Group GAP Plan with Prescription Drug Card

As healthcare costs continue to rise, employers and benefits administrators are constantly searching for ways to manage escalating expenses—especially when it comes to prescription drug coverage. One increasingly popular strategy is offering blended gap insurance plans that help reduce employees’ out-of-pocket costs not fully covered by their primary health insurance, including deductibles, coinsurance, and copays.

Why Prescription Drug Costs Are a Growing Concern

Prescription drugs have become a major area of focus in health plan management. Many group and self-funded health plans are undergoing changes that shift more of the cost burden to employees. For instance:

• Prescription coverage is being integrated into major medical plans, requiring members to meet deductibles before drug benefits apply.

• Copayments for brand-name medications are rising, encouraging the use of generic alternatives.

• Formularies are being revised, with high-cost drugs being excluded in favor of more affordable options.

These changes can leave employees facing significant costs before they receive any prescription drug benefits.

The Role of a Gap Plan with Prescription Coverage

At The General Agency, we offer Group Gap Plans that bridge these financial gaps—especially when it comes to high deductibles and coinsurance. Our plans also feature an optional Prescription Drug Rider, designed to offer immediate medication coverage so employees don’t have to meet their medical deductible before accessing affordable prescriptions.

Key Benefits of Our Group Gap Plan with Prescription Drug Coverage

Here’s what sets our plan apart:

• Combined inpatient and outpatient coverage for easier understanding and usage

• Benefit amounts up to $10,000 per person per benefit year

• Flexible deductible options, from $0 to $7,000

• Guaranteed issue — no health questions or pre-existing condition exclusions

• Outpatient prescription coverage for generic, brand-name, and specialty drugs
  

Prescription Drug Copay Ranges:

• Generic drugs: $10 to $50

• Brand-name drugs: $25 to $250

• Specialty drugs: $250 to $750 or 50% of the medication cost
  

Eligibility and Enrollment

To qualify for a Group Gap Plan with Prescription Drug Coverage:

• Your group must have a minimum of five employees

• The gap plan must match your major medical insurance benefits

• The coverage ends if your major medical plan terminates or by employer/insurer request

For more information about how a Group Gap Plan with Prescription Drug Coverage can benefit your organization, contact The General Agency at (817) 717-2660.