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Maryland Insurance Administration MarylandAccident and Health or Sickness Producer Series 20-24 Exam Sample Questions (Q36-Q41):

NEW QUESTION # 36
To be eligible for major medical extended care benefits, a patient must:

A. Be terminally ill
B. Have had surgery
C. Require continuous skilled nursing care
D. Require physical therapy

Answer: C

Explanation:
Extended care under major medical (Insurance Article, § 15-201) requires continuous skilled nursing care (e.
g., nursing home), not just terminal illness, surgery, or therapy, which have broadercriteria.
References:Maryland Insurance Article, § 15-201; MIA major medical standards.

NEW QUESTION # 37
A nonprofit health service plan may NOT issue a contract that covers which of the following types of benefits?

A. Dental benefits
B. Medical expense benefits
C. Disability income benefits
D. Vision benefits

Answer: C

Explanation:
Nonprofit health service plans (Insurance Article, § 14-102), like HMOs, provide medical, vision, and dental benefits, but disability income-replacing lost wages-is outside their scope and belongs to separate insurance types.
References:Maryland Insurance Article, § 14-102; MIA nonprofit plan rules.

NEW QUESTION # 38
Which type of Medicare Supplement information can be used without prior state approval?

A. Radio announcements approved by the insurer
B. Insurance company brochures
C. Government publications
D. Television advertisements approved by the insurer

Answer: C

Explanation:
Medigap marketing materials (Insurance Article, § 15-912) require MIA approval, except for government publications (e.g., CMS's "Medicare & You"), which are exempt as official federal resources. Insurer- approved ads still need state review.
References:Maryland Insurance Article, § 15-912; MIA Medigap advertising rules.

NEW QUESTION # 39
A health maintenance organization may issue a contract that provides benefits for the following:

A. The accidental death of an HMO member
B. The dismemberment of an HMO member
C. Replacement of income lost by a member due to the member's disability
D. Health care services provided to members of the HMO

Answer: D

Explanation:
HMOs (Health-General Article, § 19-701) provide health care services to members, not income replacement (disability insurance), accidental death, or dismemberment benefits (life/accident insurance).
References:Maryland Health-General Article, § 19-701; MIA HMO guidelines.

NEW QUESTION # 40
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 because coverage has been terminated
B. Must pay the claim within one year of termination of coverage
C. Must pay the claim upon receipt of the proof of loss
D. Can refuse to pay the claim under the pre-existing conditions exclusion

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 # 41
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