AWA HealthGuard provides access to Fixed Indemnity Insurance for eligible members. This coverage pays a per-day or per-event fixed amount when members are injured in covered accidents or are struck with a covered illness.  

There are various coverage types and options available to ensure each member can find the level of coverage they need within their budget.

What is Fixed Indemnity Insurance?

affiliated workers association_fingers holding block with heart and heartbeatFixed Indemnity Insurance is a form of health insurance that pays a fixed amount either per incident or period. The amount paid does not change based on the total charges of the doctor or medical professional.

For example, a plan might pay $1,000 when a covered party is admitted to the hospital plus up to $1,000 per day while they remain in the hospital.  

How is Fixed Indemnity Insurance Different from HMOs and PPOs?

The insurance company generally pays your healthcare providers and hospitals directly in an HMO or PPO. With fixed indemnity insurance, you are paid directly for covered benefits. Paid via direct deposit, you can use these benefits however you see fit.  

Additionally, fixed indemnity policies do not require deductibles, coinsurance, or copays. You are not limited to a network as you would be with most HMOs or PPOs.  

Is Fixed Indemnity Insurance Used Instead of or in Addition to HMOs or PPOs? 

That’s up to each person to decide. When the Affordable Care Act (ACA) was passed, it specified that Fixed Indemnity Insurance would be exempt from the rules of ACA only if the policy benefits were paid on a per-period basis – and would not be exempt if they were paid on a per-service basis.  

In 2014, the rules were relaxed to also allow for per-service payments – but only if the person who was covered had minimum essential coverage in addition to their fixed indemnity policy.  

In 2016, health insurers and more than ten states took legal action, and the federal appeals court struck down this requirement. Today, there are no restrictions on who can apply for Fixed Indemnity Insurance, and you are not required to have additional coverage to be eligible. 

Who is Fixed Indemnity Insurance Right For?

A child and her doctor.There are two main categories of people who choose fixed indemnity insurance: those who have additional insurance and those who choose fixed indemnity as their primary insurance. 

Adding Fixed Indemnity Insurance in Addition to an Existing Policy 

Those who choose to add this coverage often want to visit specialists or doctors outside of their network. Others have high deductibles on their primary coverage and want the additional coverage that comes with fixed indemnity insurance. 

Remember, the money paid out in benefits can be used for any purpose. As a result, some people use it to cover expenses that occur due to missing work after an illness or accident, paying for childcare while they are in a doctor’s appointment, or paying for medications that are not covered by their primary insurance. 

Using Fixed Indemnity Insurance in Place of Health Insurance 

There are those who have no other health insurance and do not want to pay the hefty premiums that come along with it, yet they do not want to risk having no coverage. Fixed indemnity is a middle-ground that can be more comfortable.  

These are flexible and easy plans to sign up for and cancel. Unlike traditional health insurance that only allows for sign-ups or changes during an open enrollment period, you can sign up for or cancel these plans at any time you would like. 

What Does Fixed Indemnity Insurance Cover?

A woman signing up for open enrollment.That depends on the plan you choose. Generally speaking, you can expect the following to be covered to some extent. 

Doctor’s Office Coverage  

With the AWA HealthGuard membership, you will receive a benefit of between $60 and $85 (depending on your level) any day you incur charges and require a visit to a doctor’s office due to a covered sickness or accident. Your maximum days of benefits range from four to five, depending on coverage.  

The First Day in the Hospital Coverage  

AWA HealthGuard pays a benefit for the first day a covered party is confined in a hospital. This amount ranges from $250 to $1,000, depending on the level of coverage.  

Daily Hospital Coverage  

Once again, the coverage available from HealthGuard varies from $250 to $1,000 per day. Additionally, the level you choose will determine if the maximum days paid will be 15 or 30 per year.  

Note that this does not include the first day, so if you are in the hospital for ten days, your daily hospital coverage will cover you for days two to ten.  

Intensive Care Unit (ICU) Coverage 

Each of the HealthGuard levels provides up to three days of ICU coverage between $250 to $1,000 per day based on the level chosen.  

Surgery Coverage 

A surgery benefit may apply if you require inpatient or outpatient surgery for a covered accident or sickness. Note that the most affordable level does not cover inpatient surgery. The other three options cover 100% of an inpatient or outpatient surgical fee schedule and 25% of the anesthesia fee.  

For surgeries to be covered, they must be performed by a board-certified surgeon either in a hospital or in an ambulatory surgical center. A licensed anesthesiologist or certified registered nurse anesthetist must administer anesthesia to be covered.  

ER Visit Coverage  

If a covered party requires care in an emergency room due to injuries in a covered accident or caused by a covered sickness, they are entitled to a benefit of between $100 and $250.  

Eligibility requires that the services rendered in the ER are from a physician and that the covered party visits the ER within 72 hours of the covered accident. Note that if you are admitted to the hospital, you will be covered by the hospital coverage described above – not the ER coverage.  

Ambulance Coverage 

Suppose you are transferred to or from a hospital or medical facility via a licensed ambulance company within 90 days of a covered sickness or accident. In that case, you will receive a benefit of between $100 and $250.  

X-Ray and Lab Coverage 

If you require x-rays and/or labs for a covered accident or sickness, your coverage will range from $50 to $100. A physician must order the test or x-ray, and the benefit is not payable if you are admitted to the hospital, receive the emergency room coverage, or doctor office benefits. 

What Are the Limits to Fixed Indemnity Insurance?

It’s essential to have all the facts to decide if this is the right choice. First, know that this coverage is not included in the ACA and, therefore, will not prevent a tax penalty for not having health insurance. 

Second, you do not have some of the protections the ACA provides. For example, fixed indemnity insurance is not required to cover pre-existing conditions and can have annual lifetime limits.  

Note that there are some states in which HealthGuard is not available, and you cannot be enrolled in a federal or state-funded health care program such as Medicare or Medicaid. It is also not an option for active, full-time members of the Armed Forces. 

Is HealthGuard the Right Option for You?

If you are at least 18 and under the age of 65, a legal resident of the United States, and either a small business owner, self-employed professional, entrepreneur, or contractor, and a member of the Affiliated Workers Association, then you are likely eligible for HealthGuard. Coverage is available for domestic partners and dependent children until they reach their 26th birthday.  

If you are looking access to affordable, flexible insurance that can relieve financial strain caused by illnesses and accidents, then this could be the right choice for you. For any further questions about AWA HealthGuard and fixed indemnity insurance, please contact us. We’re happy to help!

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