General
General Products
Simple & Transparent! Policies that match all your insurance needs.
37K+ Reviews
7K+ Reviews
Scan to download
Life
Life Products
Digit Life is here! To help you save & secure your loved ones' future in the most simplified way.
37K+ Reviews
7K+ Reviews
Scan to download
Claims
Claims
We'll be there! Whenever and however you'll need us.
37K+ Reviews
7K+ Reviews
Scan to download
Resources
Resources
All the more reasons to feel the Digit simplicity in your life!
37K+ Reviews
7K+ Reviews
Scan to download
37K+ Reviews
7K+ Reviews
Our WhatsApp number cannot be used for calls. This is a chat only number.
Exclusive
Wellness Benefits
24*7 Claims
Support
Tax Savings
u/s 80D
Try agian later
I agree to the Terms & Conditions
We require some time to check & resolve the issue. If customers policy is expiring soon, please proceed with other insurers to issue the policy.
While we would never want to lose a customer, you are requested to consider exploring other insurers in case your policy is expiring soon.
Analysing your health details
Please wait a moment....
Terms and conditions
Terms and conditions
In today’s world, health and wellness aren’t just trends; they’re a way of life! 💯
More people are focusing on fitness and well-being, but staying prepared for unexpected medical expenses is just as important. After all, a healthy lifestyle is incomplete without a solid health insurance plan!
Many people hesitate to get insured due to confusion or misinformation. That’s why we’re here to clarify things! This guide will break down the difference between fixed benefit health insurance and indemnity medical insurance, helping you understand the meaning of both in a simple and practical way.
Fixed benefit plans pay out a set sum insured if an insured person files a claim for a particular medical condition. The plan extends a guaranteed and fixed amount to its insurer if he/she experiences an insured event as laid out by the policy terms.
Here, the insured event can be medical conditions or critical illnesses, such as cardiovascular diseases, kidney functioning issues, and cancer, among others.
Moreover, a fixed-benefit health insurance plan extends a lump sum amount to the insured as a claim, regardless of the actual or intended expenses that he/she incurred during hospitalisation.
Think of a fixed-benefit health insurance plan like a set-price meal at a restaurant. No matter how much food actually costs, you get a fixed amount for each item on the menu.
For example, imagine you have a critical illness health insurance plan that offers ₹50,000 for a hospital stay, regardless of the actual hospital bill.
Now, let’s look at two different cases to understand how this works:
Case 1: If your hospital bill comes to around ₹40,000:
Since your insurance policy offers a fixed benefit of ₹50,000 for hospitalisation, you still receive ₹50,000, even though your actual expenses were lower. This extra amount can be used for post-hospitalization costs, medicines, or any other personal needs.
Case 2: If your hospital bill comes to around ₹60,000:
Since your policy provides a fixed payout of ₹50,000 for hospitalisation, you must pay ₹10,000 out of your pocket.
As the name suggests, an indemnity medical insurance plan indemnifies its policyholder against hospitalisation expenses. This plan reimburses the actual expenses incurred by the insured during hospitalisation. However, the plan reimburses these expenses only up to the total sum insured under it. A good example of this plan is Mediclaim, which is a popular insurance product.
Moreover, if an insured opts for a cashless hospitalisation plan, he/she only pays a certain fixed amount, and the insurer takes care of the rest. However, if this individual does not have a cashless hospitalisation plan, he must submit all receipts and bills to the insurer. Based on these documents, the insurance provider will reimburse the insured person.
Think of an indemnity health insurance plan as a safety net for unexpected medical expenses, similar to how a company reimburses an employee’s travel expenses. Suppose an employee travels for work; they first pay for flights, hotels, and food, then submit the bills, and the company reimburses them. Indemnity health insurance works the same way!
Suppose Mr. Mehta, a 45-year-old businessman, has an indemnity-based health insurance policy with a sum insured of ₹10 lakh. One day, he experiences severe abdominal pain and is diagnosed with appendicitis, requiring immediate surgery.
Scenario 1: If He Chooses a Cashless Network Hospital
Scenario 2: If He Chooses a Non-Network Hospital
If you are still confused between the fixed benefit and indemnity plans, we have made it simple for you! 🙂 Here are some key differences between both the plans based on sum insured, claim amount, limitations and premium which will help you compare the policy better.
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 reimburses an individual for the money spent on 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. |
It 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. |
Ideal For |
Ideal for critical illnesses, covering high medical costs and income loss. |
Covers a wide range of illnesses and medical treatments. |
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. Also, this plan has particular items in the expenses list whose cost it shall not bear, like gauze, gloves, oxygen masks, etc. Therefore, a policyholder must pay for these items in the event of hospitalisation or buy an add-on for consumable cover to cover such expenses. |
No. of Claims |
Just one claim: when you file a claim, the insurer provides the full amount insured. |
A single policy may be used for more than one claim during the policy's term up to the sum insured. |
Out-of-Pocket Expenses |
No sub-limits on specific medical conditions, full coverage as per policy. |
Comes with deductibles or a co-payment clause as per the policy. |
Premium |
Generally higher as compared to indemnity policy. |
Generally cost-effective, with rates depending on age, pre-existing conditions, and policy features. |
Medical emergencies often lead to prolonged hospital stays and significant financial strain. This burden is even greater for individuals diagnosed with life-threatening diseases, which have been on the rise in recent years.
In India, the prevalence of critical illnesses has seen a sharp increase. A 2020 report by the Indian Council of Medical Research (ICMR) predicts that fatalities due to such conditions will rise in the coming years (1). Given this concerning trend, it is essential to take proactive measures to safeguard yourself and your loved ones.
This is where fixed benefit health insurance plans prove to be particularly useful. 🙂
When it comes to managing medical expenses, indemnity-based health insurance plans offer a flexible and comprehensive approach to coverage. These plans reimburse actual hospitalisation costs, ensuring that policyholders can access quality healthcare without worrying about financial constraints.
One key advantage of indemnity health insurance is that insurers often have tie-ups with a vast network of hospitals and medical centres. This allows policyholders to choose from a wide range of healthcare providers for treatment without the burden of upfront expenses.
Both of these health plans are extremely distinctive and serve varied medical needs. Moreover, as observed in the table above, each of these plans has its benefits and drawbacks.
Another aspect of evaluating these two plans can be their respective tax benefits. However, health insurance tax benefits for both these plans are the same. Therefore, regardless of your choice, you can avail yourself of tax deductions as per Section 80D of the Income Tax Act, 1961. Here, a premium up to Rs.50,000 for senior citizens and up to Rs.25,000 in case of non-senior citizens is eligible for a tax deduction.
So, which one should you opt for?
This decision should be based on your needs and requirements. With a fixed indemnity medical insurance plan, you can achieve financial preparedness and higher protection for yourself and your family.
Moreover, given that we live stressful lives today that make us vulnerable to critical illnesses, it would make sense to supplement your existing health policy with a fixed-benefit health plan.
Taking care of your health and that of your family is a matter of the greatest importance. However, it is common knowledge that medical care is currently expensive. Therefore, insurance plans offer you a way to evade hefty medical bills that can derail your finances. And we hope this guide provided you enough insight on the same and eliminated your hesitance to buy a health plan.
Indemnity-based health policies cover one’s cost of hospitalisation. However, it does not cover a number of expenses, such as the cost of medicines and post-operative care.
Indemnity-based health policies cover one’s cost of hospitalisation. However, it does not cover a number of expenses, such as the cost of medicines and post-operative care.
A fixed benefit health plan extends a guaranteed and fixed amount to its insurers when they face an insured event as per terms and conditions of the policy. Here, the payable insured amount is pre-decided and does not consider the actual amount of expenses incurred by the insured.
A fixed benefit health plan extends a guaranteed and fixed amount to its insurers when they face an insured event as per terms and conditions of the policy. Here, the payable insured amount is pre-decided and does not consider the actual amount of expenses incurred by the insured.
Health insurance offers financial relief in the present by covering medical costs in the future. Therefore, it helps to be financially prepared and well-protected against health emergencies.
Health insurance offers financial relief in the present by covering medical costs in the future. Therefore, it helps to be financially prepared and well-protected against health emergencies.
Yes, insurance premiums up to Rs.25,000 for non-senior citizens and Rs.50,000 for senior citizens are eligible for tax deduction under Section 80D of the Income Tax Act, 1961.
Yes, insurance premiums up to Rs.25,000 for non-senior citizens and Rs.50,000 for senior citizens are eligible for tax deduction under Section 80D of the Income Tax Act, 1961.
Fixed benefit plans provide a lump sum payout for covered events, while indemnity plans reimburse the actual expenses incurred, subject to policy limits.
Fixed benefit plans provide a lump sum payout for covered events, while indemnity plans reimburse the actual expenses incurred, subject to policy limits.
Indemnity plans typically offer more flexibility, allowing you to choose any doctor or hospital, whereas fixed-benefit plans may have a more limited network.
Indemnity plans typically offer more flexibility, allowing you to choose any doctor or hospital, whereas fixed-benefit plans may have a more limited network.
Fixed benefit plans can help cover hospitalisation costs, but they may not fully cover all expenses if the actual costs exceed the fixed payout.
Fixed benefit plans can help cover hospitalisation costs, but they may not fully cover all expenses if the actual costs exceed the fixed payout.
Yes, you can make multiple claims with both fixed benefit and indemnity plans. Indemnity plans allow claims up to the sum insured, while fixed benefit plans pay a fixed amount per event.
Yes, you can make multiple claims with both fixed benefit and indemnity plans. Indemnity plans allow claims up to the sum insured, while fixed benefit plans pay a fixed amount per event.
Fixed benefit plans are often better for critical illnesses as they provide a lump sum payout that can be used for various expenses, including non-medical costs.
Fixed benefit plans are often better for critical illnesses as they provide a lump sum payout that can be used for various expenses, including non-medical costs.
Premiums for fixed benefit plans are usually lower than those for indemnity plans, as the payouts are predetermined and not based on actual expenses.
Premiums for fixed benefit plans are usually lower than those for indemnity plans, as the payouts are predetermined and not based on actual expenses.
Yes, you can have both types of plans simultaneously to maximise coverage and benefits.
Yes, you can have both types of plans simultaneously to maximise coverage and benefits.
Indemnity plans are generally more suitable for families as they offer comprehensive coverage for a wide range of medical expenses.
Indemnity plans are generally more suitable for families as they offer comprehensive coverage for a wide range of medical expenses.
When choosing between fixed benefit and indemnity plans, consider factors like Your healthcare needs Your financial budget The type of coverage required The flexibility in choosing healthcare providers Network Hospital
When choosing between fixed benefit and indemnity plans, consider factors like
Your healthcare needs
Your financial budget
The type of coverage required
The flexibility in choosing healthcare providers
Network Hospital
Please try one more time!
More articles related to Health Insurance
Currently there are no news to show.
Read More
Renew & Download Policy Document, Check Challan, Credit Score, PUC & more
Anytime, Anywhere. Only on Digit App!
4.8
Rated App60K+ Reviews
4.8
Rated App
60K+ Reviews
4.3
Rated App12K+ Reviews
4.3
Rated App
12K+ Reviews
Scan to Download
Author: Team Digit
Last updated: 20-05-2025
CIN: L66010PN2016PLC167410, IRDAI Reg. No. 158.
Go Digit General Insurance Limited | Corporate Office Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru 560095 | Registered Office Address: 1 to 6 floors, Ananta One (AR One), Pride Hotel Lane, Narveer Tanaji Wadi, Shivaji Nagar, Pune-411005, Maharashtra | Trade logo of Go Digit General Insurance Ltd. displayed above belongs to Go Digit lnfoworks Services Private Limited and is provided and used by Go Digit General Insurance Ltd. under license.
Explore exclusive features, file claims & access policy on Digit App!
You can also scan this QR code to download the App.