As you determine the type of insurance coverage your students and scholars must have, it’s important to be well-versed on key insurance benefits.
Every insurance plan has a Certificate or Master Policy that has the fine print of what is and isn’t covered. In this document, you will find a table of benefits that outlines the coverage of the plan. While this can be a quick and easy way to get an overview of the policy details, it should not be relied upon. Instead, thoroughly read the description of each benefit and the full list of exclusions to prevent any surprises during the claims process.
Listed below are some key plan benefits that should be considered before finalizing any insurance plan for your students.
The policy maximum is the overall coverage that each student will receive for all eligible claims. With ACA-compliant plans, this is no longer a concern as these plans are required to offer unlimited coverage. If your plan is ACA–exempt, either as a group or individual plan, it’s important to evaluate the coverage to ensure it will cover major emergencies. Coverage for these plans typically range from $100,000 to $1,000,000, however we recommend that the plan provides at least $200,000 per student.
Ideally the plan should not have a per-condition cap separate from the overall policy maximum
When evaluating an insurance policy, be sure to review the benefit descriptions and look for any internal caps. Some plans may contain a per-condition cap on how much coverage a plan will pay out, regardless of the overall coverage amount. For example, it’s not uncommon to find a plan with $1 million in coverage (or unlimited lifetime coverage), but that same plan has a $50,000 per injury/illness benefit caps. On a plan like this, the student would receive $50,000 coverage maximum for any one condition. In that case, the $1 million limit is useless to the student – it's like having a $50,000 plan. Ideally the plan should not have a per-condition cap separate from the overall policy maximum.
Just like domestic insurance plans, international student insurance will have out-of-pocket expenses, particularly deductibles, separate ER deductibles, copays and coinsurance to consider. As mentioned previously, ACA-compliant plans typically have large deductibles and then cover a certain percentage, ACA-exempt plans on the other hand tend to have a deductibles of $100 or less.
After the deductible, the insurance plan may cover a percentage of eligible expenses (known as coinsurance). Most insurance plans will cover between 80% - 100% of an international student’s eligible expenses after the deductible, assuming he or she visits an in-network provider. The percentage of coverage will likely be lower if students elect treatment at a non-participating or out-of-network provider.
Many insurance plans have a network of doctors, hospitals and clinics that can be used by the students. While they are not often required, these providers have agreed to discounted rates and often accept direct billing from the insurance company. It’s important to search for nearby network providers before choosing a plan for your students to confirm there are adequate facilities nearby.
You may find that certain benefits have a limit on how much the plan will cover. This can be done in two ways, either by placing a maximum dollar amount on coverage or by limiting the number of days the plan will cover a condition or treatment. Some plans may try to hide internal caps by failing to mention this in the table of benefits, so it’s important to read through the benefit wording in the Certificate to avoid any misconceptions. These benefit caps, also known as internal limits, can be potentially applied to hospital visits, whereby the plan may only cover hospitalization up to $500 per day, or only cover 15 days of hospitalization. Internal benefit caps like these can lead to expensive bills so be sure to be familiar with the benefit wording and how the plan works in practice. To help ensure you are choosing an adequate plan for your international population, we suggest asking a potential insurance company example situations and have them explain in detail how coverage would be applied.
Most international student insurance plans cover pre-existing conditions, but how they will be covered will vary by plan. It’s important to be aware of what kinds of pre-existing conditions will be covered, as sometimes specific conditions, like congenital disorders, could still be excluded from coverage. ACA-compliant group plans are required to cover pre-existing conditions right away, while an ACA-exempt group or individual insurance plan will typically have a waiting period between 6 and 12 months.
Mental health has become increasingly important for international students studying in the US, and is usually covered for both inpatient and outpatient care. When evaluating a health insurance policy, consider whether you will have coverage for substance and drug abuse, and always verify if your plan will exclude suicide or self-inflicted injuries.
While ACA-compliant plans will cover maternity without any waiting period, ACA-exempt plans may have a waiting period, or exclude coverage entirely. Maternity claims are expensive, so adding a waiting period or excluding coverage entirely will reduce the overall cost of your insurance plan. The importance of this benefit will depend on your international student and scholar population, typical family situation and the average duration they stay in the United States.
Medical Evacuation and Repatriation of Remains
Emergency medical evacuation and repatriation of remains, sometimes referred to as return of mortal remains, is essential to any health insurance policy for international students and scholars. While all J visa holders are required to have these benefits in place for the full duration of their time in the US, all international students should have this coverage. Emergency medical evacuation provides transportation to the nearest facility equipped to handle treatment, generally determined by the overseeing physician, which can also include their home country if medically necessary. In case of death, repatriation of remains provides transportation for the body to be brought back to the home country. Both benefits are typically coordinated by the insurance company who works with family members to coordinate these arrangements.
Another important consideration for health insurance is sports coverage. This is not typically included on group plans unless requested, and may be covered on an individual plan. There are typically three categories of sports coverage you can find on insurance plans:
- Organized sports
- Organized sports typically include club, intramural, interscholastic and intercollegiate activities. They generally do not cover extreme sports (such as bungee jumping, skiing, sky diving, etc.), and often cap the amount of coverage for organized sports.
- Recreational sports
- Recreational sports are typically athletic activities which are non-contact and engaged for leisure, recreation, entertainment or fitness purposes. This is generally covered on most insurance plans automatically.
- Extreme or hazardous sports
- Extreme or hazardous sports are generally undertaken for thrill seeking, and may be excluded on most health insurance plans. This may include, but is not limited to, sky diving, scuba diving, hang gliding, caving, etc
As with all insurance plans, be sure to check the benefits of the plan as well as exclusions to review how the insurance plan handles these three levels of coverage for sports.