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Retirees

Posted on: May 15, 2019

Take Advantage of Your Hospital GAP Benefit

Hospital GAP

Many pre-65 aged retirees are enrolled in the American Fidelity Hospital GAP benefit but never file claims. Did you know you can submit claims as far back as when you originally enrolled in the Hospital GAP plan? Don’t leave your money on the table!

Hospital GAP reimburses you in three ways:

In-Hospital
The in-hospital benefit is payable for covered out-of-pocket expenses up to the maximum benefit elected ($500, $1000 or $1500) for an overnight hospital stay due to injury or sickness.

 Outpatient
The outpatient benefit is payable for out-of-pocket covered charges up to a maximum of $200 for outpatient treatment rendered:

  • In a hospital emergency room
  • For outpatient surgery in a hospital outpatient facility or free-standing outpatient surgery center
  • For diagnostic testing in a hospital outpatient facility or MRI facility

All benefits for the same or related conditions will be subject to the maximum outpatient benefit, unless the conditions are separated by 90-consecutive days. New maximum outpatient benefits apply for treatments more than three months apart.

Physician Outpatient Treatment
The physician outpatient treatment benefit is payable for physician visits. This benefit pays $25 per visit for up to five visits ($125) per family per calendar year. This applies to out-of-pocket covered charges for treatment for sickness or injuries due to an accident.   

Filing a Claim:

American Fidelity does not have record of your medical claims because UnitedHealthcare and other carriers don’t provide your health information to them. When submitting a claim form, include itemized bills with diagnosis and a complete breakdown of charges for each date of service.

Reduce claim processing time and receive your money faster by filing online (www.americanfidelity.com) or with the AFmobile® app. Through an online or mobile account, you can file claims, check claim status, sign up for notifications, update personal information, enroll in direct deposit, view your policy and much more!

If filing a claim by mail or fax, complete the claim form fully to avoid delays in processing. For the fastest turnaround, submit separate claim forms for each diagnosis. For updates on the status of processed or paid claims, visit www.americanfidelity.com/myaccount. Contact American Fidelity at 1-800-662-1113 with questions regarding your claim.

For more information, review the Hospital GAP Brochure or contact the HR Benefits Team.

American Fidelity Mobile App Flyer
American Fidelity Hospital GAP Claim Form
American Fidelity Hospital GAP Brochure

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