Indemnity Health Plan

Indemnity health insurance plans are also called “fee-for-service.” These are the types of plans that primarily existed before the rise of HMOs, IPAs, and PPOs. With indemnity plans, the individual pays a pre-determined percentage of the cost of health care services, and the insurance company (or self-insured employer) pays the other percentage. For example, an individual might pay 20 percent for services and the insurance company pays 80 percent. The fees for services are defined by the providers and vary from physician to physician. Indemnity health plans offer individuals the freedom to choose their health care professionals.


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Benefit
Carrier
Certificate of Insurance
Claim
Co-insurance
Co-payment
Deductible
Denial of Claim
Dependents
Effective Date
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Group Insurance
Health Maintenance Organizations (HMO)
HIPPA
In-network
Individual Health Insurance
Length of Stay (LOS)
Lifetime Maximum Benefit
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Maximum Dollar Limit
Medigap Insurance Policies
Network
Open-Ended HMO
Out-of-network (Out-of-plan)
Out-of-pocket Maximum
Outpatient
Pre-admission Certification
Pre-admission Review
Pre-admission Testing
Pre-existing Conditions
Preferred Provider Organizations (PPO)
Primary Care Provider (PCP)
Provider
Reasonable & Customary Fees
Rider
Second Opinion
Second Surgical Opinion
Short-term Disability
Short-term Medical
State Mandated Benefits
Stop-loss
Usual, Customary, & Reasonable (UCR) or Covered Expenses
Waiting Period

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