Health Insurance Guide

Transcription

1 Health Insurance Guide For J- 1 Visa Scholars and their J- 2 Bechtel International Center Stanford University 584 Capistrano Way, Stanford, CA Information Intended for International Scholars on J visas not Eligible for Stanford s (Cardinal) Health Health Insurance Requirements for J- 1 Visa Holders and Their (J- 2 s) Health insurance for J visa- holders is required by the U.S. Department of State. All J- 1 visa holders and their J- 2 dependents must be covered by medical insurance for the entire duration of their J visa status in the U.S. The I- Center is obligated by federal law to terminate the record of any Exchange Visitor who willfully neglects to maintain medical insurance for themselves or their family members. Below are the requirements for J visa- holders: Medical benefits of at least $50,000 per accident or illness. Repatriation of remains in the amount of $7,500. Expenses associated with the medical evacuation of the Exchange Visitor to his or her home country in the amount of $10,000. A deductible not to exceed $500 per accident or illness. If a particular activity is a part of the Exchange Visitor program, insurance must cover injuries resulting from participation in that activity. This coverage must begin immediately upon arrival in the U.S. and extend to departure from the U.S. ***Do not assume that a U.S. health insurance plan meets DOS requirements. In fact, most do not. It is particularly important to maintain coverage for medical evacuation and repatriation, which are requirements unique to J- visa Exchange Visitors and are not regularly covered by U.S. health insurance plans. If your health insurance plan covers everything but evacuation/repatriation, you may purchase a rider which adds this coverage to your other plan. Here is a list of such riders: BETiNS BETA plan: Harbour Group: Compass Benefits: IMG Sky Rescue: quote?imgac=12128 International SOS: Barney & Barney: family- students/ Frontier MEDEX SafeTrip: Frontier MEDEX Scholastic:

2 Choosing an Insurance Policy and Important Terms The information here may provide assistance in choosing a health insurance policy. However, it is ultimately up to the individual to acquire insurance that meets the requirements set by the DOS and covers his/her particular health needs and those of his/her dependents. The following are issues and terms that you should keep in mind: Medical Evacuation and Repatriation. Evacuation involves transporting the insured person to the nearest hospital or medical facility in case of an emergency injury or sickness, or possibly back to his/her home country. Repatriation covers transportation of the remains of an insured person back to his or her family/home country if that person dies while abroad. The Department of State requires that Exchange Visitors and their family- members be insured for at least $10,000 for medical evacuation and $7,500 for repatriation. *** Evacuation and repatriation are not always covered by insurance plans intended for U.S. citizens but usually are by plans intended for J visa- holders and other visitors. Check to see that your plan does provide coverage. It is also possible to purchase a rider with evacuation and repatriation coverage in order to supplement another plan. Rider. Benefit riders are add- on insurance policies that cover health- related services that are not typically covered by your health insurance plan. It is possible to purchase a rider with evacuation and repatriation coverage in order to supplement another plan and fulfill DOS requirements. Premium. All insurance policies require the insured individual to pay a premium. This is the amount of money required for coverage under a specific policy for a given period of time. Depending on the policy, the premium may be paid monthly or for a specified time agreed to by the insurance company. The premium varies depending on the policy, the amount and types of benefits or coverage that policy provides and the age of the individual being insured. Although the premium is the primary way in which an individual pays for insurance, they may end up paying more through deductibles and coinsurance. They may also have to pay for medical services or products that are not covered or that are covered only up to a certain amount. While it may be tempting to choose the cheapest policy that satisfies DOS requirements, this may result in you paying much more if you encounter unexpected injuries or illnesses. Deductible. Most insurance policies require you to cover part of your health expenses yourself (your part is called the deductible), before the company pays anything. Under some policies the deductible is annual, and you pay only once each year if you use the insurance. Under others, you pay the deductible each time you have an illness or injury. In choosing insurance, you should think carefully about how much you could afford to pay out of your own pocket each time you are sick or injured, and weigh the deductible against the premium before you decide. Co- insurance (or Co- pay). Usually, even after you have paid the deductible, an insurance policy pays only a percentage of your medical expenses. The policy might pay 80%, for example, and the remaining 20%, which you would have to pay, is called the coinsurance. Thus, if you were injured and incurred $3,000 in medical expenses, a policy with a $400 deductible and 20% coinsurance would cover $2,080 (80% of $2,600). Age. Individuals of different ages will pay different premiums. Many policies also have a maximum age for which they will insure someone. If you are 65 or older, pay attention to choosing a policy that covers someone of your age (to the level of DOS requirements).. Many policies will also insure the spouse and/or children of the primary insured person (usually those on the J- 2 visa) at additional cost. In some cases, dependents can be enrolled separately from the primary insured person. (J- 2 s) of the J- 1 must also be

3 insured to the level required by the DOS. A spouse is someone who is legally married to the primary individual. For the purposes of a J- 2, a dependent child must be 21 or younger.. Insurance policies differ in their coverage of medical services and products associated with pregnancy and childbirth. Pregnancy is considered a pre- existing condition and insurance policies will only pay medical bills if conception occurs after the insurance start date. And, in this case, only some policies will cover expenses associated with pregnancy and childbirth and only to certain limits.. Insurance policies also differ in the amount that they will pay for mental or psychological issues (including alcohol and drug abuse). If this is a concern, choose a policy accordingly. Pre- existing. Many policies will not cover health problems you had before you bought the insurance (known as pre- existing conditions). Others will but only after certain amounts of time (a waiting period), which can be between 6 months and 48 months. If you have such a condition, make sure to note how it is covered and how long the waiting period may be as this term is defined differently by different insurance companies and plans. Acute Onset of a Pre- existing Condition. Although policies often will not pay for treatment of a pre- existing condition, they will pay for an acute onset of that condition. This is a sudden and unexpected recurrence of the condition and treatment often must be obtained within 24 hours.. Insurance policies differ in the amount that they will pay for medication prescribed to you by a doctor. If this is a concern, choose a policy accordingly. Travel Outside the U.S. Insurance policies that cover visiting students and scholars differ in their coverage for travel outside the U.S. and often give very limited coverage to that individual while visiting his or her home country. is limited to a certain amount of time and/or to a specific amount of funding. Travel to Home Country. An individual s Home Country is the country in which they principally reside and receive regular mail. Specific limits. Some policies state specific dollar limits on what they will pay for particular services. Other policies pay "usual" or "reasonable and customary" charges, which means they pay what is usually charged in the local area. Be careful in evaluating policies with specific dollar limits; for serious illnesses, the limit might be far too low and you might have large medical bills not covered by your insurance. Lifetime/per- occurrence maximums. Many insurance policies limit the amount they will pay for any single individual's medical bills or for any specific illness or injury. Exchange Visitors must have insurance with a maximum no lower than $50,000 for each specific illness or injury, which may be enough for most conditions. Major illnesses, however, can cost several times that amount. Benefit period. Some insurance policies limit the amount of time they will go on paying for each illness or injury. In that case, after the benefit period for a condition has expired, you must pay the full cost of continuing treatment of the illness, even if you are still insured by the company. A policy with a long benefit period provides the best coverage. Exclusions. Most insurance policies exclude coverage for certain conditions. Read the list of exclusions carefully so that you understand exactly what is not covered by the policy. Examples could include pregnancy, injuries from sports, Usual, Reasonable and Customary (URC) charges. Many policies will cover funding for medical services that are determined usual, reasonable and customary (URC). This is the amount normally charged by medical service providers for similar services and supplies in that area. Claim. After paying for medical services, the insured individual must often make a written request to the insurance company for funds to pay for those medical services. This request is known as a claim.. The amount and the types of payments an insurance company will provide. This

4 coverage is provided over a certain length of time, known as a coverage period. The types of services or products that are covered are known as covered expenses. Renewal. Policies can be bought for certain periods of time (usually not more than 12 months). For stays longer than 12 months, the policies must be renewed at a later date. Inpatient vs. Outpatient. Medical services or products provided to a patient that is required to stay overnight in a hospital or clinic is considered inpatient. Outpatient care is for individuals that do not stay overnight. Insurance Providers Insurance can be bought directly from these insurance providers; they are listed in random order. They will assist you in choosing the best policy for your needs. More details on their policies can be found in the table below. Seven Corners cs@sevencorners.com Phone: Fax: (317) www2.sevencorners.com HCC Medical Insurance Services Phone: or (317) Fax: (317) Compass Benefits Group Phone: (781) Fax: (781) info@compassbenefits.com Frontier MEDEX Phone: (800) inquiries@frontiermedex.com The Harbour Group Phone: (800) Fax: (937) info@hginsurance.com Cultural Insurance Services International (CISI) Phone: (800) Fax: (203) enrollments@culturalinsurance.com International Medical Group Phone: (317) or (800) Fax: (317) insurance@imglobal.com International Student Organization Phone: (800) or (212) Fax: (212) mailbox@isoa.org International Student Protection Phone: (877) or (212) Fax: (212) info@intlstudentprotection.com HTH Worldwide Phone: (888) studentinfo@hthworldwide.com Insurance Agents It is also possible to purchase health insurance from an insurance agent. Agents deal with multiple insurance providers and can assist you in choosing one of these. Their websites also provide you with the ability to enter data

5 about yourself and any family- members in order to see how much it would cost you and to help you compare different policies. These agents will do this free of charge. Here are some such agents: Insubuy (specialize in students from India) Phone: (972) Fax: (972) International Student Insurance Phone: (904) Visitors Phone: (866) Fax: (408) ivisitor Insurance Phone: (877) Health Insurance Policy Options: The following is a guide that may assist you in finding a health insurance policy that is right for you. The J visa- holder is ultimately responsible for acquiring a health insurance policy that meets the requirements of the DOS and your health needs. The I- Center does not endorse any particular policy or company over another. As of July 2013, the following policies do meet requirements set by the DOS. The order of the policies listed is random. *Note: This summary was created in July As rates vary by age and duration of coverage, and as these rates and policies change over time, please verify with the insurance company or an insurance broker before purchasing the policy. Much of this information is also online. for Inbound USA Seven Corners A B C D J K Up to $5,000 in coverage for Myocardial Infarction (heart attack) or Stroke. Acute Onset: up to max per injury/sickness but per policy period and up to $25,000 for evacuation. Up to $3,000 in coverage for Myocardial Infarction (heart attack) or Stroke. Acute Onset: not covered. Dependent children coverage available when one parent covered under policy, at additional cost. Maximum Age Up to 69 years old years old. Up to $100. Up to $125. Up to $150. Up to $200. Up to $80. Up to $110. Mental & Nervous Disorder & Substance Abuse Same as sickness/injury. Travel outside the U.S. Covered up to 30 days outside U.S. except home country. 5 days 364 days and renewable.

6 for Maximum Age Mental Health Travel outside the U.S. Atlas Travel/Atlas America HCC Medical Insurance Services If under 70, covered for Acute Onset of Pre- existing. Maximum expenses: $50,000 or $100,000. Emergency Evacuation: Up to $25,000. Not covered other than coverage for complications of pregnancy during the first 26 weeks of gestation. Must buy separate policies, but 1 free child age 10 or younger per parent. Up to age 79 for policies that meet DOS requirements. 100% to maximum limit after deductible. Not Covered. Worldwide coverage outside Home Country plus 15 days of incidental coverage for trips to Home Country for every 3 months of coverage purchased. From 5 days up to 364 days. Nonrenewable. america- insurance/ oads/at_ _9800.pdf StudentSecure: HCC Medical Insurance Services Select Budget Smart Covered after 6- month waiting period based on 12- month definition. 1 Covered for usual, reasonable and customary charges (URC) if conception occurs after start. Select: $750 nursery care. Budget: $250 nursery care. Covered for Acute Onset of Pre- existing Condition up to $25,000 lifetime maximum. Over 65 years of age, contact company or agent. Yes, subject to coinsurance and deductibles Outpatient or inpatient: 80% within PPO, 60% out of network. Maximum 30 days of coverage. Outpatient: $50 maximum per day, $500 maximum per lifetime. Inpatient: URC charges to $10,000 maximum per lifetime. Outpatient: $50 maximum per day, $500 maximum per lifetime. Inpatient: URC charges to $5,000 maximum per lifetime. Worldwide coverage outside Home Country plus 15 days of incidental coverage for trips to Home Country for every 3 months of coverage purchased. May extend or renew coverage. secure- insurance/ 1 A pre- existing condition under this plan is defined as any injury or illness, which, within the 12 months prior to the effective date of coverage, manifested itself, exhibited symptoms, or required medical treatment or medication, or for which a physician was consulted.

7 Compass Insurance s Compass Benefits Group Compass Elite Compass Care Compass Budget Based on 24- month definition. 2 Covered as any other injury/illness. for Maximum Age Mental Health Travel outside the U.S. Available up to age 64. Covered, subject to coinsurance and deductibles Inpatient: $10,000 covered at 50%, up to a max of 40 days Outpatient: $500 covered at 80%. Worldwide coverage outside Home Country plus coverage up to $1,000 in Home Country up to 30 days. mpassstudenthea lthinsurance.com /compare_interna tional_insurance_ plans.php Frontier MEDEX TravMed International 1 year waiting period 3 based on 12- month definition. $5,000 for an uncomplicated pregnancy (including delivery) and $7,500 for a complicated pregnancy. Lifetime benefit limited to $25,000. Dependent children covered at additional cost. Available up to age % covered after $100 deductible. Worldwide coverage outside Home Country plus coverage up to $100,000 and 30 days in Home Country. 15 days to 12 months, renewable months, renewable. mpassstudenthea lthinsurance.com /compare_interna tional_insurance_ plans.php passstudenthealt hinsurance.com/c ompare_internati onal_insurance_pl ans.php viduals/products/detailinternation al.aspx Liaison s 2 Pre- existing Condition for this policy shall mean any condition for which a licensed Physician was consulted, or for which Treatment or Medication was prescribed, or for which manifestations or symptoms would have caused a person to seek medical advice 24 months prior to the Effective Date of coverage under the Policy, except If the Injured Person is covered under the Policy for 24 consecutive months, the Pre- existing Condition exclusion will no longer apply and any eligible expenses incurred thereafter will be considered for reimbursement. 3 Any injury or sickness, or complications arising therefrom, for which you had manifested symptoms, or for which a Physician was consulted, treatment or medication was prescribed or taken, within one year (365 days) immediately prior to the Period of Insurance.

8 for Maximum Age Travel outside the U.S. Seven Corners Liaison Student Liaison Continent Liaison International Under 70, up to $150,000 Under 70, acute onset of a pre- (varies per chosen medical Based on 24- month existing condition covered up to definition 4 maximum). based on 36- $15,000 based on 36- month month definition. definition. Covered as any other illness/injury. At additional cost. At additional cost. Available up to age 64. $10- $20 copay. Inpatient: 50% covered up to $10,000 and 45 days. Outpatient: covered up to 80% and $500. Worldwide coverage outside Home Country plus 30 days of coverage in Home Country up to a maximum of $1, to 364 days, renewable. s.com/downloads/brochur es/liaisonstudent_br.pdf s.com/study- abroad/ Available up to age 79 that meet DOS requirements Please contact Seven Corners. Worldwide coverage outside Home Country plus trips to Home Country up to $50,000. Follow Me Home : Up to $5, days. To purchase additional coverage, must return to home country for 30 days. s.com/downloads/brochu res/liaisoncontinent_br.pd f s.com/liaisoncontinent/ Available up to age 79. Please contact Seven Corners. Worldwide coverage outside Home Country plus trips to Home Country up to $50,000. Follow Me Home : Up to $5, days 12 months. ownloads/brochures/liaisoninter national_br.pdf aison- international- travel- insurance/ 4 A Pre- existing Condition for this company or policy is any condition for which a licensed physician was consulted, or for which treatment or medication was prescribed, or for which manifestations or symptoms would have caused a person to seek medical advice 24 months prior to the Effective Date of coverage under the Policy, except If the Injured Person is covered under the Policy for 24 consecutive months, the Pre- existing Condition exclusion will no longer apply and any eligible expenses incurred thereafter will be considered for reimbursement. 5 Pre- existing Condition(s) shall mean any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder, regardless of the cause including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting therefrom that with reasonable medical certainty existed at the time of application or any time during the 36* months prior to the effective date of coverage under this policy.

9 International Student & Scholar Medical Insurance s The Harbour Group International International+ Based on 6- month definition preceding start date. Applies for 12 months after start date. 6 International Student and Scholar Cultural Insurance Services International Based on 12- month definition. Covered as any other illness/injury. Please contact CISI. for Maximum Age Travel outside the U.S. Please contact The Harbour Group. If over 71, contact The Harbour Group. Outpatient: covered at 50% up to a Covered. maximum of $500. Outpatient: covered Covered for at 50% up to $500. inpatient and Inpatient: Up to outpatient. $5,000. Worldwide coverage outside of Home Country. 3 9 months, renewable. urance.com/intern ational_overview_1 2.asp urance.com/pdf/in tl_broch_12.pdf 3 12 months, renewable. urance.com/plus_int ernational_overview _12.asp urance.com/pdf/intl _plus_12.pdf Covered at additional cost. If 65+, please contact CISI. Covered. $500 for outpatient; $5,000 for inpatient (1 occurrence/lifetime). Worldwide coverage outside of Home Country. Purchased monthly, please contact for duration. surance.com/pdf/inter national_student_schol ar_policy.pdf surance.com/students / Global Student HTH Worldwide Global Student USA and Preferred Based on 1- year definition. 7 URC charges covered up to 1 year. Up to 64. Outpatient covered at 50%. Outpatient: up to $500. Inpatient: up to $5,000. Worldwide coverage outside of Home Country and limited Home Country coverage up to $5,000 after deductible. Renewable. ts.com/students/benef its_slv.cfm ts.com/students/benef its_gold.cfm 6 Pre- existing Condition means any condition for which medical advice or treatment was received or recommended within the six months immediately preceding Your effective date of coverage. This exclusion applies for 12 months after Your effective date of coverage. This exclusion does not apply to a pregnancy existing on Your effective date of coverage. This exclusion does not apply to a pregnancy existing on Your effective date of coverage. 7 This plan does not pay benefits for loss due to a Condition during the first one (1) year of coverage (this limitation does not apply to the Medical Evacuation Benefit, the Repatriation of Remains Benefit and to the Bedside Visit Benefit).

10 8 Patriot America If under 65, sudden and unexpected recurrence covered up to $50,000 lifetime maximum. If 65+, $2,500 lifetime maximum. $25,000 for evacuation. Patriot s International Medical Group Patriot Exchange (Standard) Covered after 12 months of continuous coverage with $500 maximum per year and $50,000 lifetime maximum. for Maximum Age Mental Health Travel outside the U.S. Student Health Advantage Covered after 12 months. URC charges covered, if conception occurs after start date. Covered at additional cost Covered at additional cost Age 80+. Up to 64. Up to 64. Covered to policy maximum. URC charges covered. Inpatient: URC charges. Outpatient: 50% covered. Outpatient: $50/day, $500 lifetime maximum. Inpatient: $10,000 lifetime maximum. Worldwide coverage outside Home Country plus Home Country coverage up to a cumulative of 2 weeks. Renewable up to 24 months. Renewable up to 48 months. Renewable up to 48 months. /producerdocuments.ashx?do cumentid= g- insurance/travel- medical- insurance/patriot- travel- medical- insurance/additional- information.aspx /ProducerDocuments.ashx?Do cumentid= g- insurance/international- student- insurance/patriot- exchange- program.aspx /ProducerDocuments.ashx?Do cumentid= g- insurance/international- student- insurance/student- health- advantage/benefits.aspx 8 A Pre- existing Condition which is defined as any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment that, with reasonable medical certainty, existed at the time of application or at any time during the three years prior to the effective date of the insurance

11 10 for Maximum Age Travel outside the U.S. International Student Organization 9 Compass Gold Compass Silver ISO Med 1 ISO Med 2 Covered after 6 months based on 12- month definition. Covered up to $7,500 maximum for normal delivery; $10,000 maximum for C- section If conception occurred during policy. Covered if conception occurs after start date of policy. Up to % of Usual & Customary charges $100 maximum covered for outpatient. covered up to $1,000 per year. Covered with limit of 1 visit per day and 30 visits per year. 80% covered in network, 60% out of network with $5,000 annual maximum. 80% of Usual & Customary charges covered up to $500 per year. Inpatient and outpatient: Covered with limit of 1 visit per day/30 visits per year up to $5,000 per year. 80% (In- network) and 60%(Out- of- network) covered. Worldwide coverage outside Home Country plus Home Country coverage up to $ MPASS_2013_2014.pdf 3 12 months, renewable. _MED_2013_2014.pdf International Student Protection 9 Must be a member of ISO to be eligible for ISO insurance. 10 Condition means an Injury or Sickness, disease, or other condition during the 12 month period immediately prior to the date the Covered Person s coverage is effective for which the Covered Person: 1) received or received a recommendation for a test, examination, or medical treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or 2) took or received a prescription for drugs or medicine. Item (2) of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the 12 month period before coverage is effective under the Covered Person s.

12 11 for Maximum Age Travel outside the U.S. Tourer Explorer Pioneer Basic Pioneer Enriched Mountaineer Covered after 6 months based on 12- month definition. No waiting period. Covered after 6 months. Covered for Covered for $5,000 for $7,500 for natural delivery natural delivery Covered as any other sickness if conception occurs after and $7,500 for and $10,000 for start. C-section C-section delivery. delivery. Covered up to $1,000 with $25 copay. Up to 65. Covered as any other sickness. Worldwide coverage outside Home Country plus Home Country coverage up to $ om/documents/isp_tourer- EXPLORER_brochure.pdf om/insurance_plans/international_s tudents_in_the_us.php Up to $750. Up to $1000. Up to $2000. Worldwide coverage outside Home Country. Up to 12 months, renewable. ection.com/documents/isp_ PIONEER_brochure.pdf ection.com/insurance_plans/ international_students_in_th e_us.php Limited to 1 visit per day to maximum of 35 visits per year. Worldwide coverage outside Home Country plus Home country coverage up to $1,000 Maximum. protection.com/docume nts/isp_mountaineer _brochure.pdf protection.com/insuran ce_plans/international_s tudents_in_the_us.php Visit International Health Insurance s 11 Condition means an Injury or Sickness, disease, or other condition during the 12 month period immediately prior to the date the Covered Person s coverage is effective for which the Covered Person: 1) received or received a recommendation for a test, examination, or medical treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment; or 2) took or received a prescription for drugs or medicine. Item (2) of this definition does not apply to a condition which is treated or controlled solely through the taking of prescription drugs or medicine and remains treated or controlled without any adjustment or change in the required prescription throughout the 12 month period before coverage is effective under the Covered Person s.

13 for Maximum Age Travel outside the U.S. Economy Standard Super Based on 12- month definition. Covered up to $10,000 per policy year, must be insured minimum 30 days prior to conception. Up to 64. Covered as any other injury/illness. $0 per script. 100% up to policy maximum per script. Inpatient: 50% covered up to $10,000 and 40 days. Outpatient: 80% covered up to $500. Worldwide coverage outside Home Country plus 30 days of Home Country coverage up to $25,000 per policy period. Renewable. for Maximum Age Travel outside the U.S. Visit International Health Insurance s Platinum E Plus Based on 6- month definition. Covered up to $10,000 per policy year, must be insured minimum 30 days prior to conception. Also may enroll separately. Ages Covered as any other injury/illness. $0 per script. 100% covered up to policy maximum per Covered as any other illness. script. Inpatient: 50% covered up to $10,000 and 40 days. Outpatient: 80% covered up to $500. Worldwide coverage outside Home Country plus 30 days of Home Country coverage up to $25,000 per policy period. Renewable. Worldwide coverage outside Home Country plus 60 days in Home Country per 12 months of coverage, up to $50,000.