• Health Insurance Requirements and Regulations
• Health Care Coverage
• Health Care System in the United States
• Processing Insurance Claims
• Choosing an Insurance Policy
• Health Insurance Policy Options

All J-1 exchange visitors and their dependents must be enrolled in an insurance plan that meets the following minimum levels of coverage:

• medical benefits of at least US$50,000 per accident or illness;
  
• repatriation of remains in case of death in the amount of US$7,500;
  
• medical evacuation of the exchange visitor to his or her home country in the amount of US$10,000;
  
• a deductible not to exceed US$500 per accident or illness; and
  
• co-payment not to exceed 25% of covered medical expenses.

An exchange visitor who willfully fails to maintain minimum insurance coverage will be subject to revocation of the exchange visitor status.

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As a Fulbright grantee, you have health care coverage through the United States Department of State Accident and Sickness Program for Exchanges (ASPE). LASPAU will issue you a card for your ASPE health care coverage policy, currently administered by Seven Corners. This policy is only for accidents and illnesses, which means that it will not cover routine checkups or visits to the doctor. The policy covers up to US$100,000 for each accident or illness for a maximum of 52 weeks. Before being treated for any illness consult the ASPE Health Benefit Guide (PDF) regarding the benefits of the ASPE health care coverage; a copy of this booklet should have been mailed to you along with your ASPE health coverage identification card. After reviewing the booklet, visit the ChoiceCare Network on the Seven Corners-ASPE website to find a physician or medical facility in your town or city within the Preferred Provider Organization (a network of physicians, hospitals and clinics that have agreed to offer the U.S. Department of State discounted health care services). Using ChoiceCare saves you money because U.S. Department of State will generally pay 100% of the covered charges when you use a ChoiceCare preferred physician or medical provider. Failure to use a ChoiceCare provider in a network area may result in your being responsible for charges over the usual and customary amount. You may also call customer service for free (if you are calling from within the United States) at 1-800-461-0430 for assistance in locating a provider.

You will need to pay the first US$25 of the treatment of any illness or injury (as mentioned in the information on processing insurance claims in , this is called a "deductible"). Ask your health care provider whether you will need to pay upon being treated or whether the provider can bill your Health Benefit Plan directly. In most states, payment will not be required at the time of services (except for the deductible amount). Please be aware that the policy is only valid in the United States and will not cover you in your home country. The coverage is only for you and does not include any dependents here with you in the United States. If your university has required that you purchase its medical insurance policy, you must use the university policy first before you use the ASPE Health Benefit Plan. Contact LASPAU with any additional questions regarding your health coverage and policy.

Your plan is valid only for the period during which you receive financial support from your funding sponsor, even if your health coverage identification card indicates that you are covered for a longer period of time.

Eye and Dental Coverage

The health care coverage you receive does not cover routine eye exams and dental checkups, athough some university health plans include access to an on-campus dental clinic. We recommend that you see your optometrist and dentist before leaving your home country, as these types of checkups can be expensive in the United States. If you are interested in purchasing a separate dental coverage policy, the international student office at your host institution may be able to recommend a reputable insurance company.

Prescription Medication

If you are taking a prescription medication, we recommend that you bring a sufficient amount with you to the United States, as well as a copy of your prescription. Many pharmacies will not honor a prescription written in another country, and you may need to obtain a new prescription from a physician in the United States. The visit required to obtain the prescription might not be covered by your health care policy.

Mental Health

It is important that you read and understand how this aspect of your health care coverage works. Keep in mind that your emotional well-being is as important as your physical well-being. As you adjust to your program and new surroundings, you may feel depressed, confused, or unhappy for a time. If you find that you are not feeling well emotionally, we recommend that you see a professional, just as you would for a physical problem. Most universities have mental health professionals who can help you. Please contact your advisor at LASPAU if you need assistance.

Dependents' Health Insurance

Dependents of J-1 visa holders must be covered by health insurance while they are in the United States. You will need to send LASPAU proof that your dependents have adequate medical insurance coverage that will take effect as soon as they arrive in the United States and that will last for at least three months. Their coverage must meet the same levels that the U.S. government has established for your own coverage as outlined above.

The insurance policy offered by your U.S. university might be a valid option for your dependents, as long as it meets the requirements for J-1 exchange visitors. For other options, please refer to the sections on Choosing an Insurance Policy and Health Insurance Policy Options.

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The health care system in the United States is different from that in many countries. While elsewhere the government bears the expense of health coverage for its citizens (and sometimes even for visitors), individuals in the United States are responsible for these costs themselves. Since a single day of hospitalization and medical treatment can cost several thousand dollars, hospitals and doctors have been known to refuse to treat uninsured patients except in life-threatening emergencies. Most U.S. citizens rely on insurance, and the United States Department of State, which oversees the Exchange Visitor Program, requires that exchange visitors do the same. Insurance gives you access to better and more timely health care and provides the only protection against its enormous costs.

How Medical Insurance Works

When health coverage is purchased, the fee paid (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. Coverage remains valid only as long as your insurance premium is paid.

After your insurance is purchased, the company will provide you with an insurance identification card to use as proof of your coverage. Doctors, hospitals, and universities often ask to see this card, so you should carry it with you at all times. The company will also provide written instructions for reporting and documenting medical expenses (called "filing a claim"). The company will evaluate any claim that you file and make the appropriate payment for your particular policy. In some cases, the company pays the hospital or doctor directly; in others, the company reimburses the policyholder after he or she has paid the bills. Not all policies cover the same expenses, so it is important to read all literature sent to you regarding your policy.

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All insurance policies designed to cover accidents and illnesses will require you or your dependents to complete and submit a claim form with your medical bills when you ask for payment or reimbursement. Please keep the following guidelines in mind to avoid delays:

• Pay the deductible (that is, the amount you have to pay before your insurance will cover any of your bills). The deductible may vary from one company to another, so check your policy to find out how much you have to pay.
  
  
• Use the claim form issued by the insurance company, and follow the instructions printed on it.
  
  
• Fill out the form completely.
  
  
• Send all of your bills together, if possible.
  
  
• Sign the form and send it to the address for making claims, which may differ from the company’s main address.
  
  
• Keep a copy of everything you submit to the insurance company and record the date you sent it, in case you have to contact the insurance company again.
  
  
• In all correspondence to the insurance company, be sure to include an address and phone number where you can be reached as well as your insurance ID number.

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If you need to select a health insurance policy for your dependents, keep the following in mind:

• The reliability of the company: Does it treat people fairly? Does it pay claims promptly? Does it have staff to answer your questions and resolve your problems? Ask other students what their experiences have been with the insurance company or ask the international student office if they have any suggestions.
  
  
• Specific monetary limits: Some policies state specific dollar amounts that they will pay for particular services. Other policies pay "usual" or "customary" charges, which means that they pay what is usually charged in the local area. Be careful when evaluating policies with specific amounts; these amounts may not cover the full charges for serious illnesses, and you might find yourself responsible for large medical bills.
  
  
• Benefit period: Some insurance policies limit the amount of time they will cover any one accident or illness. Once this benefit period has elapsed, you will be responsible for all charges associated with treatment for this illness, even if you are still insured and the maximum coverage amount has not been reached.
  
  
• Exclusions: Most insurance policies exclude coverage for certain conditions. Read the list of exclusions carefully so that you understand exactly what is not covered by the policy. You would be responsible for paying any excluded charges yourself. If you are presently being treated for an accident, illness, or condition (including maternity), pay close attention to how the policy you are considering handles preexisting conditions.
  
  
• Insurance agents: 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, consult a knowledgeable friend, the international office at your university, or LASPAU before you sign anything.
  
  
• Deductibles: Make sure you understand how the deductible is paid for any policy you are considering. Under some policies the deductible is annual, and you pay only once each year if you use the insurance. Under other policies, you pay the deductible each time you have an illness or accident. In choosing a policy, think carefully about how much you can afford to pay out of your pocket each time you are sick or injured, and weigh the cost of the deductible against the premium cost before you decide on a policy.
  
  
• If it seems too good to be true, it probably is. If you find a policy with a very low premium, it probably does not provide the level of protection you need.
  

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Following is information on several policies that meet U.S. government guidelines. Please contact the companies listed to request further information and/or a brochure. The policies differ in both price and type of coverage, so it is important that you review the information carefully in order to choose a policy that best meets your needs. Should you wish to use an alternative policy to the ones listed here, please send a copy of the brochure to LASPAU before purchasing the policy so that your program advisor can examine and approve the coverage.

The insurance policies below offer coverage for varying lengths of time, from 15 days to several years. Please review the policies to determine which is the best one for you and/or your dependents.

If your current health insurance policy meets all requirements except repatriation and medical evacuation coverage, you may continue to use it as long as you buy an additional policy, referred to as a "rider policy," which will provide you with sufficient repatriation and medical evacuation coverage. International SOS provides an acceptable repatriation and medical evacuation rider policy:

Some insurance companies will allow the J-2 dependents of J-1 grantees to apply separately for their own coverage. However, there are some policies that can only be used for dependents when purchased for the grantee as well. Please contact each company directly for more information.

Insurance Policies

This list is provided for the convenience of our grantees.  LASPAU is not endorsing nor recommending these policies.

*A grantee must be enrolled in the SOS plan in order for his or her dependents to be eligible for this policy.

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