MISSOURI COUNCIL OF THE BLIND
HEALTH BENEFITS PROGRAM GUIDELINES
MISSOURI COUNCIL OF THE BLIND
HEALTH BENEFITS PROGRAM GUIDELINES
Revised November 12, 2005
I. THE PURPOSE
The Missouri Council of the Blind has established a health benefits program in order to provide financial assistance to legally blind citizens of Missouri, including all MCB members in good standing.
II. APPLYING FOR HEALTH BENEFITS
1. The application form may be obtained from the MCB office by phoning toll free (800) 342-5632 or (314) 832-7172; or e-mailing: ExecutiveDirector@MissouriCouncilOfTheBlind.Org; or by writing the Missouri Council of the Blind, 5453 Chippewa Street St. Louis, MO 63109.
2. The application must be fully completed with all requested information provided.
3. Other requested documents must accompany the application, including a physician's statement of the application, a visual status statement (if needed) and a release of information form - fully filled out.
4. The application and supporting documents should be sent to the chairperson of the Health Benefits Committee.
5. Applicant must sign application.
6. The application must have all the dates for the illness or injury included, and the application must be submitted within 90 (ninety) days of the last date shown on the physician’s statement.
1. Physician's statement completed on application.
2. If you are not a member of the MCB, a signed statement of your legally blind status, from an ophthalmologist, or other reasonable authority such as Rehabilitation Services for the Blind, must accompany the application.
3. Due to the Health Information Privacy Act, you must sign and include the release of information form with your application. The release of information must include the physician’s name, address, and phone number (PRINTED or TYPED).
III. ELIGIBILITY
A. Who Is Eligible?
All legally blind citizens of Missouri as well as sighted members of MCB are eligible to apply for health benefits through this plan.
B. Who Is Ineligible?
Any individual determined by the Health Benefits Committee to have wrongly received benefits under this plan may be declared ineligible for any further participation in this plan and requested to return all overpaid benefits.
C. What If My Application Is Denied?
If the applicant has completed the application, provided the requested documents and has submitted the application in a timely manner but the claim is denied, the applicant may submit a written appeal to the MCB Board at its next regularly scheduled meeting. The Committee chairperson will notify in writing the applicant of the Board’s decision.
IV. BENEFITS
A. Maximum Benefit per Claim
A benefit in the amount of $40.00 (forty) dollars per week shall be payable to an individual determined eligible for benefits by the Health Benefits Committee for a maximum of ten weeks commencing on the eighth day following:
1. An accident or illness commencing after December 31, 1980, resulting in confinement of the individual in his or her home or hospital or substantially restricting the individual in their normal activity and,
2. Under the care of a duly licensed physician.
3. The maximum benefit is limited to ten weeks of benefits during each fiscal year of the Council.
4. The maximum claim per illness or accident is $400.00 per year per applicant. If a claim is presented with dates that cover two fiscal years, the maximum
amount is still $400.00 and the applicant will submit a signed original and a signed copy of the original. The Committee will then allocate the division
of coverage to the appropriate fiscal year. The recipient will receive two (2) checks: one (1) to cover the portion of the eligible illness or accident
for the first year and another to cover the portion of the eligible illness or accident for the second year.
5. Benefits shall be paid at the conclusion of the illness or ten covered weeks, whichever comes first. But benefits are never to be paid ahead of those times.
6. Benefits will be computed at $5.71 per day if the time period is less than the maximum limit of ten (10) weeks.
B. Chronic Illness
No benefits shall be paid under this plan to any person with a chronic illness or condition which existed on or before December 31, 1980. Any individual who makes an application under this plan and has a chronic illness or condition which commenced after December 31, 1980, shall be entitled to not more than ten (10) weeks of benefits during the entire term of the chronic illness or condition.
V. REVISION
The MCB Board shall have the authority to revise the Health Benefits Program as needed in order to maintain and protect the best interest of the Program and the Council. Revisions shall be effective as directed by the Board with the approval of the Convention at its next annual meeting.
VI. EXPENSES
All expenses associated with the administration of this program shall be paid from program funds.
The Health Benefits Committee shall make an annual report of the Fund to Convention at its next annual meeting. This report shall not contain the names of any individuals.
VII. THE COMMITTEE
The Health Benefits Committee shall consist of three members of the Council to be appointed by the President with concurrence of the MCB Board.
The Committee shall review all applications and make a determination of eligibility within not more than thirty days from receipt of application.
MISSOURI COUNCIL OF THE BLIND HEALTH BENEFITS PROGRAM
APPLICATION
Revised January 27, 2007
PERSONAL DATA
Please send this application and supporting documents to:
Cathie Brauner
C/O MCB
5453 Chippewa
St. Louis, MO. 63109
Phone: (314) 832-7172
RELEASE OF INFORMATION FORM
*Applicant is to fill in the name, address and phone number of the physician; sign and date the Release Form and enclose it with the application.
This is to authorize:
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