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Georgia Individual Health Insurance Indemnity Information Page

What is the difference between Georgia indvidual Indemnity health insurance and other types of Georgia individual health insurance plans?

Before we begin to try to understand the different types of Georgia health insurance, there is a bit of information we need to be familiar with. All insurance plans have certain things in common. It would be helpful to understand what they are so you can see how they apply to each type of insurance.

Deductible-This is the portion of any health charges that you pay before the insurance company pays anything (many plans waive the deductible for physician office visits, instead using an office visit co-pay). ALL plans have a deductible. It may be vary form $0 to $10,000, but it's always included in the plan benefits.

Coinsurance- After the deductible is met, you enter into a period of coinsurance. It's just what the name says. Two entities are paying the health costs during the coinsurance period. When you see the term 80/60 it means that if you stay in network, you pay 20% and the insurance company pays 80% of the charges. Out of network, you pay 40% and the insurance company pays 60%. There is normally a stop loss of $1000 or more that the insured has to pay. In other words, if your plan reads 80/20 through $5000, you would be responsible for 20% of $5000 after the deductible has been met. Then the insured's liability would stop and the insurance company would pay the rest.

Not all plans have coinsurance. Often, you won't find coinsurance in an HMO or POS plan, and often it won't be in an H S A eligible plan.

After the deductible and coinsurance have been met, the insurance company has the liability of any other covered health charges during the plan year.

There are 2 more terms you should be familiar with:

NETWORK - A group of providers, doctors, hospitals, labs, etc. that have a relationship with the insurance company and have established specific pricing for services. This is the way that insurance companies manage their costs.

OUT OF NETWORK - An out of network provider is any physician, hospital, lab, etc. who does not participate (or "accept") your insurance plan. In the event that you utilize one of these providers, your "out of network" benefit would apply, if your plan includes an out of network benefit. Your out of pocket costs and deductibles are usually higher when utilizing this benefit. This benefit is also known as a type of Indemnity benefit.

Now that you have a general definition of insurance terms, let's look at the different types of plans.

Indemnity Health Insurance Plans. An indemnity plan was the first type of health insurance. There is no network of providers (you can go to any doctor or hospital) and there are no copays for doctors office visits or prescriptions. All charges are applied toward the deductible and then paid at co insurance amounts. For example, as an insured with a $500 deductible, you would pay the first $500 of any charges. Then you would go into the coinsurance period where both you and the insurance company are paying, i.e. 80/20 for typically $5000 to $10,000, costing you another $1000 to $2000. After that, the insurance company pays everything up to the limit of the policy. There is always an indemnity plan attached to every POS and PPO plan. It is known as the "out of network benefit"

Advantages-There are no networks to worry about. The insured can see any provider in the United States for any covered procedure.
Disadvantages- Monthly health insurance premiums are VERY expensive. You will experience greater out of pocket expense because there are no co pays and the insurance benefits are determined by what is considered in the insurance industry as "reasonable and customary", not what the physician you see charges for his services. Any charges that are above "reasonable and customary" will be paid by the policy holder.

Here are some of the other types of insurance plans that are available in Georgia:
HMO Individual and Group Health Insurance Plans
Open Access HMO Individual and Group Health Insurance Plans
POS Individual and Group Health Insurance Plans
Open Access POS Individual and Group Health Insurance Plans
H S A Individual and Group Health Insurance Plans

 We hope this information is helpful to you. If you would like further information or have questions, please feel free to contact us at Insurance Now and we will spend whatever time is needed to help you make sure that you select the right plan for you.


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Call Holly, Chris or Bob at
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Outside of the Atlanta area,
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