Medical Gap Insurance

Medical Gap Insurance

Solutions Plus+ Gap – Now down to Two Lives

The Solutions Plus+ Gap plan provides coverage that offsets employee deductible and coinsurance expenses. Additional medical expenses can also be offset when combined with Critical Illness and Accident plans — truly reducing employee financial exposure.  Our gap health insurance includes:

  • Non-Routine Doctor Visits
  • Covered Hospitalization
  • Outpatient Surgeries
  • Related Diagnostic Labs — X-Rays, CTs, MRIs

Our expert consultants will assist you in designing a reimbursement gap health insurance plan with rich benefit amounts that may include:  

  • $500 to $10,000 Inpatient Hospitalization
  • $500 to $2,500 Outpatient Surgery

The wide range of benefit amounts allows for the creation of a multiple-year strategy to stabilize the employer’s health insurance budget. Over several years, the employer increases deductibles and/or coinsurance at renewal. In turn, the employer also increases the underlying gap insurance coverage to help offset the employees’ financial exposure. This strategy is a proven tool that has helped thousands of companies significantly reduce their group benefits costs comfortably.

As a worksite MGA, the experienced team at Chimienti & Associates knows the gap insurance market thoroughly.  We help build the perfect benefits package for our direct clients, as well as for Brokers to offer their clients.     

Gap Insurance Claim Example

See an example of how our Solutions Plus+ Gap plan works. The sample is based on a $2,500 deductible medical plan, with 20% coinsurance, and a maximum out-of-pocket limit of $5,000. This is an in-network hospitalization claim for a covered surgery, with an in-patient plan benefit of $5,000.

Without GAP 
In-Patient Benefit

With GAP 
In-Patient Benefit

Deductible:

$2,500

Deductible:

$2,500

Co-Insurance (20%):

$2,500

Co-Insurance (20%):

$2,500

Max Out-of-Pocket:

$5,000

Max Out-of-Pocket:

$5,000

In-Patient Gap Benefit:

$0

In-Patient Gap Benefit:

$5,000

Insured’s Out-of-Pocket:

$5,000

Insured’s Out-of-Pocket:

$0

Plan Highlights

  • Guarantee Issue for Employee and Family
  • No Pre-Existing Conditions Exclusions
  • No Participation Percentage Required. Only 2 Enrolled Employees Required to Issue the Case.
  • Maintains Carriers and PPO Networks for Multiple Years
  • An Underlying Group Major Medical Plan is Required
  • Benefits are Assignable to Hospital or Medical Facility
  • Identification Card Issued
  • Simplified Claim Submission
  • Benefits are Paid Starting with the First Dollar of Covered Out-of-Pocket Expenses