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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.

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:

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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:

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:

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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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