Provider Network

Traditional indemnity (fee-for-service) plan — A traditional indemnity, or fee-for-service, medical expense plan is the most flexible plan type: the insured can generally choose any licensed physician, hospital, or other provider, and the insurer reimburses a stated percentage of covered charges after the deductible is met. Unlike HMOs, EPOs, and POS plans, an indemnity plan has no provider network and no gatekeeper. The absence of network restrictions is the defining characteristic of traditional indemnity coverage, which is why these plans are described as offering the greatest freedom of provider choice.

National insurance concept

Medicare pays the plan a set amount, and the plan decides what it will pay providers, who may accept or decline to treat members. — A private fee-for-service (PFFS) plan is a Medicare Advantage product in which the plan sets its own payment rates and terms for providers rather than paying Medicare-approved amounts. Medicare pays the plan a capitated amount, and the plan decides how much it will pay doctors and hospitals; any provider willing to accept the plan's terms can treat a member, but providers are not required to accept the plan and may decline. There is no network and no gatekeeper requirement, but deductibles and copayments still apply. The opt-in provider structure of PFFS is a defining Medicare Advantage type tested in the senior products outline.

National insurance concept