Group Gap Insurance - Quick quote

No census required.

Gap insurance covers the high cost of medical deductibles and out-of-pocket expenses associated with today's group health plans. 

No pre-existing conditions exclusions when employer paid.1

  • In-patient and out-patient benefit levels from $500 to $10,000

  • Family benefit up to 3 times the employee benefit

  • Doctor office treatment rider*

  • Cancer Outpatient Treatment Rider*

  • Independent Lab Facility Rider*

  • Durable Medical Equipment Rider*

  • Critical Illness Rider*

* Optional rider.

Please see the summery plan description and / or the certificate of coverage for the carrier quoted.

Company Information

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How would you like us to contact you?

SIC - Standard Industry Code:

SIC - Standard industry code description:

Number of eligible employees:

State:

Zip Code:

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Step 2 - Major medical plan information

Major medical plan information

Major medical insurance  company:

Major medical  deductible:

Major medical  maximum out of pocket:

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Step 3 - Gap plan quote request

In-patient benefits

In-patient benefit type:

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Family maximum:

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In-patient benefit maximum::

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In-patient benefit deductible::

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Waive in-patient deductible for accident:

Out-patient benefits

Out-patient benefit type:

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Out-patient benefit maximum::

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Out-patient benefit deductible::

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Emergency room deductible:

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(Per occurrence)

Waive emergency room deductible for accident:

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Step 4 - Optional riders

Optional Riders

Office visit fee rider?

Physician/specialist benefit amount?

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Maximum MD visits per year?

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Doctor office treatment rider?

Cancer outpatient treatment rider?

Independent lab facility rider?

Durable medical equipment rider?

Critical illness rider?

Insured critical illness  amount?

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Spouse % critical illness  amount?

Child % critical illness  amount?

Notes

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