SUPPLEMENTAL HEALTH COVERAGE

SUPPLEMENTAL
HEALTH COVERAGE
GAPS IN MEDICAL COVERAGE MAY RESULT
IN UNEXPECTED COSTS TO EMPLOYEES
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SUPPLEMENTAL HEALTH COVERAGE
WE’VE GOT YOU COVERED
The health insurance market has radically changed in the past
few years, leaving many employers to question how they can
best meet their employees’ benefit needs. Companies have
been forced to make tough decisions about the benefit plans
they offer, often opting to increase deductibles and other
out-of-pocket expenses rather than terminate medical plans
altogether due to rising costs. Unfortunately, there are
already reports of employees avoiding medical treatment at
the onset of symptoms in order to avoid the need to pay for
care. In many ways, this behavior defeats the purpose of the
Affordable Care Act (ACA).
This turmoil has led to a strong need in the market for
supplemental health products, to help cover some of the
additional out-of-pocket expenses for employees. But the
introduction of these products also brings more confusion.
The size of the company, the type of major medical plan and
the type of employment offered — these are all factors that
greatly impact which products are right for your organization.
ACE’s Accident & Health division is pleased to offer this
breakdown to help organizations of all sizes identify the
supplemental health coverage that could be most beneficial
to both your company and your employees.
I AM A SMALL- OR MID-SIZED BUSINESS
What does this mean?
• I employ fewer than 250 employees.
• I provide major medical coverage to my employees.
GAP Supplement Insurance Coverage and Benefits:
• Supplements an employer’s major medical plan by
reimbursing individuals for covered out-of-pocket expenses
for which they are responsible.
• Hospital Benefit reimburses deductibles, coinsurance and
other eligible out-of-pocket expenses for covered benefits
incurred during an inpatient hospitalization.
• Optional Outpatient Benefit reimburses eligible out-ofpocket expenses incurred for hospital emergency room
visits (not admitted) and use of outpatient surgical,
diagnostic testing and other similar facilities licensed to
provide outpatient treatment.
• Optional Ambulance Benefit reimburses eligible out-ofpocket expenses incurred for transportation provided by a
licensed ambulance company to the nearest hospital.
• Coverage is guaranteed issue — no health questions are
asked and no health underwriting is required.
• Individuals covered under ACE’s GAP Supplement Plan
must also be covered by their employer’s major medical
plan.
• I have access to state healthcare exchanges.
I AM A LARGE EMPLOYER
• I have either moved or am contemplating moving to
a high deductible health plan due to rising costs.
What does this mean?
• I employ more than 250 employees.
How can ACE help?
Few medical insurance plans pay 100 percent of the
expenses for hospital and medical care. Even qualified health
plans usually require an individual to cover deductibles, copays, co-insurance and other out-of-pocket expenses — which
can add up to thousands of dollars a year. This is a significant
burden on workers, and can negatively impact your ability to
keep the best workers as they seek opportunities with larger
organizations that can better cover their benefit needs.
ACE’s GAP Supplement Insurance Plan is specifically
designed to fill the gaps of an underlying major medical plan.
Employers purchase this coverage directly, and offer it to
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their employees as an additional benefit. Why? Because even
when combined with the cost of your underlying major
medical plan, it still costs less than a medical plan that offers
low out-of-pocket expenses. That means savings for the
employer and a reimbursement of expenses not otherwise
covered for the employee.
• I have either implemented a high deductible health plan
or am increasing deductibles under my existing plan.
• I have an in-network deductible of $1,500 or more.
• I don’t have access to state healthcare exchanges and
am searching for optional cost sharing solutions to offer
my employees.
How can ACE help?
Hospital and medical charges have risen significantly in the
past few years, and few major medical plans cover all of the
expenses associated with a hospitalization. Unfortunately,
most individuals need to rely on their savings to make up
the difference.
SUPPLEMENTAL HEALTH COVERAGE
ACE’s Hospital Cash Supplement Plan helps defray the
costs associated with a hospital stay, so individuals don’t have
to turn to their savings when facing higher hospitalization
expenses that aren’t reimbursable under their healthcare plans.
This coverage is voluntary, which means the employer offers it
as part of a larger benefit package, but it’s purchased by the
employee and paid through convenient payroll deduction.
Hospital Cash Supplement Plan Coverage and Benefits:
• Standard policy benefits include a hospital admission
benefit as well as a daily lump sum benefit for each day
an individual remains confined in a hospital, typically for
up to four or five days in a policy year.
• Optional ICU benefit doubles the daily confinement
benefit amount for days in which confinement is in an ICU.
• For an additional premium, employers can offer an
additional package of benefits, including coverage for
emergency room visits, outpatient surgery and
ambulatory services.
• Features a Fast Track Claims process that allows an
individual to submit claims online or over the phone in
as little as five minutes; assuming the information
provided is complete and accurate, claims are processed
and checks issued within four business days.
• Coverage is guaranteed issue — no health questions
are asked and no medical underwriting is required.
• Health Savings Account (HSA) compatible — purchasing
these plans will not disqualify the tax preference of any
HSA included in the employer’s high deductible plan.
• Indemnity benefits are payable regardless of any other
medical coverage employees may have.
I am a large employer...
and I self-fund my major medical plan:
In addition to the Hospital Cash Supplement Plan, large
employers who self-fund their major medical plans can
take advantage of ACE’s Medical Stop-Loss Insurance,
to help control the increasing costs of specific large
claims and/or overall higher than expected claims. With
this coverage, employers continue to self-fund to a
certain dollar amount, but are able to rely on this
insurance to help cover costs in excess of deductibles
in the plan.
I EMPLOY PART-TIME OR CONTRACT WORKERS
Many classes of employees — such as hourly or seasonal
workers, retail stock or sales employees, restaurant workers
and certain healthcare professionals — don’t qualify for
traditional health insurance benefits. Employers often struggle
with what to offer these employees.
How can ACE help?
ACE’s Limited Medical Insurance Plan is specifically
designed to help employers in this situation, providing fixed
indemnity benefits for part time and contracting employees.
Designed for affordability, this coverage offers the basic
health benefits most individuals need most — doctor’s visits,
diagnostic lab fees, short hospital stays and other indemnity
benefits. This plan does not provide the minimum essential
coverage required by the ACA, but does provide fixed
indemnity benefits for covered services.
Limited Medical Insurance Plan Coverage and Benefits:
• Standard plan includes office visits, diagnostic services,
laboratory, hospital indemnity, intensive care unit and
Accidental Death & Dismemberment (AD&D).
• Additional benefits may include wellness, surgery, physical
therapy, inpatient mental health, critical illness,
prescription drug or vision benefits.
• Limited accident and sickness indemnity plans can be
packaged with other accident medical benefits, such as
supplemental AD&D or dental plans.
• Preferred provider plans are available to maximize
benefit dollars.
• Convenient payroll deduction makes it easy to apply
and administer the program.
• Weekly pay and continuation options make it easy to
go in and out of coverage or continue coverage when an
employee is no longer working for the group sponsor.
• Optional coverage is available for eligible spouses and
dependent children.
• Coverage is guaranteed issue — no health questions
are asked and no health underwriting is required.
• Indemnity benefits are payable regardless of any other
medical coverage employees may have.
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FOR MORE INFORMATION
To find out more about how ACE’s Supplemental Health product
offerings can be customized to meet your specific needs, contact:
Jaede Barg
(732) 945-2302
[email protected]
www.acegroup.com/us/supplementalhealth
Insurance is provided by ACE American Insurance Company, Philadelphia, Pennsylvania, or, in some states, other insurers within ACE Group. Product
highlights are summaries only. Please see the actual policy for terms and conditions. Products may not be available in all locations, and remain subject
to ACE Group’s underwriting criteria.
ACE’s Accident & Health division is part of ACE USA, the U.S.-based operating division of ACE Group. ACE Group is a global leader in insurance and
reinsurance, serving a diverse group of clients. Headed by ACE Limited (NYSE: ACE), a component of the S&P 500 stock index, ACE Group conducts its
business on a worldwide basis, with operating subsidiaries in 54 countries.
©2015 ACE
617573 10/2015