AHIP PHIAS study guide
AHIP PHIAS · Work through your exam, one topic at a time.
The Professional, Health Insurance Advanced Studies (PHIAS) designation is one of the professional designations offered by AHIP (America's Health Insurance Plans), a national trade association whose members provide health and supplemental benefits through employer-sponsored coverage, the individual market, and public programs such as Medicare and Medicaid. AHIP's site lists "Professional Designations" as a category under Professional Development, alongside online learning, continuing education credits, and courses. The AHIP PHIAS study guide has 4 sections and about 1,518 words.
01Medical Plans and Managed Care: Cost-Sharing, Networks, and Benefit Design
Advanced medical-plan questions test whether you can trace a claim through a plan's cost-sharing structure and network rules. Know the vocabulary precisely: deductible (member cost before the plan pays, excluding first-dollar services), coinsurance (a percentage of the allowed amount), copayment (a fixed dollar amount), and out-of-pocket maximum (the ceiling on in-network member cost-sharing, which typically excludes premiums and often excludes balance billing).
384 words, about 2 min02Medicare and Medicare Advantage: Eligibility, Parts, and Enrollment Rules
Original Medicare = Part A (hospital insurance, usually premium-free with 40 quarters of work) plus Part B (medical insurance, income-related premium, generally optional but needed to enroll in Medicare Advantage). Part C (Medicare Advantage) contracts with CMS to deliver Part A and B benefits, often including Part D, and must provide an out-of-pocket maximum and at least the actuarial value of Original Medicare.
390 words, about 2 min03Consumer-Directed and Supplemental Coverage: HSAs, HRAs, and Ancillary Products
Health Savings Accounts (HSAs) require enrollment in a qualifying high-deductible health plan (HDHP) , have annual contribution limits with catch-up contributions for those 55+, are portable, and are triple tax-advantaged (contributions, growth, qualified withdrawals). Funds roll over indefinitely.
364 words, about 2 min04Disability, Long-Term Care, and Worksite Benefits: Definitions, Triggers, and Coordination
Distinguish short-term disability (STD) (often 13–26 weeks, higher replacement ratio) from long-term disability (LTD) (longer elimination period, lower replacement ratio, often 60% of income). Key definitions: own occupation (pays if you cannot perform your own occupation) versus any occupation (pays only if you cannot perform any occupation for which you are reasonably suited by education, training, or experience).
380 words, about 2 min