Accident-and-Health-or-Sickness-Producer Exam Dumps - Maryland Insurance Administration Maryland Insurance Questions and Answers

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.

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.

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.

Illegal occupations (Insurance Article, § 12-101) can lead to claim denials if disability arises from illegal acts, per public policy. Disclosure isn’t mandated, waivers don’t apply, and ratings adjust risk, not legality.

References:Maryland Insurance Article, § 12-101; MIA claims policies.

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.

The Maryland Health Benefit Exchange Act (Insurance Article, § 31-101) defines a qualified employer as one with its principal place of business in Maryland for SHOP Exchange eligibility. Premium contributions are optional, and employee work or residency percentages aren’t required.

References:Maryland Insurance Article, § 31-101; MIA SHOP Exchange rules.

Under Insurance Article, § 15-401, coverage for handicapped children extends beyond age limits if they’re incapacitated (unable to work) and dependent on the insured at the age limit. Insurability isn’t required, incapacity alone isn’t enough, and dependency isn’t time-limited to two years.

References:Maryland Insurance Article, § 15-401; MIA dependent coverage rules.

The MIA (Insurance Article, § 2-201, § 10-126) can investigate, suspend licenses, and issue orders, but its decisions are appealable to Maryland courts, not final.

References:Maryland Insurance Article, § 2-201, § 10-126; MIA enforcement powers.

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.

Commissions (Insurance Article, § 10-103) require a license, but a producer earning a commission while licensed can be paid post-termination. Unlicensed individuals or brokers can’t legally receive commissions.

References:Maryland Insurance Article, § 10-103, § 10-130, § 3-306; MIA commission rules.