Group Gap Plan
Your link to affordable group health and comprehensive employee benefits
• Reduce employee out-of-pocket medical costs
• Traditional and HSA-compatible options
• Simple to understand and easy to implement
Link is designed to reduce total out-of-pocket costs when used to supplement an ACA-qualified group major medical plan.
Benefits are available for medical expenses applied to the major medical deductible and coinsurance, reducing employees’ up-front expenses.
Consider the following example:
An employee has an appendectomy that results in $15,000 of covered inpatient expenses. The group major medical plan has a $3,500 deductible followed by 80 percent coinsurance up to an additional $1,500 out-of-pocket. Therefore, the
major medical explanation of benefits (EOB) would display the following:
$3,500 applied to deductible
$1,500 applied to coinsurance
$10,000 paid to medical providers
The EOB is then submitted for payment through the employee’s Link 50 group gap plan with a $2,500 inpatient and $2,200 outpatient maximum benefit. Since the
Link 50 plan has $0 deductible and 50 percent coinsurance, the employee will receive a benefit of $2,500, cutting their total out-of-pocket responsibility in half.