Hospital and Doctor Insurance
Frequently Asked Questions
Fixed Indemnity Plans1
What is indemnity insurance?
A fixed indemnity plan sends you a preset—“fixed”—payment when you receive any of the qualified medical services specified in the plan. The money paid out stays the same no matter what the total bill for the qualified service was. That’s why fixed indemnity insurance can also be called fixed benefit insurance or fee for service insurance.
Can I avoid the Affordable Care Act (ACA) tax penalty by having fixed indemnity insurance?
No, you can’t. Fixed indemnity insurance provides limited benefits, paying a set amount for covered services up to a maximum for the year. It doesn’t cover all the essential health benefits outlined by the ACA and doesn’t qualify as the minimum essential coverage. Also, it will not cover expenses related to preexisting conditions. ACA plans do. In fact, it’s designed more as a supplement to a major medical plan.
How do I receive my benefits?
After you have a qualified medical expense under the fixed indemnity plan, you simply submit a claim with your receipt. You are then paid a predetermined amount for that health care expense as detailed in the plan. You don’t have to pay a deductible first, and it doesn’t matter if you have other insurance covering the same expense. The money from this plan is fixed and comes directly to you to use as you want.
|1. Receive care for a qualified medical expense||2. Submit your receipt and your completed claim form||3. Receive a check to use any way you see fit|
What do I have to pay before I get money from the plan?
Nothing beyond your monthly premium, which is what you pay to have the plan.
You don’t have deductibles or copays with fixed indemnity insurance. If you have a covered expense, your benefit is paid after you submit your claim and receipt.
When can I file a claim?
Right after a qualified expense. Once you have a receipt for a medical cost that is covered by your hospital and doctor fixed indemnity plan, you just send it in along with a completed claim form. You are then paid the preset amount.
Why would I buy indemnity insurance?
To help you manage potential out-of-pocket costs from your major medical plan.
Whatever your main health insurance plan is, it comes with out-of-pocket expenses. Deductibles , copays , coinsurance —these are all things you pay before your insurance plan pays benefits.
Fixed indemnity insurance supplements your health insurance by paying you a set benefit for certain qualified expenses. You can then use that money to help meet some of these out-of-pocket costs you are responsible for under your medical plan.
If my health insurance plan covers me for something, will the fixed indemnity plan still pay?
Yes. There are no coordination of benefits conflicts with your fixed indemnity insurance. It pays you for the covered expense regardless of overlap from what other health insurance you have might cover.
Am I confined to a narrow network of doctors or hospitals?
No, where you go for care is up to you. Since you are paid a fixed amount for covered services up to an annual maximum amount, the plan doesn’t restrict you to a specific network of doctors or providers.
Note: Even if fixed indemnity insurance doesn’t have network limitations, your major medical plan might. Be sure to check your health insurance plan’s network restrictions so you can be sure to get the most coverage out of it, too.
1This is a supplement to health insurance and is not a substitute for the minimum essential coverage required by the Affordable Care Act (ACA). Lack of major medical coverage (or other minimum essential coverage) may result in an additional payment with your taxes.
No individual applying for health coverage through the individual Marketplace will be discouraged from applying for benefits, turned down for coverage, or charged more premium because of health status, medical condition, mental illness claims experience, medical history, genetic information or health disability. In addition, no individual will be denied coverage based on race, color, religion, national origin, sex, sexual orientation, marital status, personal appearance, political affiliation or source of income.
References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies.
Each company is a separate entity and is not responsible for another's financial or contractual obligations.
Administrative services are provided by United HealthCare Services, Inc. or their affiliates.
Products and services offered are underwritten by All Savers Insurance Company, Golden Rule Insurance Company, Health Plan of Nevada, Inc., Oxford Health Plans (NJ), Inc., UnitedHealthcare Benefits Plan of California, UnitedHealthcare Community Plan, Inc., UnitedHealthcare Insurance Company, UnitedHealthcare Life Insurance Company, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Alabama, Inc., UnitedHealthcare of Arkansas, Inc., UnitedHealthcare of Florida, Inc., UnitedHealthcare of Georgia, Inc., UnitedHealthcare of Kentucky, LTD., UnitedHealthcare of Louisiana, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., UnitedHealthcare of the Midlands, Inc., UnitedHealthcare of the Midwest, UnitedHealthcare of Mississippi, Inc., UnitedHealthcare of New England, Inc., UnitedHealthcare of New York, Inc., UnitedHealthcare of North Carolina, Inc., UnitedHealthcare of Ohio, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Pennsylvania, Inc., Unitedhealthcare of Washington, Inc.
This policy is subject to various exclusions and limitations. For costs and complete details of the coverage, call (or write) your insurance agent or the company (whichever is applicable).