Understanding the IMG Group Insurance Policy as an Exchange Visitor

Filed in J-1 Regulation Explainers by on March 24, 2015 0 Comments

Photo by Alex Proimos.

All J Visa holders are required to have sickness and accident insurance during their time in the U.S. American Immigration Council exchange participants can enroll in a policy negotiated with the International Medical Group (IMG). It is not mandatory that our participants enroll in this insurance policy through IMG. However, many do because it is an easy way to meet all federal regulations.

For those who have enrolled in this policy, here are four things you need to know:

1. What Does the Insurance Policy Not Include?

The IMG insurance policy is not a comprehensive health insurance policy. It only covers sickness and accidents. This means that you must be either seriously sick or injured in order to benefit from the insurance policy.  It is not used for preventative care, like regular doctor’s visits or medical “check-ups.”

It does not cover wellness care, mental health, maternity, sports, or pre-existing conditions. In addition to filing a claim with the insurance company after treatment, there is a precertification process that should be completed whenever possible before you receive any medical treatment or make a visit to a healthcare provider.

2. How do I Find a Doctor in the IMG Network of Healthcare Providers?

A questions you will encounter when seeking out a healthcare provide is whether or not that doctor or medical professional is a member of your insurance company’s network. As defined in our post about healthcare insurance terms, a network is a group of doctors or hospitals that have negotiated a contract with an insurance company or insurance companies.

IMG is only one of many insurance companies under the First Health Network, so as a J-1 or J-2 participant, you should make sure to follow the steps below when speaking with a healthcare provider (doctor’s office, clinic, hospital, etc.):

  • First, ask the doctor, “Are you a member of First Health Network?”
  • If the medical office says “yes,” you should then follow up with the question, “Do you accept IMG/Sirius International insurance?”
  • If the answer to both of those questions is “yes,” then you should proceed with the precertification process and then schedule an appointment.
  • Some providers will say “no” to the second question above. If this is the case, you should continue to call the next provider on the list until you find a provider who is part of First Health Network and accepts the IMG insurance company’s policies.
  • In some cities, it might not be possible to find a medical provider who will directly bill IMG/Sirius International. You may need to pay for the treatment and then submit the insurance claim to IMG/Sirius International yourself. In this case, it is extremely important to follow the IMG Precertification Process below so that you will know what the insurance will cover.

Medical treatment costs can be very expensive in the U.S. compared to what you are used to in your home country. As a J-1 or J-2 participant, if possibleyou should always consult with the medical provider’s office (doctor, clinic, hospital) before agreeing to be treated. Consulting with the doctor’s office before you make an appointment can help you to become aware of your options. There are often different costs for in-network and out-of-network providers, so following the steps above can help you avoid potentially incurring an expensive bill after your medical visit.

3. What is the IMG Precertification Process?

Precertification is a requirement for certain medical services. You must contact the insurance company before receiving treatment in order to verify whether or not the particular procedure you are seeking will be paid for in part by IMG.

Following the precertification process also lowers the costs of your medical treatment in cases where IMG agrees to pay for your claim. It is a good idea to always submit a precertification request before receiving medical treatment, unless you are physically unable to do so.

Precertification may be initiated by the patient, the patient’s designated representative, or the medical provider. Most U.S. hospitals and physicians are familiar with the precertification process and will make the phone call for the patient, though they are not required to do this. The patient is responsible for ensuring the precertification process is done five days before hospitalization or within 48 hours after an accident or emergency illness.

Certain treatments require that precertification be done in order for the insurance company to pay for the claim. The following treatments and/or supplies require Precertification:

  • Inpatient treatment and or any supplies of any kind;
  • Any surgery or surgical procedure;
  • Any home nursing care;
  • Artificial limbs;
  • Computerized Axial Tomography (CAT Scan);
  • Magnetic Resonance Tomography (MRI)

4. What Documents Must I Submit to File a Claim for Reimbursement with IMG?

The final step in the process of receiving reimbursement from IMG for your treatment costs is to submit a claim to the insurance company. A claim is a request that the insurance company assess the incident which required medical assistance and review the treatment that was administered in response to that injury or illness. Once the insurance company has reviewed the claim and all related documentation, they will make a determination as to what portion of the costs they will reimburse.

IMG Claims department handles all claims submitted by J-1 and J-2 participants who are enrolled in the group insurance policy. IMG requires that all insured participants to complete a Claim Form for each new onset of an illness or injury. In addition to submitting the claim form, you should include copies of any medical bills that you received from the healthcare provider. You will also need to submit an accident report in the event of an injury. This process gives IMG knowledge that you are receiving medical treatment and allows IMG to watch for appropriate billing to be filed on your behalf. A claim must be initiated within 90 days of the initial treatment.

Submitting a claim does not guarantee that the treatment will be covered under the insurance policy. The insurance company will evaluate each claim, and then make a determination on how much of the treatment they will cover financially. As we stated above, performing precertification before treatment can substantially lower the costs of your treatment.

The process of submitting claims and receiving reimbursement can be tricky, so it is best to keep in constant communication with an IMG representative throughout the process. The contact information for IMG customer service is below:

International Medical Group, Inc.
Claims Department
P.O. Box 88500
Indianapolis, Indiana 46208-0550 USA
Phone: 1-800-628-4664 or Outside US 1-317-655-4500