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Fixed Indemnity Insurance in California

Fixed indemnity pays a set cash amount per covered event or hospital day regardless of the bill, a supplement to health insurance rather than a replacement for it. California carves it out of health insurance entirely and requires a mandatory outline-of-coverage format.

At a glance

Fixed indemnity is available in California as a supplemental, limited-benefit product, but California carves it out of "health insurance" and sets specific format requirements on it.
California defines fixed indemnity as hospital indemnity, accident-only, and specified-disease insurance paid on a fixed, cash-payment-only basis (Cal. Ins. Code 106(b)(2)), with a mandatory Outline-of-Coverage format (10 CCR 2540.5(e)).
It pays a fixed cash amount per covered event or day, regardless of your actual costs — it doesn't work like major medical.
It's not ACA minimum essential coverage and not a substitute for a comprehensive plan. California runs its own state exchange, Covered California, and has expanded Medicaid through Medi-Cal.

What California requires

California permits fixed indemnity as a supplemental, limited-benefit product, but it treats these products differently from comprehensive coverage. Fixed indemnity is carved out of "health insurance" under Cal. Ins. Code 106(b)(2), which describes it as "hospital indemnity, accident only, and specified disease insurance that pays benefits on a fixed benefit, cash payment only basis." These products must follow a mandatory Outline-of-Coverage format (10 CCR 2540.5(e)) so you can see exactly what the plan does and does not pay. A separate per-day floor — at least $15 per day for 60 days — applies only to insureds who are eligible for Medicare (10 CCR 2220.29). The California Department of Insurance (CDI) regulates these products; the Department of Managed Health Care (DMHC) regulates HMOs and most comprehensive health plans.

Because fixed indemnity is an excepted benefit, it sits outside ACA rules. At the federal level, a 2024 fixed-indemnity consumer-notice requirement was vacated by a court in December 2024, so it is not federally required; an earlier 2014 individual-market notice still applies. California did not separately adopt the 2024 federal fixed-indemnity notice, and no California-specific 2025-26 fixed-indemnity change exists (CDI bulletins and notices from 2023 through 2026 were reviewed).

The core thing to understand is how it pays: fixed indemnity pays a predetermined cash amount when a covered event happens — no matter what your treatment actually costs. That's very different from major medical, which pays a share of your actual bills.

How fixed indemnity works in California

Fixed indemnity and related excepted benefits come in a few forms (described as coverage types, not specific products):

Hospital indemnity — pays a fixed amount per hospital stay or per day admitted.
Accident coverage — pays fixed amounts for specified injuries or accident-related care.
Specified-disease or critical-illness coverage — pays a fixed benefit if you're diagnosed with a covered condition.

Each pays a fixed cash benefit you can use toward bills, deductibles, or everyday costs during a covered event, on a fixed, cash-payment-only basis. Because California requires a set Outline-of-Coverage format, read that document closely to see exactly what a plan pays. As an independent, carrier-neutral brokerage, we don't push any single insurer — and we'll be clear that fixed indemnity works best alongside a comprehensive plan, not instead of one.

How to get coverage here

Fixed indemnity isn't sold through the health insurance marketplace, and it isn't tied to Open Enrollment — you can generally apply for it year-round, directly from an insurer or through a broker, subject to the product's terms and California's requirements.

For the comprehensive coverage that fixed indemnity is meant to supplement, California runs its own state-based exchange, Covered California, where ACA plans have an annual Open Enrollment (typically each fall through early winter) and Special Enrollment Periods for qualifying life events like losing job-based coverage, moving, or having a baby. California has expanded Medicaid through Medi-Cal, so it's worth checking your eligibility there as well.

What it costs

We don't quote premiums here — prices depend on your situation — but the cost of fixed indemnity in California is driven by:

The benefit amounts you choose — higher fixed payouts (for example, a larger per-day hospital benefit) cost more.
The type of product — hospital indemnity, accident, or specified-disease coverage.
Your age — older applicants generally pay more.
Who's covered — an individual or a family.
Any riders or add-ons you select.

Because fixed indemnity pays fixed amounts rather than a share of your bills, use the required Outline of Coverage to compare exactly what a plan pays — and remember it's supplemental, so weigh it alongside the cost of the comprehensive coverage it's meant to support.

MG Matthew T. Giberti Licensed Expert · NPN 20698856 · Updated July 2026

Fixed indemnity insurance is a supplemental, limited-benefit (excepted-benefit) product. It pays fixed cash amounts for covered events regardless of your actual medical costs, is not major medical coverage, and is not minimum essential coverage under the Affordable Care Act. It does not cover the full range of essential health benefits and is not a substitute for a comprehensive health plan.

GetHealthPlans.com is operated by MTG Insurance Agency, an independent, carrier-neutral brokerage. We do not issue insurance and are not a government agency or the health insurance marketplace. Regulatory details on this page reflect California law and California Department of Insurance guidance as of the last-reviewed date and can change; confirm current terms and the specific product's approved form before you enroll.