HIA study guide
HIA · Work through your exam, one topic at a time.
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 HIA study guide has 7 sections and about 2,055 words.
01Health Insurance Basics
Health insurance transfers the financial risk of medical costs from an individual to an insurer in exchange for a premium. Candidates must distinguish risk pooling (spreading losses across many insureds), adverse selection (sicker-than-average applicants seeking coverage), and moral hazard (insureds using more care because someone else pays).
318 words, about 2 min02Health Insurance Policy Provisions
Policy provisions define the rights and obligations of insurer and insured. Master the entire contract clause (policy plus attached endorsements/riders form the whole agreement), incontestability (insurer cannot contest the policy after a stated period, typically two years, except for fraud or nonpayment), grace period (time to pay a late premium before lapse), reinstatement (restoring a lapsed policy, often with new contestability), and free look (right to return the policy for a refund).
323 words, about 2 min03Health Insurance Providers and Products
Know the major delivery models. Indemnity (fee-for-service) plans let insureds choose any provider and reimburse charges.
295 words, about 1 min04Government Health Insurance Programs
Understand Medicare parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drugs). Know eligibility (age 65, certain disabilities, ESRD), enrollment periods (initial, general, special), and late-enrollment penalties.
280 words, about 1 min05Health Insurance Underwriting and Rating
Underwriting is the process of evaluating risk and deciding whether and on what terms to insure an applicant. Know medical underwriting (health history, medications, prior claims), risk classification , and field underwriting (agent's role in gathering accurate information).
289 words, about 1 min06Health Insurance Claims and Benefits
Know the claims process: notice of claim , proof of loss , claim forms , coordination of benefits , and claim payment timelines . Understand allowed amount , usual, customary, and reasonable (UCR) charges, balance billing , and network discounts .
279 words, about 1 min07Health Insurance Regulation and Ethics
Understand the regulatory framework: state insurance departments regulate insurance, while federal laws set minimum standards. Know licensing requirements for agents and insurers, market conduct exams, rate filing , and solvency regulation.
271 words, about 1 min