t GAP Plan

Supplemental GAP Group Medical Insurance

The GAP Plan is an employer-sponsored group supplemental insurance plan which is designed to help reduce the cost of group medical coverage.  Combining the GAP Plan with certain major medical plans can deliver coverage groups want and can afford.

How does the GAP Plan pay claims?  It’s simple!

The GAP Plan follows the major medical plan.  The GAP Plan pays off of the underlying major medical plan EOB, and it pays benefits directly to the subscriber.  When the insured goes in-network they always receive the carrier’s in-network discounts.

What coverage does the GAP Plan provide?*

GAP plans have a supplemental deductible and co-insurance per insured person. After the insured’s deductible has been satisfied, the GAP Plan pays the benefits described in the policy until the payments reach the Maximum Benefit Amount.

Benefits for Hospital and Outpatient Expenses

The GAP Plan pays the amount applied to your major medical deductible and co-insurance. It covers the same expenses as your major medical plan, with the exception of charges for professional fees in a doctor’s office or medical clinic or for outpatient prescription drugs.

What GAP Plan designs are available?

Each group can choose the plan design and benefit amount to achieve the maximum overall premium savings for their group.  The GAP Plan is extremely flexible

Maximum Benefit Amount Options are any amount from $1,000 to $9,500 per person per policy/calendar year.

Deductible Options range from $250 to $3,000 (higher deductible available upon request).

Co-Insurance Options are 0%, 90/10%, 80/20%, 70/30%, 50/50% from $0 to $10,000 Out-of-Pocket.

Are there any participation requirements or waiting periods?

Everyone (employees and dependents) enrolled on the group’s major medical plan must be enrolled with the GAP Plan.  On the GAP Plan effective date, everyone covered by the group’s major medical plan will be covered by the GAP Plan.

What are the underwriting guidelines?

There are no excluded groups.  The minimum group size is 10.  Guaranteed issue.

*This is a brief description of coverage.  See policy for complete details.

Available in Pennsylvania only.

The application(s) available for download are in Portable Document Format (PDF).  In order to download and view these files you must have a version of Adobe Acrabat ReaderClick here to download Adobe Acrobat Reader.

             Premium Savings Example

             Claim Form

             Frequently Asked Questions

The Aegis Group

A.M. Best

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