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Understand Fixed and Indemnity-based Health Insurance

Fixed benefit health insurance plan: What you should know

Are there any benefits of buying fixed benefit health plans?

Indemnity-based health insurance plan

What are the benefits of indemnity health plans?

Fixed benefit and indemnity-based health plans – A comparison

Now that you are familiar with these two health plans, let’s compare them through the following table:

Basis of Comparison

Fixed Benefit Health Plan

Indemnity-Based Health Plan

Utility

This plan pays out the sum insured for pre-determined medical conditions or critical illnesses.

This type of health plan provides reimbursement to an individual for the money spent in medical treatment up to the sum insured.

Basic requirements

It requires a policyholder to be diagnosed with a pre-determined medical condition as per the policy terms, To claim the insured amount, one must provide a diagnosis report by a certified doctor.

Indemnity medical insurance typically requires the insured to be hospitalised or undergo medical treatment (day-care procedure or diagnostic tests), To make a claim, a policyholder must provide all hospital bills detailing every expense to the insurer or insurance company. Moreover, he/she must duly fill out and sign a claim form. This form requires several key details, such as the period of hospitalisation, date of discharge, etc.

Highlighting feature of the plan

Boosts cash flow by offering a lump sum payment. This payment is all the more resourceful in case of critical illnesses, whose treatment requires substantial funding, This plan serves as compensation for the loss of livelihood or earnings at the time of treatment and recovery. As a result, it allows the insured to cover household expenses, nursing costs and finance children’s education, Fixed benefit health insurance plans do not have sub-limits to avail coverage for a particular medical condition, The documentation process for a claim is simpler and easier than that of indemnity medical insurance, These plans come with an array of policies that cater to varied medical needs.

It offers extensive coverage for a wide range of ailments and medical treatments, Insured individuals can submit multiple claims in any given year till he/she utilises the entire sum insured, It extends the facility to choose between a variety of medical centres and hospitals alongside the added benefit of a cashless facility in some cases, Premiums under fixed indemnity health insurance plans are usually cost-effective. Moreover, the premium amount depends on a prospective policyholder’s age, his/her pre-existing illnesses, and features of the policy, among other factors.

Limitation of the plan

Eligibility for a fixed benefit health plan is limited to specific illnesses or ailments. Additionally, premiums for these plans tend to be more expensive than indemnity-based health plans.

Indemnity-based health insurance plans do not pay for deductibles as per the terms of their policy. In simpler words, this plan has particular items in the expenses list whose cost it shall not bear, like gauze, glove, oxygen mask, etc. Therefore, a policyholder must pay for these items in the event of hospitalisation, The documentation process for a claim is usually extensive, and thus, time-consuming.

Is one better than the other?

Frequently Asked Questions