4 Common Misconceptions to Clear Up for Your Clients About Health Benefit Insurance

Your clients come to you with a broad range of health concerns and ask for a personalized approach to help them manage those concerns.  It’s crucial to your success that you listen to and understand those needs and that you have a variety of coverage options to offer them.

One of those options often prompts questions and discussions of myths and misconceptions: health benefit insurance plans – also known as limited benefit medical plans or fixed cash plans. HBI plans provide a fixed benefit payment for specific covered services. They can provide a range of benefits to help meet your clients’ needs, but they have distinct differences from the major medical policies.

Healthcare costs are undoubtedly rising. Your assistance in providing your clients coverage that fits their needs can impact how they are able to manage their healthcare spending. This type of coverage can often be misunderstood, prompting your clients to ask questions about how the plans work and how they can benefit from such a plan. HBI coverage can be a viable option, but it’s imperative to understand your clients’ needs and to make sure they understand how the coverage works before enrolling them.

Let’s take a look at some common misconceptions about health benefit insurance coverage:

Misconception #1: Health benefit insurance plans work the same way as major medical or short-term medical insurance.

HBI plans have some significant differences from major medical policies. Helping your clients understand these differences can allow them to decide if this type of coverage will be helpful as they consider their healthcare realities.

These plans pay fixed indemnity benefits towards covered procedures as well as offer discounted rates for using in-network providers. They can provide flexibility for those who need to supplement their major medical coverage.

When discussing health benefit insurance plans with your clients, remind them that they have no deductibles or copays to satisfy, and let them know that their fixed cash benefits and in-network discounts can combine to bring them additional savings. Clients must also understand the plans are not a replacement for major medical insurance. Policies do have limitations, restrictions, and exclusions to consider.

Misconception #2: Health benefit insurance plans don’t provide quality benefits and have a small network of doctors.

HBI plans often have lower premiums than major medical plans since they are not providing comprehensive coverage. That said, they may still provide members with a host of benefits to help with their medical needs.

The core benefits offered by health benefit insurance plans can include fixed benefit payments for the following services:

  • Hospitalization*
  • Emergency care*
  • Doctor’s office visits
  • Surgery*
  • Diagnostics and labs
  • Wellness

*Typically not covered for pre-existing conditions

This level of coverage can also come with a wide network of doctors nationwide. If the doctor your client chooses does not accept the insurance, your client can opt to pay upfront and then submit her own claims for reimbursement. Remind her though she may be subject to higher out-of-pocket costs if she goes this route.

When your clients enroll in HBI plans, they may also have the option to take advantage of other non-insurance healthcare features as well.

These may include:

  • Prescription savings program on generic and brand-name medications
  • Ability to speak to a licensed doctor over the phone or mobile app to diagnose common illnesses
  • Patient advocacy service that can help your clients find procedures for the lowest cost and can negotiate medical bills

Keep in mind that there are often exclusions with health benefit insurance plans that are important for your clients to consider before they enroll.

Exclusions may include:

  • Pre-existing conditions (12-month waiting period)
  • Prescription benefits
  • Maternity benefits

Make sure your clients are aware of how to leverage our online Member Portal. This includes knowing how to log into the portal, where to access their ID cards, and how to reach out to the different parties who can help them with questions about benefits, billing, claims, etc.

Misconception #3: Health benefit insurance plans are only beneficial for young people or as supplementary insurance.

HBI plans can benefit clients of all ages with varying medical needs.

While this level of coverage is designed to be supplementary to major medical policies, members can use them in a variety of circumstances.

This type of coverage may fit the needs of those who:

  • Are priced out of major medical coverage, but seek a limited level of coverage for basic healthcare needs
  • Want additional benefits to help cover deductibles and copays of a major medical policy
  • Are seeking limited coverage until they are eligible for a major medical policy during Open Enrollment or through their employer

Note: Health benefit insurance plans are not intended to be a replacement or alternative to ACA or other major medical plans nor does it provide the minimum essential health benefits that are required, and it won’t help to avoid the fee for not carrying health insurance. These plans can have exclusions and limitations, which may not make them a valid option for some clients.

Misconception #4: Health benefit insurance plans can satisfy ACA requirements.

These plans do not meet the minimum essential coverage required under the Affordable Care Act, so your clients would likely be subject to a tax penalty. Because they do not have to follow the guidelines for the ACA, premiums tend to be lower as more limited and/or restricted benefits are being offered. Still, these plans can be useful solutions for some who may need to supplement a high-deductible plan or who may otherwise go completely uninsured.


Are you ready to help your clients learn more about health benefit insurance plans?

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Health Insurance Innovations, Inc. is a leading developer and administrator of affordable, web-based individual health insurance plans and ancillary products. We help consumers address their health insurance needs by offering access to a number of products offered by various insurance carriers.


“The Rising Cost of Health Care by Year and Its Causes.” The Balance. https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878


4 Common Misconceptions to Clear Up for Your Clients About Health Benefit Insurance