HS 311 study plan

Map the core risk-transfer and indemnity concepts of health insurance (adverse selection, moral hazard, underwriting, premium rating factors) and write a one-paragraph plain-language definition of each from memory

Break down a medical expense policy into its cost-sharing components - deductible, coinsurance, copayment, out-of-pocket maximum, stop-loss - and calculate the insured's share for three worked claim scenarios

Distinguish basic hospital/surgical coverage from major medical and comprehensive plans, and list which services each typically covers

Explain how individual vs. group underwriting differs and identify at least four rating factors used in individual medical underwriting

Build a one-page glossary of 20 Domain 1 and Domain 3 terms with your own examples

Sequence the standard health insurance policy provisions (entire contract, incontestability, grace period, reinstatement, claim procedures, legal actions) and state the purpose of each

Explain the interaction between a grace period, reinstatement, and a claim incurred during a lapse, using a dated timeline example

Describe the mandated uniform policy provision topics and which ones are typically required vs. optional in individual health policies

Analyze coordination-of-benefits and subrogation rules by working through a dual-coverage claim and determining each insurer's payment

Draft five original multiple-choice questions on policy provisions and justify the correct answer for each

Compare the major provider types - commercial carriers, Blue Cross/Blue Shield, HMOs, PPOs, POS plans, EPOs, and consumer-driven health plans - on network rules, referrals, and out-of-network benefits

Explain how the individual marketplace works: open enrollment, special enrollment triggers, metal tiers, subsidies, and guaranteed issue

Describe group health mechanics: eligibility, actively-at-work requirements, employer contribution, and the distinction between contributory and noncontributory plans

Trace COBRA qualifying events, notice timelines, and duration of continuation coverage

Contrast group conversion rights with portability options and state when each applies

Break Medicare into Part A, Part B, Part C, and Part D and state eligibility, financing, and covered services for each

Calculate a Part B premium scenario including IRMAA surcharges and late-enrollment penalties

Explain Medigap plan standardization, guaranteed-issue windows, and how Medigap interacts with Medicare Advantage

Outline Medicaid eligibility categories, mandatory vs. optional benefits, federal-state financing, and the relationship to Medicare for dual eligibles

Summarize key ACA and HIPAA market reforms (guaranteed renewability, preexisting condition limits, dependent coverage, portability) and identify which population each protects

Define the components of disability income insurance - own-occupation vs. any-occupation definitions, elimination period, benefit period, residual/partial disability, and waiver of premium

Calculate a disability benefit given a stated monthly income, benefit percentage, elimination period, and offset for Social Security or workers' compensation

Explain occupational vs. nonoccupational coverage and how each treats work-related injury claims

Distinguish accident and sickness (accidental death and dismemberment, hospital indemnity, critical illness) benefit triggers and payout structures

Compare key provisions unique to disability and accident policies, such as presumptive disability, recurrent disability, and the relation of earnings to insurance clause

Classify long-term care settings and levels of care (skilled, intermediate, custodial, home care, adult day care) and identify what each policy type covers

Explain LTC benefit triggers, activities of daily living, cognitive impairment standards, and the role of the elimination period and benefit maximum

Describe LTC policy provisions including inflation protection, nonforfeiture, waiver of premium, and return-of-premium, and how each affects premium

Analyze the regulatory framework for LTC - NAIC model standards, suitability requirements, and partnership programs - and how they protect consumers

Review the regulatory environment for health insurance broadly: state vs. federal authority, producer licensing, market conduct, and unfair trade practices

Re-read condensed notes for every domain and flag any topic you cannot explain without notes

Complete a full-length timed practice exam under exam conditions and record your score by domain

Identify the three lowest-scoring domains and write a targeted remediation list for each

Re-derive the formulas and calculation methods (cost-sharing, disability offsets, Medicare premiums) without reference materials

Re-drill your three weakest domains using focused practice sets and re-explain each missed concept in your own words

Review the highest-yield regulatory and policy-provision content one final time, focusing on timelines, notice periods, and required provisions

Take a second timed practice exam and compare domain scores against Week 7 to confirm improvement

Build a one-page final review sheet limited to facts you keep missing, and rehearse it aloud

Plan exam-day logistics: timing strategy, question-flagging approach, and a rest schedule for the final 48 hours