In accordance with, the Affordable Care Act (ACA),  Medical Gap premium may not exceed 15% of the employer group’s major medical premium.

Medical Gap 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.

Medical Gap 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 Medical Gap available, but by law employees can only contribute to one of them in the same benefit year.

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. Medical Gap 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 (“Medical Gap”) 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: AK (SPI GGAP0915 P AK), AL (SPIGGAP0915P), AR (SPI GGAP0915 P AR), AZ (SPI GGAP0915 P), CO (SPI GGAP0915 P CO), DC (SPI GGAP0915 P), DE (SPI GGAP0915 P DE), FL (SPI GGAP0915 P FL), GA (SPI GGAP0915 P MO), HI (SPI GGAP0915 P), IA (SPI GGAP0915 P), IL (SPI GGAP0915 P IL), IN (SPI GGAP0915 P IN), KY (SPI GGAP0915 P KY), LA (SPI GGAP0915 P LA), MA (SPI GGAP0915 P MA), MD (SPI GGAP0915 P MD), MO (SPI GGAP0915 P MO), MS (SPI GGAP0915 P MS), MT (SPI GGAP0915 P MT), NC (SPI GGAP0915 P NC), NE (SPI GGAP0915 P), NV (SPI GGAP0915 P NV), OH (SPI GGAP0915 P), OK (SPI GGAP0915 P OK), OR (SPI GGAP0915 P OR), PA (SPI GGAP0915 P PA), SC (SPI GGAP0915 P), SD (SPI GGAP0915 P SD), TN (SPI GGAP0915 P), TX (SPI GGAP0915 P TX), WI (SPI GGAP0915 P WI), WV (SPI GGAP0915 P), WY (SPI GGAP0915 P), VA (SPI GGAP0915 P VA)

Administered by:
United Group Programs, Inc. or
90 Degree Benefits

Please note: If selected, the OptiMed plan (Administered by United Group Programs, Inc) invoice will include the applicable fee for non-insurance programs and distribution fees.  These are optional non-insurance benefits, including but not limited to Online Services and HR Administration, Telephonic Doctor Visits, Patient Advocacy, Section 125 POP, and Cobra Administration.  These programs are NOT insurance, and are not underwritten by, associated with, nor administered by, ShelterPoint Life Insurance Company or ShelterPoint Insurance Company.