
- C. The insurer utilizes the applicant's automatic bank draft authorization
- D. The insurer bills the applicant when the application is approved
Answer: A
Explanation:
Producers (Insurance Article, § 10-126) typically collect the initial premium with the application and forward it to the insurer, streamlining the process, unlike direct payment, billing, or bank drafts, which are less common initially.
References:Maryland Insurance Article, § 10-126; MIA producer procedures.
NEW QUESTION # 60
All of the following factors may affect premium determination in individual life insurance EXCEPT:
- A. Health
- B. Age
- C. Race
- D. Occupation
Answer: C
Explanation:
Comprehensive and Detailed Step by Step Explanation:Premium determination in life insurance depends on factors that measure risk, butrace (D)is not and cannot be used due to anti-discrimination laws.
Age (A):A primary factor; younger applicants are charged lower premiums due to lower mortality risk.
Health (B):Significant; poor health or pre-existing conditions increase premiums.
Occupation (C):Risky professions (e.g., construction or aviation) may result in higher premiums.
Race (D):Prohibited by Maryland law, which ensures fairness and prohibits underwriting based on race, ethnicity, or similar discriminatory criteria.
References:Maryland Insurance Article §27-501, COMAR 31.09.03, and Anti-Discrimination Standards in Insurance.
NEW QUESTION # 61
Which of the following is a requirement of an insurable risk?
- A. The chance of loss must be calculable.
- B. The loss must be catastrophic.
- C. There must be a large number of different loss exposures.
- D. The loss must be intentional.
Answer: A
Explanation:
Comprehensive and Detailed Step by Step Explanation:Aninsurable riskmust meet specific criteria to ensure fair and financially viable coverage:
Chance of loss must be calculable (C):Correct. Insurers need statistical data to assess risk and determine premiums.
Loss must be intentional (A):Incorrect; intentional losses are not insurable.
Loss must be catastrophic (B):Incorrect; catastrophic losses (e.g., war or large-scale disasters) are often excluded or managed through reinsurance.
Large number of different loss exposures (D):A large number of similar, not different, exposures is required for risk pooling.
References:Maryland Insurance Principles, Actuarial Standards, and COMAR 31.09.14.
NEW QUESTION # 62
Accident and health policies must cover physically or mentally handicapped dependent children:
- A. For life
- B. To age 25
- C. To age 19
- D. Until they become self-sustaining
Answer: A
Explanation:
Maryland law (Insurance Article, § 15-401) requires coverage for handicapped dependent children beyond standard age limits if they're incapable of self-sustaining employment and dependent on the insured. This extends for life, or as long as the policy is active, not limited to ages 19 or 25, nor tied to self-sustainability.
References:Maryland Insurance Article, § 15-401; MIA dependent coverage regulations.
NEW QUESTION # 63
An insurance producer provided several examples to the applicant persuasively demonstrating that the insurance coverage offered under his company's policy was superior to a competitor's product. The insurance producer knew he was misrepresenting or stretching the truth in order to induce the applicant to forfeit her current policy and purchase a similar but inferior insurance policy from him. The insurance producer is involved in which one of the following unfair trade practices?
- A. Rebating
- B. Discrimination
- C. Fraud
- D. Twisting
Answer: D
Explanation:
Twisting (Insurance Article, § 27-203) involves misrepresenting policy benefits to induce replacement with an inferior product. Fraud is broader, discrimination isn't relevant, and rebating offers financial inducements, not misrepresentation.
References:Maryland Insurance Article, § 27-203; MIA trade practice rules.
NEW QUESTION # 64
If an employer with 200 employees wants to offer health insurance and calls a SHOP Exchange Navigator, what should the navigator do?
- A. Refer the employer to the carrier where a friend works
- B. Refer the employer to the Maryland Insurance Administration
- C. Help the employer sign-up through the SHOP Exchange
- D. Refer the employer to a licensed insurance producer
Answer: D
Explanation:
SHOP Exchange (Insurance Article, § 31-101) serves employers with 1-50 employees; a 200-employee firm exceeds this, so the navigator should refer them to a producer for large group plans, not assist via SHOP, refer personally, or send to the MIA.
References:Maryland Insurance Article, § 31-101; MIA SHOP Exchange guidelines.
NEW QUESTION # 65
All of the following are considered to be fraud EXCEPT:
- A. Collecting a charge for insurance that is less than the charge applicable to that insurance
- B. Willfully collecting a premium that exceeds the amount of the premium
- C. Collecting a proper premium for insurance that is provided
- D. Collecting a premium for insurance that is not provided
Answer: C
Explanation:
Fraud involves intentional deception for gain (Insurance Article, § 27-401). Overcharging, undercharging deceptively, or charging for nonexistent coverage are fraudulent. Collecting the proper premium for provided insurance is a legitimate transaction and not fraud, making it the exception.
References:Maryland Insurance Article, § 27-401, § 27-212; MIA fraud regulations.
NEW QUESTION # 66
All of the following are basic underwriting actions in accident and health insurance EXCEPT:
- A. Issuing standard policies as applied for
- B. Issuing policies with exclusion riders
- C. Deleting uniform policy provisions
- D. Rejecting applicants
Answer: C
Explanation:
Underwriting involves assessing risk by rejecting high-risk applicants, issuing standard policies, or adding exclusion riders for specific conditions. Deleting uniform policy provisions-mandatory clauses like grace periods (Insurance Article, § 15-201)-isn't an underwriting action, as these are legally required and cannot be altered by underwriters.
References:Maryland Insurance Article, § 15-201 et seq.; MIA underwriting guidelines.
NEW QUESTION # 67
Which one of the following causes of death typically would be included under an accidental death rider attached to a life insurance policy?
- A. Automobile accidents resulting from the insured's negligence
- B. War or acts of war
- C. Intentionally self-inflicted injuries
- D. Illness or disease
Answer: A
Explanation:
Comprehensive and Detailed Step by Step Explanation:Accidental death riders provide additional benefits if the insured dies due to an unforeseen accident.
* Automobile accidents resulting from the insured's negligence (D):Covered because negligence in driving does not disqualify the event from being an accident. The death must be directly and solely caused by the accident.
* Intentionally self-inflicted injuries (A):Excluded as they are not accidental but intentional.
* Illness or disease (B):Excluded as accidental death benefits do not apply to natural causes.
* War or acts of war (C):Generally excluded under most policies as a specific clause addresses wartime risks.
References:Maryland Insurance Guidelines for Accidental Death Riders and Policy Exclusions, COMAR
31.09.04.
NEW QUESTION # 68
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. Individual Health Benefit Plans sold through the Exchange
- D. Medicaid plans sold through the Exchange
Answer: C
Explanation:
The Maryland Benchmark Plan (Insurance Article, § 31-115) defines EHBs for individual and small group plans sold via the Maryland Health Connection Exchange, not Medicaid, Medigap, or pre-2014 off-Exchange plans.
References:Maryland Insurance Article, § 31-115; MIA ACA guidelines.
NEW QUESTION # 69
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