Chapter 8: Healthcare Benefit Support

HEALTHCARE BENEFIT OVERVIEW

Thumbnail for [node:title][user:name][comment:title] As an AmeriCorps VISTA member, you are eligible for certain health benefits through AmeriCorps VISTA for the duration of your service term.
 
Under the Affordable Care Act, all Americans, including VISTA members, are required to have health coverage; therefore, you are expected to have health coverage 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 currently have or have completed enrollment in 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.
 
AmeriCorps VISTA members starting or ending service are eligible for a special enrollment period through the Health Insurance Marketplace at healthcare.gov because it is a specific “qualifying change.” Within 30 days of ending service, members should take action to convert their healthcare benefits to a private plan to avoid a lapse in coverage which could result in tax penalties.  Information about “qualifying changes” can be found at https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period under “More qualifying changes.”
 
 

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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 
 
 

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HEALTHCARE BENEFIT COVERAGE

All AmeriCorps VISTA members are eligible to participate in one of the following benefits:
  1. AmeriCorps VISTA Healthcare Allowance – To participate, you must currently have, or have completed enrollment in, 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 Allowance is 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 ($7,350 in 2018). 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 your primary healthcare coverage information including 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 other healthcare coverage’s information. While you are waiting for that coverage to take effect, you can apply for temporary coverage under the AmeriCorps VISTA Health Benefit Plan. At the end of the 60 days, you must submit a Member Enrollment Form along with your other coverage’s information to complete your enrollment in the Healthcare Allowance plan.
 
Thumbnail for [node:title][user:name][comment:title] The AmeriCorps VISTA Health Benefit Plan is a 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. A Member Enrollment Form will be required to demonstrate legal exemption from having ACA-compliant coverage to remain covered on the Health Benefit Plan past 60 days.
 
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 many 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, CNCS 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), CNCS has the right to recover from you the cost of whatever medical care it 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 CNCS, and that person's insurance company, or your insurance company, settles with you, CNCS has the right to recover from you the cost of any health care it has paid, regardless of the reason for the settlement.
 

ACCESS TO VIRTUAL CARE

In addition to their elected health benefit, AmeriCorps VISTA members and Leaders can now access virtual care at no cost. This free service is done through International Medical Group (IMG), the administrator of the AmeriCorps VISTA Healthcare Allowance and the AmeriCorps VISTA Health Benefit Plan, via a partnership with MYidealDOCTOR. 

Virtual care allows members and Leaders to immediately consult with board certified physicians, psychologists, social workers, and professional counselors 24/7/365 via phone or video chat, at no cost to the member or Leader. For more information and to access this benefit, please visit: https://americorpsvista.imglobal.com/my-benefits/connect-with-a-telehealth-provider. Virtual care will not be available in Arkansas until January 1, 2018.

 

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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 CNCS.

BENEFITS

Thumbnail for [node:title][user:name][comment:title] 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 sworn in to 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 CNCS 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). 
 
For faster and more accurate processing, please complete and submit the electronic version of the forms: 
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.
 
Submit all FECA claims and relevant material to your CNCS State Office. The CNCS 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 your CNCS State Office if you need assistance in receiving these forms back from your former sponsoring organization.

APPEAL PROCEDURE

You may petition any claim rejected by OWCP by following the appeal rights process outlined in the rejection notice you received by mail from OWCP, or 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 CNCS (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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