Trouble Nailing Down July 1 Renewals? Gap Insurance Could Seal the Deal
COVID craziness may be stalling your July 1 renewals. It’s easy to understand. Employers are consumed with developing coronavirus strategies. sifting contingencies, wondering what might happen next, creating social distance and other safeguards in their work space, and maybe even wondering when they can open again.
We're all wondering:
- What is our stage of business recovery?
- Is a new wave of the coronavirus likely?
- What is the new normal?
- What is an intelligent decision on employee benefits?
If concerns such as these are impeding renewal finalizations, the flexibility afforded in OptiMed Gap secondary insurance may be the antidote to the disease of indecision.
Gear Up Gap
A quick question:
With OptiMed Gap, a group member will never again have to pay a deductible, coinsurance or a copay for any medical service covered by its major medical plan?
The quick answer: that maybe true, but it depends upon options selected in numerous categories of customization.
How many, and precisely what options are available, depend on two primary factors: the state in which the policy is issued, and choice of carrier. The basic and most common selections involve:
- Inpatient Coverage annual maximum – sets a dollar limit on eligible expenses if insured person is hospital confined under the regular care and attendance of a physician.
- Outpatient Coverage annual maximum – covers eligible expenses for treatment at a licensed facility, including physician’s office, diagnostic clinic, urgent care clinic, outpatient surgical center and others.
- Combined Benefits Option – inpatient and outpatient combined limit, as opposed to limits in separate categories.
- Prescription Drug Rider – may cover generic-only or generic plus brand drugs.
- Mental Nervous/Substance Abuse option
- Set a Gap deductible – an option to lower the premium.
- HSA Compliant Option – allows employer to offer GAP along with HSA qualified medical plans, in which case a Gap deductible is mandatory.
- Cost sharing – employer can choose to pay all or a percentage of the premium, making the coverage optional for employees.
Each of these – and other – optional selections impact the premium and affect financial feasibility. Keep in mind that even if the employer chooses not to include Gap, employees may welcome the chance to fund coverage.
Chances of contracting COVID are increasing in many areas of the country. With the average cost of a COVID hospitalization at $23,489,[i] it makes sense to offer Gap with an inpatient benefit equal to the HDHP deductible with an outpatient buyup option.
A Harvard study indicates that 62 percent of personal bankruptcies are attributable to medical expenses,[ii] even though 78 percent of those have some form of health insurance. That is strong incentive for anyone in a high-deductible plan to obtain Gap insurance, even if they have to pay the premiums themselves.
OptiMed Gap pays or reimburses medical expenses that fall within the deductible or coinsurance obligations of a major medical plan.
OptiMed has numerous marketing tools available to assist in educating your groups about this product.
Gap may not be the best choice in every situation, but its flexibility makes it a strong contender for cost-effectiveness in a broad range of HDHPs.
The OptiMed Gap brochure recounts an employer that achieved more than a quarter-million-dollar savings by replacing its major medical coverage with an HDHP and Gap. It provided $5,000 inpatient and $2,500 outpatient coverage to its 150 employees.
A great online tool for quickly examining/assessing Gap options is soon to be released. It’s a number-crunching hybrid; call your OptiMed rep for details.
Call your OptiMed rep also for the last-minute assistance you need to nail down your July 1 renewals.