Health Insurance Requirement

Overview

  1. Why you must always have health insurance as a J-1 visa holder
  2. How health insurance works in the U.S.
  3. What health insurance the U.S. Department of State requires for J-1 visa holders
  4. How to Choose a provider of health insurance
  5. The Affordable Care Act (ACA) and how it may impact your health insurance choice

 

  1. Why do you need health insurance?
     
  1. To have access to, and be able to afford, medical care in U.S.
    • Being in the United States without adequate health insurance carries notable risk. In many countries the government bears the expense of health care for its citizens. This is not the case in the United States: individuals are responsible for paying health care costs themselves.
    • Having adequate insurance allows you to access timely health care and provides financial protection from high health care costs associated with medical care.
  2. To comply with U.S. Department of State requirements for participants in the Exchange Visitor Program, to avoid being “out of status” and its consequences
    • The Dept. of State requires all Exchange Visitors to purchase and maintain health insurance, and medical evacuation/repatriation insurance, that meets or exceeds U.S. Department of State standards for yourself and all J-2 dependents for the full duration of your J program. This must include any and all time you and/or your dependents are outside the United States during your exchange program.
    • If you do not have health insurance for yourself and your dependents during your exchange program, your J-1 sponsor (Georgia Tech) is obligated to report the violation by terminating your Exchange Visitor SEVIS record. This will result in immediate cancelation of your current exchange and could negatively impact future attempts to request entry to the United States.

Section Summary:

--Having health insurance is the only way to assure you will have access to, and be able to afford, medical care in the U.S.

--Having qualifying health insurance for you and your dependents for the entire length of your program is required by the U.S. State Dept to engage in Exchange Visitor activities

 

  1. How does health insurance work in the U.S.?
  • When you pay health coverage, the money you pay (your premium) is combined with the premiums of others to for a pool of money.
  • That money is then used 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 health insurance from a health insurance provider (company), 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 will also provide written instructions for reporting and documenting medical expenses (filing a claim). Depending on how your insurance in structured, your insurance company will either pay a hospital or doctor directly with little or no out-of-pocket cost to you or reimburse you for medical expenses after you have paid these expenses yourself. The amount you are required to pay before the insurance company starts paying for services is referred to as your “deductible.”

Section Summary:

--You must purchase health insurance through your employer or as an individual. Either way, you pay a monthly fee each month (the premium) that you have the insurance

--Sometimes your insurance provider will pay medical costs directly to the doctor on your behalf; alternatively, you may have to pay full amount of medical expenses and then get reimbursed by your provider after the fact

--The amount that you have to pay for medical care before your insurance provider will begin paying is called the deductible

 

  1. What kinds of insurance does the U.S. Department of State require?

Your health insurance coverage must meet or exceed these requirements established by the U.S. Department of State.

Minimum medical benefit

(minimum insurance coverage)

$100,000

Deductible

Not more than $500

Medical evacuation insurance*

At least $50,000

Repatriation of remains insurance*

At least $25,000

*Some insurance plans combine these 2 types of insurance, which is fine as long as the combined total is $75,000 or above

IMPORTANT NOTE: Some health insurance policies (such as GT student insurance, voluntary plan) include medical evacuation and repatriation coverages, others (such as GT employee insurance plans) do not. If your health insurance plan does not include medical evac/repat insurance, you are required to purchase this coverage separately.

*INSURANCE OPTION*: Georgia Tech’s student health insurance, offered on behalf of the University System of Georgia’s Student Health Insurance Program (SHIP), is available for you to purchase (called “voluntary plan”) if you choose. SHIP offers high quality health insurance and med evac/repat insurance that exceeds the U.S. Department of State minimum requirements. For more info, go here and here (look at info on voluntary plan only).

Section Summary:

--You and your dependents must have health insurance for the entire length of your exchange program that meets or exceeds U.S. Dept of State requirements.

--If your health insurance does not include medical evacuation/repatriation insurance (such as all GT employee insurance plans), you must purchase them separately.

 

 

  1. Insurance providers

Type of insurance

Cost/what is included

More info

GT employee health insurance-- only available if you are a GT employee-- and

Separately purchased med evac/repat insurance

$$$$

Most expensive to you, but pays for more medical costs

 

GT HR employee insurance

PGH Global standalone med evac/repat insurance (ACSA travel)

GT Student insurance through SHIP (voluntary plan)

 

Stamps Health Ctr. student insurance (look at Voluntary Plan column)

GT partner PGH Global insurance

 

PGH Global health insurance (can include med evac/repat)

Insurance from provider of your choice in the U.S.

 

 

Insurance from foreign provider of your choice

$

Least expensive to you, but likely pays for less medical costs

--

 

IMPORTANT NOTE: As part of OIE’s mandatory check-in process after you arrive in the U.S., you will be required to upload your health insurance policy summary  (and medical evacuation/repatriation insurance, if purchased separately) as evidence that you are enrolled in health insurance plan(s) that meet or exceed U.S. Dept of State requirements.

  • What kind of insurance is best?

Think about how/how often you might need to utilize health insurance and for what purpose(s), for yourself and/or any J-2 dependents you have staying with you in the U.S. Before purchasing a health insurance plan, be sure to carefully read the plan’s description of benefits and coverages so you know which services are included in the plan and which are not, and what costs you will be responsible for.

Only read this section if you are a GT employee

  • Be aware that certain GT employee health insurance plans do not meet the U.S. Department of State minimum standards. It is your responsibility to ensure that the GT employee insurance plan you select is in compliance with U.S. Department of State requirements. For further details please examine the USG Comparison Guide. As health insurance coverage amounts can change at any time, OIE recommends that you confirm that your health insurance plan is compliant with U.S. Department of State standards when you initially select a plan, as well as re-confirm that your plan is compliant annually during the GT employee insurance open enrollment period.
  • If you are eligible for GT employee benefits: 1) you must complete the OHR enrollment process including selecting health insurance, 2) ensure you have temporary health insurance coverage if the insurance plan will not begin with the start of your J program, AND 3) purchase a separate Medical Evacuation and Repatriation plan in order to be in compliance with Department of State regulations. Georgia Tech Employee Health Insurance info: https://hr.gatech.edu/benefits/health-welfare-benefits

Section Summary:

--Health insurance vary providers vary in terms the quality of care, and which medical services are paid for by the insurance provider versus paid for by you out of pocket. The cost of insurance plans (premiums) vary accordingly.

--When choosing a provider/insurance plan, consider how often and/or what kinds of medical services you or your dependents may need to use; also be sure to read the insurance description so you know what you are paying for


 

  1. What is the Affordable Care Act (ACA), and how might it impact my choice of health insurance?
  • ACA is a federal statute that aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare for individuals and the government.
  • Individuals who are considered resident aliens for U.S. tax purposes are expected to be enrolled in an ACA compliant insurance plan. Insurance plans offered by PGH Global (linked to above) are not ACA-compliant. Student and GT employee health insurance offered by Georgia Tech/University System of Georgia is ACA-compliant. For more info on tax filing, go to /nrtaxes
  • If you use PGH Global or another insurance provider that is not ACA-compliant, you may be subject to an IRS tax penalty if you are considered a U.S. resident alien for tax purposes.

Additional resources for Georgia Tech visiting scholars to help explain the ACA:

Section Summary:

--If you are considered a resident alien of the U.S. for tax purposes, your health insurance must be Affordable Care Act (ACA)-compliant.

--If this applies to you, be sure to find out if the health insurance you have or are thinking of buying is/is not ACA-compliant.