The GAP Plan replaces the risk of an HSA or HRA with a fully insured option.
E Employee-paid, or voluntary, coverage
HOW ARE CLAIMS PAID?
The GAP Plan follows the major medical plan. The GAP Plan pays off of the underlying major medical plan EOB, and it pays benefits directly to the subscriber or provider. When the insured goes in-network they always receive the carrier’s in-network discounts.
GAP plans have a supplemental deductible and co-insurance per insured person. After the insured’s deductible with Aegis Security has been satisfied, the GAP Plan pays the benefits described in the policy until the payments reach the Maximum Benefit Amount.
The GAP Plan pays the amount applied to your major medical deductible and/or co-insurance. It covers the same expenses as your major medical plan, with the exception of charges for professional fees (Office Visit Co-pays) in a doctor’s office or medical clinic or for outpatient prescription drugs.