Individual Health Insurance - Traditional Indemnity Plan

Solutions for Your Health Insurance Needs

Traditional Plan

Typical $500 Deductible Traditional Plan (Indemnity Plan)

Only covered expenses are considered eligible for payment.

Know your policy’s limitations and exclusions.

Some policies have the further stipulation that expenses must be for medically necessary care.

Other policies may include limited preventative care.

Family coverage: deductibles are usually limited to 2 or 3 per family. Each person may have to meet their own deductible or deductibles may accumulate toward a single family deductible.

$2,000,000
Lifetime Maximum

Insurance
Company
Pays at
100% Rate

You Share Expenses
You Pay 20%	They Pay 80%

You Pay
All
Expenses
(Deductible)

Payments are limited to a set dollar amount based on usual, customary, and reasonable (UCR) fees.

UCR fees are arbitrary. Charges for a procedure in a geographic area form a range. If an insurance company pays at the 90th percentile, 90% of the fees in the range are less than their rate of payment and 10% are more. Different insurance companies pay at different percentiles. If you go to a provider who charges above the payment limit, you are 100% responsible for the excess charges. They do not count toward the deductible.

	$5,000 is called the Stop-Loss (where your losses stop and the insurance company takes over). You could still be liable for excess charges above UCR amounts depending on company and plan.
	May be waived for an accident in the first 90 days.

Traditional Policy

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