Indemnity Plan
Indemnity, or "fee for service" insurance, provides reimbursement for medical expenses regardless of who provides the service. The member pays a premium for coverage. In return for the premium, RMHP pays a percentage of the member's eligible health care expenses. Indemnity plans are subject to annual deductibles, lifetime maximums, coinsurance, and annual out-of-pocket maximums.
Getting Care
Indemnity plan members may seek care as needed from any physician, hospital, or other provider. Indemnity members do not select primary care physicians (PCPs) or need referrals for care. There is not a limited service area for indemnity plan members; members can live and receive care anywhere.
Preauthorization
Indemnity plan members are required to follow the preauthorization guidelines in their Health Benefits Contract. Preauthorization for services provided by nonparticipating providers is the Indemnity member’s responsibility. A provider can request preauthorization on the member’s behalf but is not required to do so.
Failure to obtain preauthorization as required for medical services provided by nonparticipating providers will result in a significant reduction of benefits. Examples of services that require preauthorization are listed in the member’s Health Benefits Contract. Click here to see the list of services requiring preauthorization. Click here to see the list of durable medical equipment and medical supplies that require preauthorization.
RMHP offers an extensive formulary of prescription drugs. Some drugs require preauthorization. Click here to see the Formulary for all prescription drugs, including those that require preauthorization.
Click on the link to the left to learn more about Prescription Drug Information.
Payment for Services
If an Indemnity plan member uses a participating provider, the provider will submit the claim to RMHP on behalf of the member. When an Indemnity plan member sees a nonparticipating provider, the member may have to pay the provider in full for services and submit a reimbursement form to RMHP. In this case, RMHP reimburses the member based on the terms of the member's contract.
RMHP will send the member an explanation of benefits (EOB), which shows the services billed, the amount paid by RMHP, and the amount the member was responsible to pay to the provider. The member will pay the applicable coinsurance to the provider regardless of where the services are provided.
For out of state services, Indemnity members can access negotiated pricing for services by using our nationwide network of PHCS providers. To locate PHCS providers, call RMHP Customer Service or go to www.PHCS.com.