Choosing an Insurance Policy

When choosing an insurance policy, in addition to the minimum requirements as stipulated by the DOS, you should consider several factors:

The reliability of the company: Does it treat people fairly? Does it pay claims promptly? Does it have staff to answer your question and resolve your problems?

Deductible amounts: Most insurance policies require you to cover part of your health expenses yourself (your part is called the "deductible"), before the company pays anything. Under some policies the deductible is annual, and you pay only once each year if you use the insurance. Under others, you pay the deductible each time you have an illness or injury. The J regulations limit the deductible to $500 per accident or illness, but many policies (generally, the more expensive ones) offer a lower, more advantageous one.

Co-insurance: Even after you have paid the deductible, an insurance policy only pays a percentage of your medical expenses. The policy might pay 80%, for example, and the remaining 20%, which you would have to pay, is called the coinsurance (or "co-payment"). Thus, if you were injured and incurred $3,000 in medical expenses, a policy with a $500 deductible and 20% coinsurance would cover $2,080 (80% of $2,600). The J regulations require the insurance company to pay at least 75 % of covered medical expenses.

Specific limits: Some policies state specific dollar limits on what they will pay for particular services. Other policies pay "usual" or "reasonable and customary" charges, which means they pay what is usually charged in the local area. Be very careful in evaluating policies with specific dollar limits; for serious illnesses, the limit might be far too low and you might have large medical bills not covered by your insurance.

Lifetime/Per-occurrence maximums: Many insurance policies limit the amount they will pay for any single individual's medical bills or for any specific illness or injury. Exchange Visitors must have insurance with a maximum no lower than $50,000 for each specific illness or injury, which may be enough for most conditions. Major illnesses, however, can cost several times that amount.

Benefit period: Some insurance policies limit the amount of time they will go on paying for each illness or injury. In that case, after the benefit period for a condition has expired, you must pay the full cost of continuing treatment of the illness, even if you are still insured by the company. A policy with a long benefit period provides the best coverage.

Exclusions: Most insurance policies exclude coverage for certain conditions. The J regulations require that if a particular activity is a part of your Exchange Visitor program, your insurance must cover injuries resulting from your participation in that activity. Read the list of exclusions carefully so that you understand exactly what is not covered by the policy.