For an expense to be eligible under GAP, it must be covered by your major medical plan. If an expense is denied by your major medical plan but would otherwise have been an eligible expense under GAP, it will not be covered by GAP. A couple of simple examples to illustrate this are:
1. Your major medical plan limits diagnostic testing to a maximum of $500 and does not cover testing in excess of this amount. If you incur diagnostic testing expenses in the amount of $750 due to an illness or injury, and your major medical plan pays $500, the remaining $250 would not be reimbursable or payable by GAP because it would be denied under the major medical insurance plan. 2. Your major medical plan has a pre-existing limitation provision and denies benefits because you were not able to show proof of creditable coverage. Those expenses that were denied would be ineligible under GAP.
