J-1 Status Students
Health InsurancePlease note that the following information is meant to be used only by Florida State University faculty, staff, students, and potential students of Florida State University and only in the context of international visits to FSU specifically. It is not intended to be used and should not be construed as general legal advice.
Health insurance which covers one in the U.S. is required of everyone in J status, both students and their dependents. It is required at all times of one's J program, from day a student begins their academic program until the end of their academic program, including any academic training time. The U.S. Department of State places strong importance on maintaining continuous insurance coverage and requires the sponsor of the J program to terminate the immigration status of anyone willfully failing to maintain the minimum levels of insurance or making material misrepresentations regarding health insurance for themselves or their family members.
The minimum requirements for insurance are also listed on page 2 of the DS-2019 form. All exchange visitors must sign the certification on the front page of their DS-2019 form indicating that they have read all of page two. Therefore, not knowing about the insurance requirement is not a valid reason for failing to maintain coverage. If a student has forgotten to renew a policy or otherwise made a mistake, though, the International Center will be glad to help the student regain compliance with this regulation.
In addition to federal requirements for health insurance, the State of Florida also has additional health insurance requirements for all enrolled F-1, J-1, or J-2 international students. The higher requirements for each benefit prevail for the J-1 or J-2 student. Complete information on the State of Florida insurance requirements and options for payment may be obtained at the Thagard Student Health Center's website - http://studentinsurance.fsu.edu/. The Thagard Student Health Center provides students and their dependents access to a group insurance plan which covers all the State of Florida and federal requirements.
Please note that students who are covered under a group plan provided by their sponsor will need to purchase a second health insurance policy through the Thagard Student Health Center in order to be in compliance with State of Florida requirements. The plans provided by IIE, LASPAU, OAS, Amideast, and other similar sponsors do not comply with State of Florida health insurance requirements, but only federal requirements. If the sponsor will pay for the second health insurance policy, the third party billing process for insurance (in addition to the separate billing process for tuition and fees) should be carefully followed.
Family members in J-2 status do not have to maintain insurance coverage which meets the State of Florida requirements, but they always carry insurance which meets the minimum federal requirements. It may be difficult for family members to obtain insurance apart from the primary J-1, though. Normally, J-2 dependents are not eligible for insurance without the J-1 also being covered under the same plan. Travel insurance from one's home country may meet the requirements and provide comprehensive and affordable coverage in the U.S. for dependents. Plans from abroad normally do not meet the State of Florida requirements for students.
Other plans which may provide appropriate coverage for both the student and their dependents are listed on the Thagard Student Health Center's website - http://studentinsurance.fsu.edu/. Please note that the policy brochure links provide there are for informational purposes only; the CGE and Thagard cannot endorse or recommend any particular insurance plan, other than the plan offered directly through the Thagard Student Health Center. That is the only plan of which we have in-depth knowledge and experience. If you choose a plan not offered directly through FSU, you must make a determination as to which plan is most appropriate for your particular circumstances. To do so, you should consider the following:
Eligibility - Is the applicant's (student or dependent) particular immigration status and J-1 category covered by this plan? Does the plan require the student to be enrolled? Keep in mind that, if someone in the student category is currently in Academic Training, they will generally not be enrolled as required by some plans. Is a minimum number of hours or status of enrollment required - full-time, 12 hours? During final terms or periods of approved underenrollment (for medical or academic reasons), the student may not technically be eligible. Although insurers will accept applications and premiums without checking on enrollment, later claims for reimbursement or payment for treatment may be rejected without documentation of the student's enrollment status.
Renewal options - Check to see if the plan can be continuously renewed. Some plans do not allow renewal. So, each time the policy is re-purchased a period of non-coverage for pre-existing conditions begins again. This means that if a student becomes pregnant at the end of one period of paid coverage, the continuing care, the birth, and the pre-natal care will not be covered under the new period of coverage. The condition will be considered pre-existing. Choose plans that allow for renewal, and be sure to renew within the specific period outlined in the insurance plan details in order to maintain continuous insurance coverage.
Pre-existing conditions exclusions - Nearly every insurance plan excludes pre-existing conditions. These are generally defined as any condition which manifested or were diagnosed prior to the beginning of the insurance policy. So, if a doctor determines that a student may have had untreated diabetes for a year before the student began their insurance coverage, all treatment for that condition will be the student's responsibility for at least the first six months of the insurance policy, if not more. Be sure to read carefully and understand all language regarding pre-existing conditions, and if you or your family members have a condition which will require continuing care during your stay, avoid switching insurance plans. Look for plans which do not exclude pre-existing conditions in order to have the most comprehensive coverage available.
Exclusions - Be sure to understand all exclusions. Regulations for the J program require that an exchange visitor's insurance plan covers all risks inherent to the student's main activity. So, chemistry students will want to be sure that their plan does not exclude contact with dangerous chemicals or machinery. Many plans do exclude such activities. If the student is involved in intramural sports or other types of hobbies like scuba diving, climbing, or motor biking, they will want to be sure that injuries resulting from these activities are covered, or that they have purchased an additional "rider" or extra coverage which will provide for treatment of such injuries. Some plans exclude children's ear infections, immunizations, pregnancy testing, birth control, STD testing, treatment of back or joint pain, or treatment of foot conditions. Be aware of these exclusions and make the best decision based upon your and your family's needs. Plans with minimal exclusions provide the most comprehensive coverage.
Benefit limits - Be aware of the limits placed on certain diagnostic tools or treatments. Plans which appear to provide the same maximum coverage amounts may limit the amounts they pay for CT Scans, X-rays, laboratory tests, emergency room care, for example. If a plan pays for only $1,000 of the cost of a CT Scan, you would be expected to cover the entire remaining amount.
Provider Network - If you chose an on-line plan, be sure that you look at the provider network used by the plan. This is the list of doctors, hospitals, specialists, and laboratories that have contracted (at some point) to provide service for the insurer. You will want to make sure that there are available providers in a multitude of specialties and facilities in Tallahassee and that these listed providers are still accepting your insurance plan or are still part of that provider network. Many doctors move, do not renew the contract, or contract with other agencies which disallow their participation in any other network. So, it is always best to check directly with the doctor's office. If you prefer a certain doctor, be sure that your doctor is in the network. Out-of-network care often involves a higher deductible and co-payment. Plans with extensive networks of providers will give you more comprehensive coverage and will reduce your out-of-pocket expenses for healthcare.
Usual and Customary - If you choose a provider which is out-of-network, or if there is no in-network provider in the specialty area you need, the insurer will pay their percentage of what they feel is "usual and customary", or the an amount similar to what they pay other such providers in the same geographic area or in a similar geographic area.Â If the amount charged by the doctor is more than what is considered "usual and customary", you will be charged the difference, in addition to your normal deductible and co-pay.
Deductible - The first amount of healthcare charges which are the responsibility of the insured student. Be sure you understand whether you have a deductible which covers your whole family, the whole year, or is charged each time you have a healthcare claim. If you have a $250 deductible, $250 will be deducted from what is billed to the insurance company and you will pay that full amount.
Co-pay - This is a percentage amount which is billed to you, in addition to your deductible amount. This amount is typically around 20% of the bill which remains after your deductible. Sometimes different treatments or diagnostic procedures will have different co-pay amounts.
Costs - Be sure that you understand what costs you will incur if you must be treated. Here is an example. A healthy 30 year old male is outside in the hot Tallahassee sun walking, falls and loses consciousness due to dehydration, and an ambulance is called before he awakes. He is placed in the ambulance, taken to the hospital, and examined at the hospital. The costs are:
$900 - Ambulance
$500 - Emergency Room Services
$250 - Doctor's Bill
$900 - CT Scan/X-rays
$250 - Follow up Doctor's Visit
Total medical bill: $2800
Student pays regular deductible: $250
Student pays emergency room deductible: $200
Student pays 20% of remaining amount: $470
Total billed to student: $920
Insurance is essentially a discount off of your total healthcare costs. Be sure that you understand each potential cost to you with the plan you choose.
If it seems worthwhile to go with a plan that provides less comprehensive coverage but lower premiums, keep in mind what you might actually pay in the end should you need healthcare.
Claim procedures - Be sure that you understand what is required in order to file a claim. Will the healthcare provider present a bill to the insurer? Are you responsible for the entire bill in the beginning and must apply for reimbursement at a later date? What is the standard time for reimbursement? When must bills be submitted? Many plans require that bills be submitted within 30 days of the injury or illness, but many doctors and healthcare providers do not provide a bill that quickly. In that case, you will have to make calls to get the bill more quickly, or the claim will likely not be paid.
Healthcare in the U.S. will be different than what you would expect at home. The process can seem confusing. The Thagard Student Health Center and the CGE will do their best to provide you assistance along the way. Please feel free to ask questions and seek advice.