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An indemnity plan, also known as a “fee-for-service plan,” is one of the most flexible healthcare plans around. These plans allow you to visit any doctor, hospital or provider you choose, which means not having to worry about getting hit with a giant bill for out-of-network care. If flexibility and choice are at the top of your list of insurance priorities this might be the best option for you. At Best Insurance Group we can give you instant, accurate quotes on all of the indemnity plans available in your area and help you compare them to any other plan types you might be curious about. We’ll work hard to compare them, and will make sure you get the coverage you’re looking for, at a price that works with your budget.

An Indemnity Plan Is Perfect If:

  • You are looking for the freedom and flexibility of choosing which doctors and hospitals you want to go to.
  • You do not want to choose a primary care physician.
  • You do not want to get referrals to see specialists.

When Choosing A Plan

Some indemnity plans cover preventive care services, such as annual exams and routine office visits, while others do not. Some plans will cover a portion of these costs, and some will not allow preventative care to count towards your deductible. If preventative care is important to you, then make sure that you know how these services are covered before choosing a plan.

How It Works

With an indemnity plan, you don’t have to worry about staying in a provider network, choosing a primary care physician, or getting referrals to see specialists. You probably will have to pay upfront for services, and then submit a claim to your insurance company for reimbursement. You also have to meet your annual deductible before they will pay your claims.

Once you meet this deductible, your insurance company will pay a percentage of your claims based on the UCR rate, or “usual, customary and reasonable rate.” This rate is the typical rate charged for any service in your area by healthcare providers. If your bill is above the insurance company’s UCR rate, they may not agree to cover the whole bill, and may charge you a UCR fee to pay the rest.

Understanding The UCR Rate

With some types of healthcare plans, like PPOs and HMOs, there is a network of providers you can see, and your insurance company will negotiate with that network to lower the costs of medical services. Indemnity plans do not have networks, so there is no negotiating for lower prices. Instead, your insurance company will pay a percentage of your costs (after you meet your deductible). But they will not actually pay the bill that you get from your provider, they will pay a percentage of the bill based on the UCR.

Most insurance companies set their UCR charges at the 80th percentile. That means that 80% of the medical providers in a given area charged equal to or less than the insurance company’s UCR rate. If your bill is higher than your insurance company’s UCR rate, you may need to pay the difference. In order to help break it down, here is an example:

  • Let’s say you have a medical procedure done and receive a bill of $2000, but your insurance company’s UCR for that procedure is $1500. If your insurance company usually pays 80% of your bill before you meet your deductible, they would cover 80% of $1500, and you would have to pay the other 20% plus the remaining $500.

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