J Visa Health Insurance Requirements and Options

J-1 Exchange Visitors and their accompanying J-2 dependents are required to have in place primary insurance and medical evacuation and repatriation insurance that covers them while physically in the USA, for the duration of the J exchange visitor program. 

What does the Law Require?

 

Minimum Coverage

Minimum levels of health insurance coverage must provide:

  • Coverage for both accident and illness
  • Medical benefits of at least $100,000 per illness or accident event
  • Deductible not to exceed $500 per accident or illness
  • Expenses associated with medical evacuation in the amount of $50,000
  • Repatriation of remains in the event of death in the amount of $25,000
  • Coverage of pre-existing conditions after a reasonable waiting period
  • Coverage of "perils" inherent to the activities of the exchange program in which the scholar is participating
  • Co-payments that do not exceed 25 percent

Additionally-

  • The corporation underwriting the insurance policy must have one of the following ratings:
    • an A.M. Best rating of “A-” or above;
    • a McGraw Hill Financial/Standard & Poor’s Claims-paying Ability rating of “A-” or above; or
    • 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 the insurance policy must be backed by the full faith and credit of the government of the exchange visitor's home country
  • Or the insurance must be part of a health benefits program offered on a group basis to employees of Purdue University
  • Or the insurance must be 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

DOS also explains the insurance requirement in its USDOS Welcome Brochure.

COVID-19 Coverage

J-1 exchange visitors seeking COVID-19 coverage must independently confirm that the insurance policy they purchase covers COVID-19 related hospitalizations, testing and illnesses.

Why does the Law for J-1 Scholars Focus on Health Insurance?

There often is confusion about why a set of laws focused on international research and collaboration spends so much time focusing on health insurance. TThis focus is the result of a concern to "protect the health, safety, and welfare of foreign nationals who come to the United States as exchange visitors."

Unlike most other developed countries in the world, the US has no centralized healthcare system. The decentralized healthcare system that does exist is complex and most costs are market driven. Adding to this are high, unregulated prescription drug costs. Healthcare providers are expect higher compensation than in other countries, and hospitals and healthcare facilities are profit centers for large healthcare organizations. Administrative regulations regarding billing and coding also add to an individual's cost. Because of the complexity of the system and the market-driven nature of services (which vary wildly from one location to another), providers are free to charge what the market will bear. There also are concerns that some healthcare facilities might over-charge for services rendered. 

The amount paid for the same healthcare service can vary significantly depending on the payer (i.e. private insurance or government programs, such as Medicare or Medicaid) and geographical area. Indiana, recent data shows, is one of the more expensive locations in the USA.

See, for example, this article from Investopedia, or this article from Harvard. See also this article (from 2014) comparing US health insurance to other countries. 

If a scholar becomes even mildly ill while in the USA (but needing care), the costs can escalate significantly, very quickly. Imagine, for example, if a person with asthma develops a respiratory infection, or a parent contracts pink eye from a child. The cost solely for seeking care might be-

  • Between $84 and $131 at a doctor's office
  • Between $98 and $163 at an urgent care center
  • Between $358 and $1,595 at the emergency room of a hospital
  • Between $66 and $89 at a retail clinic

The above costs are only for seeking a consultation with a healthcare provider. If diagnostic tests are required (blood tests, nasal swabs, etc), then the costs go up. Similarly, if treatment is then recommend (plasma, medicine, etc), then the cost again goes up. Overall, a visit to a doctor's office for a mild condition might add up to $250 or more. An average emergency room visit can total up to $2,500 or more. The more serious the medical condition, the more expensive the care will be.

When is Insurance Coverage Required?

Duration of Coverage

The law requires that the insurance coverage must begin no later than the start date of the program as listed on the Form DS-2019, or the start of program activities in the USA, whichever comes first. Thus, for example, if the scholar arrives in the USA shortly before the program start (in order to get themselves and their family settled), the insurance must begin on the date of the program start as listed on the Form DS-2019. If the scholar arrives in the USA later than originally anticipated (after the start date listed on the DS-2019), then the insurance must begin on the same day the scholar actually begins their program activities in the USA.

The law requires the insurance coverage to continue throughout the program activities in the USA, to the program end date, as listed on their most recent DS-2019. 

Purdue University (and the US Department of State) strongly recommends that scholars consider having insurance coverage beginning the moment they physically arrive in the USA, through to the moment they physically depart, to better manage the risk of unexpected healthcare costs.

For example - the following are examples of some of the unexpected situations that might arise-

  • A scholar is scheduled to visit the US as a J-1 Short-Term Scholar. During the plane flight she becomes unwell. When the plane lands she is unconscious and extremely ill. An ambulance takes her from the airport to the nearest hospital, where it is discovered that her appendix burst. She has emergency surgery. While ultimately fine, her has -- within days of arrival in the USA - more than $25,000 of medical bills. 
  • A scholar is invited to visit Purdue to engage in research supporting their doctoral work back at their home institution. They land in Chicago O'Hare and find a taxi to take them to a local hotel before setting out to Purdue the next day. The taxi they are in gets into a horrible accident right outside O'Hare. The scholar is helicoptored to one hospital to be stabilized, and then to another hospital for treatment. The scholar ultimately goes home for longterm treatment and recovery - but not before having accumulated more than $50,000 in medical bills. 

Increments of Insurance Purchases

Scholars are not required to purchase insurance for their entire program duration up front. We do understand that this would be prohibitively expensive.

Scholars may purchase insurance for them and their accompanying family members in whatever increments seems affordable to them. There also is no need to continually update International Scholar Services will additional insurance documentation after arrival at Purdue.

However, the requirement in law to maintain the insurance coverage does not go away. Scholars must be able to document insurance at any time, if asked. Please see below for a discussion of the consequences of failing to maintain insurance. 

How is the Insurance Mandate Satisfied?

There are two possible kinds of insurance coverage situations:

  • The J scholar (and accompanying family members) are provided health insurance by Purdue University as part of the offered employment
  • The J scholar (and accompanying family members) must purchase their own health insurance

Each option is discussed below. 

Health Insurance is Provided by Purdue University

J scholars who are offered employment with Purdue University will receive health insurance as part of the terms of the offered employment. The scholar's offer letter will specifically confirm that health insurance will be provided to the scholar.  The scholar generally selects the health insurance during 'onboarding'. Selection of insurance is part of an electronic "New Hire Wizard" tool. The scholar is sent the link to the New Hire Wizard via email after they accept the offer and before they physically arrive on campus. All Purdue insurance offerings for employees meet the J-1 requirements listed above.

International Scholar Services counselors accept as demonstration of qualifying insurance, a copy of the offer letter signed by the scholar in which insurance is listed as a term being offered. 

The Scholar Must Purchase Insurance

An excellent article on how US health insurance actually works is here

In general, there are two possible types of health insurance-

  • Wellness coverage
    • This is insurance that is intended to support and maintain the individual's general health. These plans tend to be more inclusive of pre-existing health conditions. They also tend to include wellness checkups. Wellness health insurance tends to be relatively expensive by US standards.
  • Travel Insurance
    • Insurance that is labelled "J-1 Exchange Visitor Insurance" generally is travel insurance. This is insurance that is intended to meet the minimum requirements of the law. The focus is solely on coverage of emergencies and disasters - not maintenance of health. Travel insurance tends to be relatively inexpensive by US standards, although this likely still is expensive by non-US standards. NOte - travel insurance generally is not suited to chronic health conditions or wellness care.

There are many companies that offer J-1 insurance. Scholars may google "J-1 insurance" to find options from both US carriers and international carriers.

Seven Corner Insurance utilizes Purdue's campus health services as well as having several 'in network' service providers in the community, and can be purchased here- https://www.sevencorners.com/groupenrollment/quote?a=b76dc64c-90e4-425a-89a4-5e64a98db0bf&p=2038#/quote

It is the Scholar's responsibility to select an insurance plan that best covers their unique health needs and circumstances, and those of any accompanying spouse/children. Additionally, Scholars are responsible for verifying for themselves that their insurance meets Department of State requirements. Note (again) - you will be required to show proof of insurance for both yourself and any accompanying family members when you report to Purdue.

 

Insurance Documents that Show You have Satisfied the Law

There are two possible ways to demonstate to the International Scholar Services counselor assigned to your request that you have satisfied the law relating to health insurance-

  • If the scholar will be employed by Purdue University and the offered employment includes health insurance, then
    • provide to International Scholar Services a copy of the offer letter, signed by the scholar, in which insurance is listed as a term being offered.
  • If the scholar will not be employed by Purdue University or the offered employment does not include health insurance, then
    • provide the following-
      • A document showing that you are covered by insurance, such as a certificate of coverage or an insurance card
      • A document showing what the coverage includes. Usually the insurance company will send you a link to the 'terms and conditions' of coverage that list what is included, the dollar value of coverage, and details of what is not covered.
      • Sometimes these might be the same document. 

International Scholar Services counselors are not insurance experts and cannot assist in finding insurance for you, and cannot interpret the insurance documents for you. 

That being said, International Scholar Services is obligated under the terms of our J-1 Program administration to require documentation that proves that the insurance you purchased satisfies the law. If the paperwork you provide to us is unclear, we are not allowed to assume it is fine and accept it.

Counselors will not accept insurance documents that do not clearly demonstrate the coverage requirements listed above, and without qualifying insurance, the J program cannot proceed.

 

 

Consequence for Failing to Maintain Insurance Coverage

Consequence for Failure to Hold Required Insurance

Government regulations require that sponsors such as Purdue University immediately terminate the J program if a scholar or their J-2 dependent willfully fails to comply with insurance requirements. If this happens, the scholar is not eligible to apply for reinstatement. If the J program is terminated, both the J-1 scholar and all accompanying family must return to their home country immediately. 

Affordable Care Act

Affordable Care Act

J-1 and J-2 exchange visitors whose programs in the USA continue for more than 2 years may additionally be subject to the requirements of the Affordable Care Act. 

The Affordable Care Act -

  • Requires certain foreign nationals (who are 'resident' for tax purposes in the USA) to have health insurance that meets the Act's definition of “Minimum Essential Coverage”
  • Requires Insurance Plans to provide comprehensive coverage called the Essential Health Benefits
  • Provides Premium Tax Credits and Cost Sharing Reduction to assist defer cost of insurance
  • Is enforced through the Individual Shared Responsibility Provision or “Individual Mandate” of the Act
  • Resulted in the creation of Health Exchanges or market places to enable the easy comparison and purchase of health insurance plans

In general, Program sponsors are required to notify J-1 exchange visitors if the scholar or their accompanying family members might be subject to the requirements of the Affordable Care Act (ACA). Details regarding the ACA can be found here, and penalties for lack of coverage can be found here. Please click here for more information about when J scholars might become subject to the ACA.