Merritt Personal Lines Manual: Chapter 2 Choosing a Doctor

An indemnity insurance plan will usually require the insured to choose a primary care physician, if only to give the company a recognizable name to use when reviewing medical bills.

This selection is much less critical than choosing a primary physician under a managed care plan. For one thing, the insured can choose any physician the insured wishes and any health services to use. The insured can also change doctors any time by informing the insurance company.

The same rule applies to seeing specialists. An indemnity plan allows the insured to go to any specialist whenever the insured prefers to without having to get a referral from the insured's primary care physician.

An indemnity plan puts no limit on doctor visits, aside from the insured's own financial well-being. However, certain types of visits may not be covered under an indemnity plan (i.e., mental health). This means the insured will have to bear the brunt of the costs.

This is all different from managed care plans, in which the insured chooses a primary care physician from a list of doctors that the insured's health plan has contracted with to provide health services. With an HMO, the insured's primary care physician is the insured's primary contact for all health services. Instead of having a choice, primary care doctor coordinates the services provided by specialists and others that the insured will receive.

Prescriptions

If the insured has an indemnity plan, prescriptions may or may not be covered under the insured's plan.

If they are covered, the insured may have to pay the larger portion while the insurance company pays a smaller share for the insured's medications. However, the insured will have the option to choose either the brand name or the generic drug.