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NEW QUESTION # 26
The primary purpose of disability income insurance is to:
- A. Provide benefit payments for a period of time when the insured is unable to work
- B. Pay necessary hospital expenses when the insured is unable to work
- C. Pay any physicians' fees resulting from a disabling injury
- D. Provide indemnity for loss of life
Answer: A
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 # 27
An elimination period in a disability income insurance policy is the:
- A. Same as the probationary period
- B. Time during which benefits are paid under the policy
- C. Time period the policy is in force
- D. Period between the start of a disability and the beginning of benefits
Answer: D
Explanation:
The elimination period (Insurance Article, § 15-201) is the waiting time (e.g., 90 days) before disability benefits begin, distinct from the benefit period (payment duration), probationary period (pre-coverage wait), or policy term.
References:Maryland Insurance Article, § 15-201; MIA disability insurance rules.
NEW QUESTION # 28
The Maryland Insurance Administration is an agency of the:
- A. Maryland General Assembly
- B. National Association of Insurance Commissioners
- C. State government
- D. Federal government
Answer: C
Explanation:
The Maryland Insurance Administration (MIA) is a state agency under Insurance Article, § 2-101, regulating insurance within Maryland. The federal government oversees broader laws, the NAIC is a voluntary group, and the General Assembly legislates, but the MIA operates as an executive state entity.
References:Maryland Insurance Article, § 2-101; MIA official structure.
NEW QUESTION # 29
When a single major medical contract covers all medical expenses, the plan is considered to be:
- A. Comprehensive
- B. Limited
- C. Supplemental
- D. First-dollar
Answer: A
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 # 30
When a producer sells an individual accident and health insurance policy, how is the initial premium usually paid?
- A. The applicant sends it directly to the insurer with the application
- B. The insurer bills the applicant when the application is approved
- C. The producer collects and forwards it to the insurer
- D. The insurer utilizes the applicant's automatic bank draft authorization
Answer: C
Explanation:
Producers (Insurance Article, § 10-126) typically collect the initial premium with the application and forward it to the insurer, streamlining the process, unlike direct payment, billing, or bank drafts, which are less common initially.
References:Maryland Insurance Article, § 10-126; MIA producer procedures.
NEW QUESTION # 31
The Maryland State Benchmark Plan applies to which of the following?
- A. Individual Health Benefit Plans sold through the Exchange
- B. Medicare supplement plans sold outside the Exchange prior to January 1, 2014
- C. Individual Health Benefit Plans sold outside the Exchange prior to January 1, 2014
- D. Medicaid plans sold through the Exchange
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 # 32
Short-term group disability income insurance:
- A. Frequently provides coverage through age 65 for insureds who are over 55 when they become disabled
- B. Usually provides benefits expressed as a percentage of the insured's normal weekly wage, up to a specified weekly maximum
- C. Often has a benefit period extending up to a maximum of ten years
- D. Usually coordinates the amount of benefits paid with disability benefits received under Social Security
Answer: B
Explanation:
Short-term disability (Insurance Article, § 15-201) pays a percentage of wages (e.g., 50-70%) up to a weekly cap for a short duration (e.g., 13-26 weeks). Coordination with Social Security, 10-year periods, or coverage to age 65 are long-term disability features.
References:Maryland Insurance Article, § 15-201; MIA disability insurance standards.
NEW QUESTION # 33
All of the following are typical health maintenance organization (HMO) preventive care services provided by a primary care physician EXCEPT:
- A. Immunizations for children
- B. Well-baby checkups
- C. Physical examinations
- D. Experimental surgery
Answer: D
Explanation:
HMOs (Health-General Article, § 19-701) provide preventive care like checkups, immunizations, and exams.
Experimental surgery isn't preventive or standard, making it the exception to covered services.
References:Maryland Health-General Article, § 19-701; MIA HMO guidelines.
NEW QUESTION # 34
Under which marketing system do insurers solicit customers by mass media advertising and mail without the services of a producer?
- A. Contingent
- B. Direct response
- C. Branch office
- D. Captive agent
Answer: B
Explanation:
Direct response (Insurance Article, § 10-101) uses mass media and mail to sell directly, bypassing producers, unlike branch offices, captive agents, or contingent systems, which involve intermediaries.
References:Maryland Insurance Article, § 10-101; MIA marketing guidelines.
NEW QUESTION # 35
A health maintenance organization (HMO) must provide coverage for all of the following EXCEPT:
- A. Emergency services
- B. Routine physical examinations
- C. Dental and vision care
- D. Well-baby or well-child care
Answer: C
Explanation:
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.
NEW QUESTION # 36
Coverage for the first three pints of blood for Medicare enrollees is:
- A. A Medicare Supplement core benefit
- B. A Medicare Part B benefit
- C. A Medicare Supplement additional benefit
- D. A Medicare Part A benefit
Answer: A
Explanation:
Medicare Part A excludes the first three pints of blood for inpatient care, but Medigap core benefits (Insurance Article, § 15-901) cover this cost across all plans (A-J), making it a standard, not additional, benefit. Parts A and B don't include it directly.
References:Maryland Insurance Article, § 15-901; CMS Medicare guidelines.
NEW QUESTION # 37
A certificate of insurance in a group accident and health plan is:
- A. A binding contract between the employer and the insurer
- B. A binding contract between the employee and the insurer
- C. Issued to the employer for each insured location
- D. Evidence of the employee's insurance coverage
Answer: D
Explanation:
The certificate (Insurance Article, § 15-1207) provides employees with evidence of coverage under the group plan, not a binding contract (master policy) or employer-specific by location. It summarizes benefits for clarity.
References:Maryland Insurance Article, § 15-1207; MIA group insurance rules.
NEW QUESTION # 38
An insurance producer provided several examples to the applicant persuasively demonstrating that the insurance coverage offered under his company's policy was superior to a competitor's product. The insurance producer knew he was misrepresenting or stretching the truth in order to induce the applicant to forfeit her current policy and purchase a similar but inferior insurance policy from him. The insurance producer is involved in which one of the following unfair trade practices?
- A. Twisting
- B. Discrimination
- C. Rebating
- D. Fraud
Answer: A
Explanation:
Twisting (Insurance Article, § 27-203) involves misrepresenting policy benefits to induce replacement with an inferior product. Fraud is broader, discrimination isn't relevant, and rebating offers financial inducements, not misrepresentation.
References:Maryland Insurance Article, § 27-203; MIA trade practice rules.
NEW QUESTION # 39
Which one of the following causes of loss typically is EXCLUDED under a disability income insurance policy?
- A. Auto accidents
- B. Tropical disease
- C. Intentionally self-inflicted injuries
- D. Cancer
Answer: C
Explanation:
Disability income policies (Insurance Article, § 15-201) cover accidents, cancer, and diseases, but exclude intentionally self-inflicted injuries as non-accidental, aligning with standard exclusions to prevent abuse.
References:Maryland Insurance Article, § 15-201; MIA disability insurance standards.
NEW QUESTION # 40
When a producer engages in unfair practices, all of the following are true EXCEPT:
- A. The Maryland Insurance Administration's decision is final
- B. The Maryland Insurance Administration can investigate the problem and hold a hearing
- C. The Maryland Insurance Administration can suspend the producer's license
- D. The Maryland Insurance Administration can issue a cease and desist order
Answer: A
Explanation:
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.
NEW QUESTION # 41
Which benefit is usually excluded from major medical expense plan coverage?
- A. Physical therapy
- B. Hospice care
- C. Routine dental care
- D. Prescription drugs
Answer: C
Explanation:
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.
NEW QUESTION # 42
In dental insurance coverage, which one of the following typically is EXCLUDED?
- A. Treatment started prior to the eligibility date
- B. Dental X-rays
- C. Preventive care
- D. Root canal therapy
Answer: A
Explanation:
Dental insurance (Insurance Article, § 15-201) covers preventive care, X-rays, and root canals, but excludes treatment started before the eligibility date to avoid claims for pre-existing work. This ensures coverage applies only to services initiated under the policy.
References:Maryland Insurance Article, § 15-201; MIA dental insurance standards.
NEW QUESTION # 43
All of the following are examples of unfair claims settlement practices EXCEPT:
- A. Denying unsubstantiated claims on a timely basis
- B. Misrepresenting pertinent facts of coverage
- C. Failing to promptly provide a reason for a claim denial
- D. Refusing arbitrarily and unreasonably to pay claims
Answer: A
Explanation:
Unfair practices (Insurance Article, § 27-303) include delays, arbitrary refusals, and misrepresentation.
Denying unsubstantiated claims promptly is fair and expected, not an unfair practice.
References:Maryland Insurance Article, § 27-303; MIA claims regulations.
NEW QUESTION # 44
An insured incurs a covered accident and health insurance loss on May 30, which is submitted to the insurer on June 8. If the insured terminated coverage on June 1, the insurer:
- A. Can refuse to pay the claim under the pre-existing conditions exclusion
- B. Can refuse to pay the claim because coverage has been terminated
- C. Must pay the claim upon receipt of the proof of loss
- D. Must pay the claim within one year of termination of coverage
Answer: C
Explanation:
A loss on May 30, while covered (Insurance Article, § 15-201), obligates the insurer to pay upon proof, despite termination on June 1. Termination or pre-existing exclusions don't negate prior coverage, and no one- year rule applies.
References:Maryland Insurance Article, § 15-201; MIA claims rules.
NEW QUESTION # 45
An accident and health insurance producer is most likely to become liable for professional errors and omissions as the result of:
- A. An accounting error discovered by the producer's accountant
- B. Incorrect filing of federal income taxes
- C. Misleading a prospective insured in replacing accident and health insurance
- D. Submitting a premium payment to an insurer in excess of the required amount
Answer: C
Explanation:
Errors and omissions liability arises from professional negligence (Insurance Article, § 10-126). Misleading a client about policy replacement (twisting, § 27-203) directly harms them, unlike accounting errors, overpayments, or tax issues, which are internal or personal.
References:Maryland Insurance Article, § 10-126, § 27-203; MIA producer liability rules.
NEW QUESTION # 46
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 carrier where a friend works
- B. Refer the employer to a licensed insurance producer
- C. Refer the employer to the Maryland Insurance Administration
- 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 # 47
In Maryland, continuation of medical plan coverage for a handicapped child beyond the age limit stated in the policy may require proof of the child's:
- A. Continued insurability
- B. Incapacity and dependency upon reaching the age limit
- C. Dependency for the first two years of continued coverage only
- D. Incapacity only
Answer: B
Explanation:
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.
NEW QUESTION # 48
Which benefit is usually excluded from accident and health plan coverage?
- A. Physicians' visits
- B. Hospital expense
- C. Surgical expense
- D. Custodial care
Answer: D
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 # 49
All of the following are common features found in health maintenance organizations (HMOs) EXCEPT:
- A. Wellness programs
- B. Discounts on local health spa memberships
- C. Twenty-four hour access to emergency care
- D. Outpatient medical services
Answer: B
Explanation:
HMOs (Health-General Article, § 19-701) offer wellness, emergency, and outpatient services. Discounts on spa memberships aren't a standard feature, unrelated to core health care delivery.
References:Maryland Health-General Article, § 19-701; MIA HMO standards.
NEW QUESTION # 50
Misrepresenting pertinent policy provisions relating to coverages after a loss is:
- A. A violation of the principle of adhesion
- B. An unfair claim settlement practice
- C. A concealment in insurance applications
- D. An unfair discrimination between individuals
Answer: B
Explanation:
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.
NEW QUESTION # 51
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