What is fixed benefit health insurance?
Fixed benefit plans are also sometimes referred to as indemnity insurance or fee for service insurance. These plans are designed to give your traditional health insurance a boost by paying a preset — “fixed” — payment when you receive any of the qualified medical services specified in the plan. The benefit paid out stays the same no matter what the total bill for the qualified service was and no matter what other insurance pays.
What do fixed benefit health insurance plans cover?
Fixed benefit plans help cover some of the most common medical costs you and your loved ones might face. These plans offer a preset benefit amount. Some benefits increase the longer you have a plan.
See how fixed benefit insurance plans can help cover costs
With your fixed benefit plan, you may be able to:
How do fixed benefit plans work?
When you have a fixed benefit health plan, here are some things you’ll need to know to use your benefits:
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You or your provider submit a covered expense. The fixed benefit for that covered service is then paid, no matter what other insurance coverage you may have.
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You don't have to meet a deductible before you receive benefits.
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You choose the doctor or health facility you need.2
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You can go to any doctor or health care facility you want. However, you may save money with discounted rates for services if you use providers in your plan's network (varies by state).
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You can apply year-round, not just during an enrollment period or because of special circumstances.
Frequently asked questions about fixed benefit health insurance
Explore FAQs about fixed benefit health insurance to learn how to choose a plan for you.
Fixed benefit insurance can help you manage potential out-of-pocket costs from your main health insurance plan. This includes expenses like deductibles, copays and coinsurance — things you pay before your insurance plan pays benefits
With traditional health insurance, your plan typically pays for all or a percentage of covered expenses after you meet a deductible, pay a copay or reach an out-of-pocket cost limit. You pay for qualified expenses first, then your insurance company usually covers their portion based on the terms of the policy.
Fixed benefit insurance flips how you’re paid. You or your provider are paid a predetermined, fixed amount of benefit for covered health care expenses. After that, you’re responsible for the rest.
Fixed benefit insurance is not major medical insurance. Fixed benefit 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 for the first 12 months of coverage. In fact, it’s designed more as a supplement to a major medical plan.
It’s important to understand these differences:
- Indemnity insurance does not provide the coverage required under the Affordable Care Act (ACA)
- It does not provide coverage for all the essential health benefits outlined in the ACA
- It will most likely not provide coverage for expenses from preexisting medical conditions for the first 12 months of coverage
Nothing beyond your monthly premium, which is what you pay to have the plan. You don’t have deductibles or copays with fixed benefit health insurance. If you have services provided for a covered expense, the benefit is paid after the claim is submitted.
Yes. The fixed benefit health plan pays you for the covered expense, even if your other health insurance plan also covers that service.
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.
Keep in mind that your main health insurance may require you to stay within a certain network of providers.
Yes, in some plans. Many fixed benefit plans come with benefits paid for a certain number of prescription fills per year. Plans in most states come with a prescription discount card to help with the ongoing costs of medicine.
Yes, many fixed benefit plans pay for specified preventive or wellness services.3
In some states, fixed benefit health plans come with an included telehealth membership so you can access a doctor by phone or app without leaving your home.
Why choose fixed benefit health insurance plans?
Learn more about fixed benefit health insurance
(An upbeat electronic conga beat begins. The UnitedHealthcare logo appears and turns into a ribbon, gliding across the screen and revealing the words “UnitedHealthcare, Golden Rule Insurance Co. and Health ProtectorGuard”. A bright synthesizer orchestral tune is added to the conga beat. Two hands join together in a handshake to create a heart graphic on the left side of the screen. On the right, the words “Extra help for the “what ifs”” fade in.)
The bright voice of a young woman begins: A little extra help for the “what ifs” we all worry about.
(The words on the right half of the screen change to “Health ProtectorGuard”.)
Voiceover: That’s the power of Health ProtectorGuard.
(A stethoscope appears on one half of the screen; on the other half, the words “Medical Treatment”)
Voiceover: “What ifs” can be costly. Seeking medical treatment isn’t always cheap,
(The stethoscope and words disappear, and a wallet with a coin appears.)
Voiceover: and it can be hard coming up with the cash to cover doctor visits,
(Wallet disappears, and a doctor’s office graphic appears, followed by prescription and hospital graphics as they’re mentioned.)
Voiceover: prescriptions or maybe even something bigger like a hospital stay.
(Graphics are replaced by the words “Health ProtectorGuard” and dollar bill and heart graphics.)
Voiceover: Health ProtectorGuard is insurance that pays a fixed benefit amount for eligible medical services like office visits,
(Graphics are replaced by the words “Office visits”, “Prescriptions”, “Hospital stays”, and “Wellness visits” as they’re mentioned.)
Voiceover: prescriptions, hospital stays, surgeries with some plans, and even wellness visits after a 30-day waiting period. Health ProtectorGuard is not an Affordable Care Act plan.
(Previous words are replaced with “is not an Affordable Care Act plan”, “it is not for pre-existing conditions”, “flexible supplemental coverage”, and “You choose the benefit level” as they’re mentioned.)
Voiceover: It does not provide coverage for pre-existing conditions. It’s a robust supplemental insurance plan to give you extra flexibility based on your health care needs. You choose the benefit level that makes the most sense for the health services you use most often. Here’s a quick example: Let’s say you’ve had a bad cough, trouble breathing and a fever for a couple of days.
(A graphic with a person appears with an X-Ray revealing their lungs.)
Voiceover: You see your doctor and get a chest X-ray.You’re diagnosed with a severe case of pneumonia and need to be admitted to the hospital for a few days.
(A blood pressure cuff graphic appears.)
Voiceover: Your Health ProtectorGuard is ready to help with covered expenses.
(Graphic slides off the screen, replaced by the words “your plan pays” and on the right of the screen as they’re mentioned these graphics appear: a doctor’s office graphic and “$100”, an X-Ray graphic and “$50”, a hospital graphic and “$2,000”, and finally a bed graphic and “$4,000”. Underneath “your plan pays” in fine print it says: “Example based on HPG Select 2 plan”.)
Voiceover: Your plan pays $100 for the doctor visit, $50 for the X-ray, $2,000 for hospital admission and $4,000 for 2 days of inpatient hospital care.
(Graphics are replaced with the words “After claims are filed” on the left side of the screen with a document graphic and “$6,150” on the right side of the screen with a dollar bill graphic. Underneath in fine print it says: “Example based on HPG Select 2 plan”.)
Voiceover: After the claims are filed, the plan pays a benefit of $6,150 – regardless of any other health insurance coverage you may already have.
(The $6,150” with the dollar bill graphic slides to the left, replacing the words “after claims are filed.” The words “Directly paid to your provider” appear on the right.)
Voiceover: The $6,150 benefit is paid directly to your providers to help reduce and cover some of your bills.
(The upbeat gleeful tune in the background continues. Various healthcare related graphics appear in different sized circles.)
Voiceover: With Health ProtectorGuard, there are no network restrictions. You can choose any doctor or hospital you want. But you will see lower costs for care with providers in the UnitedHealthcare Choice Plus network.
(The words “Health ProtectorGuard” appear on top of the words “Choose any doctor or hospital” and “UnitedHealthcare Choice Plus Network” which fade in and fade out as they’re mentioned.)
Voiceover: Coverage is available for individuals and families – and you can apply at any time.
(A close-up graphic of a person with a heart bandage on their arm, as well as two raised hands appear.)
Voiceover: No need to wait for an enrollment period.
(An animated clock graphic appears and ticks, to the left of the words “Apply anytime” and “No enrollment period”, which fade in and fade out. The clock disappears and is replaced by the words “No deductibles'' and “Benefits paid regardless of other coverage” which fade in and out as they’re mentioned.)
Voiceover:There are no deductibles to meet, and benefits are paid regardless of other medical insurance coverage you may have.
(An animated graphic of a person holding a phone with a doctor on the screen appears to the left of the words “Telehealth available 24/7”)
Voiceover: And with Health ProtectorGuard, telehealth services are available 24/7.
(Telehealth graphic is replaced by an animated prescription graphic to the left of the words “Discounts on prescriptions” and underneath that, the words “with your Optum Perks card” in fine print.)
Voiceover: You also receive discounts on prescriptions with the Optum Perks card.
(A calendar graphic appears with the words “Doctor visits”, “Hospital stay”, and “Prescriptions” and “Telehealth” animate in.)
Voiceover: Health ProtectorGuard – simple, straight-forward benefits for covered services.
(A final screen with the words “UnitedHealthcare” and “Golden Rule Insurance Co.” in the upper left corner. In the center of the screen there are the words: “Health ProtectorGuard” and then “Questions? Call your local health insurance broker” and finally “See the product brochure for more information on benefits, exclusions and limitations.” At the bottom of the screen in fine print: “Underwritten by Golden Rule Insurance Company, a UnitedHealthcare Company, Product design and availability varies by state. This product is medically underwritten. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. Benefits provided in stated amount regardless of the actual expenses incurred. Benefits are not paid for expenses resulting from preexisting conditions. For costs and complete details of the coverage, call your insurance agent or the company.
45387-G-0321”)
Voiceover: A little extra insurance help so you can have a little less worry about the “what ifs” of life.
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