HIA case studies
HIA · Put your knowledge to work in context.
The HIA (Health Insurance Associate) designation is a professional credential for people who work in or around health insurance: agents and brokers, carrier staff in claims, underwriting and member services, benefits and HR administrators, and others who need a working command of how health coverage is designed, sold, funded, administered and regulated. The exam is multiple choice and is organized around seven domains: health insurance basics; policy provisions; providers and products; government programs such as Medicare, Medicaid and the ACA marketplaces; underwriting and rating; claims and benefits; and regulation and ethics. The policy-provisions and claims domains carry the most weight, so expect a heavy share of questions on contract language, eligibility, coordination of benefits, exclusions and the claims workflow, with government programs close behind. Preparation works best as a sequenced read of a current health insurance textbook plus state and federal program material, followed by practice questions used diagnostically rather than as a scoreboard. The HIA case studies are 5 cases and about 2,251 words.
1The COBRA Qualifying Event Dilemma
Maria, age 52, was covered under her employer's group health plan for 8 years. She was terminated for cause on March 15 due to alleged misconduct.
354 words, about 2 min2The Underwriting Risk Assessment
John, age 45, applies for a $500,000 individual life insurance policy. He discloses that he has a history of hypertension controlled with medication, and a BMI of 32.
522 words, about 3 min3The Claim Denial Appeal
Sarah was diagnosed with stage 3 breast cancer and underwent a mastectomy followed by reconstructive surgery. Her health insurance policy is an individual major medical plan with a 5,000 deductible and 20% coinsurance up to a 10,000 out-of-pocket maximum.
537 words, about 3 min4The Medicare Secondary Payer Issue
Robert is 68 years old and enrolled in Medicare Parts A and B. He continues to work full-time for a company with 25 employees and is covered under the group health plan (GHP) as an active employee.
423 words, about 2 min5The Ethics of Commission and Suitability
Agent Smith is a licensed health insurance agent. He meets with a client, Mrs.
415 words, about 2 min