Fixed Indemnity Plans

ARCHER JORDAN/General Agents – Fixed Indemnity Plans

Fixed Indemnity plans are limited medical plans that pay a set amount for specific health services such as prescriptions, office and emergency room visits, or hospital admission, regardless of the actual costs for these services. While these plans go beyond the preventive coverage of MEC plans, they offer very limited coverage and typically exclude many medical conditions and services. Fixed indemnity plans do not satisfy the ACA’s individual mandate and federal rules related to offering these plans on a group basis are still evolving.

Finally, please note that “Essential Health Benefits” is an ACA term with no relation to Minimum Essential Coverage. Essential Health Benefits refers to 10 categories of health care services that must be covered by plans in the individual and small group markets, both inside and outside of the Health Insurance Marketplace. The 10 categories include ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

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