What is Indemnity Health Insurance Plan, Its Meaning & Benefits?
Any unexpected medical emergency shouldn’t be a time to worry about hospitalisation expenses when it comes to your family's health. The best way to reduce these medical costs is to get a health insurance policy.
An Indemnity health insurance plan can help you in such situations! Under this plan, the insurance company will reimburse you for medical expenses incurred for hospitalisation or other treatments up to the sum insured.
Unlike traditional plans, indemnity insurance puts you in charge, offering flexibility, broad coverage, and financial security when needed. Let’s discuss what an indemnity policy in health insurance means and its benefits.
What is Indemnity Health Insurance?
- Policies that reimburse you for the actual medical costs incurred during hospitalisation are known as an indemnity health insurance policy. In this plan, you can claim up to the maximum amount specified in your policy.
- You can either opt for a cashless claim or a reimbursement claim under the indemnity health insurance plan. If you choose to make cashless claims while admitted to a network hospital, the hospital will receive a set amount directly from the insurance company.
- In case of a reimbursement claim, you first have to pay the expenses incurred out of your pocket, and later, the insurance company will reimburse you the amount.
How Does an Indemnity Policy in Health Insurance Work?
As mentioned above, under these kinds of plans, you will get a cashless reimbursement for the cost of hospitalisation or medical treatment up to the sum insured.
So, let’s look at an example. Say you have an indemnity-based health insurance policy with a sum insured in health insurance of ₹5 lakhs, and you undergo treatment in a hospital that costs ₹2 lakh. In this case, your insurer will compensate you for these expenses. You just have to submit the relevant bills and medical documents. The remaining ₹3 lakh can be used for further medical expenses during the policy term.
However, note that this reimbursement will not cover any deductibles or co-payments included in the policy. For example, if you have a 15% copay, your insurer will pay 85% of the claim amount, while you bear the rest. On the other hand, if you have a deductible of ₹20,000, your insurance company will reimburse ₹1.8 lakh, while you pay out the rest.
Why Should You Choose an Indemnity Health Insurance Plan?
Indemnity health insurance offers freedom from financial burden and extensive coverage during need. Whether it’s a routine check-up or a specialised treatment, you have control over your healthcare decisions, ensuring you get the best care without unnecessary restrictions under such plans.
Here is why you should choose an indemnity health insurance plan:
In India, medical care expenses are increasing by 14% every year(1). It can cost lakhs of rupees if you require a complex treatment. You can deal with these medical costs easily with an indemnity-based plan that handles everything, so you don't have to pay out of pocket.
All medical costs are covered by an indemnity health plan, except for deductibles. Both planned and unplanned plans cover unexpected hospitalisations. As a result, your financial load is lessened, and you are not required to pay out of pocket.
No more worrying about whether your favourite doctor or hospital is in-network. With an indemnity plan, you can visit any hospital, specialist, or clinic, seeking the best possible care without restrictions.
What’s Covered and Not Covered Under Indemnity Health Insurance Plan?
Indemnity health insurance offers flexibility and control over healthcare decisions, but it is essential to understand what is covered and what is not. Here’s a general representation of inclusions and exclusions under such a plan:
Note: These inclusions & exclusions are generic and not Digit specific. It can differ from policy to policy based on certain terms and conditions. Read your policy document to know what is included and excluded in your particular policy.
What are the Benefits of Indemnity Health Insurance Plans?
Indemnity health insurance plans offer a range of benefits that provide financial security, flexibility, and peace of mind regarding medical expenses.
Here are the benefits of indemnity health plans:
Indemnity health plans cover a broad spectrum of medical conditions, including hospitalisation, surgeries, diagnostic tests and specialist consultations. This ensures you have comprehensive financial protection against various health-related expenses.
Unlike restrictive network-based policies, indemnity plans allow you to seek treatment at any hospital or medical centre of your choice. This ensures you receive the best possible care based on your medical needs.
Many indemnity insurers have tie-ups with hospitals, allowing you to avail of cashless treatments. This eliminates the hassle of arranging funds during medical emergencies, as the insurer settles bills directly with the hospital.
Under an indemnity health plan, you can make multiple claims within a policy year, up to the sum insured. This ensures continuous coverage in case of multiple hospitalisations.
Indemnity health plans generally have cost-effective premiums, especially when they include deductibles or co-payment clauses. This makes them an attractive option for individuals seeking coverage without excessive financial burden.
Indemnity plans provide financial protection against unforeseen medical expenses, such as accidents or emergency treatments, ensuring you are not left to bear out-of-pocket costs.
Advantages and Drawbacks of Indemnity Health Insurance
Indemnity health insurance provides policyholders with comprehensive coverage; however, there are some disadvantages to this type of policy. Below is a comparison of the advantages and drawbacks of indemnity health insurance:
What are Fixed Benefit Health Insurance Plans?
A fixed benefit health insurance plan is a type of health insurance where a fixed amount of the sum insured is paid at the time of a claim.
Common examples include critical illness plans and personal accident policies, which provide a lump sum payment. For example, if your sum insured is ₹5 lakhs, upon diagnosis of pre-determined critical illnesses, or after an accident, you will receive the entire ₹5 lakh, which you can then use to cover treatment expenses.
The benefits are that there are no sub-limits or co-payments, and the lump sum payment can be used for pre or post-hospitalisation expenses. However, it only covers some specific ailments or illnesses.
Difference Between Indemnity & Fixed Benefit Plans
When selecting health insurance, understanding the distinction between indemnity and fixed-benefit plans is essential. Each plan serves different needs, and selecting the right one depends on your healthcare priorities and financial preferences. Let’s see how they differ from each other:
So, when you are buying a health insurance plan, ensure that you get the one that provides optimum protection. In most cases, an indemnity-based plan will offer the most coverage as it provides more coverage, including hospitalisation, at a lower premium. However, if you already have some type of health coverage, a fixed-benefit plan will offer additional financial protection.
Thus, consider your situation, healthcare needs, and medical history before you decide which one is best for you and your family.
FAQs about Indemnity Health Insurance
What are the disadvantages of indemnity health insurance?
There are a few drawbacks to indemnity health insurance. For example, it has higher premiums, and due to co-payments or deductibles, you may also have more out-of-pocket expenses.
How do you know if an indemnity health plan is right for you?
If you have no previous health insurance or you are looking for a plan that covers a wide range of illnesses and treatments, indemnity health insurance might be right for you. It offers extensive coverage for all your needs and can be claimed multiple times until your sum insured is exhausted.
Is indemnity health insurance better than fixed benefit insurance?
This depends on your current situation and your healthcare needs, as the two types of policies are unique. If you need a health insurance with wider coverage (for example as your primary cover), it is advisable to opt for an indemnity-based plan. However, if you are looking to supplement your regular health cover and gain additional coverage for critical illnesses, it might be right to opt for a fixed benefit health insurance plan.
Should I get indemnity health insurance or fixed benefit insurance if I have employee health insurance?
Some employee health insurance plans might have insufficient coverage, especially when it comes to out-of-pocket expenses like deductibles, co-pays, etc. Additionally, they might not offer coverage for certain health conditions. Check the coverage you already have. If you need a second insurance to cover any gaps, opt for indemnity insurance. If all you need is additional coverage, you might wish to opt for fixed-benefit insurance.
Are preventive services covered under indemnity health insurance?
Yes, many indemnity plans cover preventive services like annual check-ups and vaccinations, but coverage can vary from insurer to insurer. It's important to review your policy details to understand what is included.
Do indemnity health insurance plans cover medicine costs?
Yes, but the indemnity health insurance that covers medicine costs differs from plan to plan. Some indemnity plans include prescription drug coverage, while others may require a separate plan or rider.
What are the advantages of indemnity health insurance?
The main advantages are flexibility and freedom to choose any healthcare provider. This can be particularly beneficial if you have a specific doctor or specialist you prefer.
Are there any disadvantages to indemnity health insurance?
Certain disadvantages of indemnity health insurance include higher out-of-pocket costs, the need to pay upfront and seek reimbursement, and paying for copayments or deductibles.
How do I file a claim with indemnity health insurance?
You typically need to submit a claim form along with your healthcare provider's bills and receipts. Your insurer will then process the claim and reimburse you for covered expenses.