Free Accident-and-Health-or-Sickness-Producer Braindumps Download Updated on Feb 26, 2026 with 92 Questions
Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer Exam Practice Test Questions
NEW QUESTION # 50
The Maryland State Benchmark Plan applies to which of the following?
- A. Individual Health Benefit Plans sold through the Exchange
- B. Individual Health Benefit Plans sold outside the Exchange prior to January 1, 2014
- C. Medicare supplement plans sold outside the Exchange prior to January 1, 2014
- D. Medicaid plans sold through the Exchange
Answer: A
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 # 51
To be eligible for major medical extended care benefits, a patient must:
- A. Be terminally ill
- B. Require physical therapy
- C. Require continuous skilled nursing care
- D. Have had surgery
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 # 52
In accident and health insurance, a waiting period for pre-existing conditions means that:
- A. Coverage for pre-existing conditions is permanently excluded by a new insurer
- B. Coverage for pre-existing conditions starts at the inception of the new policy
- C. Payment for expenses resulting from pre-existing conditions is held in escrow
- D. A period of time must elapse before pre-existing conditions are covered
Answer: D
Explanation:
A waiting period (Insurance Article, § 15-109) delays coverage for pre-existing conditions (e.g., 6-12 months), not permanently excluding them, starting at inception, or holding payments in escrow.
References:Maryland Insurance Article, § 15-109; MIA pre-existing condition rules.
NEW QUESTION # 53
An insurance producer's license may be suspended or revoked by:
- A. The continuing education course provider
- B. The Maryland Insurance Administration
- C. The Attorney General
- D. The appointing insurer
Answer: B
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 # 54
A health maintenance organization may issue a contract that provides benefits for the following:
- A. The accidental death of an HMO member
- B. Health care services provided to members of the HMO
- C. The dismemberment of an HMO member
- D. Replacement of income lost by a member due to the member's disability
Answer: B
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.
NEW QUESTION # 55
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?
- A. Replacement
- B. Twisting
- C. Fraud
- D. Rebating
Answer: C
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.
NEW QUESTION # 56
All of the following are common features found in health maintenance organizations (HMOs) EXCEPT:
- A. Discounts on local health spa memberships
- B. Twenty-four hour access to emergency care
- C. Wellness programs
- D. Outpatient medical services
Answer: A
Explanation:
HMOs (Health-General Article, § 19-701) offer wellness, emergency, and outpatient services. Discounts on spa memberships aren't a standard feature, unrelated to core health care delivery.
References:Maryland Health-General Article, § 19-701; MIA HMO standards.
NEW QUESTION # 57
All of the following are considered to be fraud EXCEPT:
- A. Collecting a proper premium for insurance that is provided
- B. Willfully collecting a premium that exceeds the amount of the premium
- C. Collecting a premium for insurance that is not provided
- D. Collecting a charge for insurance that is less than the charge applicable to that insurance
Answer: A
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 # 58
In Maryland, an insurance producer is a person who solicits, negotiates, or sells insurance plans PRIMARILY in conjunction with:
- A. Performing clerical duties
- B. Acting as a regularly salaried officer
- C. Enrolling individuals in group plans
- D. Earning commission
Answer: D
Explanation:
A producer (Insurance Article, § 1-101(aa)) solicits and sells insurance primarily for commissions, distinguishing them from clerical staff, enrollment facilitators, or salaried insurer employees. This reflects their independent role.
References:Maryland Insurance Article, § 1-101(aa), § 10-101; MIA producer definitions.
NEW QUESTION # 59
All of the following services are covered under the Medicare Supplement preventive care benefit EXCEPT:
- A. Routine physical examinations
- B. Immunizations
- C. Hearing tests
- D. Outpatient prescription vitamins
Answer: D
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 # 60
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. Emergency medical care
- C. Primary care
- D. Dental care
Answer: D
Explanation:
HMOs (Health-General Article, § 19-701) ensure 24/7 access to hospital, emergency, and primary care services. Dental care isn't a core requirement and isn't typically available 24/7 unless added separately.
References:Maryland Health-General Article, § 19-701; MIA HMO standards.
NEW QUESTION # 61
The entire contract provision in an individual accident and health insurance policy states that the producer:
- A. May waive only certain contract provisions
- B. Has company authority to waive any contract provisions
- C. Has no authority to change the policy or waive any of its provisions
- D. Has company authority to change the policy
Answer: C
Explanation:
The entire contract provision (Insurance Article, § 15-207) defines the policy and application as the full agreement, barring producers from altering or waiving terms. Only the insurer has such authority.
References:Maryland Insurance Article, § 15-207; MIA policy standards.
NEW QUESTION # 62
Which statement describes the most likely federal income tax treatment of death benefits paid to the family of an insured under an accident and health insurance policy?
- A. Some benefits will usually be taxable
- B. Benefits will not be taxable
- C. Taxation depends on the beneficiary's tax bracket
- D. All benefits will be taxable
Answer: B
Explanation:
Death benefits from accident and health policies (e.g., accidental death, IRC § 101) are generally tax-free to beneficiaries. Partial or full taxation is rare unless tied to taxable settlements, and tax brackets don't determine this exemption.
References:IRC § 101; MIA tax treatment guidelines.
NEW QUESTION # 63
In accident and health insurance underwriting, when the risk imposed by an applicant is similar to the risks imposed by most other applicants, the applicant is:
- A. Charged the standard premium rate
- B. Charged an additional premium for the first three years
- C. Required to pay the first year's premium in a lump sum
- D. Declined coverage
Answer: A
Explanation:
Standard risk applicants (Insurance Article, § 15-201) receive the standard premium rate, as their risk aligns with the average pool. Declining coverage or adjusting payment terms applies to higher risks, not standard ones.
References:Maryland Insurance Article, § 15-201; MIA underwriting guidelines.
NEW QUESTION # 64
When a single major medical contract covers all medical expenses, the plan is considered to be:
- A. Supplemental
- B. Comprehensive
- C. Limited
- D. First-dollar
Answer: B
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.
NEW QUESTION # 65
It is unlawful for a person to provide an advertisement that:
- A. Uses a policy title to misrepresent a coverage
- B. Points out coverage advantages of a policy
- C. Makes a comparison of benefits between policies
- D. Refers to the insurer's financial rating
Answer: A
Explanation:
Advertisements (Insurance Article, § 27-503) can highlight advantages or ratings if true, but misrepresenting coverage via a title is illegal, deceiving consumers about policy benefits.
References:Maryland Insurance Article, § 27-503; MIA advertising standards.
NEW QUESTION # 66
Accident and health policies must cover physically or mentally handicapped dependent children:
- A. Until they become self-sustaining
- B. For life
- C. To age 25
- D. To age 19
Answer: B
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 # 67
In general practice, can the Maryland Insurance Administration inspect the business records of an insurance company or agency?
- A. Yes, because all company and agency records are public domain
- B. No, because only an officer of the court can inspect these records
- C. No, because of privacy considerations
- D. Yes, because of the powers defined by state laws
Answer: D
Explanation:
Comprehensive and Detailed Step by Step Explanation:The Maryland Insurance Administration (MIA) is authorized to inspect the records of insurers and agencies to ensure compliance with laws:
Yes, because of the powers defined by state laws (B):Correct. The MIA has broad authority under Maryland law to audit, inspect, and investigate insurance business practices.
No, because of privacy considerations (A):Incorrect. Regulatory inspections are exempt from privacy concerns when conducted lawfully.
Only an officer of the court (C):Not required; the MIA operates independently within its legal mandate.
Public domain records (D):Incorrect; insurance records are not publicly accessible unless required by law.
References:Maryland Insurance Article §2-209, COMAR 31.03.01, and Regulatory Oversight Guidelines.
NEW QUESTION # 68
When the insured's willful failure to disclose a material fact at the time of application is discovered by the insurer shortly after the policy is issued:
- A. The insurer must continue the insurance policy in full force
- B. The policy is voidable at the insurer's option
- C. The insurer may cancel the policy only at the expiration or renewal date
- D. The policy is automatically void
Answer: B
Explanation:
A material misrepresentation (Insurance Article, § 12-206) allows the insurer to void the policy within the contestability period (typically 2 years) if willful. It's not automatically void, nor must it continue or wait until renewal; the insurer decides based on materiality.
References:Maryland Insurance Article, § 12-206; MIA misrepresentation rules.
NEW QUESTION # 69
All of the following are typical health maintenance organization (HMO) preventive care services provided by a primary care physician EXCEPT:
- A. Experimental surgery
- B. Immunizations for children
- C. Physical examinations
- D. Well-baby checkups
Answer: A
Explanation:
HMOs (Health-General Article, § 19-701) provide preventive care like checkups, immunizations, and exams.
Experimental surgery isn't preventive or standard, making it the exception to covered services.
References:Maryland Health-General Article, § 19-701; MIA HMO guidelines.
NEW QUESTION # 70
All of the following are characteristics of a preferred risk applicant for disability income insurance EXCEPT:
- A. High income
- B. Non-hazardous occupation
- C. Non-smoker
- D. Physically active
Answer: A
Explanation:
Preferred risk applicants (Insurance Article, § 15-201) have low disability risk due to non-smoking, safe jobs, and physical activity. High income affects benefit amounts, not risk classification, making it the exception.
References:Maryland Insurance Article, § 15-201; MIA underwriting standards.
NEW QUESTION # 71
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 a licensed insurance producer
- B. Help the employer sign-up through the SHOP Exchange
- C. Refer the employer to the Maryland Insurance Administration
- D. Refer the employer to the carrier where a friend works
Answer: A
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 # 72
A health maintenance organization (HMO) must provide coverage for all of the following EXCEPT:
- A. Routine physical examinations
- B. Emergency services
- C. Dental and vision care
- D. Well-baby or well-child care
Answer: C
Explanation:
Maryland HMOs (Health-General Article, § 19-701) must provide basic health services like routine physicals, well-child care, and emergency services. Dental and vision care, however, are not required unless specified as supplemental benefits. State law mandates pediatric care but excludes routine dental and vision from standard HMO coverage unless the plan explicitly includes them.
References:Maryland Health-General Article, § 19-701; Insurance Article, § 15-1201; MIA HMO guidelines.
NEW QUESTION # 73
Medical expense insurance typically EXCLUDES coverage for treatment of:
- A. Chronic back pain
- B. Intentionally self-inflicted injuries
- C. Undiagnosed diseases
- D. Eating disorders
Answer: B
Explanation:
Medical expense insurance covers necessary treatments like chronic pain, eating disorders (under parity laws,
§ 15-802), and undiagnosed conditions if treated, but excludes intentionally self-inflicted injuries (e.g., suicide attempts) as non-accidental losses (Insurance Article, § 15-201).
References:Maryland Insurance Article, § 15-201, § 15-802; MIA health insurance exclusions.
NEW QUESTION # 74
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