Gap Insurance Support
Frequently Asked Questions
AF™ Limited Benefit Hospital GAP PLAN® Insurance is a group supplemental insurance product designed to provide benefits that cover certain out-of-pocket expenses as a result of medical treatment for injury or sickness. It is paired with the employer’s medical plan based on the medical deductibles available to the employees.
No. Gap insurance pays toward the deductible, co-insurance, or other out-of-pocket expenses related to inpatient confinement or treatment while hospital indemnity insurance is designed to offer benefits per day spent receiving inpatient treatment. Gap insurance also coordinates with most major medical insurance plans, but not a High Deductible Health Plan (HDHP) or a Health Savings Account (HSA). Hospital indemnity insurance is compatible with an HSA, but doesn’t coordinate with a major medical plan.
To learn more about the differences between gap and hospital indemnity insurance, read this blog
Benefits are paid directly to you, so you may use the money toward medical costs or daily living expenses as needed.
For American Fidelity to release information to anyone other than the insured, the insured will need to complete the Friends/Family Authorization to Disclose Information Including PHI form.
Or, the insured may create and submit a signed and dated statement indicating who they are giving authorization to speak on their behalf. If the insured is unable to sign their own authorization, we would need a Power of Attorney on file to release any information.
The fastest way to file a gap insurance claim is through your online account or our mobile app, AFmobile®.
- Online
- Log in to your online account
- Click the File a Claim button
- Select Insurance Claim
- Upload the requested documentation and click the Upload File button
- Click the Next button and enter the remaining information
- Check the acknowledgment box and click the Submit button
- AFmobile
- Touch the File a Claim button on the AFmobile dashboard
- Select the policy you are filing a claim and touch the Choose Files button
- Either snap a photo of your documentation and touch the Attach Documents button or upload it from your mobile device and hit Next
- Follow the prompts and fill out the required information
- Check the acknowledgment box and click on the Submit button
- Fax or Mail
- Download and complete a gap insurance claim form here. Please note, paper claim filing is not the fastest option.
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.
TIP: When completing a paper claim form, please submit a separate form for each unique diagnosis.
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, mail it in, or fax it.
Claims are generally processed within 5-7 business days after all required documentation is submitted.
The fastest way to check the status of a claim is through your online account, or on our mobile app, AFmobile®.
- Online
- Log in to your online account
- Click on the Claims tab
- AFmobile
- From the AFmobile dashboard, scroll down to Insurance Claims
- Once a claim has been processed, find the status of the claim under the insurance policy name
This benefit provides payments for Inpatient Hospital treatment, defined as hospital confinement for 18 consecutive hours or more and charges for room and board facilities. This benefit can be used to cover out-of-pocket costs that result from plan deductibles, copayments, and co-insurance not covered by your health insurance plan.
This benefit provides payments for outpatient treatment that can be use to cover out-of-pocket costs that result from plan deductibles, copayments, and co-insurance not covered by your health insurance plan. The outpatient benefit covers:
- Outpatient ER Visits
- Diagnostic Testing
- Outpatient Surgery
You may receive this benefit for visiting a physician’s office, with a maximum of five visits per family per calendar year.
The plan selected will determine the occurrence maximum. Log in to your online account to view your policy details.
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).
No. Eligible employees and dependents must be covered under the insured's employer’s major medical or comprehensive medical 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.
Any expense for which benefits are not payable under the covered person’s medical plan are excluded under this plan.
File a Hospital GAP PLAN® Insurance Claim
The fastest way to file a gap insurance claim is through your online account or our mobile app, AFmobile®. Download AFmobile from the App Store® or Google Play™.
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