HS 311 case studies
HS 311 · Put your knowledge to work in context.
HS 311 is a state health insurance licensing exam line covering the knowledge a producer needs to sell, explain, and service health and related coverage. It is intended for candidates entering the individual and group health market, agency staff who support licensed producers, and career changers moving into benefits or senior-market work. The HS 311 case studies are 5 cases and about 4,709 words.
1The 14% Renewal: MLR Rebate, Self-Funding, and a New State Mandate
Northline Fabrication is a metal-stamping company in Ohio with 120 full-time employees. It has been fully insured with the same carrier for six years under a large-group policy with a 2,000 individual deductible and an 80/20 coinsurance split.
922 words, about 5 min2Appendectomy, an Out-of-Network Anesthesiologist, and a Denied MRI
Maya, 41, is covered by a non-grandfathered ACA-compliant PPO through her employer: 2,000 individual deductible, 4,000 family deductible, 20% in-network coinsurance after the deductible, a 40 office-visit copay that does not apply to the deductible, a 7,500 individual in-network out-of-pocket maximum, and a separate 12,000 out-of-network maximum with 50% coinsurance and balance billing permitted. By March she has paid 1,400 in allowed charges toward her deductible.
915 words, about 5 min3The Surgeon Who Cannot Operate: Residual Disability and a Definition Change
Amara Okafor, 44, is an orthopedic surgeon in a four-physician practice. In 2019 she bought an individual noncancelable disability income policy: 12,000 monthly benefit, 90-day elimination period, benefit period to age 65, a true own-occupation definition for the first 60 months and any-gainful-occupation thereafter, a residual disability rider paying a proportional benefit for income loss of 20% or more, a 3% compound cost-of-living rider, and a Social Security offset.
979 words, about 5 min4Dementia, a Calendar-Day Elimination Period, and a Three-Year Benefit
Eleanor, 79, lives alone in Nebraska. Twelve years ago she bought a tax-qualified long-term care policy: 180 per day benefit, 3-year benefit period, 90-day elimination period counted in calendar days, 5% compound inflation protection, reimbursement (not indemnity) basis, and home care reimbursed at 50% of the daily benefit.
886 words, about 4 min5Working Past 65: Deferred Part B, an HSA, IRMAA, and Medigap Underwriting
Irwin, 68, has worked full time for 22 years as a plant manager for a 30-employee manufacturer in Arizona. He is not receiving Social Security.
1,007 words, about 5 min