Accident & Health Producer — Information & Free Practice

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Accident & Health Producer

Provider: Pearson VUE for the Maine Bureau of Insurance
Format: Computer-based examination at an authorized testing center
Exam questions: 88 scoreable questions plus 10 pretest questions (50+38 scoreable; 5+5 pretest)
Time limit: 2 hours
Passing score: 70 on the 0–100 scaled score; not 70 percent correct
Exam fee: $55

Examination outline

Accident & Health – General Knowledge Content Outline / I. TYPES OF POLICIES (16 scoreable questions)
- A. Disability income
- A. Disability income > 1. Individual disability income policy
- A. Disability income > 2. Business overhead expense policy
- A. Disability income > 3. Business disability buyout policy
- A. Disability income > 4. Group disability income policy
- A. Disability income > 5. Key employee policy
- B. Accidental death and dismemberment
- C. Medical expense insurance
- C. Medical expense insurance > 1. Basic hospital, medical, and surgical policies
- C. Medical expense insurance > 2. Major medical policies
- C. Medical expense insurance > 3. Health Maintenance Organizations (HMOs)
- C. Medical expense insurance > 4. Preferred Provider Organizations (PPOs)
- C. Medical expense insurance > 5. Point of Service (POS) plans
- C. Medical expense insurance > 6. Flexible Spending Accounts (FSAs)
- C. Medical expense insurance > 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
- C. Medical expense insurance > 8. Health Reimbursement Accounts (HRAs)
- D. Medicare supplement policies
- E. Group insurance
- E. Group insurance > 1. Differences between individual and group contracts
- E. Group insurance > 2. General characteristics
- E. Group insurance > 3. COBRA
- F. Individual/Group Long Term Care (LTC)
- F. Individual/Group Long Term Care (LTC) > 1. Eligibility
- F. Individual/Group Long Term Care (LTC) > 2. Levels of care
- G. Other policies
- G. Other policies > 1. Dental
- G. Other policies > 2. Vision
- G. Other policies > 3. Cancer
- G. Other policies > 4. Critical illness or specified disease
- G. Other policies > 5. Worksite (employer-sponsored)
- G. Other policies > 6. Hospital indemnity
- G. Other policies > 7. Short-term medical
- G. Other policies > 8. Accident
Accident & Health – General Knowledge Content Outline / II. POLICY PROVISIONS, CLAUSES, AND RIDERS (15 scoreable questions)
- A. Mandatory and optional provisions
- A. Mandatory and optional provisions > 1. Entire contract
- A. Mandatory and optional provisions > 2. Time limit on certain defenses (incontestable)
- A. Mandatory and optional provisions > 3. Grace period
- A. Mandatory and optional provisions > 4. Reinstatement
- A. Mandatory and optional provisions > 5. Notice of claim
- A. Mandatory and optional provisions > 6. Claim forms
- A. Mandatory and optional provisions > 7. Proof of loss
- A. Mandatory and optional provisions > 8. Time of payment of claims
- A. Mandatory and optional provisions > 9. Payment of claims
- A. Mandatory and optional provisions > 10. Physical examination and autopsy
- A. Mandatory and optional provisions > 11. Legal actions
- A. Mandatory and optional provisions > 12. Change of beneficiary
- A. Mandatory and optional provisions > 13. Misstatement of age or gender
- A. Mandatory and optional provisions > 14. Change of occupation
- A. Mandatory and optional provisions > 15. Illegal occupation
- A. Mandatory and optional provisions > 16. Relation of earning to insurance
- B. Other provisions and clauses
- B. Other provisions and clauses > 1. Insuring clause
- B. Other provisions and clauses > 2. Free look
- B. Other provisions and clauses > 3. Consideration clause
- B. Other provisions and clauses > 4. Probationary period
- B. Other provisions and clauses > 5. Elimination period
- B. Other provisions and clauses > 6. Waiver of premium
- B. Other provisions and clauses > 7. Exclusions and limitations
- B. Other provisions and clauses > 8. Preexisting conditions
- B. Other provisions and clauses > 9. Coinsurance
- B. Other provisions and clauses > 10. Deductibles
- B. Other provisions and clauses > 11. Eligible expenses
- B. Other provisions and clauses > 12. Copayments
- B. Other provisions and clauses > 13. Pre-authorizations and prior approval requirements
- B. Other provisions and clauses > 14. Usual, reasonable, and customary (URC) charges
- B. Other provisions and clauses > 15. Lifetime, annual, or per cause maximum benefit limits
- C. Riders
- C. Riders > 1. Impairment/exclusions
- C. Riders > 2. Guaranteed insurability
- C. Riders > 3. Future increase options
- D. Rights of renewability
- D. Rights of renewability > 1. Noncancelable
- D. Rights of renewability > 2. Cancelable
- D. Rights of renewability > 3. Guaranteed renewable
Accident & Health – General Knowledge Content Outline / III. SOCIAL INSURANCE (6 scoreable questions)
- A. Medicare (Parts A, B, C, D)
- B. Medicaid
- C. Social Security benefits
Accident & Health – General Knowledge Content Outline / IV. OTHER INSURANCE CONCEPTS (5 scoreable questions)
- A. Total, partial, recurrent and residual disability
- B. Owner’s rights
- C. Dependent children benefits
- D. Primary and contingent beneficiaries
- E. Modes of premium payments
- F. Nonduplication and coordination of benefits (e.g., primary vs. excess)
- G. Occupational vs. non-occupational
- H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
- I. Managed care
- J. Workers Compensation
- K. Subrogation
- L. Cost containment
Accident & Health – General Knowledge Content Outline / V. FIELD UNDERWRITING PROCEDURES (8 scoreable questions)
- A. Completing the application
- B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
- C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.)
- D. Submitting application (and initial premium if collected) to company for underwriting
- E. Policy delivery
- F. Explaining policy and its provisions, riders, exclusions, and ratings to clients
- G. Replacement
- H. Contract law
- H. Contract law > 1. Elements of a contract
- H. Contract law > 2. Insurable interest
- H. Contract law > 3. Warranties and representations
- H. Contract law > 4. Unique aspects of the insurance contract
- H. Contract law > 4. Unique aspects of the insurance contract > a. Conditional
- H. Contract law > 4. Unique aspects of the insurance contract > b. Unilateral
- H. Contract law > 4. Unique aspects of the insurance contract > c. Adhesion
- H. Contract law > 4. Unique aspects of the insurance contract > d. Aleatory
Accident & Health – Maine-Specific Content Outline – State Laws and Rules / I. MAINE LAWS AND RULES COMMON TO LIFE, ACCIDENT, AND HEALTH INSURANCE (18 scoreable questions)
- A. Superintendent of Insurance
- A. Superintendent of Insurance > 1. Broad powers
- A. Superintendent of Insurance > 2. Notice and hearing
- B. Definitions
- B. Definitions > 1. Authorized, unauthorized, and certificate of authority
- B. Definitions > 2. Domestic, foreign, and alien
- B. Definitions > 3. Stock and mutual
- B. Definitions > 4. Transacting insurance
- B. Definitions > 5. Maine Life and Health Insurance Guaranty Association
- C. Licensing requirements and limitations
- C. Licensing requirements and limitations > 1. Types of licenses
- C. Licensing requirements and limitations > 1. Types of licenses > a. Producer
- C. Licensing requirements and limitations > 1. Types of licenses > b. Consultant
- C. Licensing requirements and limitations > 1. Types of licenses > c. Temporary
- C. Licensing requirements and limitations > 1. Types of licenses > d. Nonresident
- C. Licensing requirements and limitations > 1. Types of licenses > e. Limited
- C. Licensing requirements and limitations > 1. Types of licenses > f. Adjuster
- C. Licensing requirements and limitations > 1. Types of licenses > g. Business entity
- C. Licensing requirements and limitations > 1. Types of licenses > h. Apprentice
- C. Licensing requirements and limitations > 2. Exemptions/exceptions
- C. Licensing requirements and limitations > 3. Appointment
- C. Licensing requirements and limitations > 4. License refusal, termination, expiration, revocation, suspension, and nonrenewal
- C. Licensing requirements and limitations > 5. Educational requirements
- D. Marketing practices
- D. Marketing practices > 1. Unfair practices
- D. Marketing practices > 1. Unfair practices > a. Claims methods and practices
- D. Marketing practices > 1. Unfair practices > b. Excess charges
- D. Marketing practices > 1. Unfair practices > c. Rebating
- D. Marketing practices > 1. Unfair practices > d. Twisting
- D. Marketing practices > 1. Unfair practices > e. Misrepresentation
- D. Marketing practices > 1. Unfair practices > f. Defamation
- D. Marketing practices > 1. Unfair practices > g. False information and advertising
- D. Marketing practices > 1. Unfair practices > h. Penalties
- D. Marketing practices > 1. Unfair practices > i. Fraud
- D. Marketing practices > 1. Unfair practices > j. Cross-selling/Unfair Solicitation Methods
- D. Marketing practices > 2. Producer responsibilities
- D. Marketing practices > 3. Compensation of licensees
- D. Marketing practices > 4. Privacy
- E. Third-party notice of cancellation
Accident & Health – Maine-Specific Content Outline – State Laws and Rules / II. MAINE LAWS AND RULES PERTINENT TO ACCIDENT AND HEALTH INSURANCE ONLY (20 scoreable questions)
- A. Policy rate discrimination
- B. Required policy provisions
- B. Required policy provisions > 1. Coverage for newborns
- B. Required policy provisions > 2. Coverage for maternity benefits
- B. Required policy provisions > 3. Coverage for home health care
- B. Required policy provisions > 4. Coverage for domestic partners
- B. Required policy provisions > 5. Renewal and cancellation
- B. Required policy provisions > 6. Assignment
- B. Required policy provisions > 7. Coverage for dependent children
- B. Required policy provisions > 8. Emergency services
- C. Medicare supplement
- C. Medicare supplement > 1. Benefit standards
- C. Medicare supplement > 2. Sale of insurance to beneficiaries
- C. Medicare supplement > 3. Preexisting conditions
- C. Medicare supplement > 4. Nursing home coverage
- C. Medicare supplement > 5. Guaranteed issue
- D. AIDS testing requirements
- E. Long-Term Care/Partnership coverage
- F. Continuity of coverage
- G. Small group and individual health insurance plans
- G. Small group and individual health insurance plans > 1. Guaranteed issue
- G. Small group and individual health insurance plans > 2. Guaranteed renewal
- G. Small group and individual health insurance plans > 3. Coverage and benefits
- G. Small group and individual health insurance plans > 4. Market practices
- G. Small group and individual health insurance plans > 5. Rating practices
- H. Health Maintenance Organization (HMO)
- I. Medical Utilization Review Entities
- J. Preferred Provider Arrangement
- K. Appeals, Grievances, and External Review
- L. Affordable Care Act
- L. Affordable Care Act > 1. State based Marketplace/The SHOP Exchange
- L. Affordable Care Act > 2. Taxes, penalties, and subsidies
- L. Affordable Care Act > 3. Essential health benefits
- L. Affordable Care Act > 3. Essential health benefits > a. Mental health parity
- L. Affordable Care Act > 3. Essential health benefits > b. Pediatric services
- L. Affordable Care Act > 3. Essential health benefits > c. Preventive services
- M. Wellness Programs
- N. COBRA and state continuation coverage
- O. Pharmacy Benefit Managers

Examination sources

Maine Insurance Supplement – Examination Content Outlines
Page 1, publication effective date
Maine Insurance Licensing Candidate Handbook
Page 11, Exam Content, examination blueprints
Maine Insurance Supplement – Examination Content Outlines
Page 3, Accident and Health general knowledge heading
Maine Insurance Supplement – Examination Content Outlines
Page 4, Accident and Health state outline heading
Maine Insurance Licensing Candidate Handbook
Page 9, Scaled Score, actual scoring scale
Maine Insurance Licensing Candidate Handbook
Page 7, Exam Procedures, computer examination
Maine Insurance Licensing Candidate Handbook
Back cover, Available Exams and Fees, 12-ME-42
Maine Insurance Licensing Candidate Handbook
Page 4, Making an Examination Reservation