Have Questions About Health Benefit Insurance? Let Us Clear Up These 4 Common Misconceptions

Health benefit insurance plans, also known as limited benefit medical plans, indemnity plans, and fixed cash plans, are plans that provide a fixed benefit payment for covered services. They can offer a range of benefits to help meet you or your family’s needs. But do you have all the right information about this type of coverage before you enroll?

Familiarizing yourself with this type of coverage as a viable option may be a good idea for you and your loved ones, especially in the face of skyrocketing healthcare costs. It can help supplement your major medical coverage and can provide you access to options that may bring you the benefits and features you’ve been looking for.

Take a look below as we debunk common misconceptions about this level of coverage.

Misconception #1: Health benefit insurance plans work the same way as major medical or short-term medical insurance.

Health benefit insurance plans have some important differences from major medical policies. Understanding those differences will help you decide if this type of coverage is right for you.

These plans pay fixed indemnity benefits towards covered procedures as well as offer discounted rates for using in-network providers. There are no deductibles or copays with health benefit insurance plans, and they can provide another layer of financial protection if you need to supplement your major medical coverage. They are not a replacement for major medical insurance. Policies do have limitations, restrictions, and exclusions to consider.

This coverage provides the most benefit to those who are proactive about using in-network providers and taking advantage of the services and features provided. It can also offer guaranteed acceptance.

Misconception #2: Health benefit insurance plans don’t provide quality benefits and have a small network of doctors.

Health benefit insurance plans can often have lower premiums than major medical insurance since they are not providing comprehensive coverage. But they can also provide a host of valuable benefits to help you and your family with medical needs.

The core benefits of a limited benefit medical insurance plan can include fixed benefit payments for the following services:

  • Hospitalization*
  • Emergency care*
  • Doctor’s visits
  • Surgery*
  • Diagnostics and labs
  • Wellness care

*Typically not covered for pre-existing conditions

Fixed benefit health insurance plans can also come with a wide network of doctors nationwide. If the doctor you choose does not accept the insurance, you can pay upfront and submit your own claims for reimbursement, but you may be subject to higher out-of-pocket costs.

They may also provide supplementary non-insurance benefits to serve your needs in other areas of healthcare.

These may include:

  • Prescription savings program on generic and brand-name medications
  • Ability to speak to a licensed doctor over the phone or mobile app to diagnose common illnesses
  • Patient advocacy service that can help you find procedures for the lowest cost and can negotiate medical bills

These benefits combine to create coverage designed to help you and your family with high medical costs or to supplement other insurance. When considering health benefit insurance plans, make sure to learn about all the features that can help you manage healthcare costs and save time.

Keep in mind that there are often exclusions with health benefit insurance plans that are important to look into before choosing a policy.

Exclusions may include:

  • Pre-existing conditions (12-month waiting period)
  • Prescription benefits
  • Maternity benefits

If you have decided on this type of coverage, we provide access to key information to help make the most of your benefits. Your Member Portal access is secure, and you can access it anytime with the username and password sent in your welcome email. The portal will provide you access to a range of information such as your ID cards, claims status, and contact information for your carrier, claims administrator, and MyBenefitsKeeper.

Misconception #3: Hospital indemnity insurance plans are only beneficial for young people or as supplementary insurance.

Health benefit insurance plans can be beneficial for people of all ages with varying medical needs.

While these plans are designed to be supplementary to major medical policies, you can use them in a variety of circumstances.

This type of coverage may fit the needs of those who:

  • Are priced out of major medical coverage, but seek a limited level of coverage for basic needs
  • Want additional benefits to help cover deductibles and copays of a major medical policy
  • Are seeking limited coverage until they are eligible for a major medical policy during Open Enrollment or through their employer

Making the decision about whether health benefit insurance coverage is right for you can be challenging, so talk to your agent about the specific benefits, conditions, and exclusions of any policies.

Note: Health benefit insurance plans are not intended to be a replacement or alternative to ACA or other major medical plans nor does it provide the minimum essential health benefits that are required, and it won’t help to avoid the fee for not carrying health insurance. These plans can have exclusions and limitations, which may not make them a valid option for some.

Misconception #4: Health benefit insurance plans can satisfy ACA requirements.

Fixed benefit insurance plans do not meet the minimum essential coverage required under the Affordable Care Act, so you would likely be subject to a tax penalty. Because they do not have to follow the guidelines for the ACA, premiums tend to be lower as more limited and/or restricted benefits are being offered. Still, these plans can be useful solutions for some who may need to supplement a high-deductible plan or who may otherwise go uninsured.

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.


“The Rising Cost of Health Care by Year and Its Causes.” The Balance. https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878


Family sitting by fire during Open Enrollment

Open Enrollment is Coming to Town: Holidays and Your Loved Ones’ Health

The holiday season and Open Enrollment have arrived, and so have opportunities to spend time with your loved ones. Food, laughs, and gifts are likely on your agenda, but something else – something more important – may be as well: protecting the health of your loved ones.

Maybe you’re catching up with Aunt Linda who is facing an illness after losing her job. Maybe you’re hanging out with your roommate Ruben who has a pre-existing condition and can’t afford major medical coverage. No matter who you’re talking to, the topic of healthcare is likely to arise . What do you know about your available coverage options? Let’s take a look at some of the features you and your loved ones can take advantage of:

Limited Medical Coverage

  • Helpful if you (or a loved one) are anticipating rising medical expenses, are unable to afford major medical, are not eligible for short-term medical, and/or are looking for supplemental coverage to major medical plans
  • Guaranteed issue coverage if eligibility is met and available in state
  • Premiums often lower than major medical
  • Benefits such as $50-$100 paid toward doctor and specialist visits available
  • Not required to use a network of doctors – freedom to see any doctor or visit any facility of your choice (*Note: you may still exceed eligible benefit)
  • Preventive care available for as low as $50
  • Next day coverage available or little to no waiting periods for accidental injuries or sickness
  • 12 month waiting period for pre-existing conditions (limitations and exclusions may apply)
  • Does not count as minimum essential coverage required by the Affordable Care Act and is not suitable to serve as sole medical coverage

Short-Term Medical Coverage

  • Helpful if you (or a loved one) are facing life-altering transition periods such as pre-Medicare retirement, change in employment status, rolling off parental or student insurance, bridging a gap in major medical coverage or if you missed Open Enrollment (This coverage is designed solely to provide healthcare coverage during unexpected coverage gaps)
  • Flexibility in coverage length and cost (coverage duration varies by state and is non-renewable)
  • Variety of deductible and coinsurance options
  • Low copay options for in-network benefits
  • Limited preventive care available
  • Ability to cancel at any time without penalty (benefits may be limited and subject to exclusions and restrictions)
  • Does not cover pre-existing conditions
  • Coverage is not guaranteed
  • Not intended to be a replacement or alternative to ACA or other major medical plans and does not provide the minimum essential health benefits that are required; may result in a tax penalty.

ACA Coverage

  • Helpful if you (or a loved one) are seeking major medical but may not be able to afford it, have a pre-existing condition, and/or need a broad array of health benefits
  • Option to change plan every year and to stay on policy as long as needed
  • Renews annually
  • Provides coverage for pre-existing conditions; you can’t be rejected based on health
  • Provides preventive care
  • Provides the option for subsidies to lower costs
  • Provides minimum essential health benefits
  • Must enroll during the Open Enrollment period, the Special Enrollment period, or when a qualifying life event occurs

Critical Illness Coverage 

  • Helpful if you (or a loved one) are seeking an added layer of financial protection in the face of critical health concerns
  • Pays benefits directly to you or your designee(s)
  • Benefits can be used to pay living expenses such as mortgage, rent, and car payments as well as prescriptions, copays, medical bills, and a myriad of other costs
  • Benefits available up to $50,000
  • Limitations and exclusions may apply
  • Little to no waiting period

Talk to your loved ones this holiday season about Open Enrollment, their health concerns, and their current coverage. You’re already adding extra layers of clothes to stay warm; now may be a good time for you and your loved ones to consider adding extra layers of coverage to stay protected from potentially costly health events.

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.