The Gap Plan Strategy: 6 Discovery Questions Every Employer Should Ask

Описание: In this episode of the Cutting Edge Benefits Podcast, Tom Quigley of ClaimLinx breaks down the Gap Plan Strategy and the six critical discovery questions that employers should ask before renewing their healthcare plans.

Many companies rely on traditional insurance structures that leave significant financial gaps between deductibles and coverage, often filling those gaps with additional insurance policies that create even more premiums.

Tom explains why Medical Expense Reimbursement Plans (MERPs) and Health Reimbursement Arrangements (HRAs) can provide a smarter alternative—allowing employers to maintain strong coverage for employees while dramatically reducing unnecessary insurance premiums.

Key Discussion Points
What Is the “Premium Plateau”?

The “premium plateau” refers to the growing problem employers face when healthcare premiums rise year after year, forcing companies to increase deductibles just to control costs.

However, Tom explains that the solution isn’t simply adding additional insurance policies to cover the gaps.

Instead, employers should examine how they structure their plans and consider using tax-advantaged reimbursement strategies that allow them to manage risk internally rather than paying additional premiums to insurance carriers.

The Gap Insurance Dilemma

Gap insurance products are commonly sold to cover the difference between a high deductible and an employee’s out-of-pocket costs.

While these policies can provide limited protection for specific conditions—such as:

Cancer plans

Critical illness policies

Accident coverage

They rarely cover the full spectrum of expenses employees face.

According to Tom, the biggest issue with gap insurance is simple:

It requires paying even more premiums to insurance companies.

Instead, companies can often achieve better outcomes using reimbursement structures that allow them to cover these costs directly while avoiding extra premiums.

The Deductible Dilemma

Many employers attempt to control healthcare costs by moving employees into higher deductible plans.

While this reduces premiums for the employer, it often shifts financial burden onto employees, potentially impacting:

Employee morale

Retention

Recruitment competitiveness

Tom argues that businesses should instead purchase the lowest-cost option available from the carrier and then use reimbursement strategies to support employees when claims occur.

This approach can produce better benefits at a lower overall cost.

Who Keeps the Unused Premiums?

One of the biggest hidden issues in traditional fully insured plans is the question of unused premiums.

If employees remain healthy and file fewer claims:

The employer does not receive the savings

The insurance carrier keeps the unused premium dollars

With reimbursement-based strategies, however, employers maintain control over those funds instead of handing them over to insurance companies.

Claims Transparency

Another major challenge with traditional insurance plans is the lack of transparency.

Most employers:

Write a check every month

Receive little insight into how their healthcare dollars are actually being spent

Tom explains that under traditional plans, insurance carriers control the data and reveal very little information about claims utilization.

By managing certain portions of the plan differently, employers can gain greater insight into:

Emergency room visits

Overall utilization trends

Actual healthcare spending patterns

This allows companies to make smarter decisions about their benefits strategies.

Breaking the Renewal Trap

Many companies wait until 30 days before renewal to begin reviewing healthcare options.

By that point, most employers feel forced to accept whatever rate increases their broker presents.

Tom explains that businesses have far more flexibility than they realize. With the right strategy, companies can restructure benefits at any time during the year, rather than being locked into the carrier’s traditional renewal calendar.

This creates more control over budgeting and long-term benefits planning.

Key Takeaway

Employers don’t need to rely on traditional insurance models that continue to increase premiums each year.

By understanding the tax laws and plan structures available—including Section 105 Medical Expense Reimbursement Plans—companies can build benefits strategies that:

Reduce healthcare costs

Improve employee coverage

Increase financial control

Who Should Listen

This episode is especially valuable for:

Small and mid-sized business owners

CFOs and financial decision-makers

HR directors responsible for benefits planning

Employers frustrated by rising healthcare costs

Learn More

Businesses interested in exploring smarter healthcare strategies can visit:

ClaimLinx.com

Schedule a call with Tom Quigley and his team to learn how modern benefits strategies can help control healthcare costs while improving employee coverage.