Group Supplemental Medical Expense (Gap)

Our Supplemental Medical Expense (Gap) insurance reimburses eligible out-of-pocket medical expenses incurred under the group major medical insurance plan, such as deductibles, copays, and coinsurance.

39%
Only 39% of U.S. adults say they could cover the cost of a $1,000 emergency room visit using savings.1

The need

Your employees may need help paying eligible out-of-pocket expenses incurred from major medical insurance.

The solution

Gap insurance reimburses eligible out-of-pocket medical expenses like deductibles, copays, and coinsurance. (Gap insurance is not meant to replace health insurance. It is only available if an employer has a major medical health insurance plan in place.)

No Health Savings Account (HSA)? No problem.

This coverage can be a beneficial supplement for high deductible health insurance plans without HSAs.

Gap insurance features include:

  • Guaranteed issue
  • No medical questions
  • Optional dependent coverage
  • Simplified administration and use

How Gap Insurance Works

Major Medical Plan Benefits

Charges

Hospital: $7,105
Office Visit: $435 (not eligible for reimbursement under Gap plan)

Patient Responsibility
(what patient owes after major medical health insurance has paid)

Deductible: $1,200
Co-Insurance: $1,902
Office Visit Co-Pay: $50
Total Patient Responsibility: $3,152

Gap Plan Benefits

None

Inpatient: $5,000
Outpatient: $3,000

Gap reimbursement

$0

$3,102

Net out-of-pocket cost
(paid by insured)

$3,152

$50

Source:
1. Bankrate, Financial Security Index, 2021

 
Insurance is underwritten by Beazley Insurance Company, Inc., 30 Batterson Park Road, Farmington, Connecticut, 06032. Beazley is rated A by A.M. Best. Beazley is licensed in all 50 states and the District of Columbia. CA License # 2868-8. Supplemental Medical Expense insurance is offered under Policy Form Series AHGMM0001. Coverage is not available in all states. Benefits may vary by state. Premium will vary based on the plan chosen. A waiting period for late entrants may apply. This policy is renewable at the option of Beazley. Refer to the Master Policy and Certificate for all terms, conditions, exclusions, and limitations. Beazley uses the services of third party administrators.

The Supplemental Medical Expense plan is not a major medical plan. The product is designed to reimburse certain covered expenses, and is only available if an employer has a major medical plan in place. Out-of-pocket expenses submitted for reimbursement must be eligible under the major medical plan, and must meet the coverage definitions under our policy (may not include full reimbursement, if annual plan limits have been met). Riders for outpatient services performed in a physician’s office/urgent care, or for outpatient chemotherapy/radiation performed in a licensed facility, may not be available in all states.

Globe Life And Accident Insurance Company manages and reinsures the Beazley Benefits program.