J Visa Holders Guide to Health Insurance
The basic J1 Insurance Requirements are:
- Medical benefits of at least $100,000 per accident or illness;
- Repatriation of remains in the amount of $25,000;
- Expenses associated with the medical evacuation of exchange visitors to his or her home country in the amount of $50,000; and
- Deductibles not to exceed $500 per accident or illness.
A few other J1 insurance requirements are:
- The plan is allowed to have waiting periods for pre-exisisting conditions.
- The health insurance for a J visa holder may have coinsurance up to 25%.
- The plan must meet certain credit ratings criteria.
- J visa holders spouses and children who hold a J2 visa are subject to the same requirements.
- You can lose your visa if you fail to maintain adequate coverage. Since the sponsor that issued your DS-2019 is also subject to penalties if their sponsored J visa holders fail to maintain adequate coverage, sponsors take these rules very seriously.
Wait, there’s still more!
While that’s a good overview, the actual requirements for different J visa holders are a bit more complicated. First, your sponsor (the program that issues your DS-2019) may have their own J1 insurance requirements. These may be their interpretation of the US Department of State requirements or they may be a higher standard. So, really you need to comply with whichever requirement is higher. If you want to look up your sponsor, you can find details here:
Look up your sponsors required health insurance coverage HERE
If you can’t find your sponsor, feel free to ask. For many sponsors we will be able to tell you the J1 insurance requirements.
The US Federal Register is the definitive source for information about the J1 insurance requirements as dictated by the US Department of State. The section below is quoted from the federal register. Red color has been added to highlight what is most important.
Federal Register Excerpt:
J1 Insurance Requirements
(a) Sponsors must require that all exchange visitors have insurance in effect that covers the exchange visitors for sickness or accidents during the period of time that they participate in the sponsor’s exchange visitor program. In addition, sponsors must require that accompanying spouses and dependents of exchange visitors have insurance for sickness and accidents. Sponsors must inform all exchange visitors that they, and any accompanying spouse and dependent(s), also may be subject to the requirements of the Affordable Care Act.
(b) The period of required coverage is the actual duration of the exchange visitor’s participation in the sponsor’s exchange visitor program as recorded in SEVIS in the “Program Begin Date,” and as applicable, the “Program End Date,” “Effective Program End Date,” or “Effective Date of Termination” fields. Sponsors are not authorized to charge fees to their sponsored exchange visitors for the provision of insurance coverage beyond any demonstrable and justifiable staff time. Sponsors are not required to, but may, offer supplemental “entry to exit” coverage (i.e., coverage from the time the exchange visitor departs his or her home country until he or she returns). If the sponsor provides health insurance, or arranges for health insurance to be offered the exchange visitor, via payroll deduction at the host organization, the exchange visitor must voluntarily authorize this action in writing and also be given the opportunity to make other arrangements to obtain insurance. These authorizations must be kept on file by the sponsor. Minimum coverage must provide:
(1) Medical benefits of at least $100,000 per accident or illness;
(2) Repatriation of remains in the amount of $25,000;
(3) Expenses associated with the medical evacuation of exchange visitors to his or her home country in the amount of $50,000; and
(4) Deductibles not to exceed $500 per accident or illness.
(c) Insurance policies secured to fulfill the requirements of this section:
(1) May require a waiting period for pre-existing conditions that is reasonable as determined by current industry standards;
(2) May include provisions for co-insurance under the terms of which the exchange visitor may be required to pay up to 25% of the covered benefits per accident or illness; and
(3) Must not unreasonably exclude coverage for perils inherent to the activities of the exchange program in which the exchange visitor participates.
(d) Any policy, plan, or contract secured to fill the above requirements must, at a minimum, be:
(1) Underwritten by an insurance corporation having an A.M. Best rating of “A−” or above; a McGraw Hill Financial/Standard & Poor’s Claims-paying Ability rating of “A−” or above; a Weiss Research, Inc. rating of “B + ” or above; a Fitch Ratings, Inc. rating of “A−” or above; a Moody’s Investor Services rating of “A3” or above; or such other rating as the Department of State may from time to time specify; or
(2) Backed by the full faith and credit of the government of the exchange visitor’s home country; or
(3) Part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor; or
(4) Offered through or underwritten by a federally qualified Health Maintenance Organization or eligible Competitive Medical Plan as determined by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services.
(e) Federal, state or local government agencies; state colleges and universities; and public community colleges may, if permitted by law, self-insure any or all of the above-required insurance coverage.
(f) At the request of a non-governmental sponsor of an exchange visitor program, and upon a showing that such sponsor has funds readily available and under its control sufficient to meet the requirements of this section, the Department of State may permit the sponsor to self-insure or to accept full financial responsibility for such requirements.
(g) The Department of State may, in its sole discretion, condition its approval of self-insurance or the acceptance of full financial responsibility by the non-governmental sponsor by requiring such sponsor to secure a payment bond in favor of the Department of State guaranteeing the sponsor’s obligations hereunder.
(h) Accompanying spouses and dependents are required to be covered by insurance in the amounts set forth in paragraph (b) of this section. Sponsors must inform exchange visitors of this requirement, in writing, in advance of the exchange visitor’s arrival in the United States.
(i) Exchange visitors who willfully fail to maintain the insurance coverage set forth above while a participant in an exchange visitor program or who make material misrepresentations to the sponsor concerning such coverage will be deemed to be in violation of these regulations and will be subject to termination as an exchange visitor.
(j) Sponsors must terminate an exchange visitor’s participation in their program if the sponsor determines that the exchange visitor or any accompanying spouse or dependent willfully fails to remain in compliance with this section.
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