Insurance is only PART of the cost of healthcare.
Healthcare costs include:
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INSURANCE PREMIUMS (the amount you pay every month, whether you use the insurance or not)
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CO-PAYS AND DEDUCTIBLES (the amount that you pay before insurance pays their part)
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OUT OF POCKET EXPENSES (healthcare costs that your insurance doesn’t pay for)
Understanding the US Healthcare System
Insurance in the United States
For exchange visitors, insurance in the United States can be very confusing. There are many different kinds of insurance. Some are required by law, and some are just a good idea. Insurance provides protection for your health, your car, and your belongings (furniture, tv, camera, computer, jewelry). There are some vocabulary words that are important to understand, like “policy” and “premium” and “deductible.” See the bottom of this page for those definitions.
First, let’s look at the insurance that is REQUIRED for all exchange visitors.
Insurance Requirements for all Exchange Visitors (teachers and dependents)
Here are the requirements from the State Department (found in 22 CFR 62.14)
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.
How do Teachers Meet the Insurance Requirement?
We have a partnership with an insurance provider that offers coverage for all sponsored teachers and dependents. Teachers and dependents new to the US will start coverage from the first day that they arrive and will maintain coverage until the end of their program.
This insurance includes medical/health insurance, repatriation of remains and medical evacuation coverage. Although this insurance meets the program requirements, it MAY NOT cover all of your medical expenses. There are exclusions (things that the insurance that does not cover) that may impact some teachers. It is important to read the insurance information carefully to understand the coverage and limitations.
Most school districts will offer health insurance for teachers (and sometimes dependents) that may offer more comprehensive insurance coverage. Teachers are encouraged to take advantage of this if the premium (the amount deducted from the teacher’s paycheck to pay for the insurance) is low. Teachers who have both the required insurance AND the school insurance will have more of their medical expenses covered.
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.
This is also called health insurance, and helps to cover things like doctor visits, hospital stays, and prescription medicines while you are in the US.
The insurance that we offer will satisfy all of the medical insurance requirements, but it may not cover all of your medical expenses. Some teachers choose to purchase additional health insurance through their school and may pay a “premium” that is deducted from their paycheck. Key questions to ask:
- What is included in the health insurance (sometimes called a summary of benefits)?
- Can my family be covered too?
- How much does the premium cost?
- What are the deductibles, co-pays and co-insurance (the amount the teachers pays for each service)?
The purpose of this insurance is to get you back to your home country in the event of extreme illness/injury or death.
Definitions:
Insurance Policy
A document dealing with the terms and conditions of a contract of insurance.
Insurance Premium
An insurance premium is the amount you pay for an insurance policy. Simply put, premiums are what you pay insurance companies in exchange for coverage. These can be paid for a year at a time or a little each month.
Deductible
The amount you pay for covered services before your insurance plan starts to pay.
Quotes
An insurance quote is an estimate provided by the insurer concerning the price of a policy. It is wise to get more than one quote before purchasing insurance.
Co-Pay or Coinsurance
Your insurance may include co-pays and coinsurance. A co-pay is the amount that you pay every time you access a service (for example, you may pay an amount every time you go to the doctor or fill a prescription). Coinsurance is the amount that you will pay after your deductible has been met (if your coinsurance is 20% and you go to the hospital, your insurance company will pay 80% of the bill and you will pay 20% of the bill).
Exclusions
An insurance policy may EXCLUDE (not cover) certain types of expenses. Be sure that you are aware of the exclusions, as these could impact your budget!
Other Common Types of Insurance in the US
Auto Insurance
If you plan to drive in the US, auto insurance is required by law in most states. If you are at fault in a car accident, the auto liability coverage required on your car insurance policy helps pay for covered losses, such as the other party’s medical bills and damage to their vehicle or other property that results from the accident.
Renters Insurance
Renters insurance covers your belongings if something happens in the home or apartment you are renting. This may be required by your landlord, or your may choose to buy this insurance to protect your belongings. Depending on the policy, renters insurance might cover your furniture, tv, jewelry, computer, etc.
Life Insurance
Life insurance pays a sum of money to your beneficiary upon your death. Your school may provide a small amount of life insurance. You are not required to have life insurance while in the US.
Dental Insurance
This will often be offered by your employer but separate from your health insurance (an additional cost). It pays for all or part of routine dental care and may cover things like getting cavities repaired. This is usually optional and not required.
Vision Insurance
This is sometimes offered by your employer for a low cost. It covers things like an annual eye exam and might provide discounts on glasses or contact lenses. It is optional, so consider whether or not you need this coverage.
Disability Insurance
This may also be offered by your employer and can provide income if you are unable to work (there is short-term disability and long-term disability, so read the description carefully). This is also optional, so consider carefully whether you need it or not.