01.10.04: Medical coverage

Short-term medical coverage requirement
EMM requires short­-term workers serving domestically and internationally to have adequate medical coverage while participating in our programs, including emergency medical evacuation as well as overseas coverage for participants serving internationally. We encourage all eligible workers to enroll in EMM’s medical plan. 

For all short­-term workers not eligible for EMM medical coverage, EMM requires participants to find or continue in an alternative medical coverage plan. Alternative medical coverage must provide for emergency medical evacuation, and have an emergency contact number that can be reached at any hour of the day, and include overseas coverage for participants serving 
internationally. Coverage is required for the entire assignment, not just partial periods. 

(Note: Some insurance providers offer basic emergency medical evacuation coverage which may serve to supplement another overseas coverage plan, if needed. For recommendations of alternative health insurance providers, ask the Human Resources administrative assistant.)

EMM expects all workers to work at maintaining good health and take reasonable safety precautions, including any required immunizations for their designated outreach locations. 

Eligibility
Short­-term workers (from the U.S. or international locations) with assignments six months or longer are eligible for EMM medical coverage. Short­-term workers (from the U.S. or international locations) with assignments less than six months are not eligible for EMM medical coverage. Exception: All short-­term assignments to Guinea­-Bissau for two months or more are eligible for and encouraged to enroll in EMM medical coverage (because of the lack of adequate medical services and the need for EMM to act quickly in an emergency). 

Pre-service
Candidates who are enrolled in a health care insurance plan prior to service with EMM should not terminate that policy until it has been determined that they are eligible for EMM coverage. Once it has been determined that you are eligible, please check with the Human Resources administrative assistant before canceling your current policy. In some cases it may be advisable to continue your current coverage. 

Pre-appointment claims
Any pending pre-­appointment claims that are or were eligible for payment under another insurance policy, including, without limitation, Medicare and workers’ compensation, are not covered by EMM.

Beginning and ending dates
EMM’s coverage begins the date of departure for assignment or the first day of training if the worker is leaving for the field within two weeks following training and the decision has been made to enroll the worker for coverage. Health care costs for services received prior to the effective date of coverage are the responsibility of the worker (except in the case of EMM­required immunizations). EMM assumes that all health care needs have been satisfied prior to EMM assignment. Coverage ends on the date of your return from the assignment. Near the end of their assignment, workers enrolled in EMM medical coverage have the option of purchasing temporary medical coverage which begins immediately following their 
assignment for a duration of up to six months. 

Under normal circumstances, EMM coverage must be purchased for an entire assignment and is not offered for partial periods. Legally however, there is provision for a worker to enroll in EMM medical coverage after an assignment has started if they experience an official change in family status or lose coverage under another plan in which they are currently enrolled or another event occurs that will allow a change to their election in accordance with the Internal Revenue Code.

If a worker continues to have alternative medical coverage after they are enrolled in EMM’s plan, the alternative coverage will be primary and EMM’s will be secondary. All claims must be submitted first to the other provider, and then to EMM if and when the claim is denied. 

Coverage
It is expected that the worker has practiced preventative health care (regular physicals, vision and dental exams and care) before coverage begins in order to help control EMM’s health care costs. 

This is a "zero" deductible plan, so all covered items are paid within the limits of "reasonable and customary health care costs." Coverage is subject to change without notice. EMM is not an insurance company. Workers are urged to make conscious efforts to control medical costs without sacrificing needed medical care. This includes accessing "in-network" providers whenever possible while in the U.S. 

For coverage under the EMM medical plan, please see the summary plan description for the appropriate calendar year. 

Payment and pre-certification for medical services for workers on EMM international health plan:
  • EMM monthly financial reporting system (routine – non major medical services on the field)
  • If you are covered under the EMM medical plan while on assignment in the U.S., a different procedure applies. You will need to use your EMM medical card and find in­network providers. (Please contact the HR Administrative Assistant for more information.)

Air ambulance
For all workers on EMM International Health Plan emergency medical evacuation is provided(Prior to leaving for the field, be sure to familiarize yourself with the instructions in your Crisis Contingency Plan. It will tell you who to contact in case of a medical emergency.)

Cost
The medical rate is graduated according to age group and is subject to yearly updates. Total cost is calculated according to the number of months you will be on assignment. 

Mission interns may include the cost of EMM medical coverage in the total amount of tax­deductible support funds they need to raise for their assignment. In all cases, workers must submit their medical enrollment form (and applicable payment) by the deadline given in order to be enrolled in EMM’s coverage plan. 

A health savings account (HSA) is not available for interns. 

Temporary medical coverage
Temporary medical coverage (TMC) is available to EMM workers who were enrolled in EMM medical coverage during their assignment. TMC begins immediately following their assignment for a duration of up to six months. TMC application and payment for the first month of coverage must be submitted to the Human Resources administrative assistant by the deadline given in order to be enrolled. Subsequent payments are due by the 15th of each month. Payments are for services rendered and are not tax­ deductible as a contribution to EMM. (If choosing to enroll, participants must purchase at least one month of coverage. Following this, they have the option of purchasing a partial month using the prorated day rate, if the need arises. The partial period must be purchased at once and payment is due by the 
usual deadline. EMM does not issue refunds for periods that have already been paid.)

TMC begins the day after the assignment ends. The premium cost is graduated according to age group and subject to yearly updates. There is a deductible (based on single/couple or family) per calendar year for services rendered within the network. (Refer to TMC application for current deductible rates.) TMC is administered through Significa. If enrolled, participants will receive medical and prescription cards by mail from Significa. For details on coverage, see the summary plan description (CAO) generated by Significa. For further questions, please contact Significa:

Significa Benefit Services, Inc.
P.O. Box 7777
Lancaster, Pennsylvania 17604-7777

800.433.3746
717.581.1300

customerservice@significabenefits.com
www.significabenefits.com

Participants enrolled in TMC are expected to pursue other insurance options and to notify EMM when they have made other arrangements. 

Payment for health care services
When asked if you have medical insurance, respond with, “I work for a non­profit mission agency and my coverage is self­-pay. Any reduction of charges is much appreciated.” 

If confirmation/prepayment is required, consult with the Human Resources director. EMM is not an insurance company. EMM shares costs with other Anabaptist Mennonite service agencies.
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TMC Application 2019.rtf
(108k)
Cara Kilheffer,
Jan 14, 2019, 10:30 AM
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Cara Kilheffer,
Jan 14, 2019, 10:30 AM
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