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Gap Medical Plan

The True-Gap Plan™  is a benefit “program” comprised of 7 distinct “benefits” rolled into one bundle.  When you select one of the coverage options under the True-Gap Plan™ you get all 7 benefits under one price!  

Employee Concerns About Health Insurance

  • Most employees don’t have a $1,000 or more in the bank to pay their deductible
  • Increased deductibles mean greater financial exposure
  • Lost income resulting from a hospital stay or surgery
  • Possible reduction in overall benefits For most employees, a stay in the hospital or having an out-patient surgery can be financially devastating.  Also, the number one reason for people filing bankruptcy today…is medical bills.

The True-Gap Plan™ is comprised of seven high paying benefits, each designed to cover a number of possible gaps in your current benefits package. 

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True-Gap Plan™ Benefits

All benefits below are Guaranteed Issue.
Please review all the included benefits below:

There are three benefit levels designed to meet you needs and budget: $5,000, $3,500 and $2,500.
The $5,000 level is used below for illustrative purposes.

  • Gap Plan Coverage

  • Telemedicine and Behavioral Therapy

  • Accidental Death and Dismemberment

  • Accident Indemnity

  • Evacuation and Repatriation

  • Discount Prescription Card

  • Discount Lab Services & MRI & Imaging Discounts

1.  Gap Plan Coverage

 (Provided by Crum & Forster)

Coverage is designed to pay to medical provider so that employee, has no money out-of-pocket or a low out-of-pocket expense.  Plan pays the appropriate amount listed per benefit regardless of actual medical expenses incurred and pays out per year the full amount per covered person.

The following example compares the projected out-of-pocket expenses incurred by a typical employee during a hospital stay.   (The “With TGP” column illustrates the employer increasing the deductible which results in the maximum OOP going from $5,000 to $6,500)

SAMPLE HOSPITAL BILL Current Plan With True-Gap Plan™
Total Hospital Bill $15,000 $15,000
Deductible (Change in deductible not required) $2,500 $5,000 (New Deductible)
Potential Maximum Employee Out-of-Pocket $5,000 $5,000
True-Gap Plan™ Payout (In-Patient Hospitalization)   $0 $5,000
Employee Total Out-of-Pocket Expense $5,000 $0

When an employee goes to the hospital, or has out-patient surgery, they simply present their True-Gap Plan™ card to the medical provider.  The card is basically like your health insurance card and has information for the medical provider to call in to verify coverage.  As a result, in most situations, the member will not have to pay anything to the provider at time of service. (Individual may elect Gap Plan coverage for:  Employee Only, Employee/Spouse, Employee/Dependents, or family.

2. Telemedicine and Behavioral Therapy

  (Provided by 24 HrVirtual Clinic) 

Allows an employee, and their household, to access a doctor 24/7 via a phone consultation, with no co-payment.  Doctors may diagnose most situations over the phone, or video call, and are able to call in prescriptions to a pharmacy of the employee’s choice, as well as renew most prescriptions, (no habit-forming drugs allowed).  Benefit allows employee to skip the doctor’s office visit, thus saving time, and co-payments.

Behavioral health support is provided for the member and their family with work and life integration. Members are allowed the freedom and confidentiality to speak with a licensed behavioral health counselor, via phone, once a month, for any reason.  Behavioral Health benefits provides assistance with anxiety, depression, loss and grief, and other benefits),

Also included in the Telemedicine benefit is: Couple’s Counseling, Chiropractic Discounts, and Imaging Discounts.

The Telemedicine phone number will also be located on the True-Gap Plan™ card. 

(The employee’s full household is covered whether or not covered on health insurance.  Dependents are covered up to age 26 or if child is classified as a dependent)                                                      

3. Accidental Death and Dismemberment Policy

 (Provided by Crum & Forster) 

An Accidental Death and Dismemberment policy, (AD&D), in the amount of $100,000 is provided on the individual only.

4. Accident Indemnity Policy – $1,000 per day 

 (Provided by Crum & Forster) 

In the event of an off-the-job accident, and the employee is admitted to the hospital, the employee, or covered family member would be eligible for a direct cash benefit of $1,000 per day, up to 60 days.  So, the employee could potentially receive $60,000 to use as needed.   Typically, a hospital stay means time off of work.  Lost work usually means lost income.  The cash benefit is paid directly to the employee to supplement lost income and pay their mortgage, car payment, or any other miscellaneous expenses needed for. (Dependent coverage for Accident Indemnity will be the same election as on the Gap Plan)

5. Emergency Evacuation and Repatriation Policy

 (Provided by EuropAssistance 

An unexpected illness, tooth ache or forgotten medication can ruin a trip.  With travel assistance services from EuropAssistanceUSA (EA), help is only a phone call away.  When an employee is travelling more than 100 miles away from home, the employee can have access to Travel medical, personal and security assistance services up to a combined single limit maximum for all services of $500,000.  With a presence in over 200 countries, and 24/7 assistance centers, EA is ready to assist in the event of an emergency while traveling.

Services included, but not limited to:

  • Emergency Evacuation/Medically-Necessary Repatriation
  • Emergency Medical Payment
  • Replacement of Medication and Eyeglasses
  • Visit by Family Member or Friend
  • Repatriation of Mortal Remains
  • Political, Natural Disaster or Security Evacuation
  • Emergency Cash
  • Emergency Travel Arrangements

6. Discount Prescription Card

 (FreeDiscount RX) 

Most PPO health plans have a prescription card as part of their coverage.  However, what if you are participating on a HSA plan?  In that situation, there is no prescription card and employee is responsible for 100% of the cost of the prescription.  The discount prescription card provided may save the employee, or any family member, up to 80% off of their prescription drug cost.

7. Discount Lab Services & MRI and Imaging Discounts

 (Provided by LabReqs) 

Many employees on a High Deductible Plan (HDP) or a HSA, are faced with paying more for lab services, MRIs/CT scans and x-rays than their fellow employees who choose a PPO option. Now employees can save premium dollars by staying on or moving to a HDP or HSA, and receive reduced lab and MRI and imaging, pricing similar to PPO plans. Employees participating on a PPO might also experience savings on lab services, MRIs/CT scans and x-rays.

  • 1. Gap Plan Coverage

    (Benefit amounts will vary depending on election)

  • 2. Telemedicine and Behavioral Therapy

    (Benefit amounts will vary depending on election)

  • 3. Accidental Death and Dismemberment

    $100,000 Benefit

  • 4. Accident Indemnity

    pays $1,000/day up to $60,000

  • 5. Evacuation and Repatriation

    Up to $500,000

  • 6. Discount Prescription Card

  • 7. Discount Lab Services & MRI & Imaging Discounts

All these plans are included in the True-Gap Plan™

Cost of True-Gap Plan™
Through the uniqueness of the overall program, and the multiple benefits bundled together, the individual may choose to increase their health insurance deductible, through your company, (or through your spouse’s company).  As a result of the increased deductible, typically by an increase of just $1,500 or $2,000, the savings in premium dollars will more than pay for the True-Gap Plan™ for employee and dependents.

Should an employee already be at a high deductible, they may still voluntarily elect additional coverage which will minimize their financial out-of-pocket exposure. Also, keep in mind, even when the deductible is increased, the employee’s out-of-pocket expense is actually lowered to potentially zero dollars.  Plus, with all the benefits provided, employees will be able to save money by not having to take time off of work to go to the doctor, or take a child, thus saving potentially lost income to taking time off of work, AND there are no co-payments by utilizing the Telemedicine benefit.

The accident indemnity plan pays cash benefits directly to the employee which may be used to supplement lost income for time off-of-work or for other bills, as well as all the other cost-saving benefits. In addition, should an employee have an existing supplemental policy(s) with another carrier, the True-Gap Plan™~ benefits will generally payout more and cost less.  The gap plan is for any reason of being in the hospital or out-patient surgery, some employees pay for specific coverage which is limited.  So, if comparable coverage exists either with your employer or your spouse’s employer, you may consider cancelling the other coverage which will ultimately save even more money.

SUMMARY

  • Increased Benefits
  • Lower health insurance premiums by increased deductible
  • Lower overall out-of-pocket expense
  • May save premium costs from other supplemental plans
  • Typically, no net cost of program due to increased deductible