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Group Gap Policy for Major Medical plan
Group Gap Policies can help to offset health insurance premiums. Instead of complete cost shifting a high deductive the employer can pay for a gap policy that will pay a portion of the insured’s deductible.
Typical Plan Overview and Benefits
Gap policies have been specifically designed to pay an indemnity benefit for out-of-pocket expenses of deductibles, co-insurance and co-payments from serious illnesses charges by the insured group’s comprehensive medical plan.
In-Hospital Indemnity Benefit
This benefit helps pay the deductibles, coinsurance or co-payment for:
Inpatient Hospital stays
Inpatient surgeries
Physician’s in-hospital charges
Routine nursery care for dependent children
Outpatient Hospital Indemnity Benefit
This benefit helps pay the deductibles, coinsurance or co-payment for:
Surgery in a hospital outpatient facility or a free-standing outpatient surgery center.
Diagnostic testing in a hospital outpatient facility or MRI facility..
Treatment in a hospital emergency room
Ambulance Indemnity Benefit
These benefit usually help pay for the deductibles, coinsurance or co-payment for ambulance transportation to a hospital or emergency center for injuries sustained in an accident.
Things to Consider
Some Gap Policies are not H.S.A compliant
Benefits are paid directly to the provider after an EOB has been submitted to the carrier
Gap policy may qualify for Cobra
