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Our claim engine automatically obtains proof of loss from payers and adjudicates claims algorithmically. We don't require member cards, claim forms, provider invoices, Explanation of Benefits statements, medical provider involvement, or human claim handlers. When an insured receives a provider bill (or expects to receive one soon), they simply let us know through our website with the push of a button. Outstanding Gap claims get settled in seconds right then and there.
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When a claimant reports a claim through our website, they can electronically self-disburse out-of-pocket expenses that their medical carrier has already adjudicated. We can pay out before patients must pay their medical providers and up to 12 months retroactively.
Gap is the only supplemental health insurance solution that can indemnify incurred out-of-pocket expenses such as deductibles and coinsurance. In contrast, all other supplemental health insurance products are fixed indemnity solutions that pay predefined amounts for predefined clinical events, which means they have no logical relationship with an insured’s actual cost-sharing burden.
No. Gap has per se nothing to do with HDHPs. A medical plan's cost-sharing exposure is distributed across 4-8 factors: in-network deductible, coinsurance, copays (office fees), and out-of-pocket maximum, and, if applicable, a second set of these for out-of-network coverage. Gap captures risk across all of these factors, not just the deductible.
Employers pay for Gap, because it helps them manage their own healthcare costs while keeping their health benefits competitive. For example, if an employer cannot afford a Gold medical plan, they can combine a Silver medical plan with comprehensive Gap coverage to synthesize Gold plan-level cost-sharing at a total premium cost below the Gold plan's.
Our Gap solution tailors both coverage and pricing to an insured's medical plan. Moreover, it leverages a number of electronic data sources to automate adjudication and eliminate the clunky coordination of benefits process with a patient's medical insurer. As a result, our claims process doesn't require any proof of loss submissions, only takes seconds, and enables patients to self-disburse payouts instantly into their bank accounts.
Claims administration for other Gap solutions requires a labor-intensive coordination of benefits process, which involves up to four parties (TPA, insurer, provider, patient), takes several days, and ultimately alienates patients and confuses providers. In addition, most legacy Gap solutions are priced only based on "average" health plans, fix coverage at the employer level, and have coverage gaps relative to the underlying health plans.
Our commission is competitive with other Gap products. Please get in touch for details.
We work with you like most other insurers. We can ingest census files and provide quick turnaround for both quoting and enrollment. Please get in touch to learn about our census requirements.
No. We quote, enroll, renew, and enable self-billing through census files. Claims and reporting are automated. This means that your Gap groups will run on autopilot, enabling you to focus on your highest value-add work.
At this time, we only work with producers serving groups.
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