11 Health Insurance Terms J-1’s Should Know

Filed in J-1 Regulation Explainers by on March 11, 2015 0 Comments

The American Immigration Council’s J-1 program receives more questions about healthcare insurance than any other subject. We understand that insurance is a tricky topic, and it can be just as hard for U.S. residents to understand as it is for international visitors.

Before discussing the details of healthcare insurance in the U.S., it is best to define important terms. This article in the series discusses some of the language you will commonly see used in descriptions of healthcare insurance. These articles will explore what healthcare insurance is, how to use it, and how to navigate the insurance system as a J-1 or J-2 Exchange Visitor.

We may update or revise this list, so bookmark this page and check back in the future when you have insurance-related questions:

  1. Healthcare Insurance/Coverage (sometimes called a “Policy or “Plan”): The contractual agreement between you and an insurer that determines what the insurance company will pay, under what conditions they will pay, and what you as the insured individual(s) must do in order to ensure that your healthcare costs will be covered by the insurer.
  2. Insurer/Insurance Company: An entity, usually a private company, which offers insurance coverage to individuals or groups as a paid service.
  3. Healthcare Provider: The entity that assists you by administering health-related services. For example, a doctor, hospital, clinic, or specialist—this is where you go to get treated for an accident or illness in the United States, or to receive regular screenings and immunizations in your home country.
  4. Copayment (“Copay”): A set amount of money you pay when you visit a healthcare provider.
  5. Deductible: The portion that you must pay out of the total cost of the healthcare services you receive. Usually, the insurance company agrees in the policy to pay a certain portion of the bill for healthcare services, and you must pay the rest. For example, a common situation is that an insurance company will agree to pay for your healthcare only once the bill reaches a certain amount, and anything under that amount is your responsibility to pay. So, if your deductible is $100, and the bill is $200, that means you pay $100 and the insurance company pays $100. The deductible may or may not apply in certain situations, subject to the terms of the insurance policy. This amount is in addition to the copayment mentioned above.
  6. Network: The various healthcare providers that have a contract to work with your insurance company. An insurance company will partner with local doctors, hospitals, and other facilities in the areas where their customers live. Some healthcare providers only accept patients who purchase coverage from specific insurance companies, and many insurance companies will charge additional money if one of their customers chooses to visit a healthcare provider that is not in the network.
  7. Premium: A recurring daily, weekly, monthly, quarterly, or yearly payment that you must pay to the insurance company to maintain your insurance coverage. In the case of the American Immigration Council’s group insurance.
  8. Preventative care: Visits to the doctor or other healthcare provider when an individual is still healthy. These include routine doctor visits, vaccinations and immunizations, wellness therapy, and other treatments designed to keep you healthy.
  9. Accidental Illness and Injury Insurance: A type of insurance that is common to international visitors, including J-1 trainees and interns and their J-2 dependents. Accidental Illness and Injury Insurance only covers you once you get sick or hurt and require medically necessary treatment. The insurance company will not pay for preventative care. The American Immigration Council’s group insurance policy is an Accidental Illness and Injury Insurance policy.
  10. Group Insurance: A type of insurance policy that offers the same type of healthcare coverage to multiple people, who are all registered with the same insurance company. The American Immigration Council purchases a group insurance policy for our participants through a private company insurance, called Sirius/IMG, which provides insurance coverage to our J-1 and J-2 participants who elect to purchase the policy.
  11. Claim: Documentation that must be submitted to the insurance company in order for them to pay for your healthcare services. Claims must be sent to the insurance company by either the individual who receives services, or the healthcare provider who administers treatment. Each insurance company has specific processes for how to contact them to submit a claim. For example, some insurance companies will pay the healthcare provider directly, while others will ask you to pay the bill and then reimburse you a certain amount based on the terms of the policy.

To be clear, the list above is very basic and general. For more in-depth resources, a great place to start learning about how health insurance works and the different terminology is the federal government’s website Healthcare.gov. Additionally, there is a much more thorough and much more comprehensive glossary on Healthcare.gov. If you encounter a term you do not see on this list, you may find a definition on the websites mentioned above.

If you have an insurance related question and are unsure how to proceed, or if you need medical treatment or assistance and are unsure what to do, please contact your visa sponsor by emailing J1program@immcouncil.org, or the J-1 program specialist assigned to your case, so we can advise you on your specific circumstances.