A major medical plan must be a group medical plan (whether a fully insured plan or an employer sponsored self-funded plan) that provides benefits for hospital confinements and requires you to pay a deductible and/or portion of coinsurance. A major medical plan does not include Medicare, Medicaid or government sponsored programs not typically considered major medical coverage (such as, but not limited to, veterans’ benefits, etc.)

Employers choose the benefits and plan structure along with the assistance of insurance professionals. The insurance professional should have reviewed and analyzed your major medical plan coverage and its associated costs, to determine the most effective GAP plan(s) available.

Each covered person has a maximum out-patient benefit per calendar year subject to a maximum benefit for all covered persons within a family unit that is equal to two (2) or three (3) times the individual out-patient benefit maximum. This feature is determined by the plan design the employer and the insurance professional choose. This family maximum applies to the entire family unit, regardless of the number of covered persons within the family unit, however, in no event will the maximum calendar year out-patient benefit for any one person exceed the individual maximum.