Question

multiple select question
select all that apply
which of the following are true of indemnity plans?
(more than one answer may be correct)

they offer protection against loss.
providers always send the healthcare claims directly to the patients.
patients are limited in the providers they can see.
physicians send healthcare claims to the payer on behalf of the patient.
the payer indemnifies the policyholder against costs of medical services listed on the benefits schedule.

Explanation:

Define indemnity plans and protection against loss

Using the Indemnity Plans and Medical Insurance Policy knowledge points, we analyze the first option. An indemnity plan is a traditional type of health insurance. The word "indemnity" literally means protection or security against damage or loss. Therefore, these plans are designed to offer protection against financial loss due to medical expenses. This statement is correct.

Analyze claim submission processes

Using the Indemnity Plans knowledge point, we evaluate how claims are handled. Under traditional indemnity plans, patients often pay the provider directly and then submit the claim to the insurance company themselves to get reimbursed. However, it is not true that providers always send claims directly to patients, nor is it true that physicians always send claims to the payer on behalf of the patient. Because practices vary and neither of these is an absolute rule defining indemnity plans, these options are typically not selected as defining characteristics.

Evaluate provider choice limitations

Using the Indemnity Plans knowledge point, we look at provider networks. Unlike managed care plans, indemnity plans do not restrict patients to a specific network of doctors or hospitals. Patients can see any healthcare provider they choose without penalty. Therefore, the statement that patients are limited in the providers they can see is incorrect.

Analyze payer indemnification and benefits schedule

Using the Indemnity Plans and Schedule of Benefits knowledge points, we evaluate the final option. In an indemnity contract, the insurance company (the payer) agrees to indemnify (reimburse) the policyholder for the actual costs of covered medical services, up to the limits specified in the policy's schedule of benefits. This is the core mechanism of an indemnity plan. This statement is correct.

Answer:

• They offer protection against loss. (Correct answer)
• Providers always send the healthcare claims directly to the patients.
• Patients are limited in the providers they can see.
• Physicians send healthcare claims to the payer on behalf of the patient.
• The payer indemnifies the policyholder against costs of medical services listed on the benefits schedule. (Correct answer)