Sagamore partners with a company called Envisage Global Insurance (EGI) to offer our teachers and their families affordable emergency insurance that meets all of the requirements for the Exchange Teacher Program.
► Your healthcare choices should align with State Department requirements AND the needs of your family.
► You might choose to pay more in insurance premiums, but have lower out of pocket expenses, co-pays and deductibles. On the other hand, your insurance premiums could be lower, but your other expenses might be higher.
► Understanding how to use your insurance is important so that you can access the appropriate treatment at the best price.
- Insurance Requirements
- What is EGI Insurance? Do I need it?
- What about my school health insurance?
- Exclusions to the EGI Insurance
- Who do I contact with a question?
Here are the requirements from the State Department (found in 22 CFR 62.14) for ALL J-1 teachers and J-2 dependents.
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.
In 2021, Sagamore started working with a company called Envisage Global Insurance (EGI) to offer our teachers and their families affordable, emergency insurance that meets all of the requirements for the J-1 program. Here are the partners involved:
- Envisage Global Insurance (EGI) manages our plan
- International Medical Group (IMG) is the insurance provider
- UnitedHealthCare is the Network used by the plan (to get the best rates, use providers who are part of this network)
There are limits to this insurance plan, but it includes health insurance, medical evacuation and repatriation insurance that will keep you compliant with the State Department requirements. The cost of coverage is $65 per person per month for each teacher and sponsored dependent. Children born in the U.S. cannot be insured on this plan.
Do you need to SIGN UP for EGI coverage or change your coverage details? Let us know HERE!
Examine your school health insurance plan options to see if one or more meet the insurance requirements.
IF YOUR SCHOOL PLAN MEETS THE REQUIREMENTS: If your school coverage meets the health insurance requirements outlined by the State Department (except for the medevac/repatriation requirement), you may choose to use your school insurance instead of EGI. In this case, you would also need a supplemental policy to cover the repatriation/medical evacuation requirement. We are required to keep copies of your coverage details at all times and you must remain covered on compliant insurance for every day of your stay in the U.S.
IF YOUR SCHOOL PLAN DOES NOT MEET THE REQUIREMENTS: Your school health insurance may cover many of the things that the EGI insurance doesn’t cover. We always suggest that teachers take advantage of their school insurance coverage if it is affordable. Some schools provide the health coverage at a low cost, and it would be wise to subscribe to it in addition to the EGI insurance.
The insurance through EGI is intended to help you with an accident or illness that befalls you while you are in the US. It does not cover routine preventive care, pregnancy and newborn care, and it excludes most costs associated with pre-existing conditions. There are other exclusions that are listed in the program brochure. See slide 4 of the presentation below for a list of some of things that the plan does cover and some things that it does not cover.
Again, we always suggest that teachers add their school insurance coverage if it is affordable. You can have both the EGI insurance (to meet the requirement) and your school plan (to provide more comprehensive coverage).
If you have any questions about your plan, you can contact IMG (the insurance provider) directly by phone or email 24 hours a day, 7 days a week. Translation services are available; you simply need to ask!
- USA Toll Free: 855-731-9445
- USA Direct: 317-927-6806
- CustomerCare@IMGlobal.com
Complete the form linked here for Email support (for things like claims updates, etc.)
For issues with using the insurance (Teladoc or Dial Care can’t find you in the system, etc.), email EGI here.
Please reach out to us if you can’t get the help that you need!
Program sponsors are required to notify J-1 visa holders that they and their J-2 dependents may be subject to the requirements of the Affordable Care Act (ACA). Details regarding the ACA can be found at https://www.healthcare.gov/immigrants/lawfully-present-immigrants/, and penalties for lack of coverage can be found at https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/. Note that the insurance offered by EGI does not meet the requirements of the ACA.
Understanding how to USE the EGI Insurance
- Using the Insurance
- The "Student Zone"
- Teladoc
- Dial Care
- Help with Prescriptions
- Money Saving Tips
- How Do I Appeal a Claim that Was Denied
Once you have enrolled in the EGI insurance, it is VERY IMPORTANT that you learn to use the insurance correctly. Study the powerpoint slides below.
Key things to understand:
- plan limits, copayments and deductibles (see slide 3 below)
- the difference between using Teladoc, a walk-in clinic, an urgent care center, a private doctor and an emergency room for treatment (see slides 5 and 12 below)
- when you need pre-treatment certification (see slide 13 below)
- when/how to file a claim form (see slides 14 and 16 below)
How do you find a provider that is in the network, file or track a claim form, or get a copy of your insurance card? Where can you watch videos about issues related to your insurance?
IT IS ALL ON THE STUDENT ZONE!
Bookmark the STUDENT ZONE on your browser so that you can find it later, and take a minute now to see all of the options that are there. Click around to discover all that the STUDENT ZONE has to offer!
Teladoc provides FREE access to a doctor via the phone to those with the EGI insurance. You must register for the Teladoc service before you can use it. Register now so that when you get sick, you are all set up!
Teladoc may be able to help with things that are not covered by your insurance. For example, if you have a pre-existing condition that insurance does not cover, you may still be able to talk to a doctor and get prescription help through Teladoc.
You can find information about how to register with Teladoc attached to your insurance card and on slides 8-11 on the powerpoint below (hint: it starts with downloading an app on your phone).
BE SURE TO FOLLOW THE STEPS VERY CAREFULLY. When you are prompted to enter a zip code, use 46208. Do NOT use your home address or zip code (the insurance company does not have this information on file and it will result in an error).
If you have family members covered by the EGI insurance, EACH FAMILY MEMBER WILL HAVE A SEPARATE TELADOC ACCOUNT. All accounts can be accessed on the same app, using different logins.
Let us know if you are having trouble getting registered with Teladoc.
DialCare is a virtual telephone counseling service focused on providing safe, secure and private means of seeking mental health assistance from licensed counselors. Dial Care is a FREE service included with your insurance and can help with things like depression, stress, eating disorders, addiction, relationship problems, anxiety and grief.
Members can schedule appointments with licensed and trained mental health professionals via phone or video chat to get the help they need between the hours of 7 a.m. and 10 p.m. seven days a week.
To activate your account and schedule a session, call DialCare at +1 (855) 335-2255.
There is a prescription discount card attached to every insurance ID card (it is linked in the “Helpful Information” section in the last dot point under Find a Doctor/Hospital). You can also find it here. This is not prescription insurance, but it will help you get prescriptions at a lower cost.
You may also get reimbursed for eligible prescription expenses. Prescriptions are covered under the same $100 per illness/injury deductible as other costs. For example, if you have a sore throat at go to the doctor and receive a prescription for an antibiotic, your total out of pocket cost will be $100. However, you will have to pay for the prescription and then complete a claim for to get reimbursed. You can find claim forms in the Student Zone.
There are other prescription discount cards available to everyone. A popular one is called GoodRx. There is an app you can install on your phone that will help you find prescription discounts.
We have put together a document to help you make wise use of the EGI insurance (see Download Helpful Hints below). Remember to seek the right level of care:
- Teladoc (free)
- Walk-In clinic ($10 copay in network; may be inside a retail drugstore)
- Urgent care clinic ($25 copay in network)
- Visit doctor (use an in-network doctor)
- Emergency room (ONLY USE IN A TRUE EMERGENCY – You will pay a $250 fee if you are not admitted to the hospital. If you are admitted, you will only pay the $100 deductible.)
Take advantage of free or low cost services for things that are not covered by EGI such as immunizations, birth control, mammograms, school or sports physicals, etc. See the helpful hints guide here!
What happens if you submit a claim to insurance or try to get pre-certified for a procedure and it is denied by the insurance company?
You have a right to APPEAL their decision, but this must be done within 90 days of the denial. The insured person should submit a written request for an appeal along with comments, all relevant documents and medical records, and any other information to:
International Medical Group, Inc.
Attn: Benefit Review
2960 N. Meridian Street
Indianapolis, IN 46208
Send your appeal from the US Post Office with TRACKING information so that you have proof that it was sent. The company will respond in writing within 90 days. They may not approve the claim, but you have a right to know exactly why it was denied and to provide information that supports your position. Don’t be afraid to advocate for yourself/your family, whether that is with the insurance company or a hospital/medical provider!