What the Amerus Ultimate PPO integrated gap benefit can offset

Read the 2026 Amerus PPO SBC’s conditional gap-benefit language alongside its gross deductible and out-of-pocket limits.

Read both numbers on the SBC

Amerus lists Plan 2 as Cigna PPO. Its medical SBC is titled NBBA LOCAL Bronze W4.1 PPO and covers June 1, 2026 through May 31, 2027.

The in-network medical deductible is $6,000 per person and $12,000 per family. The gap benefit may reduce eligible in-network deductible and coinsurance costs to $0, subject to its limits. You still pay applicable copays.

Know what may remain yours

The SBC says copays, noncovered services, pre-certification penalties and balance bills may not be offset by the integrated gap benefit. Out-of-network care has separate deductible and out-of-pocket figures. Ask which charges the gap benefit pays directly, which require a claim, and what happens if a provider is outside the network.

Compare a realistic use case

Choose a likely service, such as imaging or outpatient surgery, and read its medical cost-sharing row next to the gap terms. Request both governing documents and ask an advisor to show the sequence of payment in writing. A marketing shorthand such as “zero deductible” cannot replace that plan-specific explanation.

Make the comparison useful

Ask for a worked example involving one covered in-network service, such as an outpatient procedure. The explanation should show the provider’s allowed amount, medical deductible or coinsurance, what the integrated gap benefit may offset, and what is left for you. If no one can explain that sequence from the governing documents, pause before choosing on a zero-dollar headline.

Sources

Frequently asked questions

Does the gap benefit erase every medical bill?

No. The SBC limits the possible offset to eligible amounts and excludes or treats other charges separately.

Educational information reviewed November 6, 2026. Product terms, rates, network access, state availability and underwriting can change. The current official plan documents and written eligibility decision control. Prestige is an independent insurance agency, not the insurer.

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