Frequently Asked Questions

Secondary coverage (commonly referred to as "GAP") is supplemental medical coverage that is purchased by an employer group in conjunction with a Primary Medical plan to offset high out of pocket expenses for individuals and families.

Unpaid medical bills can create financial hardship for almost every family. Bankruptcy, depleted savings, and loss of real estate are a few risks directly associated with medical plans that have high out-of-pocket exposure. Secondary coverage can eliminate or reduce that risk significantly.

After the Pre-Med Defender deductible is satisfied, the coverage will pay benefits until the Maximum Benefit amount has been reached. Depending on the employer's plan design, it will help pay for covered in-patient and out-patient charges that are applied to the primary medical plan’s deductible, coinsurance, and co-payments.

Pre-Med Defender will pay the applicable benefit percentage for the Covered Expenses up to the Coverage Year maximum. The Covered Person must be under a doctor’s care, and the treatment must be for covered Injury or Sickness.

Covered Expenses are the unpaid portion of charges for medical care, treatment and services that are eligible for reimbursement under and deemed allowable by the Policyholder’s other Health Benefit Plan, which are not excluded from coverage under the policy.

No, but Pre-Med Defender is like those plans in that it can be funded with pretax dollars and can pay for a members’ out-of-pocket medical expenses. However, with HSA’s, FSA’s, and HRA’s, for every $1 you contribute you have $1 of benefit, whereas Pre-Med Defender funding operates on a premium and typically a $1 contribution equals $6 to $8 of benefit.

Since the Pre-Med Defender coverage is a "true Supplemental plan" to an existing Major Medical plan; we follow the same guidelines as your Primary Medical plan. So, if something is not covered or allowed by your Primary plan, then the Pre-Med Defender will not cover it as well. We also follow the waiting period and eligibility requirements of the in force medical plan.

No. It is NOT intended to replace your current provider or health plan, but rather it works in conjunction with your primary medical plan whether it is fully insured or self-funded.

Benefits are limited to the deductible, co-payment, and co-insurance amounts the insured is required to pay under their major medical policy, subject to provisions, limitations, and exclusions of the policy.  Pre-Med Defender plans have no pre-existing condition clauses.

With our Pre-Med Defender plan, participants and providers will understand that there are two forms of coverage, and there are two different payer ID’s.

1. Primary Major Medical Plan (Card One) and
2. Pre-Med Defender Supplemental Plan (Card Two – "Secondary Coverage").

Therefore, healthcare providers and/or facilities should automatically send Primary Coverage claims information electronically for processing. Once that process has taken place and your initial claim is accepted and processed, our job is to make sure your provider has the information they need to make sure your "secondary benefits" (or Pre-Med Defender benefits) are paid as well.

If you have questions regarding eligibility or claims, please refer to the number located on the back of your Pre-Med Defender ID card.  If you have lost your card or need additional assistance, you can call customer service at 1-866-972-2368.  We are available Monday through Friday, from 8am to 5pm CST.

The main purpose of a secondary plan is to help cover the out-of-pocket costs of the patient. From a claim’s perspective, it will reduce the amount of uncollected Accounts Receivable by shifting those claims to a highly rated insurance company verses the patient.

Most providers will file both the primary and secondary claims. Members simply need to provide both their primary medical card as well as their Pre-Med Defender card to the provider. Once the healthcare provider receives the Primary Carrier EOB, they then submit the secondary claim by filing electronically, by fax or by mail. For claim adjudication, filings must include a copy of the Primary Carrier’s EOB.

No, benefits under both your primary and secondary plans are payable directly to the provider. The provider will verify eligibility and the secondary plan will pay off the EOB processed by the primary plan. In the event a claim isn’t filed properly, members can notify our customer service center with the dates of service, and we will take the lead in contacting the provider for necessary documentation to get the claim paid.

There is no fee schedule. Pre-Med Defender will pay the patient’s portion of the claim (i.e., copays, deductible, and coinsurance) directly to the providers on a dollar-for-dollar basis. The amount that the patient owes is determined by the underlying primary insurance carrier’s contract and can be found on the primary carrier’s EOB.

No. Pre-Med Defender does not have a specific network. In fact, the network will mirror your current provider’s network. In other words, if a doctor (or facility) is in your primary medical provider’s network, then he or she will also be in the Pre-Med Defender network.

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