A few quick notes before we begin: everyone should be muted to avoid background noise during the presentation. If you have any questions, please use the chat feature to the right of your screen. Handouts along with the slide deck are also available for download under the handouts tab. For any Q&A, please use the Q&A section and we will address questions as we go.

Now that everyone knows who I am, I’m excited to welcome Melissa, Patrick, and Daniel with AIS to go over GAP coverage. I hope you find this session valuable, and thank you again for being here. Without further ado, I’ll turn it over to Patrick to get us started.

Thank you very much for taking the time to be on our call today. We really appreciate it. We know your time is valuable, so we’ll be sure to use it wisely. Joining me are Dan Hayden and Alyssa Panaya. Dan and I try to take the credit, but Alyssa does all the work, so she’s really the one doing the heavy lifting.

Today we want to talk about our GAP product, which we describe as an alternative to an HSA plan. HSAs are extremely popular, and we understand why, but this GAP product has been around for at least 15 years and our clients who use it are big fans. It’s often a good option for organizations that may not be the right fit for an HSA—maybe they’re not large enough, or they don’t have the structure or resources to manage an HSA effectively.

What the GAP program does is take a high-deductible major medical plan—say a $3,000 or $5,000 deductible—and reduces the member’s out-of-pocket to something more manageable, like $500 or $1,000. You’re probably wondering how we can do that. The reality is that mathematically, GAP coverage shouldn’t work. The reason it does is because major medical carriers tend to overvalue the financial impact of raising deductibles. When they price out a jump from a $500 deductible to $5,000, they often overestimate the cost difference. That’s where we come in.

We can usually offer a GAP benefit, such as $4,000 or $4,500, at a lower total cost than the major medical premium would have been at that lower deductible. That’s the world we operate in. It’s a very simple plan, and I’ve basically just summarized the essence of it in about 30 seconds. Because it’s simple, quoting it should take you no more than a couple minutes.

If you have a client struggling with high premiums and looking for alternatives, we encourage you to get a GAP quote from us. Best-case scenario, we save your client money. Worst-case scenario, the numbers don’t work, but you still get to show your client that you explored every available option. It’s a win-win.

We’ll walk you through how the product works, how it’s quoted, and how it’s implemented. I also encourage you to ask questions at any time.

It looks like Alyssa briefly dropped off the call, but she’s back. Great. I’ll continue. As you can see, the GAP product is available in 40 states across the country. It’s not available in New Jersey or New York due to filing issues, but otherwise it’s widely accessible.

The GAP plan follows the major medical plan. For example, if a major medical plan has a $5,000 deductible, we can offer a $4,500 GAP benefit that applies toward covered expenses processed toward the major medical deductible. Claims are administered using the EOBs from the major medical carrier. If the major medical plan covers it and applies it to the deductible, the GAP plan does as well. If the major medical plan doesn’t cover it, neither does the GAP. It’s straightforward.

Now that I’ve described the product, I’ll show you an example. A major medical plan with a $1,000 deductible might have a monthly premium of $6,772. That same plan with a $5,000 deductible might drop to $5,481. You would then fill out a GAP quote request form—again, very simple—and once you send it to Alyssa, we typically turn quotes around within 24 hours. We don’t require a census, we don’t rate by age, and we don’t look at medical conditions. It’s all based on the requested benefits and enrollment tiers.

Once you receive the proposal, it will show you the out-of-pocket level, the GAP benefit, and the rates. In the example, combining the $5,000 deductible major medical plan with the GAP benefit brings the total premium to $6,165—very similar coverage to the $1,000 deductible plan but saving the client roughly $7,000 annually.

As I said, it’s not complicated, and we aren’t doing anything mysterious behind the scenes. It’s just a simple process built on how carriers price deductible changes. It won’t always work, but it only takes a few minutes to find out. Either you save the client money, or you show them you thoroughly explored options.

Now that you’ve seen how it’s quoted and what the proposal looks like, you may be wondering how the product works once it’s actually implemented. If the administrative process causes headaches for your clients, it’s not worth doing. Fortunately, we’ve been doing GAP coverage in Pennsylvania for many years, and providers here are very familiar with it, which makes the process smooth and efficient.

With that, I’ll hand it over to Alyssa to walk you through what happens after a case has been sold.

Thank you, Pat. When a member enrolls, they receive a welcome packet that includes a welcome letter and a member ID card. They should present the GAP card along with their major medical card at the time of service. The ID card includes the insured’s name, group information, ID number, effective date, and dependents. The goal is to ensure members feel supported and informed from day one.

Using the GAP card is simple. Members show both their GAP card and their major medical card at the time of service and ask the provider to bill both plans. The GAP plan then helps cover eligible out-of-pocket costs. That’s really all there is to it.

Thank you, Alyssa. To build on that, most providers in Pennsylvania are very familiar with this process and know exactly what to do when they’re handed both cards. Our TPA then processes the claims, keeping the member out of the process in more than 90 percent of cases. Occasionally, a provider may not be familiar with GAP coverage or may refuse to bill both plans. In that situation, the member simply needs to send a copy of their EOB from the major medical carrier to our TPA, and we process it directly.

Once processed, members receive an EOB from our TPA showing what was paid, what wasn’t, and what they owe. It also includes a summary showing how much of their GAP benefit has been used and how much remains.

That brings us to the three unbelievably attractive individuals on your screen. That is the nuts and bolts of the GAP product. It’s straightforward for brokers and simple for members.

At this point, we’d love to open the floor for questions. If you have anything you’d like to ask, please submit it in the Q&A.

While we wait for questions to come in, I’ll start with one for Alyssa. Is there a specific group size or type of employer where GAP works especially well?

Great question, Dan. Our sweet spot is groups with 50 lives and under, but we can go down to three lives. We also have groups in the hundreds, so we’re flexible. We’ve seen success across many industries, including construction, contractors, autobody, nonprofits, manufacturers, and human services.

Thank you, Alyssa. That also reminds me of another advantage of GAP versus an HSA: immediate access to benefits. With an HSA, members need to contribute funds before they can use them. If someone has a $5,000 deductible and ends up in the ER during the first month of coverage, they may have only a couple hundred dollars in their HSA. With GAP, the benefit is available on day one.

We have a question from Jeff: What is the lowest GAP deductible you offer, and what does compensation look like?

Great question, Jeff. We can go down to a $0 deductible. It does get more expensive at that level, but it is available. You can also request multiple scenarios on your quote—zero, $500, $1,000—and compare the pricing. For compensation, since your contracts would be through URL, I would recommend reaching out to the URL team for specifics.

Jeff also asked about the highest major medical deductible we can work with. We can generally go up to $7,000, and we’re flexible if something unusual comes up.

One final note: as we move into the busy renewal season, we encourage you to send over GAP quote requests. They’re quick and easy, and even if the GAP option doesn’t beat the rate, it helps demonstrate thorough due diligence for your clients.

Alyssa will also be at the URL Medicare Conference next week, so feel free to stop by and speak with her in person if you have additional questions.

Thank you again to everyone who joined us today. If you have GAP quotes, please send them over so we can get your groups quoted. We appreciate your time and look forward to working with you. Have a great day.

Thanks, everyone. Bye.