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The Shortest Path to Understanding Fixed Benefit Insurance

So What Exactly Is Fixed Benefit Insurance?

More and more people are turning to Fixed Benefit insurance because it can provide some relief when those unexpected medical expenses pop up.

So there’s no confusion the term “Fixed Benefit” is synonymous with “Fixed Indemnity insurance” and “Hospital and Doctor Fixed Indemnity insurance”. No matter what you call it, it’s simply a plan that pays you cash for qualifying medical services (hospital, surgical, outpatient, pharmacy, doctor visits, etc.). It’s called a “fixed” benefit because you get a fixed amount of money depending on your plan and what eligible medical service you receive.

What Does Fixed Benefit Insurance Typically Cover?




Surgeon and Anesthesiologist


Office Visits/Urgent Care


Prescription Drugs





How Does It Work?

For example, let’s say you have a sinus infection. You go to the doctor and you’re prescribed a generic antibiotic. Let’s also say your Fixed Indemnity policy pays you $100 for a doctor’s visit and $20 for a prescription. After the claim is filed, the Fixed Indemnity plan pays a benefit of $120. Then you can apply that money to help pay down a deductible or cover a copay or coinsurance amount, whatever you want. It’s as simple as that.

Bottom line, if you’re looking for a financial cushion in the event of a medical issue, Fixed Benefit insurance can be right for you. In fact, many times it can pay for itself depending upon the medical issue you may have.

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Real life examples of how it can be a really smart decision.

The best way to truly understand the value of a Fixed Benefit plan is to see some more real-life examples of how it all works. And the plans that work well usually come from reputable insurance companies that have been around a long time. As an example, check out Health ProtectorGuard plans underwritten by Golden Rule Insurance Company, a UnitedHealthcare company. You can start to see why Fixed Benefit insurance might be something to seriously consider.


The top five reasons why you should consider getting a Fixed Benefit Insurance Plan:

1) Extra help when you need it 

A lot of times, Fixed Benefit insurance covers the most common medical expenses you or your family might have during the year. Money from your Fixed Benefit coverage can help with your major medical insurance deductibles, copays, and coinsurance.

2) It’s all about options

Because there are no in-network versus out-of-network concerns, you can go to a doctor, specialist or hospital of your choosing. You get the same benefit regardless of where you go for care. That said, to get the most coverage out of your insurance, keep your main health insurance plan’s network in mind.

3) Quick cash

Plans pay you a certain predetermined amount for health care expenses specified in the plan. There are no deductibles to meet. You simply submit a claim for a qualified expense, and you are paid cash to use as you want. Some plans even allow you to assign your benefits directly to a provider so you can handle your bills that way.

4) Available when you want

Unlike other plans that have enrollment periods, Fixed Benefit insurance is available all year round. That translates into coverage that’s accessible when you’re ready to apply.

5) Make it a family affair

Often times you can also add dependents to a Fixed Benefit plan.

What Fixed Benefit insurance ISN’T.

A Fixed Benefit insurance plan offers limited benefits and is considered Supplemental insurance. That means, although this plan can be purchased by itself, it's designed to help complement the benefits of a traditional, major medical health insurance plan.

Make no mistake, it may be a great plan to have depending on your health and financial needs, but it’s important to know that Indemnity insurance essentially flips how you are paid when compared to major medical insurance. If you have a serious accident, for example, you or your provider are paid a predetermined fixed benefit for certain qualifying health care expenses you have incurred, and then the remaining costs are your responsibility.

Fixed Indemnity insurance does not provide the coverage mandated by the Affordable Care Act (ACA), often called Obamacare. It also doesn’t provide coverage for all the essential health benefits outlined in the ACA. And unlike an ACA plan, it will most likely not provide coverage for expenses resulting from any preexisting medical conditions. Read your plan carefully to see what is and isn’t covered.

Pros and cons recap

Pros Pros

  • Many plans have $0 deductibles
  • Premiums are budget-friendly
  • Plans are customizable and flexible
  • Plans available all year round

Cons Cons

  • Preexisting conditions aren’t covered
  • It can’t replace the in-depth coverage of a typical major medical insurance plan
  • There is often a cap to medical expense coverage. If the cost of services exceeds the cap, you're responsible to pay any remaining expenses
  • Does not provide the 10 essential benefits required by the ACA

Getting paid is easier than you might think.

Many people think there’s a lot of red tape to cut through in order to get paid. However, it’s actually quite simple because the terms of the insurance plan are straightforward. With most plans, when you receive a receipt for a qualified expense (for example, a doctor’s visit), simply submit that receipt along with a completed claim form, and you will be paid the preset amount for that qualified expense.

What if your insurance plan covers you for something, will the Fixed Benefit insurance plan still pay?

You bet it will. Regardless of what your other health insurance may cover, you still get paid a set amount from your Fixed Benefit plan. For example, if you get an X-ray and your Fixed Benefit plan pays for X-rays, boom…you get paid. So in this particular case, your main health insurance may cover all your costs and any money you’d get from your Fixed Benefit would be extra spending money.

When it all comes down to it, Fixed Benefit insurance is for individuals and families who feel better knowing they have some financial cushion if a medical issue pops up.




Fixed Indemnity insurance 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.