Total Gap Insurance
Bridge the Gap Between Coverage and Costs
Total Gap Insurance is a supplemental benefit that pays cash directly to employees when they receive covered medical services, helping cover deductibles, coinsurance, and other out-of-pocket expenses that traditional health insurance doesn't cover.
What makes it different?
Unlike traditional insurance that pays healthcare providers, Gap Insurance pays cash directly to employees when they receive covered services. Employees can use these funds for any purpose: medical bills, lost wages, childcare, or everyday expenses during recovery.
Understanding Gap Insurance
Ideal For
Employers offering high-deductible health plans (HDHPs) who want to provide additional financial protection for employees. Particularly effective for businesses with 10+ employees where medical emergencies could create significant financial hardship. Gap Insurance can be employer-paid, voluntary (employee-paid), or shared contribution.
The High-Deductible Reality
As deductibles rise, employees face increasing financial exposure when they need care.
Average Individual Deductible
Average Family Deductible
Employees Can't Cover Deductible
Cause of Personal Bankruptcy
Employer Benefits
- ✓Enhanced Benefits Package
Add valuable protection without major cost increase
- ✓Flexible Contribution Options
Employer-paid, voluntary, or shared cost arrangements
- ✓Improved Retention
Employees value comprehensive protection, which reduces turnover
- ✓HDHP Complement
Makes high-deductible plans more attractive to employees
- ✓Simple Administration
Easy enrollment and minimal ongoing management
Employee Benefits
- ✓Financial Protection
Cash to cover deductibles, copays, and unexpected expenses
- ✓Direct Payment
Benefits paid directly to you, not the healthcare provider
- ✓Use Funds Freely
Cover medical bills, lost wages, childcare, and anything you need
- ✓Affordable Coverage
Low premiums for significant protection when you need it most
Traditional Health Insurance vs. Gap Insurance
Traditional Health Insurance Only
(Employee pays out-of-pocket)
- •High deductibles leave employees exposed ($5,000-$15,000)
- •Coinsurance adds additional costs (20-40%)
- •Unexpected bills can devastate family finances
- •Employees may delay care due to cost concerns
With Total Gap Insurance
(Cash benefits paid directly to employee)
- ✓Fixed cash benefits offset deductible costs
- ✓Hospital, surgical, and accident benefits provide immediate relief
- ✓Employee keeps leftover funds for any purpose
- ✓Peace of mind encourages timely healthcare utilization
"Gap Insurance turns a $7,000 out-of-pocket expense into just $1,000."
Real-World Example
Employee Has Appendix Surgery
Without Gap Insurance:
- Hospital bill: $45,000
- Insurance pays: $28,000
- Employee owes: $7,000 (deductible + coinsurance)
With Gap Insurance Benefits:
- Hospital admission benefit:$1,500
- Surgery benefit:$3,000
- Anesthesia benefit:$500
- Daily hospital stay (2 days):$1,000
Frequently Asked Questions
What does Gap Insurance cover?
Gap Insurance provides fixed cash benefits for hospital stays, surgeries, accidents, critical illness diagnoses, and other covered medical events. Benefits vary by plan but typically include hospital admission, daily hospital stay, surgical procedures, ambulance, ER visits, and more.
How do employees receive benefits?
When an employee has a covered medical event, they submit a simple claim with proof of service (like an EOB or receipt). Benefits are typically paid directly to the employee within days, not to the healthcare provider.
Can Gap Insurance be used with any health plan?
Yes! Gap Insurance works alongside any health insurance plan: group, individual, HDHP, PPO, or HMO. It's especially valuable paired with high-deductible health plans where employee out-of-pocket costs are highest.
How much does Gap Insurance cost?
Premiums are typically $25-75/month depending on coverage level and whether it's employee-only or family coverage. Employers can offer it as a voluntary benefit (employee-paid), employer-sponsored, or shared contribution.
Free Resources
Download our guides to evaluate if Gap Insurance is right for your organization.
Employee Communication Kit
Materials to help employees understand Gap Insurance benefits.
Download PDFGetting Started
Coverage analysis
Plan design & pricing
Employee education
Enrollment period
Coverage activation