AIIM Certified Health Insurance Analyst CHIA
Exam
**Question 1.** Which principle explains why insurance becomes more affordable as the
number of insured individuals increases?
A) Moral hazard
B) Law of large numbers
C) Adverse selection
D) Risk retention
Answer: B
Explanation: The law of large numbers states that with a larger risk pool, the actual loss
experience will more closely match the expected loss, stabilizing premiums.
**Question 2.** In a single‑payer health system, who primarily finances health care services?
A) Multiple private insurers
B) Federal or provincial government
C) Employers through payroll taxes
D) Individual out‑of‑pocket payments
Answer: B
Explanation: A single‑payer system is funded and administered by one public entity that pays for
all covered services.
**Question 3.** Which step in the insurance value chain directly follows underwriting?
A) Claims adjudication
B) Product development
C) Policy issuance and premium collection
D) Customer service
Answer: C
, AIIM Certified Health Insurance Analyst CHIA
Exam
Explanation: After underwriting determines risk and pricing, the insurer issues the policy and
collects the premium.
**Question 4.** The amount a member must pay before the insurer begins to pay for covered
services is called the:
A) Co‑pay
B) Deductible
C) Out‑of‑pocket maximum
D) Premium
Answer: B
Explanation: A deductible is the pre‑specified amount the insured must satisfy each benefit
period before benefits apply.
**Question 5.** The Affordable Care Act (ACA) primarily introduced which of the following
market reforms?
A) Mandatory employer contribution of 100% of premiums
B) Health insurance exchanges and guaranteed issue
C) Elimination of all co‑payments
D) Universal single‑payer system
Answer: B
Explanation: The ACA created health insurance marketplaces and required insurers to offer
coverage regardless of pre‑existing conditions.
**Question 6.** Under HIPAA, which of the following is considered a “protected health
information” (PHI) element?
A) Employer’s stock price
B) Patient’s social security number
, AIIM Certified Health Insurance Analyst CHIA
Exam
C) General health statistics for a region
D) Hospital’s financial statements
Answer: B
Explanation: PHI includes individually identifiable health information such as a patient’s SSN.
**Question 7.** Which ethical principle requires insurers to disclose all material plan limitations
to members?
A) Beneficence
B) Autonomy
C) Transparency
D) Non‑maleficence
Answer: C
Explanation: Transparency obligates insurers to clearly communicate coverage limits, exclusions,
and costs.
**Question 8.** An external audit of a health insurer most likely focuses on:
A) Employee satisfaction surveys
B) Compliance with CMS reporting requirements
C. Marketing campaign effectiveness
D. Internal IT hardware inventory
Answer: B
Explanation: External auditors verify that the insurer meets statutory and regulatory reporting
obligations.
**Question 9.** Which plan type typically requires members to obtain referrals from a primary
care physician before seeing a specialist?
, AIIM Certified Health Insurance Analyst CHIA
Exam
A) PPO
B) HMO
C) HDHP
D) POS
Answer: B
Explanation: HMOs use a gatekeeper model where the primary care physician coordinates
specialist referrals.
**Question 10.** In a Preferred Provider Organization (PPO), members receive the highest
reimbursement when they use:
A) Out‑of‑network providers
B) In‑network providers
C) Only emergency services
D. Telehealth services exclusively
Answer: B
Explanation: PPOs negotiate discounted rates with in‑network providers, resulting in higher
insurer payment and lower member cost.
**Question 11.** Which Medicare part provides coverage for outpatient prescription drugs?
A) Part A
B) Part B
C) Part C
D) Part D
Answer: D
Explanation: Medicare Part D is the standalone prescription drug benefit.
Exam
**Question 1.** Which principle explains why insurance becomes more affordable as the
number of insured individuals increases?
A) Moral hazard
B) Law of large numbers
C) Adverse selection
D) Risk retention
Answer: B
Explanation: The law of large numbers states that with a larger risk pool, the actual loss
experience will more closely match the expected loss, stabilizing premiums.
**Question 2.** In a single‑payer health system, who primarily finances health care services?
A) Multiple private insurers
B) Federal or provincial government
C) Employers through payroll taxes
D) Individual out‑of‑pocket payments
Answer: B
Explanation: A single‑payer system is funded and administered by one public entity that pays for
all covered services.
**Question 3.** Which step in the insurance value chain directly follows underwriting?
A) Claims adjudication
B) Product development
C) Policy issuance and premium collection
D) Customer service
Answer: C
, AIIM Certified Health Insurance Analyst CHIA
Exam
Explanation: After underwriting determines risk and pricing, the insurer issues the policy and
collects the premium.
**Question 4.** The amount a member must pay before the insurer begins to pay for covered
services is called the:
A) Co‑pay
B) Deductible
C) Out‑of‑pocket maximum
D) Premium
Answer: B
Explanation: A deductible is the pre‑specified amount the insured must satisfy each benefit
period before benefits apply.
**Question 5.** The Affordable Care Act (ACA) primarily introduced which of the following
market reforms?
A) Mandatory employer contribution of 100% of premiums
B) Health insurance exchanges and guaranteed issue
C) Elimination of all co‑payments
D) Universal single‑payer system
Answer: B
Explanation: The ACA created health insurance marketplaces and required insurers to offer
coverage regardless of pre‑existing conditions.
**Question 6.** Under HIPAA, which of the following is considered a “protected health
information” (PHI) element?
A) Employer’s stock price
B) Patient’s social security number
, AIIM Certified Health Insurance Analyst CHIA
Exam
C) General health statistics for a region
D) Hospital’s financial statements
Answer: B
Explanation: PHI includes individually identifiable health information such as a patient’s SSN.
**Question 7.** Which ethical principle requires insurers to disclose all material plan limitations
to members?
A) Beneficence
B) Autonomy
C) Transparency
D) Non‑maleficence
Answer: C
Explanation: Transparency obligates insurers to clearly communicate coverage limits, exclusions,
and costs.
**Question 8.** An external audit of a health insurer most likely focuses on:
A) Employee satisfaction surveys
B) Compliance with CMS reporting requirements
C. Marketing campaign effectiveness
D. Internal IT hardware inventory
Answer: B
Explanation: External auditors verify that the insurer meets statutory and regulatory reporting
obligations.
**Question 9.** Which plan type typically requires members to obtain referrals from a primary
care physician before seeing a specialist?
, AIIM Certified Health Insurance Analyst CHIA
Exam
A) PPO
B) HMO
C) HDHP
D) POS
Answer: B
Explanation: HMOs use a gatekeeper model where the primary care physician coordinates
specialist referrals.
**Question 10.** In a Preferred Provider Organization (PPO), members receive the highest
reimbursement when they use:
A) Out‑of‑network providers
B) In‑network providers
C) Only emergency services
D. Telehealth services exclusively
Answer: B
Explanation: PPOs negotiate discounted rates with in‑network providers, resulting in higher
insurer payment and lower member cost.
**Question 11.** Which Medicare part provides coverage for outpatient prescription drugs?
A) Part A
B) Part B
C) Part C
D) Part D
Answer: D
Explanation: Medicare Part D is the standalone prescription drug benefit.
