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Study Anywhere Anytime With Maryland Insurance Administration Accident-and-Health-or-Sickness-Producer PDF Questions

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Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Exam Sample Questions (Q33-Q38):

NEW QUESTION # 33
Medical charges that fall within the range of fees normally charged for a given procedure in a certain geographical area are called:

A. Utilization charges
B. Reasonable and customary charges
C. Scheduled charges
D. Preapproved charges

Answer: B

Explanation:
Reasonable and customary charges are the typical fees for a procedure in a geographic area, used to set reimbursement levels (Insurance Article, § 15-1005). Preapproved charges require prior authorization, utilization charges relate to service reviews, and scheduled charges are fixed fees, none of which define this standard.
References:Maryland Insurance Article, § 15-1005; MIA health insurance guidelines.

NEW QUESTION # 34
In accident and health insurance underwriting, when the risk imposed by an applicant is similar to the risks imposed by most other applicants, the applicant is:

A. Declined coverage
B. Charged an additional premium for the first three years
C. Required to pay the first year's premium in a lump sum
D. Charged the standard premium rate

Answer: D

Explanation:
Standard risk applicants (Insurance Article, § 15-201) receive the standard premium rate, as their risk aligns with the average pool. Declining coverage or adjusting payment terms applies to higher risks, not standard ones.
References:Maryland Insurance Article, § 15-201; MIA underwriting guidelines.

NEW QUESTION # 35
The Maryland Health Insurance Plan is designed to provide comprehensive health benefits for:

A. Low-income residents of Maryland
B. Senior citizens residing in Maryland
C. Medically uninsurable Maryland residents
D. Children of low-income Maryland residents

Answer: C

Explanation:
The Maryland Health Insurance Plan (MHIP, Insurance Article, § 15-1301) historically provided coverage for medically uninsurable residents rejected by private insurers, until phased out in 2014 by the ACA. It didn't target low-income (Medicaid), seniors (Medicare), or children (CHIP) specifically.
References:Maryland Insurance Article, § 15-1301 (historical); MIA MHIP documentation.

NEW QUESTION # 36
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. Replacement
B. Rebating
C. Fraud
D. Twisting

Answer: C

Explanation:
Producers hold premiums in a fiduciary capacity (Insurance Article, § 10-126) and must remit them to the insurer or a trust account. Depositing them into a personal account is fraud-specifically misappropriation- violating state law. Twisting, rebating, and replacement involve different unethical acts, not fund misuse.
References:Maryland Insurance Article, § 10-126; MIA producer conduct regulations.

NEW QUESTION # 37
If an employer with 200 employees wants to offer health insurance and calls a SHOP Exchange Navigator, what should the navigator do?

A. Help the employer sign-up through the SHOP Exchange
B. Refer the employer to the carrier where a friend works
C. Refer the employer to a licensed insurance producer
D. Refer the employer to the Maryland Insurance Administration

Answer: C

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 # 38
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