The J-1 Exchange Visitor Health Insurance Requirement
As a J-1 Exchange Visitor in the United States, you are required to carry health insurance for yourself and your J-2 dependents, if applicable, for the full duration of your J program. Government regulations stipulate that if, after that date, 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) in Washington.
It is dangerous to be in the United States without adequate health insurance. Although in many countries the government bears the expense of health care for its citizens, and sometimes even for visitors, individuals and families in the United States 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.
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 (filing a claim). 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.
Your J-1 sponsor may include health insurance coverage as part of sponsorship, without further charge to you. Alternatively, your J-1 sponsor may have selected and approved a specific policy for all its Exchange Visitors, and may require you to buy that insurance as soon as you arrive in the United States. In many cases, however, you will be required to select and purchase your own insurance coverage. In choosing an insurance policy, in addition to the minimum requirements 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. In choosing insurance, you should think carefully about how much you can afford to pay out of your own pocket each time you are sick or injured, and weigh the deductible against the premium before you decide.
Co-insurance. Usually, even after you have paid the deductible, an insurance policy pays only 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.
If you need information about purchasing insurance, ask your J-1 sponsor about policies available to Exchange Visitors in the United States. Read the policy information carefully and don't be afraid to ask questions before you buy. The OISS maintains a list of health insurance carriers who meet DOS requirements.
An agent is an individual who represents one or several insurance companies and sells insurance to individuals and groups. When working with an agent you should feel free to ask questions and take the time to learn about and understand several choices before you make a decision. If you are uncertain or confused, don't sign anything. Consult a knowledgeable friend, or your J-1 sponsor, for help.
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