100+ Free HIA Practice Questions

Pass your AHIP Health Insurance Associate (HIA) Designation exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

Not published Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

Under ACA, what is the actuarial value (AV) of a Silver-tier qualified health plan?

Approximately 90%

Approximately 70% (plan pays ~70% of total covered medical expenses for a standard population)

Approximately 80%

Approximately 60%

to track

Same family resources

Explore More AHIP Health Insurance Designations

Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.

2026 Statistics

Key Facts: HIA Exam

Required Course Exams

AHIP HIA designation page

~$2,150

Full Designation Cost

AHIP course catalog

70%

Typical Passing Score

AHIP exam standard

20,000+

HIA Holders Worldwide

AHIP HIA page

90 days

Per-Course Study Window

AHIP course enrollment terms

4 + 2

Required + Elective Courses

AHIP HIA curriculum

HIA is AHIP's six-course self-study designation for health-insurance professionals. The full program runs roughly $2,150 across four required courses and two electives, with each course capped by a proctored multiple-choice exam (typical 70% pass mark). The curriculum balances plan operations - health-plan types, underwriting and rating, claims, provider networks, utilization management, and pharmacy benefit - with regulatory content covering Medicare, Medicaid and CHIP, ACA market rules, ERISA preemption, and HIPAA, HITECH, and GLBA privacy.

Sample HIA Practice Questions

Try these sample questions to test your HIA exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which feature is characteristic of a Health Maintenance Organization (HMO)?

A.Members typically select a primary care physician who coordinates referrals to specialists

B.Members can see any provider out-of-network with no additional cost-sharing

C.Members are reimbursed on a fee-for-service basis with no network

D.Members pay a deductible only after they reach a high out-of-pocket maximum

Explanation: HMOs rely on a primary care physician (PCP) who serves as a gatekeeper, coordinating care and providing referrals to in-network specialists. HMOs generally do not cover out-of-network care except in emergencies.

2What is the defining difference between a PPO and an EPO?

A.An EPO generally provides no coverage for out-of-network care except emergencies, while a PPO provides reduced out-of-network benefits

B.An EPO requires a PCP referral, while a PPO does not

C.An EPO has no deductible, while a PPO always does

D.An EPO only covers preventive care, while a PPO covers all services

Explanation: An Exclusive Provider Organization (EPO) restricts coverage to its contracted network (except emergencies), while a Preferred Provider Organization (PPO) still pays partial benefits out-of-network at a higher cost-share. Neither type typically requires a PCP referral.

3Which plan type combines HMO-style in-network rules with PPO-style out-of-network coverage?

A.Point of Service (POS)

B.HDHP

C.Indemnity

D.EPO

Explanation: A Point of Service (POS) plan typically requires a PCP and referrals like an HMO for in-network care but allows out-of-network access at higher cost-sharing like a PPO.

4What IRS feature distinguishes a High-Deductible Health Plan (HDHP) eligible for HSA contributions?

A.It meets IRS minimum deductible and out-of-pocket maximum thresholds and may not cover most services pre-deductible

B.It has no out-of-pocket maximum

C.It must include dental and vision benefits

D.It is only available through Medicaid

Explanation: An HSA-qualified HDHP must satisfy IRS minimum deductible and maximum out-of-pocket thresholds (updated annually) and generally cannot pay non-preventive services before the deductible is met. Preventive care can be covered pre-deductible.

5Which statement about self-funded (self-insured) employer health plans is correct?

A.The employer assumes the financial risk of paying claims and is generally regulated by ERISA, preempting most state insurance laws

B.The plan must comply with state-mandated benefit laws on the same footing as fully insured plans

C.Premiums are paid to a commercial carrier that bears all underwriting risk

D.Self-funded plans cannot use a third-party administrator

Explanation: Self-funded group health plans are subject to ERISA, which preempts most state insurance laws. The employer bears claims risk; a TPA or ASO carrier typically administers benefits. Stop-loss insurance is often purchased to cap risk.

6Under the ACA, which of the following is NOT a permitted rating factor in the individual and small-group health insurance markets?

A.Gender

B.Age (within a 3:1 ratio for adults)

C.Geographic rating area

D.Tobacco use (within a 1.5:1 ratio)

Explanation: The ACA prohibits gender rating in the individual and small-group markets. Permitted factors are age (with a 3:1 maximum ratio for adults), geography, family size, and tobacco use (up to 1.5:1).

7What is community rating?

A.All members in a defined geographic area or pool pay the same base premium regardless of individual health status

B.Premiums are based on each individual's recent claims experience

C.Premiums vary by occupation and family history

D.Premiums are waived for low-income enrollees

Explanation: Community rating spreads risk by charging all members of a pool the same base premium, with limited adjustments. The ACA effectively requires modified community rating in the individual and small-group markets.

8Which group is typically rated using experience rating rather than community rating?

A.A large self-funded employer with sufficient claims history

B.An individual buying coverage on the ACA marketplace

C.A small employer with 25 employees in the ACA small-group market

D.A Medicaid managed care enrollee

Explanation: Large self-funded employers commonly use experience rating because their own claims data is credible enough to predict future costs. The ACA limits community-style rating in the individual and small-group markets.

9Under the ACA, what is the Medical Loss Ratio (MLR) requirement for large group plans?

A.At least 85% of premium must be spent on clinical services and quality improvement

B.At least 80% of premium must be spent on clinical services and quality improvement

C.No more than 50% of premium may be spent on administration

D.Plans must spend exactly 90% of premium on claims

Explanation: The ACA Medical Loss Ratio sets an 85% floor for large-group plans and an 80% floor for individual and small-group plans. Carriers below the threshold must rebate the difference to enrollees.

10Which 10 categories of services are required under the ACA Essential Health Benefits (EHB)?

A.Ambulatory, emergency, hospitalization, maternity/newborn, mental health/SUD, prescription drugs, rehab/habilitative, lab, preventive/wellness/chronic, and pediatric services (including dental and vision)

B.Only inpatient hospital and prescription drugs

C.Hospital, physician, and dental only

D.All cosmetic and elective services

Explanation: The ACA defines 10 EHB categories that non-grandfathered individual and small-group plans must cover: ambulatory, emergency, hospitalization, maternity/newborn, mental health/SUD, Rx, rehab/habilitative, lab, preventive/wellness/chronic management, and pediatric services including dental and vision.

About the HIA Exam

The Health Insurance Associate (HIA) is AHIP's flagship core designation for health-insurance professionals. Candidates complete six online self-study courses - four required (Fundamentals of Health Insurance Parts A and B, Health Insurance Advanced Studies Part A, and Supplemental Health Insurance) plus two electives drawn from disability, fraud, and long-term care tracks - each followed by a proctored multiple-choice exam. The curriculum spans plan design, underwriting, claims, networks, utilization management, Medicare, Medicaid, ACA compliance, and HIPAA privacy.

Questions

100 scored questions

Time Limit

Self-paced; one proctored exam per course

Passing Score

70% per course exam

Exam Fee

~$2,150 full designation (America's Health Insurance Plans (AHIP))

HIA Exam Content Outline

15%

Health Plan Types & Design

HMO, PPO, EPO, POS, and HDHP/HSA designs, group versus individual coverage, fully insured versus self-funded plans, and indemnity versus managed-care basics

10%

Underwriting & Rating

Group versus individual underwriting, community rating, experience rating, ACA 3:1 age band, geography, family size, and tobacco rating factors (no gender)

10%

Claims Administration

Adjudication workflow, coordination of benefits (birthday rule, primary/secondary), EOBs, EDI 837/835/270/271 transactions, ICD-10-CM and CPT coding

10%

Provider Networks

Credentialing, network adequacy standards, contracting, capitation versus fee-for-service, balance billing, and in-network versus out-of-network steering

10%

Utilization Management

Prior authorization, concurrent and retrospective review, case and disease management, medical-necessity criteria, and InterQual/MCG style guidelines

Pharmacy Benefit Management

Formulary tiers, PBM functions, MAC pricing, manufacturer rebates, prior authorization, step therapy, and specialty pharmacy distribution

10%

Medicare

Parts A, B, C (Medicare Advantage) and D, IRMAA, MA-PD versus PDP, MA enrollment periods, Medicare Supplement (Medigap), and dual-eligible coordination

10%

Medicaid & CHIP

Categorical and MAGI versus non-MAGI eligibility, Medicaid expansion states, dual eligibles, HCBS waivers, and CHIP coverage rules

10%

ACA & ERISA Compliance

Essential Health Benefits (EHB), Minimum Essential Coverage (MEC), Medical Loss Ratio (80/85%), preventive Grade A/B no cost-share, ERISA preemption for self-funded plans

10%

Privacy: HIPAA, HITECH, GLBA

HIPAA Privacy Rule TPO, minimum necessary, BAAs, HITECH 500-person breach threshold and HHS notification, and GLBA financial-privacy obligations

How to Pass the HIA Exam

What You Need to Know

Passing score: 70% per course exam
Exam length: 100 questions
Time limit: Self-paced; one proctored exam per course
Exam fee: ~$2,150 full designation

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

HIA Study Tips from Top Performers

1Anchor plan-type questions on cost-sharing rules: HMOs require PCP referrals and in-network use; PPOs allow out-of-network at higher cost; HDHPs pair with HSAs

2Memorize ACA rating factors - age (3:1 band), geography, family size, and tobacco - and remember gender rating is prohibited in the individual and small-group markets

3Drill MLR thresholds: 80% for individual and small-group, 85% for large-group; carriers below threshold must rebate the difference to enrollees

4Lock in HIPAA EDI codes: 837 (claim), 835 (remittance), 270/271 (eligibility), and 278 (prior authorization)

5For HITECH, remember the 500-person rule: breaches affecting 500 or more individuals require HHS notification within 60 days and media notice in the affected jurisdiction

Frequently Asked Questions

What is the AHIP HIA designation?

The Health Insurance Associate (HIA) is AHIP's core designation for health-insurance professionals, with more than 20,000 holders. Candidates complete six online self-study courses - four required and two electives - each followed by a proctored multiple-choice exam. The curriculum spans plan types, underwriting, claims, networks, utilization management, Medicare, Medicaid, ACA, and HIPAA compliance.

What courses are required for the HIA?

The four required HIA courses are Fundamentals of Health Insurance Part A (Basics of Health Insurance), Fundamentals of Health Insurance Part B (Basics of Company Operations), Health Insurance Advanced Studies Part A, and Supplemental Health Insurance. Candidates then select two electives from the disability, fraud, and long-term care course tracks to complete the six-course requirement.

How much does the HIA designation cost?

The full HIA designation costs approximately $2,150 across all six courses. Individual courses typically run about $220 for AHIP members and $280 for non-members, with pricing varying for combined-course electives such as the Long-Term Care Professional (LTCP) bundle. Always confirm current pricing on ahip.org/courses before enrolling.

What is the HIA exam format?

Each of the six HIA courses ends with a proctored online multiple-choice exam, with a typical AHIP passing threshold of 70%. Course exams test the assigned text content for that course rather than acting as a single comprehensive exam. Candidates have up to 90 days from enrollment to study and schedule the proctored exam.

How long does it take to earn the HIA?

Most candidates complete the HIA in 9 to 18 months, depending on how many courses they take in parallel. Plan for roughly 150 to 250 total study hours across all six courses. The four required courses lay the operational and compliance foundation, while the two electives let candidates specialize in disability, fraud, or long-term care.

Who is the HIA designed for?

The HIA is built for health-plan employees, brokers and agents, third-party administrators, employer benefits staff, and anyone new to the U.S. health-insurance industry. It is widely used as an onboarding credential at carriers and BUCAs and as a stepping stone to AHIP's MHP, PAHM, and FAHM designations.

How does HIA relate to ACA and HIPAA rules?

HIA content reflects the current ACA market rules - guaranteed issue, EHB, the 3:1 age band, no gender rating, 80/85% MLR, and Grade A/B preventive services at no cost-share - plus HIPAA Privacy and Security, HITECH breach notification (500-person threshold), and GLBA financial-privacy obligations. Questions on this site are written to those 2026 rules.