As a J-1 Exchange Visitor in the U.S., you are required to purchase and enroll in health insurance for yourself and your J-2 dependents, if applicable, for the full duration of your program. Government regulations stipulate that if you willfully fail to carry health insurance for yourself and/or your dependents, your J-1 sponsor must terminate your program and report the termination to the Department of State (DOS).
If you need information about purchasing insurance, the OISS maintains a list of health insurance carriers who meet DOS requirements.
How Health Insurance Works
When you purchase health insurance, the money you pay (your premium) is combined with the premiums of others to form a pool of money. That money is then used to pay the medical bills of those participants who need health care. Your coverage remains valid only as long as you continue to pay your insurance premiums.
Once you purchase insurance, the company will provide you with an insurance identification card for use as proof of your coverage when you are seeking health care from a hospital or doctor. The company will also provide written instructions for reporting and documenting medical expenses. The company will evaluate any claim that you file, and make the appropriate payment for coverage under your particular policy. In some cases the company pays the hospital or doctor directly; in others the company reimburses the policy holder after he or she has paid the bills.
The Need for Health Insurance
It is risky to be in the U.S. without adequate health insurance. In many countries, the government bears the expense of health care for its citizens, and sometimes even for visitors; however, individuals and families in the U.S. are responsible for these costs themselves. Since a single day of hospitalization and medical treatment can cost thousands of dollars, many hospitals and doctors refuse to treat uninsured patients except in life-threatening emergencies. Most Americans rely on insurance, and you should do the same. Insurance gives you access to better and more timely health care, and provides the only protection against the enormous costs of health care in this country.
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?
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.
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.
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.
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.
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.
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.
U.S. Department of State regulations require that sponsors (colleges, universities, or agencies which promote educational exchange) monitor insurance coverage for all Exchange Visitors (J-1 principal and J-2 dependents) in their programs.
While no recommendations are made on specific policies or carriers, the regulations do establish minimum coverage as follows:
- Medical benefits of at least $100,000 per accident or illness;
- Repatriation of remains in the amount of $25,000;
- Expenses associated with medical evacuation of the Exchange Visitor to his or her home country in the amount of $50,000.
An insurance policy secured to fulfill these requirements must provide coverage for activities inherent to the exchange program but may impose the following conditions:
- A waiting period for pre-existing conditions as long as the waiting period is reasonable by current industry standards;
- A co-payment not greater than 25%;
- A deductible not to exceed $500 per accident or illness.
In addition to the standards for coverage, the regulations also set forth rating requirements for acceptable policies. Coverage backed by the full faith and credit of the government of the Exchange Visitor's home country are exempt from these rating requirements.
Important: Department of State regulations require insurance coverage to be in place from the time the Exchange Visitor enters the program and through the duration of the program. UNH is required to terminate an Exchange Visitor's participation in the program if the visitor and his/her dependents willfully fail to comply with and maintain the required insurance coverage.
All Exchange Visitors must comply with this mandatory insurance requirement.
Selected List of Medical Insurance Carriers
The following health insurance plans and supplements meet all the mandatory insurance requirements for J Exchange Visitors (non-students). OISS does not recommend or endorse any of these insurance policies but has provided this list to assist you in finding an appropriate insurance provider. Contact the insurance companies directly for more information on specific plans and their fees.
This is not a comprehensive list. You may purchase other insurance plans as long as they meet the U.S. Department of State insurance requirements for J Exchange Visitors.