When you purchase health coverage, the money you pay goes to a pool of money with others. That money is then used to pay the medical bills when the insured file medical claims. Once purchased, you will receive an insurance identification card and declaration of coverage, or equivalent, from our insurance provider. The latter is required when attending a visa interview.
The J-1 insurance coverage must provide the following minimum coverage: (A1) minimum medical benefit of $100,000 per person per accident or illness; (A2) deductible that does not exceed $500 per accident or illness; (A3) minimum repatriation of remains in the amount of $25,000; (A4) minimum medical evacuation expenses in the amount of $50,000; and (A5) co-insurance paid by J-1 not to exceed 25% of covered benefits per accident or illness.
Additionally, qualified J-1 insurance policies (B1) may require a waiting period for pre-existing conditions that is reasonable as determined by current industry standards; and (B2) must not unreasonably exclude coverage for the perils inherent to the activities of the exchange program in which you participate.
Additionally, qualified J-1 insurance policies must be underwritten by an insurance carrier with: (C1) an A.M. Best rating of ‘‘A-’’ or above; (C2) a McGraw Hill Financial/Standard & Poor’s Claims Paying Ability rating of ‘‘A-’’ or above; (C3) a Weiss Research, Inc. rating of ‘‘B+’’ or above; (C4) a Fitch Ratings, Inc. rating of ‘‘A-’’ or above; or (C5) a Moody’s Investor Services rating of ‘‘A3’’ or above.
Alternative options include policies that are (C6) backed by the full faith and credit of the exchange visitor’s home country; or (C7) part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor; or (C8) offered through or underwritten by a federally qualified Health Maintenance Organization or eligible Competitive Medial Plan as determined by the Centers of Medicare and Medicaid Services of the US Department of Health and Human Services.
Exchange interns and their accompanying spouse and dependent(s) may be subject to the requirements of the Affordable Care Act [22 CFR 62.14(a)]. Generally speaking, an individual’s tax residency status is determined by the Internal Revenue Service. Non-residents for tax purposes are not subject to ACA, whereas residents for tax purposes are subject to ACA and such requirements may exceed the US Department of State requirements. Further details about ACA can be found
HERE, while penalties for lack of coverage can be found
Before the visa interview, students will submit their tentative "entry-to-exit" periods, which must be within 21 days before and after the authorized program periods. After reviewing available options and details, they will proceed with their purchase and submit proof. If they purchase one of our suggested plans, they must circle and annotate the minimum coverage requirements (A1-A5), their name, coverage period and declaration of coverage or equivalent. If they choose their own plans, they must circle B1, B2 and one of the C fields, in addition to the stated fields.
Students can get sick for various reasons, for example, a change in weather or an unhealthy lifestyle. For minor medical issues, see a regular family doctor. In some cases, s/he may refer you to a specialist. Depending on the severity of your sickness, you may also visit an urgent care clinic or a hospital. Learn the filing procedures and special terms before coming to the US. When seeing a doctor or visiting a hospital, carry your insurance ID with you.
Know the difference between network doctors and non-network doctors. Some insurance companies have contracts with some medical providers (also called in-network doctors or Preferred Provider Organizations). You pay less if you use providers that belong to your plan's network.
Unlike in Asia, where doctors typically dispense medicine themselves, the American system involves separate pharmacies that distribute the proper medications. At the end of your doctor visit, the doctor will send a prescription to the pharmacy, which you will then retrieve and pay for yourself, separate from the doctor's expense.
Generic drugs are generally cheaper and the equivalent to a corresponding brand name. If saving money is most important to you, ask the doctor to prescribe generic drugs. OTC medications can be bought by anyone at a pharmacy without a doctor's prescription. These include basic painkillers and allergy treatments. Prescription drugs are more powerful and are designed to combat infectious illnesses. These require a doctor's authorization before they are dispensed at a pharmacy.
After seeing a doctor, keep the receipts and file a claim for the medical expenses within the specified period. Your insurance company will evaluate your claim and make the appropriate payment for coverage. In some cases, the insurance company pays the hospital or doctor directly; in others, the company reimburses the policy holder after he or she has paid the bills. Be sure that you use your home address when filing a claim as your claim may take a while to process.