Latest [Jan 19, 2026] Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer Real Exam Dumps PDF
Accident-and-Health-or-Sickness-Producer Practice Test Questions Updated 92 Questions
NEW QUESTION # 31
When a single major medical contract covers all medical expenses, the plan is considered to be:
- A. First-dollar
- B. Supplemental
- C. Comprehensive
- D. Limited
Answer: C
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 # 32
Reasonable and customary charges for health care are based primarily on:
- A. Average charges within a geographic area
- B. National physician surveys
- C. Insurance industry studies
- D. Actuarial tables
Answer: A
Explanation:
Reasonable and customary charges (Insurance Article, § 15-1005) reflect average fees for procedures in a specific geographic area (e.g., 80th percentile), ensuring fair reimbursement. Actuarial tables, studies, and national surveys aren't the primary basis.
References:Maryland Insurance Article, § 15-1005; MIA health insurance guidelines.
NEW QUESTION # 33
Group health insurance contracts providing coverage for employees in more than one state are usually controlled by the laws of the state where:
- A. The majority of employees reside
- B. The producer resides
- C. The application is signed
- D. The master contract is issued
Answer: D
Explanation:
Multi-state group plans (Insurance Article, § 15-1202) are governed by the state where the master contract is issued, typically the employer's home state, ensuring consistent legal oversight regardless of employee location or producer residence.
References:Maryland Insurance Article, § 15-1202; MIA multi-state group rules.
NEW QUESTION # 34
In general practice, which one of the following is true of the powers of the Maryland Insurance Administration with respect to access to a producer's business records?
- A. Records must be produced upon the request of the Maryland Insurance Administration
- B. The Maryland Insurance Administration has no right to access a producer's business records because of privacy considerations
- C. Records can only be accessed by an order of a state court
- D. Authorization must come from the National Association of Insurance Commissioners (NAIC)
Answer: A
Explanation:
The MIA (Insurance Article, § 2-207) can request and access producer records for audits or investigations, overriding privacy for regulatory purposes. Court orders or NAIC approval aren't required, and access is a standard power.
References:Maryland Insurance Article, § 2-207; MIA regulatory authority.
NEW QUESTION # 35
All of the following are considered to be fraud EXCEPT:
- A. Collecting a charge for insurance that is less than the charge applicable to that insurance
- 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 proper premium for insurance that is provided
Answer: D
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 # 36
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. Medicaid plans sold through the Exchange
- D. Medicare supplement plans sold outside the Exchange prior to January 1, 2014
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 # 37
In Maryland, a group accident and health certificate of insurance must contain:
- A. The insurer's financial statement
- B. A copy of the group contract
- C. A summary of policy features and benefits
- D. A list of all participating physicians
Answer: C
Explanation:
Certificates (Insurance Article, § 15-1207) summarize policy features and benefits for group members, not the full contract, physician lists, or financial statements, which are separate or irrelevant. This ensures employees understand their coverage.
References:Maryland Insurance Article, § 15-1207; MIA group insurance rules.
NEW QUESTION # 38
When the employer pays the premium, covered individuals normally receive tax-free benefits under all of the following group health plans EXCEPT:
- A. Health maintenance organization
- B. Dental
- C. Disability income
- D. Major medical
Answer: C
Explanation:
Federal tax rules (IRC § 105, § 106) make employer-paid medical benefits (major medical, dental, HMO) tax- free, but disability income benefits are taxable if employer-funded, as they replace income.
References:IRC § 105, § 106; Maryland Insurance Article, § 15-1201; MIA tax guidelines.
NEW QUESTION # 39
Which benefit is usually excluded from accident and health plan coverage?
- A. Surgical expense
- B. Hospital expense
- C. Custodial care
- D. Physicians' visits
Answer: C
Explanation:
Accident and health plans (Insurance Article, § 15-201) cover acute needs like hospital, physician, and surgical expenses. Custodial care-non-medical daily assistance-is excluded, typically covered by long-term care insurance.
References:Maryland Insurance Article, § 15-201; MIA health insurance standards.
NEW QUESTION # 40
The typical group disability income insurance policy EXCLUDES coverage for disability resulting from:
- A. Military service
- B. Injuries occurring in the home
- C. Commercial airline crashes
- D. Automobile accidents
Answer: A
Explanation:
Group disability policies (Insurance Article, § 15-201) cover accidents like crashes or home injuries, but exclude military service disabilities, often covered by government programs (e.g., VA), reflecting standard exclusions.
References:Maryland Insurance Article, § 15-201; MIA disability insurance standards.
NEW QUESTION # 41
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 the Maryland Insurance Administration
- B. Refer the employer to a licensed insurance producer
- C. Refer the employer to the carrier where a friend works
- D. Help the employer sign-up through the SHOP Exchange
Answer: B
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 # 42
An insurance policy could be issued to cover losses resulting from any of the following EXCEPT:
- A. A skydiving exhibition
- B. A state-sponsored centennial celebration
- C. A drug smuggling operation
- D. A nuclear power plant
Answer: C
Explanation:
Insurance (Insurance Article, § 12-101) covers legal risks like skydiving, events, or plants, but not illegal acts like drug smuggling, barred by public policy.
References:Maryland Insurance Article, § 12-101; MIA insurability guidelines.
NEW QUESTION # 43
In accident and health insurance, a waiting period for pre-existing conditions means that:
- A. A period of time must elapse before pre-existing conditions are covered
- B. Coverage for pre-existing conditions starts at the inception of the new policy
- C. Coverage for pre-existing conditions is permanently excluded by a new insurer
- D. Payment for expenses resulting from pre-existing conditions is held in escrow
Answer: A
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 # 44
Disability income insurance premiums are a deductible expense when the premiums are paid by:
- A. An insured for individual disability income coverage
- B. An employee for group disability income coverage
- C. A partnership for group disability income coverage for the partners
- D. A corporation for group disability income coverage for the employees
Answer: D
Explanation:
Under IRC § 162, premiums paid by a corporation for group disability coverage for employees are deductible as a business expense, with benefits taxable to employees. Partnerships can't deduct for partners (owners), individual premiums aren't deductible (IRC § 213), and employee-paid premiums don't qualify unless under specific plans. Maryland follows federal tax treatment.
References:Maryland Insurance Article; IRC § 162, § 213; MIA tax guidelines.
NEW QUESTION # 45
An insurance adviser's written contract with the client must include all of the following EXCEPT:
- A. Expiration date of the consultant's license
- B. Disclosure as to whether commissions may be received
- C. Amount of the fee
- D. Duration of the contract
Answer: A
Explanation:
Adviser contracts (Insurance Article, § 10-201) require fee amounts, contract duration, and commission disclosure for transparency. The consultant's license expiration is a regulatory detail, not a client contract requirement.
References:Maryland Insurance Article, § 10-201; MIA adviser rules.
NEW QUESTION # 46
Before issuing a policy of long-term care insurance to an applicant who is at least 80 years old, unless the policy is guaranteed issue, the carrier shall obtain a:
- A. Applicant's family's consent
- B. Power of attorney
- C. Report of a physical examination
- D. Copy of the person's living will
Answer: C
Explanation:
For non-guaranteed issue long-term care policies (Insurance Article, § 18-107), a physical exam report is required for applicants 80+ to assess risk, not family consent, living wills, or power of attorney.
References:Maryland Insurance Article, § 18-107; MIA LTC underwriting rules.
NEW QUESTION # 47
The entire contract provision in an individual accident and health insurance policy states that the producer:
- A. Has company authority to waive any contract provisions
- B. Has no authority to change the policy or waive any of its provisions
- C. May waive only certain contract provisions
- D. Has company authority to change the policy
Answer: B
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 # 48
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