Effective January 1, 2001, FMCA contracted with MEDEX Assistance Corporation to provide active family and life members with coverage under the MEDEX PLUS Program. This program helps traveling members to effectively manage the complexities and expenses of out-of-area medical and travel emergencies. Members receive this coverage with no sign-up required. 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.
MEDEX provides members with toll-free access to travel assistance services and also coordinates and pays the approved costs associated with the following:
1. Emergency medical air and ground evacuation: Medically supervised evacuation to the nearest appropriate facility if an FMCA member is involved in an accident or suffers a sudden, unforeseen illness and adequate medical facilities are not available.
2. Repatriation of remains: The return of an FMCA member’s mortal remains in the event of death.
3. Return home of unattended grandchildren and dependent children: Transportation home for an FMCA member’s children and/or grandchildren left unattended as the result of a member’s accident, illness, or death.
4. RV and automobile return home: Return of an FMCA member’s drivable vehicle to his or her residence (or return of a rental vehicle) if the member is unable to operate the vehicle due to accident, illness, or death.
5. Transportation to join a hospitalized member (for member traveling alone “” if member is hospitalized for seven days or more): The transportation of a family member or friend to visit an FMCA member who is hospitalized for seven days or more.
6. Transportation home after initial evacuation: The transportation of an FMCA member to the point of origin, or permanent residence, following an emergency evacuation.
Each of these services has no limit to the cost that will be paid by MEDEX with the exception of the fifth one “” family member visit transportation for the member traveling alone “” which has a limit of $1,000.
Please remember that MEDEX must approve and coordinate all of these services.
The above description of benefits summarizes the principal features of the MEDEX PLUS program and is not intended to be a contract. The contractual provisions for the MEDEX PLUS program are stated in the MEDEX PLUS service agreement, Group 7030, issued by MEDEX Assistance Corporation to the Family Motor Coach Association, Inc., with an effective date of January 1, 2001. The final answer to any questions will be subject to the MEDEX PLUS service agreement.
The primary intent of the MEDEX PLUS Program is to provide basic benefits to FMCA members who are traveling and are not covered by some other program that they may have purchased. Should you cancel or not renew an existing medical evacuation plan that you have purchased? Initially, the answer needs to be “no.” FMCA is concerned that any plan you may currently have probably is more inclusive and provides better overall coverage than what FMCA has been able to purchase through this group policy. However, that does not mean that you cannot use the MEDEX PLUS Program even if you have other coverage.
Many of us (with or without our knowledge) have emergency medical air and ground evacuation included in our health care plan or Medicare coverage. In those cases, once the emergency is over, MEDEX probably will look to those programs for reimbursement, since MEDEX is a secondary payer. However, most of us, unless we have purchased specific medical evacuation coverage, do not have the other five benefits listed above through our routine health care insurance plans.
MEDEX has been in business for more than 25 years, supplying different plans to organizations interested in providing their families with peace of mind when they travel away from home. MEDEX’s specially trained coordinators answer calls 24 hours a day from its centralized command center, and they are prepared to provide immediate help with any MEDEX service. Each ongoing case receives expert attention from case coordinators, operations management, medical personnel, provider specialists, and regional medical advisors strategically located throughout North America “” assuring quality attention and responsiveness.
In addition to the paid services listed above, the MEDEX PLUS Program also provides assisted services both of a personal and medical nature. When talking with the MEDEX coordinator, you should share all of the concerns and needs that your medical emergency has placed upon you, and in most cases, they will be able to assist you.
There is one underlying question we all would like to know the answer to: “In the case of a medical emergency, will they fly me home to familiar surroundings and let me be treated by my personal physician?” The issue is basically twofold: What is the “most appropriate medical care” and “medical necessity”? In every situation, there probably will be three medical professionals making the movement decision “” the attending physician, your personal physician, and the MEDEX regional medical advisor. Each person will be evaluating your medical emergency and deciding what is most appropriate considering where you are, what is needed, and how best to meet that need. Each situation is handled on a case-by-case basis. Many medical conditions preclude air evacuation until the emergency is over. In those cases, the movement can then be handled by commercial air back to your point of origin or home.
Unfortunately, there is no simple answer. It is comforting to know that the physician who is most knowledgeable of your condition, the physician most aware of your ongoing health, and a medical professional familiar with medical evacuation are going to work together in your best interest.
We also need to point out a few of the specifics of the contract language.
1. There is an exclusion in the contract for travel that is made for the purpose of securing medical care or medical advice. Travel when performed against the advice of a physician is excluded. Traveling with a terminal illness also is excluded if the terminal illness is the reason for the evacuation.
2. If it’s necessary to verify eligibility as to whether you’re 100 miles from your permanent residence, contract language indicates that MEDEX will use your drivers license and FMCA address of record.
3. The MEDEX PLUS Program is a travel assistance program, and payment is over and above or on top of any existing insurance program or private pay plan that is in force. Your primary payer would pay these expenses, and MEDEX will be the secondary payer.
4. The MEDEX PLUS Program does not cover per diem costs or pet return.
FMCA members can call toll-free (800-527-0218) or collect (410-453-6330) for emergency medical, travel, and personal assistance services. When calling, please refer to MEDEX group number 7030. For more information about this program, phone FMCA (800-543-3622) or send an e-mail to email@example.com and ask for a brochure.
In order to secure this benefit, it is imperative that MEDEX be notified immediately when medical travel assistance is required. Below we have printed two cards that you can cut out for you and your spouse, laminate, and place in your wallet and purse so that you will have the information with you at all times.