Vce Accident-and-Health-or-Sickness-Producer Questions Latest

Underwriting involves assessing risk by rejecting high-risk applicants, issuing standard policies, or adding exclusion riders for specific conditions. Deleting uniform policy provisions—mandatory clauses like grace periods (Insurance Article, § 15-201)—isn’t an underwriting action, as these are legally required and cannot be altered by underwriters.

References:Maryland Insurance Article, § 15-201 et seq.; MIA underwriting guidelines.

The elimination period (Insurance Article, § 15-201) is the waiting time (e.g., 90 days) before disability benefits begin, distinct from the benefit period (payment duration), probationary period (pre-coverage wait), or policy term.

References:Maryland Insurance Article, § 15-201; MIA disability insurance rules.

Reasonable and customary charges are the typical fees for a procedure in a geographic area, used to set reimbursement levels (Insurance Article, § 15-1005). Preapproved charges require prior authorization, utilization charges relate to service reviews, and scheduled charges are fixed fees, none of which define this standard.

References:Maryland Insurance Article, § 15-1005; MIA health insurance guidelines.

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.