Medical Gap
(Group Supplemental Medical Expenses Insurance)
With rising healthcare costs, employers are finding it increasingly difficult to afford traditional health plans while maintaining current insurance premiums.* As a result, many employers are looking at high deductible plans and/or increased copays as a way to manage expenses, which, in turn may create an additional financial burden on their employees. This is where ShelterPoint can help with a solution that may provide savings to both – employers and employees:
ShelterPoint Group Supplemental Medical Expense Insurance (“Medical Gap”) is available through our partner United Group Programs (UGP) as the “OptiMed Elite” series (i.e., OptiMed Elite Essential and OptiMed Elite Enhanced).
OptiMed Elite is specifically designed to help employers find innovative ways to manage rising health care costs while providing first dollar coverage. It gives employers the flexibility to redesign their medical plans and reduce costs, while providing their employees with supplemental coverage to help offset rising out-of-pocket medical expenses – such as deductibles, copays, and coinsurance.
*Timothy Jost, Affordability: The Most Urgent Health Reform Issue for Ordinary Americans, http://healthaffairs.org/blog/2016/02/29/affordability-the-most-urgent-health-reform-issue-for-ordinary-americans (accessed June 28,2017)
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ShelterPoint Life Insurance Company, formerly The First Rehabilitation Life Insurance Company of America.
All policies are administered by ShelterPoint Life Insurance Company and underwritten by either ShelterPoint Life Insurance Company,
a NY-domiciled carrier, or ShelterPoint Insurance Company, a FL-domiciled carrier depending on the state. Contact Underwriting for details.
Not all products are available in all states and from each entity in the family of ShelterPoint companies. Click here to view availability by state.
For information about which company is licensed in your state, please visit our. Geographic & Jurisdictional Notice.
Contact our Medical Gap representative Simon Klarides:
The information in this material is for illustrative purposes only, providing a general overview of featured benefit highlights provided under the Policy. It is not a contract. In the event of conflicting information with the Policy/certificate, the Policy/certificate will take precedence over what is shown in this material. OptiMed Elite is NOT a group major medical plan, or substitute for group major medical coverages. They provide limited benefits only. They are designed to reimburse certain covered out-of-pocket expenses, and are only available if an employer who has a group major medical plan in place. Out-pocket expenses submitted for reimbursement must be eligible under the covered employee’s group underlying comprehensive major medical plan, and must meet the coverage definitions under the Policy (may not include full reimbursement, if annual plan limits have been met). Benefits and range of options may vary by state. Premium will vary based on plan chosen. Coverages may vary depending on individual state law requirements and may be unavailable in some states. All coverage extends up to Policy limits. Policies are reviewed annually and may be cancelled for nonpayment. Please refer to the Policy for coverage details, a complete listing of covered services, policy provisions, conditions, exclusions, and terms under which the Policy may be continued or cancelled. Not available in all jurisdictions. Industry restrictions may apply. Coverage will continue as long the Policy remains in force, the premiums are paid, and the insured remains eligible for coverage under the Policy. Not available in all states. Some provisions, benefits, exclusions or limitations may vary by state.
Group Supplemental Medical Expense Insurance (“OptiMed Elite”) is available in the following states and underwritten and arranged exclusively for licensed agents and brokers by:
ShelterPoint Life Insurance Company (principal office in Garden City, NY) in: MI (SPL GGAP0915 P)
ShelterPoint Insurance Company (licensed in 48 jurisdictions, not including NY) in: AL (SPI GGAP0915 P), AR (SPI GGAP0915 P AR), AZ (SPI GGAP0915 P), FL (SPI GGAP0915 P FL), GA (SPI GGAP0915 P GA), IL (SPI GGAP0915 P IL), KY (SPI GGAP0915 P KY), MA (SPIGGAP0915 P MA), MO (SPI GGAP0915 P MO), MS (SPI GGAP0915 P MS), NC (SPI GGAP0915 P NC), NV (SPI GGAP0915 P NV), OR (SPI GGAP0915 P OR), PA (SPI GGAP0915 P), SC (SPI GGAP0915 P), SD (SPI GGAP0915 P SD), TX (SPI GGAP0915 P TX).
Administered by United Group Programs, Inc.
M#18-28
In accordance with, the Affordable Care Act (ACA), OptiMed Elite premium may not exceed 15% of the employer group’s major medical premium.
OptiMed Elite does NOT constitute Minimum Essential Coverage under the Affordable Care Act (ACA), but is subject to the Privacy and Security Provisions of the Health Insurance Portability and Accountability Act ( HIPAA). HIPAA Privacy Policy is available upon request.
OptiMed Elite is available only to employees who are offered, and enroll in, a group health care program sponsored and maintained by an Employer that provides, through a separate plan or program, minimum essential coverage under the Affordable Care Act (ACA) (group major medical plan). Since the Policy provides supplemental group health care benefits, some compliance obligations that apply to the group major medical plan under the Employee Retirement Income Security Act of 1974, as amended, or other applicable law (such as providing summary plan descriptions to participants and offering health care continuation coverage) may also apply to the Policy. The Employer is advised to consult with appropriate counsel in order to determine its specific compliance obligations.
An Employer may have both an HSA and OptiMed Elite available, but by law employees can only contribute to one of them in the same benefit year.