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Deductible Guard2023-02-21T00:00:26+00:00

DEDUCTIBLE GUARD BENEFITS

Have you shopped for medical gap plans in the past and been less than impressed with poor plan designs, inconsistent Inpatient/Outpatient benefits, per occurrence deductibles, age banded rates, and inefficient claims service? If you have experienced the pain of poor gap plans, it’s time to take a look at Deductible Guard, a true secondary health insurance plan specifically designed to mirror major medical plan benefits, all while lowering the employee’s deductible, reducing out-of-pocket exposure, and saving premium cost.

The common complaint that there are “gaps in the gap” does not apply to our secondary plans. There are no limitations or exclusions outside of the major medical plan, and supplemental benefits will not exhaust prior to reaching either the primary plan deductible or out-of-pocket max. Deductible Guard is built to sync with major medical and feel like one plan to the employee, as it should.
A properly designed supplemental health insurance plan should positively impact a group’s major medical claims experience and offer a creative solution to maintain desired benefits while offering cost savings and meeting the Affordability Test under ACA mandates.

BENEFIT

OPTIONS
Deductible per Covered per Calendar year  $100;  $250;  $500;  $1,000;  $1,500;  $2,000;  $2,500
Deductible per Family per Calendar year  2x or 3x multiple consistent with Primary Plan
Inpatient/Outpatient Benefit  Tailored benefit amount to fulfill the primary plan deductible or out-of-pocket max
Coinsurance Percentage  Primary Plan matching coinsurance at 50%, 60%, 70%, 80% or 90%  or 100% coinsurance
Physician Office Benefit Rider  Pays a portion of PCP and specialists office visit copays

  • Coverage is fully insured group, guaranteed issue and not offered on a voluntary basis

  • Includes no limitations or exclusions outside of the primary health plan with no pre-existing conditions

  • Eligible charges are any charges which are allowed under the Major Medical Plan subject to deductible and coinsurance provisions

  • No more than 100% of eligible charges will be paid by both plans

  • Quoted rates are based upon benefits as outlined in the Major Medical Plan summary attached to the Application for Supplemental Insurance

  • Changes to the primary health plan without notification will render this quote invalid; rates are subject to change in the event of a 10% variance in census eligibility from the time of original application

  • Supplemental medical expense coverage issues through age 70

  • No agent/broker can bind coverage without the authorization of Deductible Guard

QUESTIONS YOUR EMPLOYEES MAY HAVE

How do I make sure I properly use the coverage available to me?2023-02-17T22:58:37+00:00

It is important when reasonably possible to stay within network for health services. Your primary and secondary plans will pay a higher benefit level, saving you money. Major medical carrier networks are very comprehensive, making this less of a concern. You will receive a Deductible Guard ID card for your plan to present every time you receive medical care.

Can I purchase Deductible Guard alone for myself or a dependent?2023-02-17T06:54:54+00:00

No, this supplemental plan works in sync with your primary health plan and is not a replacement for major medical coverage

What about limitations, exclusions or pre-existing conditions?2023-02-17T06:54:40+00:00

Deductible Guard has no limitations or exclusions outside of the primary health plan and no pre-existing condition clauses.

Will I have to pay the provider and then seek reimbursement?2023-02-17T22:59:51+00:00

No, benefits under both plans are payable directly to the provider. The provider will verify eligibility and Deductible Guard will pay from the EOB processed by the primary plan. In the event a claim isn’t filed properly, we do everything possible to take the burden off the member. Notify our claims department with date of service and we will take the lead in contacting the provider for necessary documentation to get the claim paid.

How will supplemental coverage actually save me money?2023-02-17T23:01:49+00:00

Let’s look at a simple claim example of inpatient surgery to repair a leg fracture using both a stand alone high deductible, max out-of-pocket major medical plan with 80% coinsurance and then the composite plan paired with a $1,000 deductible Deductible Guard supplemental plan with matching coinsurance.

Inpatient Surgery totaling $14,250

Stand Alone Medical Plan:

You pay $5,000 to meet your deductible but that still leaves a balance owed of $9,250. You will share in that portion at 20% and your health plan will share at 80%. To satisfy the bill, you will pay a total of $6,850 and the plan will pay $7,400. Also note that you will have satisfied your Max Out of Pocket liability.

Composite Plan (Primary and MedPlus together):

You pay $1,000 to meet your MedPlus deductible but that still leaves a balance owed of $13,250. You will only have to meet your remaining coinsurance share to the additional $1,170 while the supplemental plan pays $4,680 and again the primary plan pays $7,400.

In this scenario, supplemental coverage would have saved you $4,680 and you have also satisfied your Max Out-of-Pocket liability.

INFORMATION REQUIRED
FOR GROUP QUOTE:

  • Completed Supplemental Application

  • Census count in Excel format

  • Current Primary Health Plan with Summary of Benefits and Rates along with Alternative Renewal Options and Rates

  • If prior gap coverage, copy of renewal rates and benefits.

CONTACT

P.O. BOX 1887
Birmingham, AL 35201

205-715-3567
Request a quote: quotes@deductibleguard.com
Submit a claim: claims@deductibleguard.com

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