Deductible Gap Insurance Plan from CY Benefits
Most health insurance plans have a deductible, which requires you to pay out-of-pocket for a certain amount of treatment. Once you’ve paid the full amount, your policy steps in and covers most of the remaining charges. But most Americans don’t reach their deductible amount in a given year, so the burden of treatment still falls largely on individuals—even those with good health insurance.
Gap insurance covers your deductible, helping to free you from out-of-pocket expenses.
Deductible Gap Plan: Indemnity Insurance against out-of-pocket expense
As health insurance costs continue to increase, so do deductibles and out-of-pocket costs. Employers control the soaring costs by sharing the burden with employees in the form of deductibles and co-insurance. Our Gap Plan helps protect employees against these out-of-pocket expenses, working in conjunction with their major medical insurance to pay deductibles and co-insurance expenses.
When a covered person is confined to a hospital as an inpatient, benefits are payable for:
- Eligible inpatient hospital stays
- Inpatient surgeries
- Physician’s in-hospital charges
- Routine nursery care for dependent children
Outpatient Hospital Benefit
When a covered person receives treatment as an outpatient, benefits are payable for:
- Treatment in a hospital emergency room or urgent care center for an injury due to an accident when the covered person is not subsequently considered an inpatient (emergency room charges for sickness are not covered).
- Surgery performed in a hospital outpatient facility or a free-standing outpatient surgery center.
- A limited benefit up to $100 per surgery will be paid for outpatient surgeries performed in a physician’s office.
- Radiological diagnostic testing performed in a hospital outpatient facility or a magnetic resonance imaging (MRI) facility (does not cover lab fees).
Benefits are payable when a covered person requires ambulance transportation (ground or air) to a hospital or emergency center for injuries sustained in an accident. Ambulance transportation must be within 72 hours of the accident and must be provided by a licensed, professional ambulance company.