Mandatory Health Insurance
- Maintaining Status
- Length of Stay
- Home Country Presence Requirement
- Traveling Outside the USA
- Mandatory Health Insurance
As exchange visitors to the United States, under a rule effective 9/1/94, J-1 visa holders must carry health insurance for themselves and J-2 dependents for the full duration of a J-1 program. The insurance policy must include the following:
- A deductible of no more than $500 per accident per illness
- Minimum benefits of $50,000 per accident or illness
- $7,500 benefit for repatriation of remains in case of death
- $10,000 coverage for medical evacuation travel expenses
- Any waiting periods for pre-existing conditions should be reasonable by current industry standards
- Policy must be backed by full faith and credit of a home country government or must meet minimum rating requirements established by the US government (an A.M Best rating of “A-” or above, an Insurance Solvency International, Ltd. (ISI) rating of “A-I” or above, a Standard and Poor’s Claims-paying ability rating of “A-” or above, or a Weiss Research, Inc. rating of “B+” or above.
Government regulations stipulate that if a J-1 visa holder does not carry health insurance for himself and all dependents, they will have to depart the USA before completing the program as the J-1 Sponsor must terminate the program and report the program violation.
Why do Exchange Visitors have to have health insurance?
It is dangerous to be in the United States without adequate health insurance. In the United States, individuals, families and visitors are responsible for paying for health care costs themselves. Unlike many other countries where the government provides health care for its citizens and sometimes visitors, the United States has multiple private health care systems and insurance companies. Since a single day of hospitalization and medical treatment can cost thousands of dollars, many hospitals and doctors refuse to treat or see uninsured patients except in life threatening emergencies. Most Americans rely on insurance; Exchange Visitors must do the same. Insurance gives one access to better and more timely health care. It also provides the only protection against the enormous costs of health care in this country.
How does medical insurance work?
When one purchases health “coverage” through an insurance company, the fees or money one pays (the premium) is combined with the premiums of all others to form a large pool of money. The large fund is then used to pay the medical bills of those holding insurance policies who need health care services. An individual’s coverage remains valid only as long as s/he continues to pay insurance premiums. These premiums are usually based on a monthly rate. Also, in many cases, insurance only pays a percentage of the total bill for health care services.
Once a person purchases insurance, the company provides an insurance identification card for use as proof of coverage. Hospitals and doctors’ offices ask for this proof, or card, when one arrives at their offices seeking healthcare. The company will also provide written instructions for reporting and documenting medical expenses (“filing a claim”). The company will evaluate any claim you file, and make the appropriate payment for coverage under your particular policy. In some cases, the insurance company pays the hospital or doctor directly. In other cases, you pay and the company reimburses you after you have paid the bills and filed a claim.
How do I choose an insurance policy?
A J-1 sponsor may include insurance coverage as a part of sponsorship without further charge to you. Alternatively, a J-1 sponsor may have selected and approved a specific policy for all its Exchange Visitors and require EVs to buy that insurance policy as soon as you arrive in the United States. In many cases, however, an EV will be required to review competing policies then select and purchase insurance coverage on his or her own.
In choosing an insurance policy, one should consider many factors, not simply the minimum requirements:
The reliability of the company.
Does it treat people fairly? Does is pay its claims promptly? Does it have staff to answer questions and resolve problems? Is it accustomed to working with international students or visiting scholars?
Most insurance policies require the policy holder to pay for part of his/her health expenses (the “deductible”), before the company pays anything. Under some policies the deductible is annual, and the policy holder pays only once each year if insurance is used and expenses are claimed. Under other policies, the insured pays the deductible each time there are expenses for an an illness or injury up to a maximum. J-1 regulations limit the deductible to a maximum of $500 per accident or illness, but many policies do offer a lower, more advantageous one. In choosing insurance, 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.
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 co-insurance. Thus, if you were injured and incurred $3,000 in medical expenses, a policy with a $400 deductible and a 20% co-insurance “co-pay” would cover $2,080 (80% of $2,600). You would be responsible for $920. The J-1 regulations require you to have a policy where the insurance company covers at least 75% of covered medical expenses.
Some policies state specific dollar limits on what they will pay for particular services. Other policies pay a “usual” or “reasonable and customary charge 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-term benefit period provides the best coverage.
Exclusions and Pre-Existing Conditions
Most insurance policies exclude coverage for certain conditions. The J-1 regulations require that if a particular activity is a part of your 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.
Where can I get information on insurance?
- Your J-1 Sponsor or Responsible Officer
- Oklahoma State University Insurance Contact: Student Health Center, Farm Road and Lincoln, 744-7023
- Personnel Office, if you have insurance as a part of your benefits, 405 Whitehurst, 744-5449 (only for scholars)
READ POLICY INFORMATION CAREFULLY AND DON’T BE AFRAID TO ASK QUESTIONS BEFORE YOU BUY!!! TAKE THE TIME TO LEARN ABOUT CHOICES.
IF YOU ARE UNCERTAIN OR CONFUSED, DON’T SIGN ANYTHING!!!
oklahoma state university health insurance information
You will be required to purchase the Oklahoma State University Academic Health Plan unless you can provide evidence of a qualifying insurance that you currently purchased. If you are a J-1 Scholar who is receiving a salary by an OSU department you may have opportunity to sign-up for the University Health Insurance (Blue Cross & Blue Shield) through the University benefit office.
The proof of health insurance must be submitted to the ISS within 10 days of your arrival on the OSU campus. The insurance coverage must include all J-2 family members.
- Link to Agreement to abide by the Mandatory J-1 Health Insurance Requirements of Exchange Visitors
- Link to J-1/J-2 Visiting Scholars/Student Health Insurance Sign Up