Page 24 - 2020 Benefits Guide

Medical Gap Insurance

Benefits Provided Dependent Eligibility
The Gap Plan is a fully insured product If your dependents are eligible for
offered through Sun Life Financial. coverage in the BCBS Medical Plan
This plan provides payment to you for sponsored by the Company, they are
out of pocket expenses due to hospital eligible for enrollment in the Gap Plan.
confinements and outpatient treatment Individuals in your family on whom you
for a covered injury or sickness up to the expect to receive reimbursement under
plan’s annual calendar year limits. the Gap Plan must also be enrolled in the
Medical Plan.
Sun Life looks only to the BCBS EOB to
substantiate your out-of-pocket costs in
determining your reimbursement under the
Gap Plan. It is permissible for you to claim
the same expense under a health flexible
spending account, if applicable. A medical
GAP claim form is located on the company
Intranet.

Cost of Coverage
The cost of coverage in the Gap Plan is
100 percent paid for by the employee. The
premiums are age-banded, based on the
employee’s age as of January 1, 2020.
Premiums are withheld on a pre-tax basis.

Dan Magno, Sales Product Manager *Enrollment in the Medical Gap Plan is
Albuquerque, NM Lumber contingent on enrollment in one of the
company sponsored medical plans where
you are NOT also contributing to a Health
Savings Account (HSA).

Weekly Rates Bi-Weekly Rates
<40 40-49 50+ < 40 40-49 50+
Employee 8.05 11.02 18.02 15.80 21.64 35.37
Employee + 14.50 19.84 32.42 28.46 38.94 63.64
Spouse
Employee + 17.86 20.33 29.25 35.05 39.92 57.41
Child(ren)
Employee + 24.30 29.14 43.64 47.69 57.21 85.67
Family

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