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MarylandAccident and Health or Sickness Producer Series 20-24 Exam Questions and Answers

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Questions # 11:

Which one of the following causes of death typically would be included under an accidental death rider attached to a life insurance policy?

Options:

Intentionally self-inflicted injuries

Illness or disease

War or acts of war

Automobile accidents resulting from the insured's negligence

Answer

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., , ]

Questions # 12:

After completing an application for insurance, the insurance producer collects the premiums but deposits the check in the insurance producer’s checking account. What crime has been committed?

Options:

Twisting

Rebating

Fraud

Replacement

Answer

Explanation

Producers hold premiums in a fiduciary capacity (Insurance Article, § 10-126) and must remit them to the insurer or a trust account. Depositing them into a personal account is fraud—specifically misappropriation—violating state law. Twisting, rebating, and replacement involve different unethical acts, not fund misuse.

[References:Maryland Insurance Article, § 10-126; MIA producer conduct regulations., , ]

Questions # 13:

In general practice, which one of the following is true of the powers of the Maryland Insurance Administration with respect to access to a producer’s business records?

Options:

Records can only be accessed by an order of a state court

Authorization must come from the National Association of Insurance Commissioners (NAIC)

Records must be produced upon the request of the Maryland Insurance Administration

The Maryland Insurance Administration has no right to access a producer’s business records because of privacy considerations

Answer

Explanation

The MIA (Insurance Article, § 2-207) can request and access producer records for audits or investigations, overriding privacy for regulatory purposes. Court orders or NAIC approval aren’t required, and access is a standard power.

[References:Maryland Insurance Article, § 2-207; MIA regulatory authority., , ]

Questions # 14:

A certificate of insurance in a group accident and health plan is:

Options:

A binding contract between the employee and the insurer

A binding contract between the employer and the insurer

Evidence of the employee’s insurance coverage

Issued to the employer for each insured location

Answer

Explanation

The certificate (Insurance Article, § 15-1207) provides employees with evidence of coverage under the group plan, not a binding contract (master policy) or employer-specific by location. It summarizes benefits for clarity.

[References:Maryland Insurance Article, § 15-1207; MIA group insurance rules., , ]

Questions # 15:

When a single major medical contract covers all medical expenses, the plan is considered to be:

Options:

Comprehensive

Limited

First-dollar

Supplemental

Answer

Explanation

A single policy covering all medical expenses (Insurance Article, § 15-201) is comprehensive, unlike limited (specific), first-dollar (no deductible), or supplemental (add-on) plans.

[References:Maryland Insurance Article, § 15-201; MIA major medical standards., , , ]

Questions # 16:

Medical expense insurance typically EXCLUDES coverage for:

Options:

Hospital care extending past 30 days

Expenses incurred for primarily cosmetic surgery

Maternity care benefits

Hospital laboratory tests

Answer

Explanation

Medical expense insurance covers necessary treatments like hospital stays, maternity care, and diagnostic tests, but excludes elective procedures such as primarily cosmetic surgery unless medically necessary (e.g., reconstructive surgery post-injury). Maryland law (Insurance Article, § 15-103) allows exclusions for non-essential services, aligning with standard practice where aesthetic surgeries like facelifts are not covered.

[References:Maryland Insurance Article, § 15-103; MIA guidelines., , ]

Questions # 17:

The waiver of premium provision in a disability income policy provides that premiums will be waived during:

Options:

The disability benefit period

The elimination period

The grace period

The time limit on certain defenses

Answer

Explanation

The waiver of premium provision (Insurance Article, § 15-201) waives premiums during the disability benefit period—when benefits are paid—easing financial strain. The elimination period requires premium payment, the grace period is for late payments, and the time limit on defenses relates to incontestability, not waivers.

[References:Maryland Insurance Article, § 15-201; MIA disability insurance standards., , ]

Questions # 18:

Pat owns a small business and is interested in enrolling her son in the Maryland Children’s Health Insurance Program. Which of the following is the MOST appropriate person for Pat to contact for enrollment?

Options:

A SHOP Exchange Navigator

The Maryland Insurance Commissioner

An Insurance Producer authorized to work in the SHOP Exchange

A certified Navigator or authorized Producer for the Individual Exchange

Answer

Explanation

MCHIP enrollment (Insurance Article, § 31-113) occurs through the Individual Exchange (Maryland Health Connection), where certified Navigators or Producers assist, not SHOP (business-focused) or the Commissioner (regulatory).

[References:Maryland Insurance Article, § 31-113; MIA MCHIP guidelines., , ]

Questions # 19:

A health maintenance organization may issue a contract that provides benefits for the following:

Options:

Replacement of income lost by a member due to the member’s disability

Health care services provided to members of the HMO

The accidental death of an HMO member

The dismemberment of an HMO member

Answer

Explanation

HMOs (Health-General Article, § 19-701) provide health care services to members, not income replacement (disability insurance), accidental death, or dismemberment benefits (life/accident insurance).

[References:Maryland Health-General Article, § 19-701; MIA HMO guidelines., , ]

Questions # 20:

Medical charges that fall within the range of fees normally charged for a given procedure in a certain geographical area are called:

Options:

Reasonable and customary charges

Preapproved charges

Utilization charges

Scheduled charges

Answer

Explanation

Reasonable and customary charges are the typical fees for a procedure in a geographic area, used to set reimbursement levels (Insurance Article, § 15-1005). Preapproved charges require prior authorization, utilization charges relate to service reviews, and scheduled charges are fixed fees, none of which define this standard.

[References:Maryland Insurance Article, § 15-1005; MIA health insurance guidelines., , ]

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