AF Hospital GAP PLAN® Insurance Support
Gap Insurance is designed to help pay the deductible, co-insurance, or other out-of-pocket expenses related to inpatient confinement or treatment. Learn more about our gap insurance from the frequently asked questions below.
Gap Insurance FAQs
General
What is gap insurance?
Gap insurance is a group supplemental medical product designed to provide benefits that cover certain out-of-pocket expenses as a result of medical treatment. It is paired with the employer’s medical plan based on the medical deductibles available to the employees.
Is gap insurance the same as Hospital Indemnity coverage?
No. Gap insurance pays toward the deductible, co-insurance, or other out-of-pocket expenses related to inpatient confinement or treatment. A hospital indemnity plan is designed to offer benefits per day spent receiving inpatient treatment.
Does the payment go to me or my doctor?
Your benefit is paid directly to you, so you may apply the money toward your medical costs or daily living expenses as needed.
How do I allow others to speak to American Fidelity on my behalf?
In order for American Fidelity to release information to anyone other than the policyholder, the policyholder will need to update the Authorization to Disclose Information Including PHI to include the names of the individuals or organization we can release information to. Alternatively, the policyholder may create and submit a signed and dated statement indicating who they are giving authorization to speak on their behalf. If the policyholder is unable to sign their own authorization, we would need a Power of Attorney on file to release any information.
Claims
How do I file a gap insurance claim?
The fastest way to file a gap insurance claim is through your online account or on our mobile app, AFmobile®.
- Log in to your online account
- Download AFmobile from the Apple App Store or Google Play Store
For more details on how to file a claim, including required documentation and a step-by-step instructional video, visit our gap insurance claim page.
TIP: When completing a paper claim form, please submit a separate form for each unique diagnosis.
Where do I get a claim from?
You can download and print a paper claim form here. Please note, paper claim filing is not the fastest option. File a claim online or through AFmobile to get your money faster.
For more details on how to file a claim, including required documentation and a step-by-step instructional video, visit our gap insurance claim page.
TIP: When completing a paper claim form, please submit a separate form for each unique diagnosis.
What documentation do I need to submit?
When filing a gap insurance claim, you will need to provide the following documentation:
- Statement of Insured, completed via online claim filing or paper claim form
- Itemized Bills with diagnosis from each of your providers with a complete breakdown of charges for each date of service
- Explanation of Benefits (EOB) from your primary medical insurance carrier
We may also need:
- Authorization to Disclose Information Including PHI: This form gives us authorization to get records from your medical provider(s) and others who may hold information necessary for us to review your claim. Upload the form via your online account, or mail or fax it.
TIP: When completing a paper claim form, please submit a separate form for each unique diagnosis.
What is the processing time once a claim is submitted?
Claims are generally processed within 5-7 business days.
Benefits
What is an Inpatient Hospital Benefit?
This benefit helps pay for the difference between the actual expenses you (the Insured) incur as an inpatient and the amount your primary medical plan pays for out-of-pocket charges. An inpatient stay is considered inpatient if you are confined to the hospital for 18 hours or more and are charged for room and board facilities.
What is an Outpatient Benefit?
This benefit helps pay the difference between the actual expenses you (the Insured) incur as an outpatient and the amount paid by your primary medical plan for out-of-pocket covered charges. The outpatient benefit covers:
- Outpatient ER Visits
- Diagnostic Testing
- Outpatient Surgery
What is the Physician Office Benefit?
You may receive this benefit (as detailed in the plan’s Schedule of Benefits) for visiting a physician’s office, with a maximum of five visits per family per calendar year.
Is there a per year maximum on the Inpatient or Outpatient benefits?
The plan selected will determine the occurrence maximum. Log in to your online account to view your policy details.
Eligibility
Do I need to have medical insurance to have this coverage?
Yes. You (the Insured) and your dependents must be covered by your employer’s group major medical or comprehensive medical policy. Coverage will not be extended to medical plans that include TRICARE, Medicaid, Health Savings Accounts (HSA), or Health Reimbursement Accounts (HRA).
Can I purchase a gap insurance policy if I am on my spouse’s medical plan?
No. Eligible employees and dependents must be covered under the employer’s major medical or comprehensive medical policy.
I have a pre-existing condition, will this be covered under the policy?
Pre-existing conditions will NOT be covered for the first 12 months unless state deviations apply. Log in to your online account to view your policy details.
If my medical plan did not cover a procedure, would I be able to use my gap insurance policy to help with these costs?
Any expense for which benefits are not payable under the covered person’s medical plan are excluded under this plan.
Log in to your online account to view your policy details.
Need help?
If you need assistance filing a claim, visit the gap insurance claim page.