Enrollment in the GAP plan follows those guidelines established for enrollment in your group major medical plan. If you do not elect to enroll in the GAP plan when it is first made available to you, you will not be able to enroll in it until the next allowable period of open enrollment, unless you qualify by law as a “special enrollee” due to certain qualifying events.

No, if an employee is not covered under the group major medical plan, they are generally not eligible to participate in the GAP plan

For an expense to be eligible under GAP, it must be covered by your major medical plan. If an expense is denied by your major medical plan but would otherwise have been an eligible expense under GAP, it will not be covered by GAP. A couple of simple examples to illustrate this are:

1. Expenses that are not medically necessary and do not result from the treatment of an illness or an injury; 2. Physician office visit charges, unless the Physician Office Visit benefit has been purchased; 3. Expenses related to wellness or preventive medicine; 4. Confinement or other covered treatment for Dental or Vision care that is not related to an accidental injury.

Generally, expenses related to the treatment of mental or nervous disorders and the expenses related to treatment of alcoholism, drug addiction, or complications thereof are not covered by most GAP plans. It can be covered by carriers or can be covered by optional rider by some carriers. This is not a complete list of exclusions under the GAP plan. For a full list of exclusions, terms and conditions, you should refer to your certificate of insurance.

No.

If an employee has already met their deductible with an existing GAP plan or their major medical plan, they will stay have to pay a deductible if it is a new GAP plan. The deductible on a GAP plan will start on the effective date of the GAP plan the first year. After the first year, it will reset as a calendar year deductible.

These frequently asked questions are provided as a service to answer our most commonly asked questions. Should you have further questions, please review the GAP plan brochure provided by the insurance carrier. The information contained in the insurance company brochure is a direct representation of the coverage provided by the carrier. This document is not intended to be an exhaustive discussion of medical GAP insurance.