Chapter 8: Healthcare Benefit Support

HEALTHCARE BENEFIT OVERVIEW

65.jpgAs an AmeriCorps VISTA member, you are eligible to apply for certain health benefits through AmeriCorps VISTA for the duration of your service term.

Under the Affordable Care Act, all Americans, including VISTAs, are required to have health insurance; therefore, you are expected to have health insurance when you become an AmeriCorps VISTA member, unless you are exempt from this requirement.

All AmeriCorps VISTA members are eligible to participate in one of two Healthcare Benefit Programs:

  1. AmeriCorps VISTA Healthcare Allowance – To participate, you must have or plan to have other primary health care coverage outside of AmeriCorps VISTA
  2. AmeriCorps VISTA Healthcare Benefit Plan – For members legally exempt from maintaining health care coverage during their term of service

Eligibility and benefit information about each plan is available online at americorpsvista.imglobal.com. A general description of each plan is below.

ENROLLMENT

At the start of your VISTA term, you will need to complete a Member Enrollment Form to indicate which benefit option you would like to receive. The form may be completed by creating a MyIMGVISTA Account at americorpsvista.imglobal.com or by downloading the Member Enrollment Form and sending to IMG.

For details about the AmeriCorps VISTA Health Benefit Plan and the AmeriCorps VISTA Healthcare Allowance, please visit: americorpsvista.imglobal.com

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HEALTHCARE BENEFIT ADMINISTRATION

International Medical Group (IMG) is the administrator of the AmeriCorps VISTA Healthcare Benefit Program and is available as a resource to you.  For specific details about the benefit program, please visit americorpsvista.imglobal.com or contact IMG at:

International Medical Group
P.O. Box 88506
Indianapolis, IN 46208
Telephone: 855-851-2974
Fax: 855-851-2971
Email: vistacare@imglobal.com

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HEALTHCARE BENEFIT COVERAGE

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All AmeriCorps VISTA members are eligible to participate in one of the following benefits:

  1. AmeriCorps VISTA Healthcare Allowance – To participate, you must have or plan to have other primary health care coverage outside of AmeriCorps VISTA
  2. AmeriCorps VISTA Healthcare Benefit Plan – For members legally exempt from maintaining health care coverage during their term of service

The AmeriCorps VISTA Healthcare Allowanceis a supplemental health care reimbursement program that covers out-of-pocket costs associated with your healthcare coverage. Out-of-pocket expenses may include: your annual deductible, coinsurance, copayments, and other charges for qualified medical, dental, and vision care expenses. The Healthcare Allowance will help offset these expenses up to the out-of-pocket maximum under the ACA ($7,150 in 2017). The Healthcare Allowance does not cover costs associated with premium payments (that is, the cost of buying insurance) or charges associated with any other individual covered under your primary health care plan or policy.

Examples of health care options you may have that would make the Healthcare Allowance beneficial for you include, but are not limited to the following:

  • Family healthcare benefit – If you are 26 or younger and on a parent’s plan, or married and covered by a spouse’s plan;
  • Healthcare benefit purchased through the Health Insurance Marketplace – You can shop for coverage and find out if you qualify for lower costs by visiting the Health Insurance Marketplace at www.healthcare.gov;
  • Medicaid, Medicare, or military health care benefits 
  • Coverage under a separate government-sponsored program or act, such as benefits available to individuals in the U.S. territories or who belong to a federally recognized tribe.

If you choose to enroll in the Healthcare Allowance plan, please be prepared to provide proof and effective date of your primary healthcare coverage. If you do not yet have other health coverage but plan to within 60 days, you may wait to enroll in the Healthcare Allowance until you have secured other health care coverage and are able to provide the effective date. While you are waiting for that coverage to take effect, you can apply for temporary coverage under the AmeriCorps VISTA Health Benefit Plan.

The AmeriCorps VISTA Health Benefit Plan is a self-funded, basic health benefit plan for members who demonstrate that they are legally exempt from having ACA-compliant coverage during the term of service. It is also available during the first 60 days of VISTA service for those who have applied for other coverage and are waiting for that coverage to take effect.

The plan is available to members at no cost and covers most non-routine services, limited preventive care visits (e.g., an annual ob-gyn visit for women), medical emergencies, surgical and hospitalization expenses, certain prescription drug costs, routine dental care, and limited vision services.. The plan does not cover pre-existing conditions nor does it cover dependents, including your spouse. Although an excellent support for most VISTAs, the healthcare benefit program is not insurance and does not satisfy the individual responsibility requirement of the Affordable Care Act (ACA).

For details on eligibility and coverage for each plan, please visit: americorpsvista.imglobal.com

SUBROGATION FOR MEDICAL CARE EXPENSES

If you are in a car or other accident while serving as an AmeriCorps VISTA member, the Corporation may initially pay for your medical care. If that happens, and you then collect from the insurance company of the person who was at fault (or from your insurance company if the person at fault has no coverage), the Corporation has the right to recover from you the cost of whatever medical care it had paid for. This situation is known as subrogation. In other words, if you are injured or become ill through the fault of another person not with the Corporation and that person's insurance company, or your insurance company, settles with you, the Corporation has the right to recover from you the cost of any health care it has paid, irrespective of the reason for the settlement.

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FEDERAL EMPLOYEES' COMPENSATION ACT

Under section 415(b) of the Domestic Volunteer Service Act of 1973, as amended (42 U.S.C., § 5055), AmeriCorps VISTA members are considered employees of the federal government for purposes of coverage under the Federal Employees' Compensation Act (FECA), which is administered by the Office of Workers' Compensation Programs (OWCP) of the U.S. Department of Labor. The Department of Labor's OWCP office is solely responsible for the adjudication of FECA claims. This means that members are eligible for certain benefits in certain situations, and eligibility is determined by OWCP, not the Corporation.

BENEFITS

FECA provides compensation benefits for an illness or injury if it is judged by OWCP to be service-related (i.e., caused or aggravated by the performance of a member's assignment). Coverage by FECA begins for AmeriCorps VISTA members after they are enrolled (sworn in) in the AmeriCorps VISTA program. You are not covered by FECA, however, if the injury or disability results from your own misconduct, intoxication, or willful intent to bring about injury or death to yourself or others.

Benefits approved under FECA begin after termination from AmeriCorps VISTA service and include payment for continuing medical care and compensation for wage loss and permanent impairment of certain members or functions of the body in the event of a service-related disability. FECA also contains provisions for payment of certain death benefits, such as shipment of the body, funeral and burial costs, and survivor's benefits if the member's death results from an injury or illness sustained in the performance of official project duties.

CLAIMS PROCEDURES

If you are injured or experience an emergency illness related to your assignment, the project supervisor and the Corporation State Office must be notified immediately. To protect your right to apply to OWCP for compensation, you need to complete the form (CA-1 or CA-2) that the Corporation State Office will provide you.

  • The CA-1 form, Notice of Traumatic Injury, should be filed when an accident or physical injury occurs during performance of duties.
  • The CA-2 form, Notice of Occupational Disease or Illness, should be filed when a disease or illness is suspected of being caused by job performance.

Although an illness or injury may not appear to be serious enough to result in compensation eligibility, you should complete the claim forms to protect your rights in case future complications develop. You have up to three years from the date of injury or up to three years from the date you realize your assignment caused an injury to request your completed form be filed with OWCP.

The Corporation State Office will:

  • Advise and assist individual claimants regarding the preparation, submission, and follow-up of their respective FECA claims
  • Provide appropriate assistance in compiling and submitting all pertinent information relating to FECA claims

Parts of these forms require completion by the sponsoring organization. Notify the Corporation State Office if you need assistance in receiving these forms back from your former sponsoring organization.

Submit all FECA claims and relevant material to:

AmeriCorps Health Benefits Office
Corporation for National and Community Service
250 E St., SW
Washington, DC 20525

APPEAL PROCEDURE

You may petition any claim rejected by OWCP by following the appeal rights process outlined in the OWCP information guide, When Injured at Work. This guide and other resources about claims under FECA are available on the Division of Federal Employees' Compensation Home Page at http://www.dol.gov/owcp/dfec/regs/compliance/ca-11.htm.

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DEATH BENEFITS

In the event of a member's death during service, the next of kin or designated beneficiary is entitled to the following:

  • Coverage of expenses incurred at the place of death (ambulance service, transportation of the body, etc.)
  • Funeral and burial benefits from either the Corporation (to a maximum of $1,000) or from OWCP if the death is found to be service related
  • Shipment of member's personal effects
  • Unpaid compensation or reimbursement owed to the member
  • Any benefits available to spouse or dependents from OWCP if the death is determined to be assignment-related

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