Health Insurance Issues
Please note that the following information is meant to be used only by Florida State
University faculty, staff, students, and potential students of Florida State University
and only in the context of international visits to FSU specifically. It is not intended
to be used and should not be construed as general legal advice.
Health insurance which covers one in the U.S. is required of everyone in J status, both
students and their dependents. It is required at all times of one's J program. The U.S.
Department of State places strong importance on maintaining continuous insurance coverage
and requires the sponsor of the J program (FSU, Fulbright, LASPAU) to terminate the
immigration status of anyone willfully failing to maintain or making material
misrepresentations regarding health insurance for themselves or their family members.
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Click here to view the laws regarding health insurance for those in J status.
The minimum requirements for insurance are also listed on page 2 of the DS-2019 form.
All exchange visitors must sign the certification on the front page of their DS-2019
form indicating that they have read all of page two. Therefore, not knowing about the
insurance requirement is not a valid reason for failing to maintain coverage. If a
student has forgotten to renew a policy or otherwise made a mistake, though, the
International Center will be glad to help the student regain compliance with this
regulation.
Please keep in mind that the State of Florida and the university have higher insurance
requirements for all international students. These requirements then prevail for the
student. Complete information on the State of Florida insurance requirements and
options for payment are contained in the Health Insurance brochure located at
www.tshc.fsu.edu/international.htm. The Thagard Student Health Center provides students
and their dependents access to a group plan which covers all the State of Florida
requirements.
Family members do not have to maintain insurance coverage which meets the State of
Florida requirements, but they must meet the minimum federal requirements. It may
be difficult for family members to obtain insurance apart from the primary J-1, though.
Normally, J-2 dependents are not eligible for insurance without the J-1 also being covered
under the same plan. One plan which has accepted J-2's independently is the Gateway Plan
at www.gatewayplans.com (this is provided only for informational purposes). Travel
insurance from one's home country may also meet the requirements and provide comprehensive
and affordable coverage in the U.S. for dependents. Plans from abroad normally do not meet
the State of Florida requirements for students.
Other plans which may provide appropriate coverage for both the student and their dependents
are at:
- www.travelinsure.com
- www.isoa.org
- www.bcbs.com (separate evacuation and repatriation insurance will also be required if Blue Cross-Blue Shield is chosen, Thagard offers evacuation and repatriation insurance only for $20/annually per person)
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The above sites are provided for informational purposes only; the International Center cannot endorse or recommend any particular insurance plan, as this is not our area of expertise. You must make a determination as to which plan is most appropriate for your particular circumstances. To do so, you should consider the following:
Eligibility- Is the applicant's (student or dependent) particular immigration status covered by this plan? Does the plan require the student to be enrolled? Keep in mind that, if someone in the student category is currently in Academic Training, they will generally not be enrolled as required by some plans. Is a minimum number of hours or status of enrollment required - full-time, 12 hours? During final terms or periods of approved underenrollment (for medical or academic reasons), the student may not technically be eligible. Although insurers will accept applications and premiums without checking on enrollment, later claims for reimbursement or payment for treatment may be rejected without documentation of the student's enrollment status.
Renewal options - Check to see if the plan can be continuously renewed. Some plans do not allow renewal. So, each time the policy is re-purchased a period of non-coverage of pre-existing conditions begins again. This means that if a student becomes pregnant at the end of one period of paid coverage, the continuing care, the birth, and the pre-natal care will not be covered under the new period of coverage. The condition will be considered pre-existing. Try to chose plans that allow for renewal, and be sure to renew within the specific period outlined in the insurance plan details.
Pre-existing conditions exclusions - Every insurance plan, other than some employer-based group plans, exclude pre-existing conditions. These are generally defined as any condition which manifested itself prior to the beginning of the insurance policy, regardless of whether or not one was treated for the condition. So, if a doctor determines that a student may have had untreated diabetes for a year before the student began their insurance coverage, all treatment for that condition will be the student's responsibility for at least the first six months of the insurance policy, if not more. Be sure to read carefully and understand all language regarding pre-existing conditions, and if you have a condition which will require continuing care during your stay, avoid switching insurance plans.
Exclusions - Be sure to understand all exclusions. Regulations for the J program require that an exchange visitor's insurance plan covers all risks inherent to the student's main activity. So, chemistry students will want to be sure that their plan does not exclude contact with dangerous chemicals or machinery. Many plans do exclude such activities. If the student is involved in intramural sports or other types of hobbies like scuba diving, climbing, or motor biking, they will want to be sure that injuries resulting from these activities are covered, or that they have purchased an additional "rider" or extra coverage which will provide for treatment of such injuries. Some plans exclude children's ear infections, pregnancy and pre-natal care, leukemia, and mental health issues. Be aware of these exclusions and make the best decision based upon your and your family's needs.
Provider Network - If you chose an on-line plan, be sure that you look at the provider network used by the plan. This is the list of doctors, hospitals, specialists, and laboratories that have contracted (at some point) to provide service for the insurer. You will want to make sure that there are available providers in Tallahassee and that these listed providers are still accepting your insurance plan or are still part of that provider network. Many doctors move, do not renew the contract, or contract with other agencies which disallow their participation in any other network. So, it is always best to check. If you prefer a certain doctor, be sure that your doctor is in the network. Out-of-network care often involves a higher deductible and co-payment.
Costs - Be sure that you understand what costs you will incur if you must be treated. Here is an example. A healthy 30 year old male is outside in the hot Tallahassee sun walking, falls and loses consciousness due to dehydration, and an ambulance is called before he awakes. He is placed in the ambulance, taken to the hospital, and treated at the hospital because the man acts confused upon waking up. The costs are:
$700 - ambulance
$500 - doctor evaluation
$1,500 - x-rays and review of the x-ray by an x-ray technician
$2,500 - CT Scan and review to rule out aneurism or other issues
Total medical bill: $5,200
The insurance company determines that $3,000 is "usual and customary". The student is responsible for the remaining $2,200, plus a $100 deductible, plus 20% of the remaining $3,000.
Total billed to student: $2,900
If it seems worthwhile to go with a plan that provides less comprehensive coverage but lower premiums, keep in mind what you might actually pay in the end should you need care.
Claim procedures - Be sure that you understand what is required in order to file a claim. Will the healthcare provider present a bill to the insurer? Are you responsible for the entire bill in the beginning and must apply for reimbursement at a later date? What is the standard time for reimbursement? When must bills be submitted? Many plans require that bills be submitted within 30 days of the injury or illness, but many doctors and healthcare providers do not provide a bill that quickly. In that case, you will have to make calls to get the bill more quickly, or the claim will likely not be paid.
Healthcare in the U.S. will be different than what you would expect at home. The process can seem confusing, disjointed, and ineffective. The Thagard Student Health Center and the International Center will do their best to provide you assistance along the way. Please feel free to ask questions and seek advice.
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