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GAP Coverage

Plan Highlights

GAP is designed to help supplement your Employer's underlying Major Medical plan. It provides supplemental coverage to help offset out-of-pocket costs that you may experience due to deductibles, co-payments and coinsurance of the underlying Major Medical plan.

  • Available for groups of 5+ Eligibles
  • Up to $10,000 Per Confinement (includes In-Hospital Ambulance)
  • Up to $7,500 Per Day Outpatient (includes Outpatient Ambulance)
  • Optional deductibles for in-hospital and/or outpatient
  • Voluntary or Employer Paid
  • Waiver of Pre-Existing Available

Plan Features

Inpatient Benefit

Pays for Covered Charges incurred, after satisfaction of any applicable deductible, when a Covered Person is Confined in a Hospital as an Inpatient for at least 18 continuous hours and is covered by your Other Medical Plan.

Outpatient Benefits Rider

Pays for Covered Charges incurred by a Covered Person, if the Covered Person is covered by the Other Medical Plan, at the time the Covered Charges are incurred. Benefits payable under this rider are limited to any out-of-pocket deductible, co-payment and coinsurance amounts the Covered Person incurs under the Other Medical Plan for:

  • outpatient treatment in a Hospital Emergency Room without subsequently being considered an Inpatient; and
  • outpatient treatment in an Urgent Care Facility; and
  • Cancer Treatment performed in a Cancer Treatment Facility; and
  • Physical Therapy performed in a Physical Therapy Facility; and
  • outpatient surgery performed in a Hospital Outpatient Facility or a Freestanding Outpatient Surgery Center; and
  • outpatient diagnostic testing performed in a Hospital Outpatient Facility or a Magnetic Resonance Imaging (MRI) Facility; and
  • outpatient treatment of a Mental or Emotional Disorder performed in a Hospital Outpatient Facility.

Ambulance Benefit

Pays the out-of-pocket amount up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation

Eligibility

You are eligible to be covered under this Policy/Certificate if you are Actively At Work, qualify for coverage as defined in the Master Application, are covered under your Other Medical Plan and are under age 70 (if you work for an employer employing less than 20 employees). Your Eligible Dependents are eligible for coverage if they are covered under the Other Medical Plan. Evidence of coverage under your Other Medical Plan is required.