What can it do for me?
By Liz Sherman, F130225
When it comes to insurance, I am usually as much in the dark as the next person. However, when I found out about the Deductible Reimbursement Insurance Plan — group travel accident and medical deductible and co-insurance reimbursement coverage that is being extended to FMCA members — I immediately became interested. I could see advantages for so many of our members. Since I am married to the chairman of the FMCA Insurance and Risk Management Committee, Dick Sherman, I had an insurance expert constantly looking over my shoulder as I tried to explain the plan in language that non-insurance people could comprehend easily. I hope my explanation helps members to better understand this coverage that FMCA has acquired for us.
The plan will pay the deductibles and co-payments on your medical insurance up to $1,000 per year for each member (subject to a $100 deductible per occurrence for a sudden and unforeseen illness and no deductible per accident) when you become ill or are injured while you are on the road at least 100 miles in one direction from your residence. Travel can be while you are in or out of your motor coach, for business or pleasure, but not solely for the procurement of medical treatment or advice. This coverage is for members who are involved in an accident or suffer a sudden, unforeseen illness requiring timely medical care that cannot wait until they return home.
It is very important to remember that all claims must be submitted within 6 months from the date of occurrence in order to be eligible for consideration. The reimbursement benefits are paid directly to you, unless you specify otherwise. All family and life members of FMCA are eligible for this insurance coverage. If you’ve been injured or suddenly become ill while traveling, you may have a claim.
So, what is a Deductible Reimbursement Insurance Plan?
This is an insurance plan designed to help FMCA members handle out-of-pocket medical expenses for an accident or an unforeseen illness while they are traveling. Most of us carry medical insurance of some kind, such as Medicare A/B; Blue Cross/Blue Shield; an HMO; a major medical plan; or any group, franchise, or prepayment plan or any policy arranged through an employer, union, trustee, or association; or by a plan or policy under any federal, state, or provincial law. Many of these health insurance carriers require a deductible before they begin paying, and then they often require us to co-pay a percentage of the bill, typically 20 percent. The plan is intended to help cover those costs that would normally come out of our pocket. The official name of the plan is “Group Travel Accident and Medical Deductible and Co-Insurance Reimbursement Coverage for the Members of Family Motor Coach Association.” (You might need to know that entire name one day.)
Who is covered and under what conditions are they covered?
We are all covered if we are family or life members of FMCA. As the year progresses, nearly all of us will be traveling. Before you leave home, read through this explanation regarding the Deductible Reimbursement Insurance Plan. The information laid out here may apply to all of us at one time or another, so it makes good sense to become familiar with the benefits of the plan before we need them. And, no, it is not necessary that we be traveling in our motorhomes when illness or injury strikes in order to take advantage of this benefit. We simply need to be at least 100 miles away from home, have been involved in an accident, or have suffered a sudden and unforeseen illness requiring immediate medical care. Coverage under the plan is worldwide, with no territorial restrictions, as long as your membership in FMCA is maintained and the master policy remains in force.
Once January 1 arrives, many of us will begin a new deductible year, and this plan will be especially helpful then. At that time of year, the deductibles really can be burdensome. For instance, a gall bladder attack on the way to Arizona in February is miserable enough, but the added medical expenses can put an impossible strain on the vacation budget. At that time of year we have only just begun to amass the medical bills we have to pay before our health care insurer begins to pick up its share of the bill. The Deductible Reimbursement Insurance Plan can offer us a little relief by reimbursing us for some of the deductible and co-payments we are forced to cover at the time of the medical emergency.
The Deductible Reimbursement Insurance Plan can help out with deductibles and co-payments throughout the year if illness or injury strikes when we are more than 100 miles away from home. Under the plan, each member is entitled to $1,000 per year to cover deductibles and co-payments. However, there is a $100 deductible per occurrence for unforeseen illness, which means that the first $100 for each illness will come out of our pocket before the plan takes effect.
We all should be generally aware of which medical conditions are covered under this plan and which are not. Doctors’ care, hospital costs, lab tests and X-rays, blood, medications, and several other expenses are covered. The plan does not cover wellness care, or those members eligible for Medicaid or those who do not have primary individual or group major medical and hospitalization insurance coverage. There are a few other exclusions for which the plan will not pay, such as a loss resulting from an act of war, or from a hernia, or from an accident in which a member is legally drunk or under the influence of any narcotic drug, plus a few more.
What about us full-timers?
For those of us who are full-timers, our coach is our primary residence; therefore, we are seldom 100 miles or more away from home. These unique circumstances will be taken into consideration when processing claims for full-timers.
If you use the Cincinnati mail forwarding address for purposes of your primary health insurance coverage and you are in Cincinnati on FMCA-sponsored business, you are still eligible for this benefit without concern for the 100 miles from home eligibility qualification.
So, what is it going to cost me?
If you are a family or life member of FMCA, not including children, the plan covers you and will cost you nothing. There is no additional premium. The cost of the plan is included in your annual FMCA dues. It is a member benefit, similar to the Accidental Death and Dismemberment Policy that we automatically receive as members. However, in both cases, we won’t collect anything unless we submit claims.
How do I submit a claim?
1) First, file all medical bills with your primary and gap-filler health and accident insurance carrier(s).
2) Next, find the plan claim form, which appears in the January issue of Family Motor Coaching magazine and is also available online at www.fmca.com. Attach a copy of your doctor/hospital bills, also known as the UB-92, and/or the HCFA forms from the doctor/hospital, with your claim form.
3) Fully complete and sign the plan claim form. Incomplete claim forms will be returned to you for missing information and will delay your request for benefits.
4) Attach a photocopy of your driver’s license to the claim form.
5) Include your explanation of benefits (E.O.B.). What is an E.O.B.? It is a statement from your primary and gap-filler health and accident insurance carrier(s) giving notice of payment or a letter stating that you must satisfy a deductible, co-payment, or co-insurance. Forward that statement along with copies of your UB-92 and/or the HCFA form from your doctor/hospital, along with a copy of your driver’s license to the address listed on the claim form. All fully completed claim forms must be submitted and received within six months from the date of occurrence in order to be eligible for consideration. Please allow 90 days for processing.
If you have questions about the Deductible Reimbursement Insurance Plan, please call FMCA at (800) 543-3622 Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time.
It is hoped that the Deductible Reimbursement Insurance Plan will allow you and your loved ones greater peace of mind as you pursue your travels.
This brief description of benefits is not a contract. The contractual provisions are stated in the Master Policy, with an effective date of January 1, 2003, issued to the Family Motor Coach Association Inc., 8291 Clough Pike, Cincinnati, OH 45244.