This information sheet is designed for J-1 Exchange Visitors and their dependents. It explains the need for health, repatriation, and medical evacuation insurance in the United States and outlines the minimum provisions of the coverage required of every person in J-1 status and any dependents that are in J-2 status. It also defines some of the terms generally used in discussions of health insurance.

As a J-1 Exchange Visitor in the U.S. you must carry health insurance that meets the following minimum criteria for yourself and your J-2 dependents for the full duration of your time in the U.S. in J visa status. Government regulations state that if you willfully fail to carry the minimum coverage of health insurance for yourself and your J-2 dependents, your J-1 sponsor must terminate your program and report the termination to the Exchange Visitor Program (EVP), the government office located in the Department of State that controls this visa program.

You may purchase the required insurance policy after you arrive in the U.S., but if you choose to do so, you should purchase traveler’s insurance to guarantee coverage until your policy in the U.S. takes effect. Be sure your traveler’s insurance covers accidents and illness while you travel, and is not just financial insurance against cancellation of your trip.

REQUIRED INSURANCE SPECIFICATIONS

The specific text of the following information appears in the Exchange Visitor Regulations, Title 22 of the Code of Federal Regulations, on the Department of State web site.
Scroll down to Section 62.14 for the full text.

Summary of the requirements.

1) Medical Benefits. The policy must provide medical benefits of at least US$50,000 per accident or illness.

2) Repatriation of Remains. The policy must provide repatriation of remains benefits of at least US$7,500. If you should die in the U.S., this will provide support to return your remains to your home country.

3) Medical Evacuation. The policy must provide medical evacuation benefits of at least US$10,000. If, because of a serious illness or injury, you must be sent home on the advice of a doctor, the policy must pay at least the amount mentioned above for travel to your home country.

4) Deductible Limit. The policy must have a deductible of no greater than US$500 per accident or illness. Most insurance policies require you to cover part of your health expenses yourself before the company pays anything. Your part is called the deductible.

5) Co-insurance Limit. The policy must have a co-insurance payment of no greater than 25% or less per accident or illness of the covered benefits. Usually, even after you have paid the deductible, an insurance policy pays only a percentage of your medical expenses. The remaining portion, which you have to pay, is the co-insurance.

6) Acceptable Kind or Source of Insurance Coverage. The policy must meet one of the following minimum rating requirements established by the EVP:

• an A.M. Best rating of "A-" or above or
• an Insurance Solvency International, Ltd. (ISI) rating of "A-" or above or
• a Standard & Poor's Claims-paying Ability rating of "A" or above or
• a Weiss Research, Inc. rating of B+ or above,

OR

Be part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor,

OR

Be offered through or underwritten by a federally qualified Health Maintenance Organization (HMO) or eligible Competitive Medical Plan (CMP) as determined the Health Care Financing Administration of the U.S. Department of Health and Human Services,

OR

Be backed by the full faith and credit of your home country’s government.

IMPORTANT: Many insurance policies contain language saying they will not pay for certain conditions. These limitations are called exclusions. Please see the information on “Exclusions” below.

INSURANCE OPTIONS

The following information explains insurance policies available to those affiliated with Duke as students, employees, international scholars, or Summer Work Travel participants. Remember that the J EVP requires 3 kinds of insurance:

1. “health” insurance to help pay for usual medical care, illnesses, and injuries;
2. “repatriation” insurance to help pay the cost if you die in the U.S. and your remains need to be returned home; and
3. “medical evacuation” insurance to help pay if you have a serious illness or injury and must end your program and be returned home under medical care.

Duke Employees (NOT students)

If you are a Duke employee (not a student) you are permitted to enroll in a Duke employee health insurance plan. Duke provides a number of different health insurance options to its employees. Duke does not require you to purchase one of these Duke insurance policies. You are permitted to carry any insurance policy that meets the minimum required specifications outlined above. Generally, to qualify for a Duke employee insurance plan, you must be employed full-time. Students employed on campus generally do not qualify for the Duke employee health insurance.
Exception: If you are employed at Duke as a participant in the Duke Summer Work Travel program in J status you are required to carry insurance specified by Duke.

The Duke employee health insurance plan does not cover these repatriation or medical evacuation, items 2 and 3 on the list of requirements. If you are a Duke employee and choose to enroll in the employee health plan, you must buy additional insurance, to cover the repatriation and medical evacuation requirements. For complete information regarding this coverage, please contact Lisa Giragosian, Assistant Director, International House, tel: 919-681-3922, e-mail: lmg@duke.edu.

NOTE: Clinical House Staff employees sponsored by the Educational Commission for Foreign Medical Graduates, (ECFMG), do not need to purchase additional insurance for medical evacuation and repatriation of remains. ECFMG purchases this policy for you.

International Scholars not employed by Duke (This does NOT include enrolled students.)

If you will not be employed by Duke, determine whether your current health care plan will cover you for all six (6) of the insurance requirements while you are in the U.S. If it will cover you, you must obtain a statement in writing verifying this coverage, in detail, and bring this statement with you to the U.S.
If your health care plan will not cover you while in the U.S., then please contact Lisa Giragosian at the International House, tel: 919-681-3922, e-mail: lmg@duke.edu for complete information on the plans available to you.

Students Enrolled at Duke

Students must purchase health, medical evacuation, and repatriation insurance through the Duke University student insurance plan. That insurance fulfills the J insurance requirements for the principal J-1. Students may purchase additional coverage on this policy to meet the insurance requirements for family members.
For more information on the mandatory Duke student insurance and on how to purchase additional insurance for family members, see “Health Insurance –Students” on the International House web site.

Summer Work Travel Participants

Summer Work Travel participants must purchase health, repatriation, and medical evacuation insurance specified by Duke. That insurance fulfills the J insurance requirements for the principal J-1. Summer Work Travel participants will not need insurance for family members, as they do not bring dependents on the Summer Work Travel program. For more information, contact Lisa Giragosian at International House (tel: 919-681-3922, e-mail: lmg@duke.edu).

WHY YOU NEED HEALTH INSURANCE

It is unwise to be in the U.S. 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 U.S. are responsible for these costs themselves. Often, but not always, the employer provides an opportunity to purchase insurance coverage at a special reduced group rate. 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. Insurance gives you access to better and more timely health care and provides the only protection against the enormous costs of health care in the U.S.

HOW MEDICAL INSURANCE WORKS

When you purchase health coverage, the money you pay, called your premium, is combined with the premiums of others to form a pool of money. The insurance company invests that money and uses it and the income from investments 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 also will 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 coverage under your particular policy. In some cases the company pays the hospital or doctor directly; in others the company reimburses you after you pay the bill.

CHOOSING AN INSURANCE POLICY

Choosing a policy can be confusing. The follow information will help you understand the policies, but if you need help, please contact International House.

Premium. This is the amount that you must pay to purchase and maintain the insurance policy. The policy is only effective if you premium payments are up to date.

Deductible . The deductible is the amount you must pay before your insurance will pay anything at all for health care. Look carefully at the deductible amount and how it is managed. 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. Some policies may offer a lower, more advantageous deductible rate, but the premium may be higher. 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. For example, the policy might pay 80% of the cost of care. You would have to pay the remaining 20%, which is called the co-insurance. Thus, if you were injured and incurred $3,000 in medical expenses, a policy with a $400 deductible and 20% co-insurance would cover $2,080 ($3,000 - $400 deductible = $2,600. 80% of $2,600 = $2,080).

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.

Waiting Period. The policy may establish a waiting period before it covers health problems you had before you bought the insurance, called pre-existing conditions . Insurance companies are permitted to do this, as long as the waiting period is reasonable by current standards in the insurance industry. Pregnancy is a common pre-existing condition that insurance companies will usually not cover.

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 that will pay up to $50,000 for each specific illness or injury. This amount may be enough for most conditions. Major illnesses or injuries, however, can cost many times that amount, well into the hundreds of thousands of dollars.

Benefit Period. Some insurance policies limit the amount of time they will pay 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. Some insurance policies specify that they will not pay for certain conditions or events, especially if you are engaged in high risk activities. Check your policy carefully for exclusions and be sure any activities in which you are likely to engage are covered. The J regulations require that if a particular activity is a part of your EVP, your insurance must cover illness or injuries resulting from your participation in that activity. The insurance cannot contain an “exclusion” for that activity. Examples: If you are studying or doing research in marine biology that requires you to do scuba diving, then your insurance must cover illness or injury connect with diving; it cannot exclude that activity from coverage. If you are working in environmental studies and need to fly as a passenger or crew member in airplanes, helicopters, balloons, etc. to get aerial views of areas, the policy cannot exclude illness or injuries related to such flying. Read the list of exclusions of your insurance policy carefully so that you understand exactly what is not covered by the policy.

Special note on pregnancy and child birth. Some of the “less expensive” policies completely exclude coverage for pregnancy and child birth. Good and consistent pre-natal care is important for the health of the mother and the new baby. A premature baby or a difficult labor can result in very high medical bills in a very short time. If there is any chance at all that anyone in your family might become pregnant while in the U.S., we strongly recommend that you make sure that pregnancy and child birth are covered in your policy.

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, don't sign anything. Consult International House for help.