Human Resources

Benefits - GAP

  • Who administers the GAP Plan?

    The GAP is administered by American Fidelity Assurance (AFA).
  • How should I submit my Claim Form and supporting documentation to American Fidelity?

    The easiest way to file a gap insurance claim is through your online account at Americanfidelity.com or the mobile app, AFmobile. Download American Fideity mobile app from the App Store or Google Play. 

     

    When filing a gap insurance claim you will need to provide the following documentation:

    • Statement of Insured, completed via  online claim filing  or paper claim form
    • Itemized Bills with diagnosis from each of your providers with a complete breakdown of charges for each date of service
    • Explanation of Benefits (EOB) from your primary medical insurance carrier

    We may also need:

  • I want to submit a claim for reimbursement. Where can I find these forms?

    Forms are available on the Employee Benefit Forms page of the Human Resources website: https://www.washoecounty.us/humanresources/files/hrfiles/GAP_Claim_Form.pdf Forms can also be obtained from your department’s Human Resources representative.

    Please note that the Health Insurance Portability and Accountability Act does require that information submitted on this claim form is protected and only disclosed as necessary to process your claim. Employers, plan sponsors and providers are subject to ensuring that your data is private and secure.

  • What number do I call should I wish to follow up on the fax, or if I have other questions?

    To follow up on a fax (after 48 hours to allow processing time): 1-800-662-1113
      
    For any other plan or claim questions, contact the local American Fidelity office at 829-1313.
  • What does the GAP cover?

    The following out-of-pocket expenses are covered:

    Maximum In-Hospital Benefit:

    • Up to $1,000 per hospital confinement

    Maximum Out-patient Benefit:

    • Treatment in a hospital emergency room

    • Out-patient surgery in a hospital out-patient facility or free-standing out-patient surgery center

    • Diagnostic testing in a hospital out-patient facility or MRI facility

    • Up to $200 for treatment of the same or related conditions unless separated by a period of 90 consecutive days (then a new out-patient benefit will be payable)

    Physician Out-patient Treatment Benefit:

    • Treatment in a hospital out-patient clinic, free-standing emergency care clinic or physician’s office

    • Up to $25 per treatment; $125 maximum per family per calendar year (non-routine care excluded)

  • How can I cover my dependents through a GAP plan?

    If your dependents are covered under your HMO, you may also purchase GAP coverage for them. You may enroll dependents during the annual Open Enrollment period (mid-October through mid-November for a January 1 effective date) by meeting with an American Fidelity representative, or anytime during the year with a qualifying event. Rates can be found on the Human Resources website and premiums are collected pre-tax through payroll deduction. To enroll your dependents outside of the Open Enrollment period (with a qualifying event), contact American Fidelity at 829-1313.
  • What if I want to drop a dependent?

    Just as with your health plans, dependents can only be dropped during Open Enrollment or with a qualifying event. To delete a dependent, you must contact American Fidelity directly. Dependent GAP coverage is privately purchased insurance and it is the responsibility of the employee to maintain the integrity of that policy. Calling Health Benefits to delete a dependent from your health insurance plan will not automatically delete them from your GAP Plan.
  • How can I obtain an EOB (Explanation of Benefits)?

    To access a copy of your Explanation of Benefits, go to Prominencehealthplan.com and create an account. 
  • Can I check my individual account online?

    Employees can visit www.americanfidelity.com and to set up an online account or download the AFmobile app.
  • What is the GAP Plan?

    This supplement benefit works in conjunction with the HMO Plan and is provided only to HMO participants. The GAP was added as a result of health insurance negotiations to offset plan design changes that helped the County meet budget needs in FY 2010/2011. The cost of the GAP Plan is covered by the County for all employees and retirees, and is available on a voluntary basis for dependents.
  • What constitutes a qualifying event?

    A list of qualifying events can be found under the “Eligibility Quick Reference” link on the Medical-Dental-Vision page of the Human Resources website:
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Call 311 to find resources, ask questions, and utilize Washoe County services. Learn More »