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Group Health Insurance and Ancillary Products
3740 N. Josey Lane, Suite 125
Carrollton, Texas 75007
Phone: (972) 466-2915
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
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In-patient and out-patient benefit levels from $500 to $10,000
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Family benefit up to 3 times the employee benefit
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Doctor office treatment rider*
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Cancer Outpatient Treatment Rider*
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Independent Lab Facility Rider*
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Durable Medical Equipment Rider*
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Critical Illness Rider*
* Optional rider.
1 Please see the summery plan description and / or the certificate of coverage for the carrier quoted.
Company Information
How would you like us to contact you?
SIC - Standard Industry Code:
SIC - Standard industry code description:
Number of eligible employees:
State:
Zip Code:
Step 2 - Major medical plan information
Major medical plan information
Major medical insurance company:
Major medical deductible:
Major medical maximum out of pocket:
Step 3 - Gap plan quote request
In-patient benefits
In-patient benefit type:
Family maximum:
In-patient benefit maximum::
In-patient benefit deductible::
Waive in-patient deductible for accident:
Out-patient benefits
Out-patient benefit type:
Out-patient benefit maximum::
Out-patient benefit deductible::
Emergency room deductible:
(Per occurrence)
Waive emergency room deductible for accident:
Step 4 - Optional riders
Optional Riders
Office visit fee rider?
Physician/specialist benefit amount?
Maximum MD visits per year?
Doctor office treatment rider?
Cancer outpatient treatment rider?
Independent lab facility rider?
Durable medical equipment rider?
Critical illness rider?
Insured critical illness amount?
Spouse % critical illness amount?
Child % critical illness amount?
Notes
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