A fixed indemnity insurance product like Health ProtectorGuard, underwritten by Golden Rule Insurance Company, works differently than other insurance you might have had in the past that helped pay for health-related costs.1 Fixed indemnity insurance pays a set benefit per specified medical expense, as opposed to a share of the total covered costs after a deductible, which is an approach you might be used to.
So how does that actually work? A look at a couple common scenarios might help you understand the benefits of this type of fixed indemnity plan.
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Hector likes to say he’s “never” sick, so it takes 4 days of a worsening sore throat and a persistent headache to get him to seek help. He doesn’t have a regular doctor, so he finds the nearest Urgent Care facility with a doctor he can see on short notice and explains how he’s feeling.
The doctor examines his throat and checks his neck for inflammation. She doesn’t like what she sees, so she swabs Hector’s throat and sends the swabbed sample for testing. The result that comes back is what she expected, strep throat. The doctor prescribes a generic antibiotic to battle the infection, which Hector fills at a nearby pharmacy.
Hector has a Health ProtectorGuard Choice Plus plan in addition to his health insurance plan.2 What would his fixed indemnity insurance plan pay in this case?
|Covered Service||Health ProtectorGuard Choice Plus Benefit||Benefit Paid|
|Urgent Care visit||$100/visit||$100 (for 1 visit)|
|Outpatient lab/X-ray||$200/test||$200 (for 1 outpatient strep test)|
|Prescription antibiotic||$20 generic/$40 brand per Rx fill||$20 for generic antibiotic|
Hector would be paid a total of $320 in this case.
Network discounts without network restrictionsWhen Hector pays for his services, he gets a couple of nice surprises:
Carla’s eating dinner out with a friend when that stomach twinge she has been feeling all day gets much worse. Her friend drives her to the closest hospital and straight to the emergency room. After an initial exam, the ER doctor orders an ultrasound to look at her abdomen. The doctor diagnoses appendicitis, and Carla is prepped for surgery, in this case an open appendectomy.
After the successful surgery, Carla spends a day in the hospital recovering and is given some prescription pain medication to take home for any discomfort.
Carla has a Health ProtectorGuard Premier Plus plan in addition to her health insurance plan.2 What does her fixed indemnity insurance plan pay in this case?
|Covered Service||Health ProtectorGuard Premier Plus Benefit||Benefit Paid|
|Emergency room||$500/day||$500 (for 1 day)|
|Ultrasound||$300/test||$300 (for 1 test)|
|Surgeon||$5,000 (for Tier 3 surgery)||$5,000|
|Anesthesiologist||30% of Surgeon benefit||$1,500|
|1 day hospital stay||$5,000/day||$5,000 for 1 day|
|Prescription pain medication||$20 generic/$40 brand per Rx fill||$20 for generic pain meds|
Carla would be paid a total of $12,320 in this case.
In 2015, the International Federation of Health Plans found the average cost of an appendectomy in the United States to be $15,930. However, 25% of the time it found costs around $9,332 for the same procedure.4
Carla’s benefit of $12,320 will be paid no matter what. If her care only adds up to $9,332, then she keeps the rest. If her care costs more than what the plan pays, she’s responsible for the rest. That’s what a hospital and doctor fixed indemnity insurance plan like Health ProtectorGuard does — pays a set amount to you after a specific medical service no matter the cost.
The fixed benefits from this indemnity plan are paid regardless of other insurance you have and are designed to help cover what your major medical plan doesn’t.
In this case, if Carla’s major medical plan had a $6,000 deductible, the $12,320 her fixed indemnity insurance paid for her appendectomy could help her pay that deductible amount and then some. It might even help her pay her major medical’s maximum out-of-pocket costs for the year. After that, with her major medical plan covering most of her health care expenses, she could use any benefits paid on her fixed indemnity plan for whatever she wants.
Bundle Fixed Indemnity Insurance with Critical Illness or Accident Insurance5
1 THIS PLAN 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 for 2018.
2 Benefits vary by plan. Check brochure for details.
3 Benefits must be assigned to providers to receive reduced rates.
4 2015 Comparative Price Report Variation in Medical and Hospital Prices by Country. International Federation of Health Plans. Retrieved from http://www.ifhp.com/
5 All products require separate applications. Separate policies or certificates are issued.