Medical Gap Insurance reduces the costs of health insurance. Health Insurance costs contine to rise ans this is one of the best solutions that Insurance Brokers can show their clients and prospects. Medical gap plans can be for insured or self funded medical plans. These are not just voluntary plans any longer.
2. voluntarybenefitprograms.com
Executive Summary: Medical Gap Plan
Allows employers to reduce group health plan costs 10% to 20%
This also helps people guard against large out-of-pocket medical expenses.
1)Reduce plan costs
2)Improve benefits
5. voluntarybenefitprograms.com
Growing need for Supplemental Medical insurance
A 2007 study*
found that the
majority of
personal
bankruptcies are
due to medical
expenses, even
for those with
healthcare
coverage.
36% of adult
Americans have
no savings
earmarked for
emergencies,
according to the
Consumer
Federation of
America.
76% of Americans
are living
paycheck-to-
paycheck,
according to CNN
Money.
*Medical Bankruptcy in the United States, American Journal of Medicine, 2007
Employees Need Protection
6. voluntarybenefitprograms.com
Addressing Needs
There is increased interest in supplemental medical and hospital
indemnity products at the workplace, as employers continue efforts to
control health plan costs.
The benefit may be offered employer-paid, or employee-funded
(voluntary), or a combination of the two.
Coverage is offered on a guarantee issue basis with no medical
underwriting needed. Dependent coverage is available.
7. voluntarybenefitprograms.com
A 2011 survey indicated that more than 50% of employees say they
are concerned about costs NOT covered by medical insurance*.
*Met Life study of employee benefit trends 2011
Addressing Concerns
8. voluntarybenefitprograms.com
Over a third of employees say that supplemental benefits
are a reason to stay with or join an employer*
*Met Life study of employee benefit trends 2013
Satisfying Employees
11. voluntarybenefitprograms.com
The Gap Medical Strategy uses an employer sponsored supplemental
insurance plan paired with a high deductible health plan.
Instead of giving the medical
carrier 100% of premium...
Give the medical carrier 75%
and gap carrier the balance
This can reduce the overall
cost of group medical...
12. voluntarybenefitprograms.com
Fill in plan changes with an insured medical gap plan
(so employees are not hurt by plan changes)
Employers will pay for this if the numbers work
Next
13. voluntarybenefitprograms.com
Sample Out Patient Benefits
Pays a first dollar benefit for outpatient
expenses incurred up to plan maximum
Examples of expenses covered:
Surgery in a facility or a doctor’s office
Emergency Room – Accident or Sickness
X-ray, Lab, Diagnostic Testing, MRI
Outpatient Radiation/Chemotherapy
Specialist Visits
Physical Therapy, Chiropractic, Rehab
14. voluntarybenefitprograms.com
Sample In-Patient Benefits
Pays a first dollar benefit for inpatient out of
pocket expenses incurred up to the plan maximum
Examples of covered expenses:
In-Patient Surgeries and Hospital charges
Physician In-Hospital charges
X-ray, Lab, Diagnostic Testing, MRI’s
15. voluntarybenefitprograms.com
Example - Employer advantage
Renewal Plan:
$500 Deductible
80/20 Coinsurance
$3,000 Out of pocket max
#of lives Mo. Cost
EE only 30 $675
EE + SP 7 $1,350
EE + Ch 5 $1,170
Family 8 $1,890
Monthly Premium $50,670
Proposed Plan:
$2,500 Deductible
80/20 Coinsurance
$5,000 Out of pocket max
#of lives Mo. Cost
EE only 30 $450
EE + SP 7 $900
EE + Ch 5 $810
Family 8 $1,350
Monthly Premium $34,650
Total Savings: $16,020 monthly! ($192,240 annually)
16. voluntarybenefitprograms.com
Gap Insurance Claim Example
The following is an example of how our Gap plan works. The
example is based on a $2,500 deductible medical plan, with
20% coinsurance, and a maximum out-of-pocket limit of
$5,000.
The example is an in-network hospitalization claim for a
covered surgery, with an in-patient plan benefit of $5,000.
17. voluntarybenefitprograms.com
$15,000 Hospital & Surgery Claim (Employee advantage)
Without GAP With GAP
In-Patient Benefit In-Patient Benefit
Deductible: $2,500 Deductible: $2,500
Co-Insurance (20%): $2,500 Co-Insurance (20%): $2,500
Max Out-of-Pocket: $5,000 Max Out-of-Pocket: $5,000
In-Patient Gap Benefit: $0 In-Patient Gap Benefit: $5,000
Insured’s Out-of-Pocket:$5,000 Insured’s Out-of-Pocket: $0
18. voluntarybenefitprograms.com
The Supplemental Medical Expense plan (Gap plan) is an insurance
product which reimburses certain out-of-pocket medical expenses to
protect employees.
It is paired with a lower cost major medical plan, and works most
effectively with high-deductible plans. The combination allows the
employer to find savings and keep employees whole.
Coverage offered on a guarantee issue basis with no medical
underwriting. Dependents are covered as well.
Medical Gap Coverage
19. voluntarybenefitprograms.com
Gap premium NOT counted for Cadillac tax
This reduces any potential penalty - (IF properly structured)
The initial annual threshold amounts for the tax are:
–$10,200 for self-only coverage
–$27,500 for coverage other than self-only
Family limit example with 8% premium growth:
2016 $27,210
2017 $29,387 (maximum ceiling of $27,500 exceeded)
2018 $31,737 (over the limit by $4,237)
$4,237 of “compensation” subject to 40% excise tax. Total tax paid: $1,695...per family!
Bonus for Forward Thinkers
21. voluntarybenefitprograms.com
Make us your resource for gap plans
We help you bring clients in a new programs:
We deliver tangible savings
We help you bring innovative solutions
We help you cross sell additional benefits
22. voluntarybenefitprograms.com
Next…
We are a Managing General Agency for the top Medical Gap programs,
providing analysis and turnkey solutions with pricing & benefits.
Add us to your team & let us help you with win - win
Gap plans DO NOT require waiting for an annual medical renewal.
23. voluntarybenefitprograms.com
Why…
The trend for health plan costs is up.
Our cost savings solutions for groups help you win
We provide you with the top carrier comparisons & U/W
We also help you plan enrollment & communication
Don’t rely on single carrier solutions and risk your business….
24. voluntarybenefitprograms.com
Service…
We do the heavy lifting:
We put the programs together
Provide options & value added programs
Create an enrollment strategy
Carrier comparisons
25. voluntarybenefitprograms.com
We bring you new ideas that most group
brokers are not using
We Seamlessly become part of your team
and and work behind the scenes on your
behalf.
Your Turnkey Solution...
*Next step: Contact us for a strategy call