1 speaking out health insurance first in a series; generating thoughts and discussion in the work exchange community
2 Health Insurance About CIEE The CIEE mission is to help people gain understanding, acquire knowledge, and develop skills for living in a globally interdependent and culturally diverse world. To fulfill that mission, CIEE provides both outbound international education experiences for university students, faculty, and administrators, and study, work, and internship opportunities for people coming into the U.S. CIEE supports initiatives, viewpoints, and policies that are conducive to advancing international education and exchange. We champion the cause by lobbying government officials, collaborating with advocacy groups, and raising public awareness. CIEE was founded in 1947 and is the largest sponsor of Work & Travel USA and Internship USA programs.
3 Speaking Out What does your staff s insurance insure? One of the many advantages to employers of hiring J-Visa exchange students for short-term seasonal jobs is that they come with health insurance. The purpose of this Speaking Out piece is to provide employers with food for thought on health insurance for program participants. Insurance policies vary widely between sponsors, so the choice of sponsor that an employer makes is important. The U.S. Department of State, which regulates all J-Visa exchange programs, requires that students have a certain minimum level of health insurance coverage ($50,000) provided by a reputable company, a designation that is well defined in the rules. For more than 30 years since these public diplomacy based, experiential learning work programs were started, CIEE has been the largest sponsor of both The U.S. Department of State which regulates all J-Visa exchange programs, requires that students have certain minimum levels of health insurance coverage ($50,000) provided by a reputable company... the Work & Travel USA and Internship USA programs. Having served close to a half million students during those years, we ve gained considerable experience in dealing with insurance. 1
4 Health Insurance...proper health insurance reduces absenteeism, makes for happier workers, enhances the reputation of employers for future recruitment... and casts a positive light on the employer within their community. Most employers understand that the young people who participate in these programs are here as part of a public diplomacy student exchange effort and even though they re here to work, the program is designed to show off the United States and help people from around the world learn more about us as a country and a culture. The you re on your own approach to health insurance is totally contrary to the purpose of this program. Even more, proper health insurance reduces absenteeism, makes for happier workers, enhances the reputation of employers for future recruitment, and in general casts a positive light on the employer within their community. Being concerned and alert to employee coverage is, simply speaking, good business. 2 We all know that the U.S. health insurance system is very complex and confusing. Imagine how it appears to student visitors who mostly come from countries where there is free, universal, and widely available healthcare. Further, even in societies where there are costs associated with healthcare, they are usually much lower and much simpler to understand and pay for than those services typically provided to exchange visitors to the United States. Confusion abounds and employers can be helpful in assisting their employees to make the most of the coverage they re provided as part of their J-Visa program.
5 Speaking Out While the people involved in this program are young, and therefore relatively healthy, they do use the health insurance plans provided. Our experience over the years is that depending on the length of program, the country of origin, and the age of participant, somewhere between 10-20% of students use healthcare facilities while in the U.S. Most of these claims are very small and relate to short-term illness or minor injuries that require treatment but have no long-term consequences. A small...between 10-20% of students use healthcare facilities while in the U.S.... fraction of employees, however, have serious injuries or illness, the former resulting from automobile and related accidents, serious sports injuries, and the like. Sadly, a few students die. More than a hundred thousand people a year participate in these programs and with numbers that large, accidents happen. So, what should employers look for to ensure their students have sufficient coverage? 1 First, it s important to remember that the coverage is travel insurance, designed to provide health coverage while in the U.S., but not comprehensive long-term healthcare. As such, prior existing conditions are almost always excluded and seriously ill students are best served by getting short-term treatment in the U.S. and returning home for more comprehensive treatment that is covered in their home country. 2 Second, a good deal of the treatment takes place in emergency rooms or walk-in clinics. It is likely that the policy the student holds will have some 3
6 Health Insurance level of deductible on these services. In the case of CIEE, we keep this deductible at $100. But, we ve seen policies that have $250-$300 deductibles which in effect amounts to no coverage at all except in extreme circumstances. 3 Third, most plans provide for some form of co-pay when visiting a physician in-network but much larger fees when going out of network. Most of us in the U.S. are familiar with the advantages of using healthcare providers within a prescribed network. The key, of course, is the availability of providers in those regions of the country where students are likely to be employed. Any reasonable plan available should have an easy, online accessible list of area providers and a 24/7 number to call for assistance so that students can get help finding a provider if they can t get online and/or are confused....any reasonable plan available should have an easy, online accessible list of area providers and a 24/7 number to call for assistance so that students can get help in finding a provider... Over the years we ve seen too many plans that have very limited networks available and little support for participants in finding and using that network. While it costs a bit more, CIEE uses the Aetna Student Health Network of more than 600,000 providers, all available online or via our call center 24/7. Employers would be wise to vet the coverage of the sponsor they work with against similar criteria. 54
7 Speaking Out 4 Fourth, most plans have some exclusions, such as pre-existing conditions, as mentioned above. But, when policies start to exclude bicycle riding, playing sports, and similar activities, then in effect, the coverage is no coverage at all. While all students on the program speak English, when you re sick, frightened, or hurt, being able to talk with someone in your own language is important. 5 Fifth, while most claims and problems are minor, bigger cases do take place. Many of these require surgery and comprehensive case management. Access to case support on a 24/7 basis and help with understanding coverage and services is essential. While all students on the program speak English, when you re sick, frightened, or hurt, being able to talk with someone in your own language is important. Understanding how sponsors staff their call centers and emergency phone lines is important as it is a key component of service to participants. At CIEE, we ve developed a call center approach with multiple language speakers available. We also have a triage system for support so that complex cases and situations are referred to more senior, more skilled, and more experienced insurance and support staff. 6 Sixth, although it is rare, some students do become terminally injured. In these cases, it s often essential that their parents be brought to the United States to be with them during what are very difficult, sad, and trying final moments of life 5
8 Health Insurance and/or to accompany their body home. Many of these students have parents that have never traveled outside their home country or do not have the financial wherewithal to come to the U.S. on short notice. Having insurance coverage that quickly brings the parents to the U.S. without cost to them is essential. Employers should make sure this coverage is provided to program participants and that the coverage is adequate. All of this information should be transparent on a sponsor s website. No sponsor and/or participant should have to dig for a summary of the coverage or the detailed information on the matters described herein. The only reason not to do this is because there s something to hide. At CIEE, we ve developed our own in-house insurance management products. We did not do this to make money, or to save on costs. Rather, our goal was to ensure that our program participants would get outstanding No sponsor and/or participant should have to dig for a summary of the coverage and/or the detailed information on the matters described herein. 76 service. As we all know from personal experience, the people who handle insurance claims can often be less than professional and there is a propensity for them to respond to many claims by saying no, thereby putting the onus of collection on the policy holder. It s in no employer s interest to have local medical providers that are reluctant to treat their international staff because of fear of unpaid bills.
9 Speaking Out By operating our own insurance pool, we can provide the highest level of service and have a direct hand in managing complex cases where parents, participants, physicians, hospital case management staff, and others are often involved. All of this costs participants a tiny bit more, but it delivers a lot more to every stakeholder in the J-Visa program. We encourage employers who hire foreign students under the J-Visa program to make sure they understand the quality of health insurance coverage being provided to those participants they hire when they pick sponsors to work with. For complete information about CIEE insurance, please visit 7
10 CIEE CIEE: Council on International Educational Exchange 300 Fore Street Portland, ME July 2010
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