It is not only unwise to be in the U.S. without adequate health insurance, you and any J-2 dependents are legally required by the U.S. Department of State to have insurance for the entire duration of your program – from the day you arrive to the day you depart. Failure to maintain insurance coverage will result in the termination of your J-1 program and status.
The legal insurance requirements list minimum levels of insurance coverage (see Legal Requirements below). However, these levels are now completely out of date and do not reflect the true costs of medical care today. J-1 scholars are required to have insurance that meets the minimum legal level of coverage, but you should obtain insurance coverage that will cover today’s costs.
Therefore it is very important that you not only have health insurance, but that your insurance provides adequate coverage. Common “travel insurance” often has low maximum coverage and may only cover emergency care. They also have many coverage exceptions that could put you at risk. Good health insurance will have minimum coverage of at least $200,000 or more, and provide regular preventative care and regular check-ups, not just emergency care. This is especially true if you have children with you. We strongly recommend that you carefully review any insurance plan to be sure you and your family members are adequately covered for your health care in the U.S. When making comparisons, remember that low cost usually equals low and inadequate coverage.
The Real Costs of Health Care
The legal requirements for J-1 health insurance were created in 1993. Since then, health care costs doubled by 2004 with a similar increase from 2004 to today. One day in a hospital in 1993 averaged $581. Today, one day in a hospital averages $3,949*! A minimal $50,000 “Travel Insurance” plan will disappear very quickly when you need it. The cost of insurance has gone up too, but the cost of good insurance is very small compared to the medical expenses you will incur if not adequately insured.
*International Federation of Health Plans, 2011 Comparative Price Report
Legal Requirement Details
The table below lists the general minimum requirements. Recommended coverage must meet the same requirements, but provide a reasonable level of coverage.
|Legally Required Insurance Coverage (Summary)||Recommended Insurance Coverage|
The legal health insurance requirements are as follows:
- Sponsors shall require each exchange visitor to have insurance in effect which covers the exchange visitor for sickness or accident during the period of time that an exchange visitor participates in the sponsor’s exchange visitor program. Minimum coverage shall provide:
- medical benefits of at least $50,000 per accident or illness;
- repatriation of remains in the amount of $7,500;
- expenses associated with medical evacuation of the exchange visitor to his or her home country in the amount of $10,000;and
- a deductible not to exceed $500 per accident or illness.
- An insurance policy secured to fulfill the requirements of this section:
- may require a waiting period for pre-existing conditions which is reasonable as determined by current industry standards;
- may include provision for co-insurance under the terms of which the exchange visitor may be required to pay up to 25 percent of the covered benefits per accident or illness; and
- shall not unreasonably exclude coverage for perils inherent to the activities of the exchange program in which the exchange visitor participates.
- be payable in US Dollars (for insurance from a company outside of the United States)
- Any policy, plan, or contract secured to fulfill the above requirements must, at minimum, be:
- underwritten by an insurance corporation having an A.M. Best rating of “A-” or above, an Insurance Solvency International, Ltd. (ISI) rating of “A-i” or above, a Standard and Poor’s Claims-paying Ability rating of “A-” or above, a Weiss Research, Inc. rating of B+ or above, or such other rating service as the Agency may from time to time specify; or
- backed by the full faith and credit of the government of the exchange visitor’s home country; or
- part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor; or
- offered through or underwritten by a federally qualified Health Maintenance Organization (HMO) or eligible Competitive Medical Plan (CMP) as determined by the Health Care Financing Administration of the U.S. Department of Health and Human Services.
- An accompanying spouse or dependent of an exchange visitor is required to be covered by same insurance amounts as described for the J-1 visitor.
- An exchange visitor who willfully fails to maintain the insurance coverage set forth above while a participant in an exchange visitor program or who makes a material misrepresentation to the sponsor concerning such coverage shall be deemed to be in violation of these regulations and shall be subject to termination as a participant.
- A sponsor shall terminate an exchange visitor’s participation in its program if the sponsor determines that the exchange visitor or any accompanying spouse or dependent willfully fails to remain in compliance with the insurance requirements.
WARNING: The levels of insurance coverage in these legal requirements are out-of-date. See recommended levels of coverage above.