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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Policy Provisions and Clauses | 18-22% | - Preexisting condition clauses - Exclusions and limitations - Deductibles and copayments - Coverage terms and conditions - Benefit periods - Waiting periods |
| Topic 2: Maryland Insurance Laws and Regulations | 20-25% | - Producer licensing requirements - Violations and penalty provisions - Unfair claim settlement practices - Privacy and confidentiality requirements - Maryland Insurance Code - Consumer protection regulations |
| Topic 3: Types of Health Insurance Policies | 20-25% | - Dental and vision insurance - Group health insurance - Long-term care insurance - Medicare and Medicaid - Disability income insurance - Individual health insurance |
| Topic 4: Marketing Practices | 8-12% | - Prohibited practices - Advertising guidelines - Producer responsibilities - Marketing regulations |
| Topic 5: Field Underwriting and Application Process | 8-12% | - Application procedures - Medical underwriting - Agent responsibilities in enrollment - Risk classification |
| Topic 6: Social Insurance Programs | 8-12% | - Social Security disability benefits - Medicaid programs - CHIP (Children's Health Insurance Program) - Medicare Part A, B, C, D |
Question 1
In HMO coverage, all of the following services must be available 24 hours per day, 7 days per week EXCEPT:
A. Dental care
B. Emergency medical care
C. In-patient hospital services
D. Primary care
Question 2
The phrase, "this policy pays $1,800 for hospital room and board expenses," should include the:
A. Minimum daily benefit and the maximum time limit for hospital room and board expenses
B. Maximum daily benefit and the minimum time limit for hospital room and board expenses
C. Maximum daily benefit and the maximum time limit for hospital room and board expenses
D. Minimum daily benefit and the minimum time limit for hospital room and board expenses
Question 3
After completing an application for insurance, the insurance producer collects the premiums but deposits the check in the insurance producer's checking account. What crime has been committed?
A. Twisting
B. Fraud
C. Rebating
D. Replacement
Question 4
An insurance producer's license may be suspended or revoked by:
A. The Attorney General
B. The continuing education course provider
C. The appointing insurer
D. The Maryland Insurance Administration
Question 5
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. Major medical
C. Dental
D. Disability income
Solutions:
| Question 1 Answer: A | Question 2 Answer: C | Question 3 Answer: B | Question 4 Answer: D | Question 5 Answer: D |
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