Navigating Health Insurance Regulations as an Exchange Visitor

Filed in J-1 Regulation Explainers by on December 7, 2016 0 Comments

Photo by Sharon Sinclair.

All participants of the American Immigration Council’s Exchange Visitor Program are required to have insurance coverage for the duration of their stay.

Exchange visitors can choose one of the following options to obtain coverage: purchase insurance through the Council, purchase directly from a private insurance company, or purchase through your host company usually deducted directing from your salary.

Regardless of the option you select, the U.S. Department of State (DoS) has a minimum J-1 health insurance requirement that your insurance plan must meet. This regulation also applies to J-2 visa holders. The DoS requirements are:

  • Medical Benefits of at least $100,000 per accident or illness.
  • Repatriation of Remains in the amount of $25,000.
  • Expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $50,000.
  • A deductible not to exceed $500 per accident or illness.
  • A policy underwritten by an insurance carrier with:
    • an A.M. Best rating of ‘‘A-’’ or above;
    • a McGraw Hill Financial/Standard & Poor’s Claims paying Ability rating of ‘‘A-’’ or above;
    • a Weiss Research, Inc. rating of ‘‘B+’’ or above;
    • a Fitch Ratings, Inc. rating of ‘‘A-’’ or above;
    • a Moody’s Investor Services rating of ‘‘A3’’ or above.

It is important that exchange visitors maintain insurance coverage for the duration of the program to maintain their J-1 visa status. Failure to do so can jeopardize your status and the exchange visitor’s program is subject to termination.

Here are a few things to ask an insurance provider before purchasing insurance:

  1. Am I required to pay a deductible, if so how much? Most insurance companies require their insurance policy holder to pay out of pocket before they will pay any of the medical cost. Under the J-1 regulations, the deductible cannot exceed $500.
  2. Am I responsible for co-insurance? Insurance companies usually do not pay all of the medical expenses even after you pay your deductible. Often, they will require you to pay a percentage of the total medical cost. The insurance plan you select must pay at least 75 percent of the covered medical expenses. That means you are subsequently required to pay the remaining 25 percent.
  3. Am I required to have a Per Occurrence Maximum? Insurance companies will stipulate in the policy the amount they will pay for a single individual’s medical bills. The amount will vary. In some policies, there is no maximum—the medical bills will be paid over the life of the policy’s coverage. Other policies will limit the amount of medical bills paid for any one injury or illness. Be sure to read the policy information carefully to determine if there are limits and if they apply to you.

Obtaining insurance coverage will ensure exchange visitors not only remain in status, but also have crucial access to medical services if needed.