Executive Director’s Commentary
By Don Eversmann, F240000
Motorhome owners automatically receive many benefits when they join FMCA. This month I want to focus on two insurance-related member benefits, because I am concerned that many members may not be aware of them.
The first benefit I want to highlight is MEDEX Plus, the emergency medical assistance program. This program was first purchased for FMCA family members in January 2001.
The MEDEX Plus program helps traveling members to effectively manage the complexities and expenses of out-of-area medical and travel emergencies. MEDEX Plus provides members with toll-free access to travel assistance services and also coordinates and pays the approved costs associated with a number of these services. These include emergency medical air and ground evacuation; repatriation of remains; the return home of unattended grandchildren and dependent children; the return home of an RV or automobile; transportation to join a hospitalized member (for member traveling alone “” if member is hospitalized for seven days or more); and a member’s transportation home after his or her initial evacuation.
Travel can be for business or pleasure at a distance of 100 or more miles from your primary residence. Coverage is provided while traveling within the continental United States, Canada, or Mexico, 24 hours a day, seven days a week, 365 days a year. MEDEX must approve and coordinate all services.
The January 2002 issue of Family Motor Coaching (page 209) contains a compilation of information from two of my previous columns about MEDEX. If the term MEDEX is not familiar to you as a member of FMCA, please take time to read that article. If you do not have that issue handy, call the Membership Services Department at the national office in Cincinnati (800-543-3622) and ask for a brochure about MEDEX. This benefit is very important to you.
The other insurance-related benefit many of our members seem to be unfamiliar with is the Deductible Reimbursement Insurance Plan. This plan was purchased by FMCA to cover the deductible or co-insurance portion of a medical or dental insurance payment for members while they are traveling. If such expenses are incurred 50 or more miles away from home(s), the plan provides reimbursement for the medical or dental deductible and co-insurance out-of-pocket cost that members’ health insurance provider requires them to pay. This coverage applies while you’re traveling with or without your motorhome, for business or pleasure, but not when traveling solely to procure medical treatment or advice.
The Deductible Reimbursement Insurance Plan is not intended to reimburse the deductible your primary insurance provider requires for routine care. It is intended to cover the deductible for timely medical care that can’t wait until you return home. To qualify, you must have a primary medical insurance policy. The Deductible Reimbursement Insurance Plan is designed to coordinate with your coverage from Medicare or a basic major-medical/comprehensive policy such as those provided by Blue Cross, Blue Shield, or any health maintenance organization (HMO) or preferred provider organization (PPO).
The member must first file the claim with a primary insurance provider and then supply documentation of the deductible and/or co-insurance portion. Medical deductible and co-insurance claims can be reimbursed up to $1,000 per calendar year per person. Dental deductibles are reimbursed up to $250 per calendar year per person. A $50 deductible per occurrence is imposed by the Deductible Reimbursement Insurance Plan, but it is waived in the case of accidents.
I would like to spend a bit more time discussing this plan, because some recent enhancements have become available to the membership. I would also like to discuss the claims process in more detail than it has been explained in previous issues of FMC.
In response to requests from FMCA members, we are now offering members the opportunity to purchase an increased level of benefit in the Deductible Reimbursement Insurance Plan. Members may purchase an additional $1,000 of Medical Accident and Sickness Coverage. This “Bonus Coverage” raises the annual maximum reimbursement level to $2,000 per person. It also adds full-timer’s coverage, HMO/PPO office co-pay reimbursement, and prescription drug benefits.
In addition to increasing the level of coverage from $1,000 to $2,000 per year, which is a very significant consideration, these additional coverages are quite beneficial to traveling motorhomers:
A full-timer is either always at home or never at home, depending on how one looks at it. If your motorhome is your primary residence, you are seldom 50 miles or more away from home; thus, full-timers rarely would qualify for the original plan. A full-timer with this Bonus Coverage is not required to be 50 miles away from home for a claim to be filed. It is understood that your coach is your home.
HMO-PPO office co-pay reimbursement
You will get 100 percent of your money back for those $15, $20, or $25 doctor’s office co-payments. With Bonus Coverage, you will be 100 percent reimbursed with no deductibles, whether it is for an accident or a sickness.
Prescription drug benefits
With Bonus Coverage, you will be reimbursed 100 percent for the cost of prescriptions required as a result of an accident or sudden and unforeseen illness, with no deductible.
Your Bonus Coverage will continue protecting you as long as you maintain your membership in FMCA and continue to pay your premium (once a year), and as long as the FMCA master policy remains in effect.
Please let me emphasize that these three enhanced benefits are available by purchasing Bonus Coverage. You do not have to pay for the basic Deductible Reimbursement Insurance Plan. FMCA’s master policy covers all FMCA family members. You do not have to sign up for the basic plan, or pay an additional cost “” it’s included in your annual FMCA dues. However, if you wish to enhance what the association has purchased for you, the Bonus Coverage is available.
For additional information, ask for a Deductible and Co-Insurance Reimbursement Plan Bonus Coverage pamphlet (which includes an enrollment form) when you call the FMCA Membership Services Department. Or, you may e-mail your request to [email protected]
A claim form for the Deductible Reimbursement Insurance Plan appears in the January 2002 issue of Family Motor Coaching magazine on page 219. General claim procedures are outlined on page 218. I would like to expand upon those procedures here so that families filing claims will know exactly what is required to submit a claim and avoid the need for follow-up submissions.
Basically, four documents are required to file a claim:
1. A fully completed, signed, and dated claim form. Please be sure to answer all the questions and include the full address of the medical providers, dates of service, and your personal information. Don’t forget to sign and date the form. Incomplete claim forms will be returned for completion, which will result in processing delays.
As mentioned, a claim form appears on page 219 of the January 2002 issue. It also is available online in the For Members Only area of www.fmca.com, or you may obtain one from the Membership Services Department at the national office.
2. A photocopy of your drivers license.
3. The copy of your doctor and hospital bill, which is called a UB92 or HCFA form (pronounced HICK-fa). This is really important, and it is the one item that causes the most confusion.
For those of you not in the insurance or medical billing profession, the UB stands for “Uniform Billing,” and HCFA is short for “Health Care Financing Administration.” These forms include the computer codes for all medical procedures, supplies, and diagnostic services known to Western medicine.
However, in most cases these forms have been electronically transmitted to your primary medical insurance carrier or Medicare, and you may not have even seen them. So, you will most likely have to ask your medical providers for a copy. Your doctor’s and hospital’s billing department personnel will know exactly what you are requesting.
Unfortunately, we cannot process claims that only include a “balance due” statement from your doctor and hospital, or copies of your cancelled checks. So, please ask your healthcare providers for a UB92, or a HCFA form.
4. The notice of payment or letter (bill) stating that you are responsible for satisfying the deductible, co-payment, or co-insurance from your primary and gap-filler health and accident insurance carrier(s). This statement is known as your explanation of benefits, or EOB.
Send these four items to FMCA’s plan administrator (address on the claim form), and they will process your claim. All claims must be submitted within one year from the date of occurrence in order to be eligible for consideration.
I encourage all of you to become familiar with your member benefits. A compilation of all your member benefits is found in the January 2002 issue of Family Motor Coaching, beginning on page 189. Explanations of these benefits also are available online at www.fmca.com. Being familiar with your benefits could put money in your pocket.