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Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Exam Sample Questions (Q67-Q72):
NEW QUESTION # 67
Reasonable and customary charges for health care are based primarily on:
- A. Insurance industry studies
- B. Actuarial tables
- C. National physician surveys
- D. Average charges within a geographic area
Answer: D
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 # 68
Pre-existing conditions include conditions of health that:
- A. Have been medically treated or diagnosed prior to the effective date of coverage
- B. Develop after the effective date of the policy but before the expiration of the time limit on certain defenses
- C. Are never insurable under any circumstances or degree of severity
- D. Must exist before an applicant can be accepted by an insurer
Answer: A
Explanation:
Pre-existing conditions (Insurance Article, § 15-109) are those treated or diagnosed before coverage begins, often subject to exclusions or waiting periods, unlike new conditions or uninsurable absolutes.
References:Maryland Insurance Article, § 15-109; MIA pre-existing condition rules.
NEW QUESTION # 69
Which one of the following causes of death typically would be included under an accidental death rider attached to a life insurance policy?
- A. Automobile accidents resulting from the insured's negligence
- B. Illness or disease
- C. War or acts of war
- D. Intentionally self-inflicted injuries
Answer: A
Explanation:
Comprehensive and Detailed Step by Step Explanation:Accidental death riders provide additional benefits if the insured dies due to an unforeseen accident.
* Automobile accidents resulting from the insured's negligence (D):Covered because negligence in driving does not disqualify the event from being an accident. The death must be directly and solely caused by the accident.
* Intentionally self-inflicted injuries (A):Excluded as they are not accidental but intentional.
* Illness or disease (B):Excluded as accidental death benefits do not apply to natural causes.
* War or acts of war (C):Generally excluded under most policies as a specific clause addresses wartime risks.
References:Maryland Insurance Guidelines for Accidental Death Riders and Policy Exclusions, COMAR
31.09.04.
NEW QUESTION # 70
When the insured's willful failure to disclose a material fact at the time of application is discovered by the insurer shortly after the policy is issued:
- A. The policy is automatically void
- B. The policy is voidable at the insurer's option
- C. The insurer may cancel the policy only at the expiration or renewal date
- D. The insurer must continue the insurance policy in full force
Answer: B
Explanation:
A material misrepresentation (Insurance Article, § 12-206) allows the insurer to void the policy within the contestability period (typically 2 years) if willful. It's not automatically void, nor must it continue or wait until renewal; the insurer decides based on materiality.
References:Maryland Insurance Article, § 12-206; MIA misrepresentation rules.
NEW QUESTION # 71
Coverage for the first three pints of blood for Medicare enrollees is:
- A. A Medicare Part A benefit
- B. A Medicare Supplement core benefit
- C. A Medicare Part B benefit
- D. A Medicare Supplement additional benefit
Answer: B
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 # 72
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