Group Supplemental Medical (GAP) Insurance
GAP Insurance works alongside a company’s primary medical plan to help reimburse employees for covered out-of-pocket expenses.
Strengthening Employee Benefit Plans
As healthcare costs continue to rise, many employers have turned to high-deductible health plans as a way to manage premium expenses. While these plans can help control costs, they also shift a greater share of expenses to employees—leaving many responsible for thousands of dollars in deductibles, co-pays, and coinsurance each year.
That’s where supplemental health coverage comes in. Arch Insurance’s Group GAP insurance works alongside a company’s primary medical plan to help reimburse employees for covered out-of-pocket expenses. This coverage helps reduce the financial strain that can accompany unexpected medical needs and demonstrates an employer’s commitment to supporting its workforce beyond standard health benefits.
With flexible plan designs and dedicated administrative support, Arch Insurance makes it easier for organizations to strengthen their benefits portfolio and deliver meaningful protection to their employees.
Complete this form for more information
Coverage Highlights
- Reimburses individuals for covered out-of-pocket expenses, such as deductibles and coinsurance
- Guaranteed issue coverage (no medical underwriting required)
- Flexible plan designs
Eligibility
- Employers must offer an ACA, fully insured, or self-insured major medical plan to their employees.
- Enrollees must be enrolled in their employer-sponsored major medical plan.
- Dependents of employees who are also covered by the employer-sponsored major medical plan.
- Employers determine employee eligibility.
- Employers must have at least 5 employees participating in the plan.
Benefits Overview
| Benefit | Definition | Maximum Benefit Amount Per Insured | Maximum Benefit Amount Per Family |
|---|---|---|---|
| Inpatient Benefit | Reimburses deductibles, coinsurance, or other eligible out-of-pocket expenses for covered benefits incurred during inpatient hospitalization Includes treatment of mental illness or substance abuse in an inpatient facility (Option to limit days of treatment per Benefit Period or to exclude) | $500–$10,000 per Benefit Period | Up to 2–3 times the Maximum Benefit per Insured |
| Outpatient Benefit *There are two available Outpatient Benefit designs: Option I and Option II. See Maximum Benefit Amount columns to the right for additional details. | Reimburses eligible out-of-pocket expenses incurred in: •Hospital emergency room (not admitted) •Outpatient surgical facility •Diagnostic testing facility •Similar facilities licensed to provide outpatient treatment •Includes treatment of mental illness or substance abuse in an inpatient facility (Option to limit days of treatment per Benefit Period or to exclude) •Option to include treatment in a doctor’s office (excluding physician fees) | Option I: 5%–100% of the Maximum Benefit for Inpatient Benefits Option II: 5%–100% of the Maximum Benefit for Inpatient Benefits, up to a maximum of 1–5 outpatient occurrences per Benefit Period | Option I: Up to 2-3 times the Maximum Benefit per Insured Option II: Up to 2 –3 times the number of occurrences per Insured per Benefit Period |
| Doctor’s Office Visit (Optional) | Reimburses deductibles, coinsurance, or other eligible out-of-pocket expenses for treatment in a doctor’s office. | $15-$125 per visit; up to 3-12 visits per Benefit Period | $15-$125 per visit; up to 2-3 times the number of visits per Insured |
Optional GAP Plan Features
Definition: Amount of expenses incurred each Benefit Period for Covered Expenses that an Insured must pay before benefits will be payable under this policy.
Applicable to:
- Inpatient Benefit
- Outpatient Benefit
- Inpatient and Outpatient Benefit
- Emergency Room for Sickness Only
Definition: Maximum percentage that will be paid under this policy for Covered Expenses incurred by an Insured.
Applicable to:
- Inpatient Benefit
- Outpatient Benefit
- Inpatient and Outpatient Benefit
Definition: Combines the Inpatient and Outpatient Benefits into one benefit maximum.
Applicable to:
- Inpatient and Outpatient Benefit
Exclusions
We will not pay benefits for any loss, treatment, or services resulting from or contributed to by:
- intentionally self-inflicted Injury;
- suicide or attempted suicide;
- war or any act of war, whether declared or not;
- active duty service in the military, naval, or air force of any country or international organization.
- repair or replacement of existing dentures, partial dentures, braces, fixed or removable bridges, or other artificial dental restoration;
- repair, replacement, examinations for prescriptions or the fitting of eyeglasses or contact lenses;
- out-of-pocket medical expenses for which the Insured is entitled to benefits under any Worker’s Compensation Act, Employer’s Liability Laws, or similar occupational benefits or while engaging in activity for monetary gain from sources other than the Policyholder;
- treatment or services for Injury or Sickness provided outside of the United States;
- injuries or loss that happen while the Insured is committing or attempting to commit a felony; or actively participating in a riot, or insurrection; or while the Insured is legally intoxicated (as determined by that state’s laws) or while under the influence of any drug unless administered under the advice and consent of a Doctor;
- treatment which is not Medically Necessary or medical expenses which do not result from the treatment of an Injury or Sickness;
- treatment for dental or vision care not related to an accidental Injury;
- treatment for Injury or Sickness that is payable under any insurance that does not require Deductible and/or Coinsurance payments by the Insured;
- treatment for Injury or Sickness for which benefits are not payable under the Insured’s major medical plan;
- treatment for Injury or Sickness if, on the Insured’s Effective Date of Coverage, the Insured was not covered by a major medical plan. Our sole obligation will be to refund all premiums paid;
- prescription drugs;
- balance billing amounts incurred for non-network providers under the Insured’s major medical plan;
- expenses related to wellness visits or preventative services, including annual routine examinations and well-child care;
- out-of-pocket medical expenses paid or payable under any mandatory no fault automobile insurance contract or mandatory basic reparations benefit of no fault;
- covered medical expenses for which the Insured would not be responsible for in the absence of this Policy;
- voluntary abortion;
- elective cosmetic surgery;
- sterilization procedures and reversal of sterilization procedures.
Request a Quote
To request a quote, please provide the following:
- Policyholder information including legal name, address, Industry/SIC Code, and website
- Employer’s underlying Major Medical Plan info, including Summary Plan Description or Schedule of Benefits, Description of eligible classes, Exclusions and limitations
- Current census of eligible employees
Email information to: accidentandhealth@archinsurance.com
Notice: This is a brief description of coverage provided and is subject to the terms, conditions, limitations and exclusions of the policy. Please see the policy for complete details. Coverage may vary or may not be available in all jurisdictions. In the event of any conflict between this summary of coverage and the policy, the policy will govern. The policy is a short-term policy, with limited benefits. This insurance is not an alternative or replacement to comprehensive medical or major medical coverage. Further, this insurance is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.