Beacon is a tech-enabled specialty insurance wholesaler developing a lineup of unique worker benefits.
Our claims engine automatically obtains proof loss information from payers and adjudicates claims without having to evaluate any clinical information such as diagnoses or procedures. This means we don't require member ID cards, claim forms, Explanation of Benefits statements, or provider invoices. When an insured receives a provider bill, 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.
No more waiting for checks to arrive in the mail. At the time of claim filing, every claimant can self-disburse up to 12 months of out-of-pocket expenses electronically - even before any medical bill is due.
Gap is the only insurance solution allowed to coordinate with major medical group health plans to cover incurred out-of-pocket expenses such as deductibles and coinsurance. In contrast, all other supplemental medical insurance products are fixed indemnity solutions that pay set amounts for predefined clinical events, which means they have no logical relationship to an insured’s actual out-of-pocket expenses.
While public health insurance has had a gap solution (Medicare Supplement, also known as Medigap) since 1966, private group health insurance lacked the necessary regulatory framework until 2014, when major provisions of the Affordable Care Act (ACA) took effect. New types of insurance coverage take years to mature enough to be widely accepted. Once the federal regulatory door is opened, legal clarity needs to be established, individual state insurance departments need to come around to the idea, and insurers must accommodate any differing operational requirements and test the waters. As a result, widespread adoption takes time. Besides, considering the insurance industry's slow pace of change and the fact that US major medical group health insurance is the world's biggest insurance market, Gap is likely to take years to reach the same level of penetration as legacy ancillary insurance solutions.
Employers bundle Gap with affordable primary medical coverage to reduce health premiums without increasing employee cost-sharing. In other words, Gap is a solution that lowers the healthcare costs for both employers and employees. Because of that, employers typically pay for and enroll entire employee populations in Gap coverage.
Legacy Gap solutions have exclusions that don't match those of medical plans, fix limits at the employer level, cannot adapt coverage to different medical plans, and come with a high-friction claims process that often frustrates and angers employees. Our solution can mirror the out-of-pocket gaps of the underlying medical plan, prices risk dynamically per dollar of coverage, and automates the claim process.