All descriptions below are based on a broad overview of the majority of state's coverage available in the plan. Some coverage amounts or coverage availability may vary by state. Always review the state specific Certificate of Insurance for each plan to determine coverage benefits, availability, terms, conditions, limitations & exclusions. If there are any discrepancies between the descriptions below and the Certificate, the Certificate will govern.
TRUGAP COMPREHENSIVE
Designed to Supplement
Bronze ACA Plans.
Group Supplemental Medical Insurance
INDIVIDUAL PLAN YEAR BENEFIT MAXIMUM
$7,500 per Covered Person per Plan Year
Plan Year Benefit Maximum per Family - 2 times the Individual Maximum
DEDUCTIBLE - $1,000 per Covered Person
Combined Inpatient Hospital & Outpatient Plan Year Deductible
Maximum Deductible per Family - 2 times the Individual Deductible
- INPATIENT OR OUTPATIENT
- SICKNESS OR ACCIDENTS
- 30 DAY WAITING PERIOD
This supplemental insurance pays for pre-existing conditions and is guaranteed issue. TruGap Comprehensive is designed to fill in the gap and cover 100% of a $7500 Bronze ACA deductible for covered medical expenses (after TruGap's $1000 deductible is met1).
You must have a comprehensive ACA Bronze Plan in order to enroll in this supplemental plan.
1Some coverage amounts or coverage availablity may vary by state. Always review the state specific Certificates of Insurance for the supplemental insurance plan to determine coverage benefits, availability, terms, conditions, limitations & exclusions. If there are any discrepancies between the descriptions above and the Certificate, the Certificate will govern. Prescription coverage and Physician office visits are not covered with TruGap. Coverage ends for covered member upon turning 65.
Group Supplemental Medical Insurance is underwritten by SiriusPoint America Insurance Company.
Turn a Bronze ACA Plan into a Gold ACA plan
with TruGap Comprehensive
If you select a Bronze Plan with a $7500 deductible and then you add TruGap Comprehensive which pays a $7500 benefit with a $1000 deductible for inpatient and outpatient covered medical expenses, you will have an out-of-pocket deductible expense of only $1000 which is the deductible offering of most Gold ACA plans.
Subject to covered expenses, schedule of benefits, terms, definitions, provisions, limitations & exclusions of the Policy & Certificate of Insurance. There are four metal level plans with ACA: Bronze, Silver, Gold & Platinum. To learn more about all your options for Affordable Care Act (ACA) plans or to enroll in ACA coverage, go to healthcare.gov or contact your insurance agent.
NO Network Restrictions with TruGap
Visit any lab, outpatient clinic, or hospital with TruGap Comprehensive.
HOW DO CLAIMS WORK?
- Present both cards at Provider's office. (Your ACA or Group Major Medical card & your Supplemental TruGap ID Card).
- Provider files a claim with your ACA or Group major medical primary insurance provider carrier.
- Your primary insurance carrier sends provider payment and explanation of benefits (EOB).
- Provider files claim with TruGap claim's administrator. TruGap claim's administrator sends payment to provider and EOB statement to Member.
ASSOCIATION BENEFITS
PROVIDED BY:
GROUP SUPPLEMENTAL MEDICAL INSURANCE
UNDERWRITTEN BY:
SiriusPoint America Insurance Company
BILLING, FULFILLMENT &
CUSTOMER SERVICE PROVIDED BY:
*Billing is administered through the Third Party Administrator
of H A Partners, Inc. or HealthyAmerica (depending on state).
THE INSURANCE PORTIONS OF THIS MEMBERSHIP PLAN PROVIDE LIMITED COVERAGE. THEY DO NOT PROVIDE COMPREHENSIVE MAJOR MEDICAL INSURANCE. COVERAGE IS PROVIDED UNDER GROUP SUPPLEMENTAL MEDICAL INSURANCE ONLY POLICIES.
The following monthly insurance rates apply to coverage underwritten by SiriusPoint America Insurance Company*. Your overall total association membership dues for the optional supplemental TruGap Comprehensive plan also include these monthly insurance rates:
*Under Age 55:
$134.19 (Member), $256.72 (Member+Spouse)
$240.23 (Member+Child(ren)), & $344.75 (Family)
*Age 55+:
$201.28 (Member), $398.54 (Member+Spouse)
$259.24 (Member+Child(ren)), & $439.92 (Family)
Read the Certificate(s) of Insurance carefully. This is a brief description of one of the various group association insurance membership plans and is not an insurance contract, nor part of the Certificate of Insurance and is subject to the terms, conditions, limitations, and exclusions of the Group Policy and Certificate(s) of Insurance. Coverage may vary or may not be available in all states. You’ll find complete coverage details in the Certificate(s) of Insurance. Group Supplemental Medical Insurance is underwritten by SiriusPoint America Insurance Company, New York, NY. The insurance described in this document provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act. Coverage for Group Supplemental Medical Insurance ends at age 65. Membership plan cost for TruGap Comprehensive plan does not include the separate $10 UBA Membership dues. You must be a member of the United Business Association in order to purchase this membership plan.
United Business Association, SiriusPoint America Insurance Company, and HealthyAmerica are separate legal entities and have sole financial responsibility for their own products.
HASA-GAP-1000
