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Posted on: August 13, 2020

Are You Taking Advantage of Your Hospital GAP Plan?

GAP Insurance Money

If you are enrolled in the American Fidelity Hospital GAP plan, you may not be getting your full benefit. Many employees enroll in the plan, but forget about it or don’t understand what it covers. There are three primary benefits available:

In-Hospital 
The in-hospital benefit is payable for covered out-of-pocket expenses up to the maximum benefit selected ($500, $1000 or $1500) per confinement.

Outpatient 
The outpatient benefit is payable for the out-of-pocket covered charges up to a maximum outpatient benefit of $200 for outpatient treatment in a hospital emergency room, outpatient surgery in a hospital outpatient facility or free-standing outpatient surgery center, and diagnostic testing in a hospital outpatient facility or MRI facility. All benefits for the same or related conditions will be subject to the maximum outpatient benefit, unless such conditions are separated by 90 consecutive days, then a new maximum outpatient benefit will apply.

Physician Outpatient Treatment Hospital GAP
The physician outpatient treatment benefit is payable for physician visits. This benefit pays $25 per visit, for up to five visits ($125) per family per calendar year, for outpatient treatment due to sickness, or outpatient emergency care for an injury due to an accident, at a hospital outpatient clinic, free-standing emergency care clinic, or physician office for out-of-pocket covered charges.

Did you know you can submit claims as far back as you have been enrolled in the Hospital GAP plan?

Here is how to file claims:

  • Fully complete the American Fidelity claim form (attached).
  • For claim consideration of physician office or clinic visit, submit the itemized bills including diagnosis to the address or fax number on the claim form. American Fidelity does not have any records of your medical claims.
  • For ALL other charges, submit itemized bills including diagnosis and the medical carriers’ Explanation of Benefits. If you are enrolled in the City’s UnitedHealthcare medical plan, log onto www.myuhc.com to print statements.

American Fidelity does not provide any personal health information to the City of Plano. For more information, see attached Hospital GAP brochure or contact the HR Benefits Team at HRBenefits@plano.gov.

Hospital GAP Brochure

Hospital GAP Claim Form

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