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.
Is Health ProtectorGuard like Affordable Care Act (ACA) health insurance?
No, it isn'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. In fact, it’s designed more as a supplement to a major medical plan.
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How do I receive my benefits?
After you have a qualified medical expense under the Health ProtectorGuard plan, you submit a claim. You are then paid a predetermined amount for that covered service 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 a claim
3. Receive a check to use any way you see fit
What do I have to pay before I get a benefit 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.
When can I file a claim?
Right after a qualified expense. Once you have received services for expenses that are covered by your hospital and doctor fixed indemnity plan, you send in a claim. 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.
Health ProtectorGuard 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.
to Help You Understand Health ProtectorGuard Features
Generally speaking, benefits are any services covered by a health insurance plan. How the insurance company pays for benefits is a key difference between a major medical plan and a fixed indemnity plan. A major medical plan usually covers a service at a stated coinsurance rate after you reach your deductible.
A Health ProtectorGuard plan pays a fixed monetary amount for covered services and procedures, and pays it first, not following another payment by you, the plan holder.
Coinsurance is your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. You pay your required coinsurance plus any deductibles you may owe for a service, procedure, or visit.
There are no coinsurance payments for fixed indemnity plans. This is what makes fixed indemnity health insurance a good option to help offset out-of-pocket costs that come with a major medical plan. For example, any benefits paid out by a fixed indemnity plan can go directly towards paying your share of medical costs.
Your copay is a fixed amount (for example, $20) you pay for a health care service, usually at the time you receive the service. The amount can vary by plan, and not all major medical plans have copays. Copays do not usually count towards your medical deductible.
There are no copays for fixed indemnity insurance. The benefits that you receive from your plan can help you replace the money you've paid toward major medical copays.
Your deductible is the amount you owe for covered health care services before your major medical health insurance or plan begins to pay. Deductible amounts can vary greatly depending on the type of plan you choose. For example, if you have a $1,000 deductible, you must pay $1,000 towards covered health care expenses before your insurer begins to pay.
Some fixed indemnity plans do not have deductibles. Once you submit an eligible claim, you (or your provider) are paid the specified amount. This means fixed indemnity insurance can help you meet deductibles you have to cover through major medical plans.
Some fixed indemnity insurance plans feature an alternative form of deductible. In exchange for a smaller premium payment up front, you can agree to reduce the amount of the fixed benefits paid to you. In other words, you don’t pay the deductible. Instead, you agree to receive less benefit payment. Check specific plans for details.
First Dollar Coverage
First dollar coverage plans pay benefits without your having to meet deductibles, copays or coinsurance first.
Most, though not all, fixed indemnity insurance plans are first dollar products.
A guaranteed issue health insurance plan is one that covers a customer regardless of any pre-existing conditions, health issues or illnesses they may have, as required by the Affordable Care Act (ACA), also known as Obamacare.
Health ProtectorGuard fixed indemnity insurance plans are supplemental insurance, designed to work with other insurance you may have. They are underwritten plans, meaning you have to answer a series of medical questions to apply. They are not guaranteed issue.
Networks are the facilities, providers and suppliers your insurer or plan has contracted with to provide health care services. Network providers offer services at a discounted rate, making it more affordable to stay within your insurance plan’s network. Most major medical health insurance plans require in-network visits in order to receive the most affordable care.
Fixed indemnity plans pay a set benefit per service, so you are not restricted to visiting a network provider.
While you may have the option of visiting the doctor or provider of your choice with fixed indemnity insurance, some plans offer additional savings if you do decide to visit an in-network provider.
Open Enrollment refers to a limited time period during which individuals can choose and apply for an insurance plan for the next year.
Fixed indemnity health insurance plans are not subject to specific application dates. You may apply at any time.
Your out-of-pocket costs are the part of your health care expenses you’re responsible for paying, like copays, deductibles, and coinsurance.
One of the key benefits of fixed indemnity insurance is how it supplements major medical insurance to help offset the out-of-pocket costs you may face from hospital stays, doctor visits or other procedures.
1THIS PRODUCT PROVIDES LIMITED BENEFITS. This 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.
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).