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Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer Exam Syllabus Topics:

Section	Weight	Objectives
Topic 1: General Insurance Concepts	15%	- Policy Provisions 1. Exclusions and limitations 2. Mandatory and optional clauses - Fundamental Principles 1. Risk and risk management 2. Contract law and policy structure 3. Insurable interest and indemnity
Topic 2: Maryland State-Specific Regulations	20%	- Statutory Requirements 1. Disclosure and marketing requirements 2. Mandatory benefits and coverage mandates 3. Claims handling and settlement rules - Compliance and Enforcement 1. Reporting and recordkeeping 2. Penalties and violations
Topic 3: Insurance Regulation	30%	- Providers and Markets 1. HMOs and managed care arrangements 2. Insurers and health service organizations - Licensing 1. License issuance, renewal, and termination 2. Initial qualifications and examination 3. General provisions and definitions - Regulation of Producers 1. Compensation and commissions 2. Privacy and confidentiality rules 3. Unfair trade practices
Topic 4: Accident and Health Insurance Policies	35%	- Policy Features 1. Benefit structures and limits 2. Pre-existing conditions and exclusions 3. Waiting periods and elimination periods - Types of Coverage 1. Medical expense insurance 2. Disability income insurance 3. Long-term care insurance 4. Accident-only coverage

Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Sample Questions:

1. Which benefit is usually excluded from accident and health plan coverage?

A) Physicians' visits
B) Custodial care
C) Hospital expense
D) Surgical expense

2. Reasonable and customary charges for health care are based primarily on:

A) Average charges within a geographic area
B) Insurance industry studies
C) Actuarial tables
D) National physician surveys

3. Misrepresenting pertinent policy provisions relating to coverages after a loss is:

A) An unfair claim settlement practice
B) A violation of the principle of adhesion
C) A concealment in insurance applications
D) An unfair discrimination between individuals

4. A nonprofit health service plan may NOT issue a contract that covers which of the following types of benefits?

A) Medical expense benefits
B) Disability income benefits
C) Dental benefits
D) Vision benefits

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

A) A binding contract between the employer and the insurer
B) Issued to the employer for each insured location
C) Evidence of the employee's insurance coverage
D) A binding contract between the employee and the insurer

Solutions:

Question # 1
Answer: B

Question # 2
Answer: A

Question # 3
Answer: A

Question # 4
Answer: B

Question # 5
Answer: C