GAP Plan
GAP plans are designed to help supplement your Employer's
underlying Major Medical plan. It provides supplemental coverage to help offset
out-of-pocket costs that you may experience due to deductibles, co-payments and
coinsurance of the underlying Major Medical plan.
You are eligible to be covered under this Policy/Certificate
if you are Actively At Work, qualify for coverage as defined in the Master
Application, are covered under your Other Medical Plan and are under age 70 (if
you work for an employer employing less than 20 employees). Your Eligible
Dependents are eligible for coverage if they are covered under the Other
Medical Plan. Evidence of coverage under your Other Medical Plan is required.
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Plan Features
Inpatient Benefit
Pays for Covered Charges incurred, after satisfaction of any applicable deductible, when a Covered Person is confined in a Hospital as an Inpatient for at least 18 continuous hours and is covered by your Other Medical Plan. Outpatient Benefits Rider Pays for Covered Charges incurred by a Covered Person, if the Covered Person is covered by the Other Medical Plan, at the time the Covered Charges are incurred. Benefits payable under this rider are limited to any out-of-pocket deductible, co-payment and coinsurance amounts the Covered Person incurs under the Other Medical Plan for:
Ambulance Benefit Pays the out-of-pocket amount up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation |