Frequently asked questions

Medical Gap Inpatient/Outpatient Insurance

Below you’ll find answers to the questions we get asked the most when
inquiring about Med-Gap Insurance

What is Medical Gap Insurance?

Medical Gap Insurance is designed to offset the out of pocket costs associated with your FEHB medical plan as a result of inpatient and/or outpatient care. These costs include things like deductibles, copays, and coinsurance. Coverage includes inpatient hospital stays, inpatient surgeries, and physician’s in-hospital charges. Coverage even includes emergency room treatment if the ER treatment results in a hospital admission.

Note: Routine newborn nursery care and well-baby care is not a covered expense.

Are there exclusions and limitations?

For an expense to be eligible under the medical expense insurance plan, it has to be covered under your FEHB medical plan. If an expense is denied by your FEHB medical plan, but would otherwise have been an eligible expense under the medical expense insurance plan, it will not be covered:

Who is eligible to enroll?

The Medical Expense Insurance plan is open to active and retired federal employees and their family members who are enrolled in the FEHB program. USPS employees are not eligible to enroll.

Do I have to take a physical exam?

No, a physical exam or evidence of health is not required. All eligible employees are given guaranteed acceptance when enrolling on our program.

How does it work?

An Inpatient Medical Expense Insurance policy is designed as a companion to your medical coverage. It can reduce or in some cases, even totally eliminate the inpatient out-of-pocket expenses you or your covered dependents may incur.

What gaps does it fill?

This benefit is designed to offset the cost you incur as an inpatient in the hospital when your health plan applies such expenses to your deductible or coinsurance. Coverage includes inpatient hospital stays, inpatient surgeries, and physician’s in-hospital charges. Also includes coverage for emergency room treatment if the ER treatment results in a hospital admission.

When does the coverage become effective?

You become eligible for benefits under the plan on the first day of the month following the pay period from which an allotment has been taken.

How do I enroll?

Enrollment is a breeze, simple follow our 2 step process:

Step 1: Complete the on-line enrollment form and submit for processing

Step 2: We will mail you instructions for setting up your payment through payroll. Coverage will be effective on the first day of the month following the deduction.

How do I pay for the plan?

Premiums are paid bi-weekly from your paycheck through salary allotment. Monthly-paid employees and Retirees would pay monthly. All premiums are paid after-tax.

When can I cancel the plan?

You may cancel the plan at any time.

When I retire, can I keep it?

Yes, the Medical Expense Insurance plan is available to all retired federal employees and their family members who are enrolled in the FEHB plan.

Can I still contribute to my Flexible Spending Account?

Yes, enrolling on the medical expense insurance plan will not limit your ability to participate in a Flexible Spending Account (FSA).