Accident-and-Health-or-Sickness-Producer Exam Dumps : MarylandAccident and Health or Sickness Producer Series 20-24 Exam

Long-term care insurance (Insurance Article, § 18-101) triggers benefits based on inability to perform ADLs (e.g., bathing), unlike Medigap, major medical, or disability, which focus on medical or work criteria.

References:Maryland Insurance Article, § 18-101; MIA long-term care rules.

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.

Comprehensive and Detailed Step by Step Explanation:Misrepresentation involves providing false, misleading, or incomplete information about a policy:

Failed to disclose exclusions of the policy (A):Correct. Not informing the insured about policy exclusions misrepresents the coverage and violates Maryland law.

Denied a claim for failure to prove damages (B):This relates to claims handling and is not misrepresentation.

Required written notice of loss (C):This is a legitimate policy requirement, not misrepresentation.

Issued a full settlement check (D):Standard claims settlement practice when agreed upon; not related to misrepresentation.

References:Maryland Insurance Article §27-303, Misrepresentation and False Advertising Standards, COMAR 31.15.03.