GAP Plans

Supplemental insurance plans designed to cover large out-of-pocket expenses, such as deductibles, co-insurance and co-payments.

GAP plans give employees the ability to maintain quality health coverage when participating in a comprehensive major medical plan, providing quality healthcare benefits that are affordable.

GAP plans help pay the out-of-pocket expenses an Insured Person incurs for hospital stays, surgeries, emergency room treatment, and diagnostic testing. For an expense to be covered, the treatment must be medically necessary and covered under a Major Medical/Comprehensive Medical Plan.

in-Hospital Benefit

When confined to a hospital as an inpatient due to an eligible sickness or injury, GAP plans will pay your deductibles and co-insurance up to the selected calendar year maximum per person, up to the plan design limit for:

  • In-Patient Hospital stays
  • In-Patient Surgeries
  • Physician’s In-Hospital charges

Benefits available for Hospital Confinement Insurance range from a minimum of $500 to a maximum of $10,000.

Optional Outpatient Benefit

This benefit will pay deductible and co-insurance, up to the selected calendar year maximum, for medically necessary out-patient treatment of an injury or sickness. Benefits are limited to the difference between the benefit paid by the group Major Medical/Comprehensive Medical Plan and the actual covered out-patient expenses incurred, up to the maximum plan design limits.

  • Surgery in an Out-Patient Facility or a Physician’s Office
  • Emergency Room treatment of injury or sickness
  • Diagnostic testing, Lab, and X-ray at a diagnostic or Hospital Out-Patient facility or at a Physician’s office, if the cost is not included in the global office visit fee, and is not part of wellness/preventive care.
  • Out-patient radiation therapy or chemotherapy
  • Physical Therapy or Chiropractic Care
  • Durable Medical Equipment, if dispensed to the insured person in a hospital or provider’s office

In addition, an optional Outpatient Benefit Rider I pays on a per person per sickness or injury basis, up to a maximum of four occurrences per family per calendar year. This maximum applies to the entire family unit, regardless of the number of covered persons within the family unit. Details about this and other GAP Plansbenefits are available from National Benefit Partners.