HIA study plan

Define the major policy provisions (deductibles, coinsurance, copays, out-of-pocket maximums) and state how each shifts cost between insurer and insured

Explain the purpose and mechanics of the grace period, reinstatement, and incontestability clauses

Distinguish coordination-of-benefits and nonduplication rules and apply them to a two-plan scenario

Build a one-page glossary of policy-provision terms using your own wording

Trace a claim from submission through adjudication, identifying where policy provisions determine payment

Compute benefits payable in three worked examples involving deductibles, coinsurance, and a coordination-of-benefits offset

Describe the roles of preauthorization, utilization review, and appeals in the claims process

List the required elements of a clean claim and the consequences of an unclean claim

Explain the risk-pooling concept and how adverse selection threatens it

Identify the underwriting factors commonly used and those restricted by regulation

Differentiate manual, experience, and community rating and give a use case for each

Map how underwriting decisions flow into the rating and premium-setting process

Apply underwriting and rating concepts to five scenario-based questions under timed conditions

Explain how morbidity, mortality, and lapse assumptions feed into premium development

Describe the purpose of reserves and how they relate to solvency

Review and correct every missed item from your practice set

Outline eligibility, enrollment periods, and benefit structure for Medicare Parts A, B, C, and D

Summarize Medicaid eligibility categories and the federal-state funding relationship

Describe the interaction of Medicare with employer coverage and Medigap

Compare government programs to private coverage on cost-sharing and enrollment rules

Differentiate indemnity, HMO, PPO, POS, and EPO models on network, referral, and cost-sharing rules

Explain the structure and taxation of consumer-directed options such as HSAs paired with HDHPs

Describe managed-care cost-control tools and how each affects benefits paid

Match each product type to a plausible member scenario and justify the fit

Summarize the purpose and key requirements of major federal health insurance statutes in your own words

Explain producer licensing, continuing education, and fiduciary responsibilities

Identify common unfair trade practices and the ethical duty of suitability in sales

Apply an ethical decision framework to three short producer-conduct scenarios

Take a full-length mixed practice exam under timed conditions and score it by domain

Rank domains by weakness and re-drill the two lowest-scoring areas

Re-read only your own glossaries, charts, and error logs rather than new material

Write a final one-page formula and concept sheet from memory