AFS Participant Medical Plan and Medical Bills – Help & Learning for Host Families

AFS Medical Plan Basics

The Participant Medical Pamphlet, which has been shared with the parent(s)/guardian(s) of all AFS Participants, describes the medical coverage for participants while on the AFS Program. This booklet outlines, in detail, covered and non-covered expenses, what to do in the event of an emergency, and includes claim forms and instructions for submitting claims. This publication should provide you with ample information to determine specifics of the Participant Medical Plan and the financial responsibility for medical treatment. Please refer to the copy of the Participant Medical Pamphlet. Additionally, it can be accessed on the AFS website at: http://www.afsusa.org/host-family/resources/

AFS provides participants with travel medical insurance through a global insurer, HDI based in Hannover, Germany. The policy number for AFS is CA1823123000.

AFS refers to this insurance as the AFS Medical Plan and the administrator for the AFS Medical Plan is Global Medical Management Inc., (GMMI) based in Florida. As the administrator, GMMI reviews and pays all medical bills. This relationship also allows AFS to use the First Health Network group of medical care providers, as GMMI is a member of this Network.

The following articles provide an overview of the AFS Medical Plan:

For more information, please also review Hosted Student and Doctor Visits: Useful Tips for AFS Host Families

Other Common Medical Plan FAQs

Is there any additional coverage for participants?

AFS provides a package of additional benefits for AFS Participants that can be helpful with illness or injury that happens during travel, but that are not covered under the Participant Medical Plan. This insurance is provided by the Berkley Accident and Health and is in effect for all participants on AFS Programs. The terms and conditions of coverage for these benefits are different than the terms and condition of the coverage for the Medical Plan, which covers medical expenses, medical evacuation, and repatriation. No deductibles or co-pays are payable by the participant.

Additional Benefits provide “secondary” coverage and are not payable if there is primary insurance available either through private or national health insurance. A more detailed description of the seven benefits can be found in the Participant Medical Pamphlet. Some exclusions apply.

Do Host Families need to obtain authorization for medical treatment?

Both the participant and parent(s)/guardian(s) have signed an AFS Participation Agreement and a Parental Authorization Form. This agreement and form allow AFS to act on behalf of the parent(s)/guardian(s) should authorization for emergency medical treatment or surgery be needed when there is not enough time to contact the parent(s)/guardian(s). A copy of the Parental Authorization Form is included with your student’s application and can be presented to medical personnel if authorization for treatment is requested.

Contact your liaison to assist you in getting a copy of the Parental Authorization Form from the AFS National Office if your hosted participant doesn't have a copy and if required by the overseeing physician or hospital. Participants have also been asked to bring with them the Health Form Addendum, which provides any updated medical information, such as inoculations, from the time of application.

AFS Participants may be required to present this form in order to enroll in school. Please make sure you receive a copy of both the Parental Authorization Form and the Health Form Addendum from your hosted participant upon their arrival and keep them in a safe place.

The statement signed by parent(s)/guardian(s) on the Participation Agreement is as follows: Final determination of medical care and treatment is the decision of the Parent(s); however, the AFS Participant Medical Plan will only provide reimbursement of covered expenses incurred while in the hosting country upon the recommendation of the attending physician.

Concerning medical care and treatment we understand and accept the following conditions:

a) In the selection of medical care providers, every reasonable effort will be made to ensure that the care providers selected meet the standards of competence prevalent in the local hosting community. We understand that the laws of confidentiality and medical practice procedures in some countries may restrict AFS access to medical records and documentation regarding treatment of our son or daughter.

b) Should any medical emergency arise, if time permits, AFS will communicate with us and request permission for surgery or other necessary treatment; however, if in the sole judgment of AFS, time and circumstances do not permit communication with us, we authorize AFS to consent to medical treatment, the administration of X-ray examination, anesthetics, blood transfusion, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of, any physician and surgeon.

c) We further recognize that in extreme emergencies medical actions such as, but not limited to, x- rays, blood transfusions, and surgery, may be taken before we or AFS are notified if medical personnel determine such actions are necessary to save our child’s life.

d) Should the attending physicians recommend medical evacuation, once the Participant leaves the host country and arrives in the receiving facility, AFS medical expense insurance ceases, in accordance with these Terms and Conditions of Participation.

e) We will not hold AFS responsible for any actions relating to the emergency treatment.

Please see What to Do If Your Student Needs Emergency Medical Care for step-by-step instructions on obtaining emergency medical care for your student.

What is the process for payment of an AFS Participant’s Medical Bills?

When a hosted participant incurs a medical expense in the U.S., please ask the healthcare provider to submit a completed industry standard claim form (HCFA-1500 or UB-92) to the AFS Third-Party Administrator for the U.S.: Global Medical Management, Inc. (GMMI) 880 SW 145th Avenue, Suite 400, Pembroke Pines, Florida 33027

Phone: 954-370-6468 or 888-444-7773 (toll-free in the US) Fax: +1 (954) 370-8130.

Email: customerservice@gmmi.com

Alternatively, if the medical expense is paid by the hosted participant or host family, a reimbursement claim can be made by submitting the bill to Global Medical Management. In this case, it is important to use the Medical Claim Form. Care should be taken to fill out the entire claim form, detailing the nature of the treatment given. Please see the Medical Claim Form and the Participant Medical Pamphlet. You can also access the Participant Medical Pamphlet on the AFS-USA website at: http://www.afsusa.org/host-family/resources/

Follow the instructions below regarding medical expenses:

1. Request a copy of the completed industry standard claim form from the health care provider (Form HCFA 1500 or Form UB-92). If this form is provided, you do NOT need to ask your physician to complete the “physician or supplier” section on the second page of the Medical Claim Form.

2. Host family or hosted participant should complete a the Medical Claim Form. if requesting reimbursement for bills already paid by them. If you are given a copy of the industry standard HCFA-1500 or UB-92 Form by the healthcare provider, attach it to the form. If you do so, there is no need to complete the “physician or supplier” section on the back page of this form.

3. Reimbursement requests for prescription medications must be accompanied by the original prescription receipt. The prescription receipt is the tag/label that comes attached to the medication containing the student’s name, doctor/medicine/pharmacy name, date filled, cost, etc.

For injury cases, please ensure the *PAYMENT OF MEDICAL BILL* box is checked accordingly.

4. Do not forget to include the Participant AFS ID Number on the form. Your participant’s ID number can be found on their ID card, or on the front page of their AFS application which was sent to you with the placement confirmation. The ID number is noted on the sticker affixed to the bottom right-hand side of the outer wrap. It can also be found on the tax deduction form which you should have received along with this booklet. [MF1] [IL2]

Calling for Information about Medical Expenses in the U.S.

Doctors, host families, or participants can talk to Global Medical Management about claims or coverage by calling 1- 888-444-7773. Questions that arise about medical emergencies in the U.S. after office hours should be directed to the AFS-USA Duty Officer by calling 1-800-AFS-INFO (800-237-4636, option 9).

For more information, please see Submitting Claims and using the GMMI Portal

Does the AFS Medical plan include coverage for Dental and Eye Problems?

The Participant Medical Plan does not cover expenses related to routine and/or cosmetic dental care and vision correction for participants while on the AFS Program. Should your hosted participant require such treatment while on the program, they should contact their parent(s)/guardian(s) directly. It is essential that no treatment be started before the parent(s)/guardian(s) have a chance to approve the treatment and the expense and make arrangements for the payment. If available, such payments can be done with the hosted participant’s credit card or with a bank draft to be sent by the natural families, possibly to the medical facility directly. Once the hosted participant has contacted their parent(s)/guardian(s) and they have arranged for payment, please contact your local volunteer or the Participant Support Specialist at the AFS National Office to inform them of the treatment that the hosted participant will undergo and to let them know that the parent(s)/guardian(s) have been contacted. AFS Staff in our partner country can then follow up with the parent(s)/guardian(s).

Eye and dental care required as a result of an accident occurring while the hosted participant is on the AFS Program is covered in the Participant Medical Plan.

Additionally, please note AFS participants have a $500 Emergency Dental plan (per incident) which is put in place strictly for dental issues which become a medical necessity to alleviate pain. The AFS Travel Medical Insurance will need to agree that the treatment provided to the student was medically necessary to alleviate serious pain. Please note that any pain alleviation procedures performed by the dentist would only be covered up to $500. Any additional expense for pain alleviation would be the responsibility of the student and parent(s)/guardian(s).

What is AFS’ guidance regarding Endemic Illnesses?

Some diseases are endemic to certain areas of the United States, such as Lyme disease in the Northeast and Valley Fever in the Southwest. If such a disease exists in your part of the country, please inform your hosted participant of any precautionary measures that they should take to avoid contracting the disease.

Checking for ticks after spending time in the woods may be a routine practice for you, for example, but your hosted participant may not be aware of the importance of doing so. Should your hosted participant begin to show signs of any such endemic disease, do not hesitate to have them seen by a medical professional and inform AFS.

What if a Sports Physical or Chest X-Rays are required for a hosted student to participate with a sports team?

The health certificate in the participant’s application is a reflection of the physical examination required for participation on the AFS Program. Occasionally, additional school-mandated sports physicals or x-rays are required for students to participate in school sports. As with vaccinations, parent(s)/guardian(s)s are responsible for payment for these expenses. Your hosted participant should call their parent(s)/guardian(s)s to let them know about these costs and to arrange payment. We also ask that you call your local volunteer or AFS Participant Support Staff to let them know about these expenses so that they can alert staff in your hosted participant’s home country and assist us in ensuring payment from the parent(s)/guardian(s). Check with your hosted participant’s school counselor to see if the school might pay for the sports physical in the case of a hosted participant.

Note: For FLEX and YES students, as with vaccinations, their respective scholarships are prepared to reimburse for such expenses if necessary. Please contact your AFS Liaison or Participant Support staff in case a sport physical or chest x-ray are necessary, and they will help to coordinate reimbursement.

What should a host family consider in the case of a School Injury?

The Participant Medical Plan provides secondary medical coverage for all participants. Global Medical Management will contact you and ask for information regarding the hosted participant’s high school accident insurance in relation to claims for injury sustained during a school-related activity.

If the school has student accident insurance, this is the insurance with which the medical bills should be paid. If the school has accident insurance that only pays a portion of the bill, the balance remaining will be paid by Global Medical Management (GMMI), AFS-USA’s third-party claims administrator. It is important that you include the information requested on the back side of the Medical Claim Form when bills are forwarded to Global Medical Management (GMMI).

Please ask the school whether they have insurance coverage for your hosted participant. If so, please provide the name of the insurance company on the Medical Claim Form.

What if a doctor wants to Donate Medical Services?

AFS is a non-profit organization. Donations by physicians are welcomed. If a physician wishes to do so, the bill still needs to be submitted to Global Medical Management (GMMI), AFS-USA’s third-party claims administrator. The check sent to the physician should be endorsed, marked as a financial donation, and mailed to the attention of the Accounting Department in New York with a cover letter explaining that the check is a donation. Upon receipt of the returned check, AFS will issue an income tax deductible receipt for the amount of the check. Donation of services is not an allowable deduction by the IRS, but a returned check is recognized as an acceptable donation.