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Health Insurance

Key Points

- PDF #14 Certificate of Insurance (COI) is issued by an insurance provider.
- It displays key information about the policy, verifying insurance coverage.
- Health insurance for EVs must meet DOS minimum requirements.
- Continuous coverage for the program is required; we recommend “entry-to-exit” coverage.

How to Submit?

What to Note?

- Print a copy for your US visa interview (required by some consular posts). Keep it in your wallet for emergencies.
- Ensure it matches the program period (minimum requirement) or flight periods (recommended).
- US health insurance can be complex; review your policy benefits and read page 2 for essential information.
- We provide essential guidance & monitor compliance; EVs handle their own medical claims and benefits review.
- Failing to maintain qualified health insurance throughout the program will result in immediate program termination.

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Crash Course on US Health Insurance

Health insurance in the U.S. is quite complex, and the rules for exchange visitors are very stringent. Familiarize yourself with the basics before arrival.

Takeaways

1 Prescription Practices in the US While it’s common to receive medication directly from the doctor in many parts of the world, the process is different in the US. Doctors typically send a digital prescription to a pharmacy of your choice for pickup and separate billing. Check if your health insurance covers the medicine. If not, see if your insurance or the pharmacy has any discount prescription plans. Alternatively, request generic drugs instead of brand-name ones to save money. Also, before seeing the doctor, note down your preferred pick-up pharmacy.

2 Types of Doctors There are different types of doctors. For regular care, see a family practitioner. For slight urgency, visit urgent care. In emergencies, go to the hospital. Urgent care usually has longer hours and shorter lines than hospitals.

3 Ambulance Services Ambulance services in the US are commonly privately run and charge separately. Many insurance plans do not cover ambulance services or only cover a portion of the cost.

4 Medical Claims The process of requesting reimbursement or payment from your health insurance company for covered health care services you have received. This typically involves submitting a claim form and any necessary documentation to your insurance provider. Since it may take some time, when filing medical claims, consider using your overseas address.

5 Primary Care Physician (PCP) Vs Referral The PCP is usually the first point of contact for non-emergency health insurance. They refer you to a doctor who provides general medical care. A referral means authorization from the PCP for certain services. Some insurance plans require a referral from a regular doctor to see a specialist.

Important Terms

1 Coinsurance The percentage of costs you pay after meeting your deductible. As an example, if your coinsurance is 20% and your medical bill is $1,000, you would pay $200, and your insurance would cover the remaining $800 after you meet your deductible.

2 Copayment (Copay) A fixed amount you pay for a covered health care service, usually when you receive the service. As an example, if your deductible is $500, you must pay $500 out-of-pocket for covered services before your insurance begins to pay.

3 Deductible The amount you pay for covered health care services before your insurance plan starts to pay. As an example, if your copay is $30 for a doctor’s visit, you pay $30 each time you see the doctor, regardless of the total cost of the visit.

4 Network The facilities, providers, and suppliers your health insurer has contracted with to provide health care services. Out-of-network providers are not contracted with your plan and usually cost more. As examples, if you see a doctor in your insurance network, you only need to pay the portion you’re responsible for (after copay). If you see an out-of-network doctor, you may have to pay the full amount upfront and then claim reimbursement later.

5 Preauthorization Approval from your health insurance company before you receive a service or fill a prescription to ensure it is covered. This is also known as prior authorization or prior approval.