A Step-by-Step Guide to Staying in Compliance Updated November 2016

Transcription

1 A Step-by-Step Guide t Staying in Cmpliance Updated Nvember 2016

2 As f September 1, 1994, every persn in J-1 r J-2 status is required t maintain a gvernment-mandated minimum level f health insurance fr the full duratin f their stay in J status. Gvernment regulatins stipulate that if J-1 students r schlars willfully fail t maintain the required level f health insurance fr themselves r their dependents, their participatin in the J-1 prgram will be subject t terminatin. (22 CFR 62.14)

3 Minimum requirements fr alternate insurance plan**: Medical benefits f at least $100,000 fr each accident r illness (a higher benefit is better) Medical evacuatin in the amunt f $50,000, shuld yu need t be sent hme n the advice f a dctr Repatriatin f remains in the amunt f $25,000, shuld yu die while in the U.S. Cverage must include the semester fr which yu are at Rice University Minimum 75% cverage fr each accident r illness Maximum deductible f $500 per cnditin per plan year A pre-existing wait perid limitatin f n mre than six mnths The plicy must be backed by the full faith and credit f hme cuntry gvernment (fr thse cvered by their hme cuntry's natinal insurance plan), r the cmpany prviding the insurance must meet minimum rating requirements established by the U.S. gvernment (an A.M. Best rating f "A-" r abve, an Insurance Slvency Internatinal, Ltd. (ISI) rating f "A-i" r abve, a Standard & Pl's Claims-paying Ability rating f "A-" r abve, r a Research, Inc. rating f B+ r abve). Plicy must be in English All exchange visitrs and any accmpanying dependents may als be subject t the requirements f the Affrdable Care Act Plicy must be in English ** NOTE: Minimum requirements, by law, must be met fr all J visa hlders. (22 CFR 62.14(b))

4 Step 1. Verify if yu are a Benefits Eligible Emplyee with yur Rice University Departmental Crdinatr. If yu are benefits eligible, cntinue reading. If yu are nt, please fllw the directins n the next slide instead (Slide 5). Step 2. Pick a health insurance plan. As a benefits eligible emplyee, yu can chse the Aetna Rice Emplyee Health Insurance Plan r a nn-rice spnsred insurance plan, such as SAS*, Atlas, r ISO. Any health insurance plan yu purchase must meet the minimum health insurance requirements set by the U.S. Department f State (see slide 2). Please remember, dependents n J-2 Visas, must als be cvered. Step 3. If yu decide n the Aetna Rice Emplyee Health Insurance plan, yu will need t set up a meeting with Human Resurces t enrll. Yu will als need t purchase Medical Evacuatin and Repatriatin (ME&R) insurance, such as Betins. Yu will need t purchase this fr yurself and any dependents. Step 4. Develp an insurance timeline since yu (and any J-2 dependents) must be cvered during yur entire J-1 prgram. Aetna Rice Emplyee Health Insurance usually starts the 1 st f the next mnth after yur start date (Example: If yu start at Rice n June 15 th, yur Aetna Rice Emplyee Health Insurance plan wuld be effective starting July 1). It is imprtant t cnfirm yur benefits start date with Human Resurces. J-1s and J-2s cannt have gaps in insurance s yu may need t find additinal cverage fr the interim perid. Many schlars use daily rate insurance ptins t cver this gap but yu may purchase any insurance that meets the J-1 heath insurance requirements. Step 5. Verify yur cverage with OISS (iss@rice.edu) at least ne week prir t arrival and make sure t bring cpies with yu t yur MANDATORY OISS Check-in. *Fr the SAS frm, please use yur Emplyee/Visitr ID number in the Student ID sectin. Yur Rice University Departmental Crdinatr can assist yu with finding ut yur number.

5 Step 1. Yu are required t purchase a health insurance plan fr yu and any J-2 dependents fr the entirety f yur stay in the U.S. (22 CFR 62.14(b)) Any health insurance plan yu purchase must meet the minimum health insurance requirements set by the U.S. Department f State (see slide 2). When thinking abut which plan t chse, we recmmend discussing with yur department and any ther clleagues n J-1s yu knw here in the U.S. Many schlars chse SAS*, Atlas Elite r Select, r ISO. Fr mre infrmatin n alternate plans, please visit the OISS webpage. Step 2. Verify yur cverage with OISS (iss@rice.edu) at least ne week prir t arrival and make sure t bring cpies with yu t yur MANDATORY OISS Check-in. *Fr the SAS frm, please use yur Emplyee/Visitr ID number in the Student ID sectin. Yur Rice University Departmental Crdinatr can assist yu with finding ut yur number.

6 With the brad range f chices, the actual cst fr health care in the United States cannt be measured. Much depends n the level f insurance cverage, the number f times the plicy hlder visits the dctr and/r hspital during his/her stay here. Fr the basic plicies displayed in the OISS, there is an average mnthly cst f $100 fr the individual, with an additinal $320-$500 per mnth t include cverage fr the spuse and/r children. Be sure t include cst estimates fr health insurance in planning yur budget fr yur expenses during yur stay in the U.S. Read the plicy infrmatin carefully, and dn t be afraid t ask questins befre purchasing a plicy. Insurance agents make their living frm selling insurance plicies t individuals and grups. If purchasing a plicy thrugh an insurance agent, feel free t ask questins and take the time t learn abut and understand several chices befre making a decisin. Dn t sign anything if yu are uncertain r cnfused. Cnsult a knwledgeable friend, yur academic department, r the OISS fr help.

7 The reliability f the cmpany. Plans ffered thrugh Rice r apprved by NAFSA shuld be frm reliable cmpanies. Plans advertised utside f ur campus shuld be checked ut with smene wh is familiar with that cmpany. The recmmendatin frm the persn selling the insurance is nt always sufficient in rder t make a gd decisin as t which plicy t buy. Cmpanies vary in their level f service t custmers, hw prmptly they pay claims, and if they pay the full amunt expected by their plicy hlders. Deductible amunts. Mst insurance plicies require their hlders t pay part f their health expenses themselves (called the deductible) befre the cmpany pays anything. Under sme plicies the deductible is a yearly figure, and the hlders must pay up t that amunt nly nce each year. Under ther plans, the deductible must be paid each time there is an illness r injury. The J regulatins require that yu select a plicy where the deductible is n mre than $500 per accident r illness, but many plicies ffer a lwer, mre advantageus ne. In chsing insurance, think carefully abut hw much yu can affrd t pay ut f yur wn pcket each time yu are sick r injured, and weigh the deductible against the premium befre yu decide. C-insurance. Usually an insurance plicy nly pays a percentage f the medical expenses, even after the deductible is paid. The plicy might pay 80%, fr example, and the remaining 20% (which hlders still have t pay) is called the c-insurance. Fr example: $3,000 in medical expenses cvered by a plicy with a $400 deductible and a 20% c-insurance wuld cver $2,080 f yur expenses and require yu t pay $400 in deductible and $520 in c-insurance. The J regulatins require that insurance plicy yu chse must pay at least 75% f cvered medical expenses.

8 Life/per-ccurrence maximums. Many insurance plicies limit the amunt they will pay fr any single individual s medical bills r fr any specific illness r injury. Exchange Visitrs must have insurance with a maximum n lwer than $50,000 fr each specific illness r injury, which may be enugh fr mst cnditins. Majr illnesses, hwever, can cst the patient several times that amunt. Benefit perids. Sme insurance plicies limit the amunt f time they will g n paying fr each illness r injury. In that case, after the benefit perid fr a cnditin has expired, the plicy hlders must pay the full cst f cntinuing treatment f the illness, even if they are still insured by the cmpany. A plicy with a lng benefit perid prvides the best cverage. Exclusins. Mst insurance plicies exclude cverage fr certain cnditins. The J regulatins require that if a particular activity is part f yur Exchange Visitr prgram, yur insurance must cver injuries resulting frm yur participatin in that activity. Fr example, if a persn cmes t the U.S. t cnduct chemical experiments, s/he wuld have t be cvered fr labratry accidents. Finally mst insurance cmpanies d nt pay fr treatment f what they cnsider t be pre-existing cnditins. That is, if the plicy hlder was previusly diagnsed and/r treated fr a prblem befre purchasing the insurance, the new insurance plicy will nt pay fr cntinued treatment f that prblem. Fr thse wh suffer frm chrnic cnditins (ex: high bld pressure, diabetes, high chlesterl) r thse wh have pre-existing cnditins (ex: cancer, pregnancy), travel insurance plicies typically will nt cver thse medical needs r medicatins and therefre are nt recmmended ptins.

9 D I have t have health insurance, that meets the J-1 visa requirement, fr the full duratin f my stay in the U.S.? Yes, as per (22 CFR 62.14(b)) D my dependents have t have health insurance, that meets the J-1 visa requirement? Yes, as per (22 CFR 62.14(h)) Fr hw lng must my dependents have health insurance? Fr the full duratin f yur prgram with Rice University. Where can I g t get health insurance fr myself and my dependents? If yu are benefits eligible, mst f the requirements can be met by yur Aetna Rice Emplyee Health Insurance plan with additinal insurance needed fr Medical Evacuatin and Repatriatin. If yu are a cmplimentary academic visitr, yu can purchase insurance, thrugh a cmpany like SAS. Please see slide 4 fr mre infrmatin. Hw can I find ut what my health insurance cvers? Althugh we will nly accept health insurance plans, that meet J-1 Visa requirements, there are a plethra f cmpanies ut there with plans. Make sure that yu read ver the plicy, understand the cverage yu are receiving, understand the claims prcess, as well as where t g in case f emergency. Hw d I pay fr health insurance? Yu can purchase with a credit card fr mst plans. The University Aetna health insurance plans are deducted frm yur paycheck. What if I extend my stay what d I d abut the health insurance requirement? Yu will need t als extend yur health insurance fr yu and any dependents, as per (22 CFR 62.14(b)) Hw d I find a dctr? Cnsult yur health insurance plan and mst likely that plan s website.

10 The Office f Internatinal Students and Schlar Services is here t assist yu with making sure yu are in cmpliance with the J-1 Visa health insurance requirement. If yu have questins, please feel free t: Call ur ffice: us: iss@rice.edu Visit ur website: Schedule a meeting: OISS is lcated in Lvett Hall, Entrance A, 2 nd Flr. T schedule a meeting, please call r iss@rice.edu Welcme t Rice University!