At a glance
What Pennsylvania requires
Pennsylvania permits fixed indemnity as a supplemental, limited-benefit product, but it layers specific requirements on these plans through the Pennsylvania Insurance Department's regulations at 31 Pa. Code Chapter 88. A hospital confinement indemnity plan must pay at least $10 per day for at least 31 days (31 Pa. Code 88.164), and it must use a fixed-daily-benefit format (88.189, which sets the required outline-of-coverage form). For accident coverage, the accident definition must use "result" language and may not apply an "accidental-means" test (88.133), which affects how injuries qualify for benefits.
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. No Pennsylvania Insurance Department notice adopts the 2024 federal fixed-indemnity consumer-notice, so Pennsylvania does not layer that specific federal disclosure on top of its own rules.
The core thing to understand is how it pays: fixed indemnity pays a predetermined cash amount when a covered event happens — for example, a set amount per day in the hospital — 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 Pennsylvania
Fixed indemnity and related excepted benefits come in a few forms (described as coverage types, not specific products):
Each pays a fixed cash benefit you can use toward bills, deductibles, or everyday costs during a covered event. Because Pennsylvania prescribes the outline-of-coverage form and the fixed-daily-benefit format, read that document closely so you can see exactly what the 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 Pennsylvania's requirements.
For the comprehensive coverage that fixed indemnity is meant to supplement, Pennsylvania runs its own state-based exchange, Pennie, 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. Pennsylvania has expanded Medicaid, 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 Pennsylvania is driven by:
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.
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 Pennsylvania law and Pennsylvania Insurance Department guidance as of the last-reviewed date and can change; confirm current terms and the specific product's approved form before you enroll.