Fixed-Benefit Indemnity Insurance

What it is

A fixed-benefit plan, also called fixed indemnity insurance, lists a specific dollar amount for each covered service: for example, a set amount per doctor visit, per day in the hospital, or per X-ray. When you receive a covered service, the plan pays that fixed amount, either to you or to your provider if you assign benefits.

There's generally no deductible to meet before the fixed benefit is paid, and the plan pays the same amount whether or not you have other insurance. If the bill is higher than the fixed amount, you pay the difference. If it's lower, many plans still pay the full fixed benefit.

Because benefits are set amounts rather than a share of the bill, these plans don't use networks the way major medical plans do. You can see any licensed provider, although your main health plan may still have network rules of its own.

Who it's often a fit for

• People with a high-deductible health plan who want help with costs before the deductible is met
• People who want predictable cash benefits for doctor visits, hospital stays, or tests
• People pairing a short term plan with first-dollar benefits for everyday care
• Anyone who understands the limits and wants coverage that can be bought year-round

How it works

1. Choose a plan level. Higher levels usually pay larger fixed amounts and cost more.
2. Get care from any provider. There are no network restrictions for the fixed benefit itself.
3. Submit a claim, or let your provider submit it, and the plan pays the scheduled amount for that service, subject to frequency limits and calendar-year or lifetime maximums.
4. Use the money however you need: toward a deductible, copays, or everyday bills.

Carriers you can quote online

Online quotes for fixed-benefit indemnity insurance are available from UnitedHealthcare and Pivot Health. Each carrier designs its own plans, so benefit amounts, waiting periods, riders, and eligibility ages differ. Hollen can line them up side by side and explain the differences, and plan availability varies by state.

What affects the cost

There's no single price. These factors usually matter most:

• Your age and, where allowed, your health answers
• The plan level and the fixed amounts you choose
• Who is covered
• Your state
• Optional riders, where offered

Limits to understand

• It's not ACA coverage and doesn't cover all essential health benefits.
• Pre-existing conditions are generally excluded.
• Benefits are capped per service, per day, and per year, so a large hospital bill can exceed what the plan pays.
• Plans have to carry a federal notice explaining that they are not comprehensive coverage.

How Hollen helps

Hollen is an independent broker, so she can compare plans from several carriers instead of just one. She'll help you decide whether a supplemental plan makes sense alongside your main coverage, check what's offered in your state, and explain the fine print before you buy. You can enroll online yourself or have Hollen walk you through it.

Frequently asked questions

Related coverage

All short-term & supplemental plans · Short Term Medical · ACA Plans · Licensed states

THIS IS A LIMITED-BENEFIT PLAN. It is a supplement to health insurance, not a substitute for major medical coverage or the minimum essential coverage required by the Affordable Care Act. Plans may be medically underwritten, and benefits are generally not paid for pre-existing conditions during any limitation period. Availability, benefits, and rules vary by carrier and state. This page is general educational information, not a guarantee of coverage, eligibility, or cost.