GAP Supplemental Medical Coverage
GAP insurance is a win-win approach to rising healthcare costs. GAP insurance can provide the ability for employers to lower costs and out of pocket expenses for their employees.
Health insurance has been one of the most effective both physical and financial wellness tools employers could offer employees by helping protect them from high medical costs. To manage rising premiums, employers have migrated to higher-deductible plans. While HDHPs can be a great solution, they have the potential to impact retention by exposing employees to higher medical out-of-pocket expenses.
Gap policies are secondary insurance designed to supplement medical coverage and help offset costs related to inpatient and outpatient medical care. MedMutual Protect offers two types of GAP policies:
- Our MedMutual Protect GAP policy combines the inpatient and outpatient benefit for a straight-forward approach.
- Our Signature GAP policy includes two separate benefits for inpatient and outpatient care.
Employers have the freedom to choose policies that include inpatient hospital, outpatient care and other important benefit options.
MedMutual Protect GAP* – One Combined Benefit
The MedMutual Protect GAP policy offers a combined inpatient and outpatient benefit for employees and their covered dependents. Features include:
- Straight-forward policy design that is easy to understand
- Benefit amounts up to $10,000
- Optional benefit for treatment of mental illness and/or substance abuse
*Underwritten by Reserve National Insurance Company.
Signature GAP**
Features of the Signature GAP policy include:
- Separate benefit amounts for inpatient and optional outpatient services
- Inpatient benefit maximums up to $7,000
**Underwritten by Fidelity Security Life Insurance Company ® Kansas City, MO 64111
Policy Form No. M-9134/M-9135. Policy Nos. MG-158/MG-159/MG-160.
MedMutual Protect GAP* – One Combined Benefit
The MedMutual Protect GAP policy offers a combined inpatient and outpatient benefit for employees and their covered dependents. Features include:
- Straight-forward policy design that is easy to understand
- Benefit amounts up to $10,000
- Optional benefit for treatment of mental illness and/or substance abuse
*Underwritten by Reserve National Insurance Company.
Signature GAP**
Features of the Signature GAP policy include:
- Separate benefit amounts for inpatient and optional outpatient services
- Inpatient benefit maximums up to $7,000
**Underwritten by Fidelity Security Life Insurance Company ® Kansas City, MO 64111
Policy Form No. M-9134/M-9135. Policy Nos. MG-158/MG-159/MG-160.
How it Works
- Enrolled employees receive an ID card.
- The employer receives the policy and a certificate.
- Employees provide GAP ID cards to providers, along with their medical ID cards.
- Benefits are paid to providers (when an assignment of benefits exists) or employees.
Policy Forms KB-GAP-1020 and MG-158/MG-159/MG-160, M-9134/M-9135.
This policy has exclusions and limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact MedMutual Protect.
This is only a summary of products and services offered. Actual offerings may vary by group size and other underwriting considerations and are subject to the requirements of state insurance laws and regulations, and the benefits/provisions as described may vary due to such requirements. All products are subject to the terms, conditions, limitations and exclusions of the specific policy, and coverage will only become and remain effective to the extent provided by the applicable terms, conditions, limitations, and exclusions of such policy. Please see the specific policy and certificate for details. Policies are not available in all states.
MedMutual Protect is the brand name for insurance products issued by subsidiary insurance companies controlled by Medical Mutual of Ohio. Each subsidiary of Medical Mutual of Ohio is solely responsible for the insurance products it underwrites and issues.
The underwriting company for the worksite voluntary Accident Expense, Accident Indemnity, Cancer, Critical Illness, Dental, GAP, Short Term Disability and Life Insurance Products is Reserve National Insurance Company, which is responsible for the underwriting risks, financial and contractual obligations and support functions associated with the products it issues. The underwriting company for the worksite voluntary Hospital Indemnity and Signature Gap is Fidelity Security Life Insurance Company® (FSL). FSL is not financially affiliated with Medical Mutual of Ohio. All products are subject to the terms, conditions, limitations and exclusions of the specific policy. Product availability may vary by state. FSL is located in Kansas City, Missouri, and has been rated “A” (Excellent) based on an analysis of financial position and operating performance by A.M. Best Company, an independent analyst of the insurance industry. For the latest rating, access www.ambest.com.
Neither Reserve National Insurance Company, FSL, nor their agents, representatives, associates or employees render legal or tax advice. The employer should seek the expert assistance of its own legal or tax adviser.
The MedMutual Protect voluntary insurance products, either alone or in combination with each other, are not “minimum essential coverage” under the federal Affordable Care Act.
IMPORTANT: If an individual is insured under one or more MedMutual Protect voluntary insurance products and is also covered by Medicaid or a state variation of Medicaid, most non-disability benefits are automatically assigned according to state regulations. This means that instead of paying the benefits to the insured individual, we must pay the benefits to Medicaid or the medical provider to reduce the charges billed to Medicaid. Proposed insureds should consider their circumstances before enrolling in MedMutual Protect coverage.
If you are an employer offering one or more of these insurance products to your employees, the product(s) may constitute a part of an employee benefit plan under the Employee Retirement Income Security Act of 1974 (“ERISA”). An employer offering an ERISA employee benefit plan will be responsible for a number of obligations applicable under ERISA, including, without limitation, the obligation to make required disclosures to employees and file reports with the federal government. MedMutual Protect acts solely as the issuer and underwriter of these insurance products and as such, neither MedMutual Protect nor any of its affiliates or agents assume any fiduciary or administrative responsibility or duties with respect to any employee benefit plan under which the products are made available. You should consult with an experienced attorney concerning the requirements for compliance with ERISA.
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