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January 4, 1995

Health Insurance: Definitions and Distinctions-Reply

Author Affiliations

The Health Institute Boston, Mass

JAMA. 1995;273(1):24. doi:10.1001/jama.1995.03520250038023

In Reply.  —Dr Loftman's comments point to two important but separate issues. The first relates to whether indemnity (fee-for-service) insurance can fairly be considered separately from managed care. The second relates to whether employer-provided coverage can fairly be categorized as fee-for-service.With regard to the first point, we agree that there is an increasingly important distinction between traditional indemnity insurance and indemnity insurance with utilization review, sometimes called managed indemnity coverage. In 1994, traditional indemnity insurance is increasingly rare. But at the time that our data were collected (1986 to 1988), the distinction between traditional and managed indemnity insurance was much less important; traditional indemnity was the dominant form of indemnity coverage nationally and in our study.With regard to the second point, Loftman notes that the only true fee-for-service plan is indemnity insurance purchased by individuals (not employers or government) with no utilization review component. This form of coverage

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