ACCIDENT-AND-HEALTH-OR-SICKNESS-PRODUCER DETAILED ANSWERS - NEW ACCIDENT-AND-HEALTH-OR-SICKNESS-PRODUCER PRACTICE MATERIALS

Accident-and-Health-or-Sickness-Producer Detailed Answers - New Accident-and-Health-or-Sickness-Producer Practice Materials

Accident-and-Health-or-Sickness-Producer Detailed Answers - New Accident-and-Health-or-Sickness-Producer Practice Materials

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Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Exam Sample Questions (Q50-Q55):

NEW QUESTION # 50
In HMO coverage, all of the following services must be available 24 hours per day, 7 days per week EXCEPT:

  • A. Primary care
  • B. Dental care
  • C. In-patient hospital services
  • D. Emergency medical care

Answer: B

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 # 51
If an individual's occupation is considered to be illegal:

  • A. It must be stated as such on an accident and health insurance application
  • B. It may require a waiver on a disability income insurance policy
  • C. It results in a substandard rating on an accident and health insurance policy
  • D. It may result in a denial of a disability income claim

Answer: D

Explanation:
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.


NEW QUESTION # 52
A health maintenance organization may issue a contract that provides benefits for the following:

  • A. The dismemberment of an HMO member
  • B. Health care services provided to members of the HMO
  • C. The accidental death 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 # 53
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 of privacy considerations
  • C. Yes, because of the powers defined by state laws
  • D. No, because only an officer of the court can inspect these records

Answer: C

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 # 54
The primary purpose of disability income insurance is to:

  • A. Provide indemnity for loss of life
  • B. Pay any physicians' fees resulting from a disabling injury
  • C. Provide benefit payments for a period of time when the insured is unable to work
  • D. Pay necessary hospital expenses when the insured is unable to work

Answer: C

Explanation:
Disability income insurance (Insurance Article, § 15-201) replaces income during disability, not life indemnity, hospital costs (health insurance), or physician fees (medical insurance). It supports financial stability when work is impossible.
References:Maryland Insurance Article, § 15-201; MIA disability insurance standards.


NEW QUESTION # 55
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