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

Major medical plans (Insurance Article, § 15-201) cover hospice, drugs, and therapy, but excluderoutine dental care, which requires separate dental insurance.

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

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.

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.

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.

Misrepresenting coverage post-loss (Insurance Article, § 27-303) is an unfair claims practice, deceiving claimants about benefits. Concealment applies pre-policy, discrimination involves unequal treatment, and adhesion relates to contract terms, not claims.

References:Maryland Insurance Article, § 27-303; MIA claims practices.

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.

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.

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.

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.

Medicare Part D covers outpatient prescription drugs, not medical (Part B), hospital (Part A), or dental (excluded) expenses, per federal law applicable in Maryland. It fills a key gap for enrollees’ medication costs.

References:Medicare guidelines; Maryland Insurance Article, § 15-901.