EXAM ACCIDENT-AND-HEALTH-OR-SICKNESS-PRODUCER OBJECTIVES & ACCIDENT-AND-HEALTH-OR-SICKNESS-PRODUCER STUDY MATERIALS REVIEW

Exam Accident-and-Health-or-Sickness-Producer Objectives & Accident-and-Health-or-Sickness-Producer Study Materials Review

Exam Accident-and-Health-or-Sickness-Producer Objectives & Accident-and-Health-or-Sickness-Producer Study Materials Review

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Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Exam Sample Questions (Q49-Q54):

NEW QUESTION # 49
Which of the following is a requirement of an insurable risk?

  • A. The loss must be intentional.
  • B. The loss must be catastrophic.
  • C. The chance of loss must be calculable.
  • D. There must be a large number of different loss exposures.

Answer: C

Explanation:
Comprehensive and Detailed Step by Step Explanation:Aninsurable riskmust meet specific criteria to ensure fair and financially viable coverage:
Chance of loss must be calculable (C):Correct. Insurers need statistical data to assess risk and determine premiums.
Loss must be intentional (A):Incorrect; intentional losses are not insurable.
Loss must be catastrophic (B):Incorrect; catastrophic losses (e.g., war or large-scale disasters) are often excluded or managed through reinsurance.
Large number of different loss exposures (D):A large number of similar, not different, exposures is required for risk pooling.
References:Maryland Insurance Principles, Actuarial Standards, and COMAR 31.09.14.


NEW QUESTION # 50
Which one of the following causes of loss typically is EXCLUDED under a disability income insurance policy?

  • A. Auto accidents
  • B. Cancer
  • C. Tropical disease
  • D. Intentionally self-inflicted injuries

Answer: D

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 # 51
In dental insurance coverage, which one of the following typically is EXCLUDED?

  • A. Dental X-rays
  • B. Preventive care
  • C. Treatment started prior to the eligibility date
  • D. Root canal therapy

Answer: C

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 # 52
When an accident and health insurer requires a covered individual to undergo a physical examination, who pays the cost of the examination?

  • A. The patient or parent of the patient
  • B. The insurer
  • C. The principal insured individual
  • D. The premium payor

Answer: B

Explanation:
If an insurer mandates a physical exam (Insurance Article, § 12-202), it pays the cost, as it's a condition of coverage or claims processing. The premium payor, insured, or patient isn't responsible for insurer-initiated requirements.
References:Maryland Insurance Article, § 12-202; MIA policy standards.


NEW QUESTION # 53
All of the following are examples of unfair claims settlement practices EXCEPT:

  • A. Denying unsubstantiated claims on a timely basis
  • B. Failing to promptly provide a reason for a claim denial
  • C. Refusing arbitrarily and unreasonably to pay claims
  • D. Misrepresenting pertinent facts of coverage

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 # 54
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