Health Insurance Guide for F1 Students

Selecting an International Student Medical Insurance Plan

As an international student in the US, it is highly expected for the student to be insured for medical, repatriation, and evacuation expenses. The rates for healthcare in the US are practically exorbitant. For an international student, it would be almost impossible to meet the expenses in case of a medical crisis, without health insurance. All universities mandate insurance coverage for international students/scholars on F and J visas. Almost all universities give the permit to buy a plan of one's choice provided it meets their minimum requirements. Many insurance plans offer various benefits at various costs. One needs to consider the following factors while selecting an appropriate plan.

Example

Eric purchases an insurance plan with:

• Copay for office visit: $20
• Copay for Emergency Room visit: $500
• Copay for Surgery: $250
• Deductible: $2,500
• Co-insurance: 80%
• Out of pocket: $5,000

Eric goes to see a doctor for gastric pain. The cost of the entire visit is $250. The $20 copay is collected from Eric at the clinic before he sees the doctor and later he is billed for the remaining $230. The entire $250 counts towards his deductible and out of pocket. Now his remaining:

• deductible is $2,250
• out of pocket is $4,750

Next, he goes for an endoscopy at a hospital. The cost of the surgery is $5,000. Eric pays $3,000 in all:

• the copay of $250 (remaining cost: $4,750)
• the deductible of $2,250 (remaining cost: $2,500)
• the co-insurance of $500 (20% of $2,500)

Now Eric has satisfied the deductible but has $1,750 left towards his out of pocket. Next, he goes to an Emergency Room visit which costs $5,000. He pays $1,400:

• the copay of $500 (remaining cost: $4,500)
• the co-insurance of $900 (20% of $4,500)

Eric still has an out of pocket of $350 remaining. Once he satisfies that during his next visit, he will be covered in full for any other eligible medical expenses for the rest of the plan year. The deductible and out-of-pocket costs will reset to 0 at the beginning of the next plan year when the plan is renewed.

Policy Validity

Most of the insurance plans begin coverage at the start of the term or when the student is arriving in the US, whichever is earlier. The plans go on for a year and require to be renewed at the beginning of the next academic year. These plans are said to follow the plan year. Some plans might need to be renewed every calendar year and are called calendar year plans.

Policy Maximum

Plans can cover the medical expenses resulting from illness and injuries up to a certain maximum amount only. Any expense beyond this maximum limit will not be covered by the insurance plan. The amount varies depending on the type of plan one has chosen. This limit is typically referred to as the 'policy maximum'. It is otherwise called maximum limit, maximum coverage, or policy limit. Policy maximums range from $1,000,000 to unlimited. Plans with no policy maximums offer better protection and hence cost more.

Premium

Premium is the amount that is to be paid towards purchasing an insurance policy or a plan. By paying the premium, one can enroll in an insurance plan and protect oneself from several unforeseen expenses. Insurance plans can offer monthly, quarterly, semi-annual or annual premiums. If the insurance payment due date expires, and the payment has not been made for a stipulated period of time, the company has the authority to terminate the plan. Higher the premium, the better the coverage.

Deductible

In the event of a medical expense, the candidate, as a policyholder, will be required to make a certain fixed payment towards meeting the eligible medical expense before the insurance pays anything. This amount that is paid towards meeting the medical expense is called the 'deductible'. The insurance company will consider making payments for the medical expenses only after the candidate has satisfied the deductible amount. The amounts for a deductible can be high or low according to the policyholder's convenience, but a decrease in the deductible amount means an increase in the monthly premium.
Most policies offer an annual deductible, and one is expected to pay the deductible only once a year, irrespective of the number of times one visits the hospital or doctor. For example, if the annual deductible is $500, the student needs to pay for the first $500 in eligible medical expenses, and the insurance will consider paying after that. Other policies may require to pay the deductible for each illness or injury (one could visit the hospital or doctor several times for the same illness or injury but will be required to pay the deductible just once for each illness or injury).

Copay

Copay is the amount that has to be paid by the plan holder per service after they meet the deductible. The copay is different for different services and is decided when the student purchases the insurance plan. If the plan has a copay of $10, then the plan holder will have to pay $10 every time they go see a medical provider and the insurance will cover the rest of the cost based upon the plan benefits. The copay amount counts towards the total cost of the service. Usually, the copays are collected before the services are rendered.
To give an idea about the amount of copay usually charged:

• Office visits: $20-50
• Hospital visits (planned service): $250
• Emergency Room visits: $500
• Urgent Care Center visits: $250

Co-insurance

After the candidate has paid the deductible, insurance plans cover only a portion of the medical expenses. For example, the policy might pay 80% of eligible expenses. The remaining 20 percent, for which the candidate is responsible, is called coinsurance. Hence, if one were to be injured and incurred a $2,100 claim for eligible medical expenses, an insurance plan with a $100 deductible and 20% coinsurance would require:

• the insurance company pay $1,600 (80% of $2,000)
• and the candidate pays $400 (20% for $2,000) as co-insurance + $100 deductible.

The plans that offer the best protection are those that require one to pay the least towards co-insurance.

Out-of-Pocket

The out-of-pocket amount is the maximum amount that a policyholder has to pay in the entire policy year for eligible services. If the total amount paid by the policyholder during the year meets the out-of-pocket amount, then the insurance covers any additional amount in full. No copays or co-insurance are applicable after meeting the out-of-pocket amount.

Intermediate Coverage Limits

Some plans assign intermediate limits to each type of covered medical expense. For example, some plans, despite offering $250,000 maximum coverage, can stipulate the maximum coverage offered for surgery as $5,000, or the maximum limit for prescription drugs as $150, etc. Some plans limit the number of times a plan holder can see a doctor in a year. Therefore, it is important that one carefully reads the policy benefit details in the brochure. The plans that offer the best protection are those that have very few intermediate coverage limits.

Exclusions

Just like there are insurance inclusions within a plan, there are insurance exclusions that basically do not cover certain aspects within a plan. Most health insurances make exclusions for pre-existing diseases, self-inflicted injuries, cosmetic procedures, and so on. Yet others may not cover surgeries or preventive services. Some insurance policies either exclude coverage for certain pre-existing medical conditions or require one to be continuously covered on the plan for 6 or 12 months before covering the pre-existing conditions. All the medical plans have a fine print that they cover only medically necessary services. So, in case one has any special coverage requirements, one should seek help from a qualified US Health Insurance professional, and choose a suitable plan.

Types of Medical Insurance Plans Offered by Institutions in the US

These insurance plans are broadly divided into three main categories:

Mandatory Group Insurance Plan

As the name suggests, this is an insurance plan offered by an institute, which is compulsory for international students enrolled at a particular university. The students have no other option but to purchase the given plan. The plan offers fixed coverage policies which are generally costly but also inclusive of benefits that are not covered in most plans ( Mental health, pre-existing illness, maternity, etc.). The amount to be paid for the insurance plan is usually included with the student's tuition fee.

Group Insurance Plan with Waiving Options

In this category, students have the option to either choose a relevant plan from their institution or opt-out of it, by choosing to fill up a waiver form/application. If the student selects the option of a waiver form, they are required to inform the institute about the insurance policy they plan to purchase outside the campus. The forms are to be filled few days before the beginning of classes. The student can only move forward with the chosen plan if it meets the adequate coverage requirements or benefits put forward by the institute.

The Optional Insurance Plan

Some colleges or universities in the US give international students the option to freely choose an appropriate plan outside campus, and do not offer any mandatory plan with fixed coverage. In such cases, students should look for insurance options most beneficial to them, including essential coverage and affordability. There are several popular insurance providers for international students like ISO, ATENA, IMG, Compass Student Insurance, and so on.

Conditions for purchasing Health Insurance Outside Campus

There are various conditions put forward by institutions when a student opts for a plan outside campus. These requirements are:

• Beneficial coverage options like maternity, mental health, pre-existing illness, and preventive care
• Low or reasonable deductible
• Appropriate policy maximum
• Repatriation benefits
• A good rank or rating by AM Best
• A company based in the US

Note: some pharmacies are associated with different insurance providers or companies. Students should make sure to discover pharmacies nearby or within the locality that accept the insurance for which one has invested. This will help students make proper use of the health insurance plan and pay comparatively less for prescribed medications.

Popular Health Insurance Plans

Recommended insurance plans for international students include:

Exchange Guard Plan

This insurance plan has an A rating by AM Best and offers a policy maximum ranging from $100,000 to $500,000. Students can get a coverage benefit of repatriation, covid-19, emergency medical evacuation, pre-existing illness, and other general medical expenses from this insurance plan. To be eligible for this insurance plan, the student is required to procure essential documents including a copy of their visa and should establish residency within the country.

Student Health Advantage Plan

This plan is categorized into two main insurance plans, i.e., Student Health Advantage - Standard and Student Health Advantage - Platinum. This is a popular plan for F1 students as it includes a policy maximum of up to $500,000, and offers comprehensive coverage with reasonable deductibles. The difference in these two categories is the amount of policy maximum, deductible, and monthly coverage difference for pre-existing conditions. Other coverage benefits include repatriation, covid-19, maternity, dental checkups, substance abuse, medical prescriptions, and so on. This also has an A rating by AM Best.

Patriot Exchange Plan

This is a plan rated A by AM Best and offers international students with deductible options from $0 to $500 and a policy maximum limit of up to $5,000,000. Coverage benefits include covid-19, mental illness, substance abuse, pre-existing conditions, emergency services, medical prescriptions, repatriation, and physician visits.

Student Secure Plan

This is another health insurance plan with an A rating by AM Best and is divided into four main types, i.e., Student Secure - Budget, Student Secure - Select, Student Secure - Smart, and Student Secure - Elite. The policy maximum increases and deductible decreases according to the type of student secure plan selected by the candidate. The coverage benefits of the insurance plan include covid-19, pre-existing diseases, emergency services, medical evacuation or repatriation, adventure sports injury, mental illness, and dental care.

Study USA Plan

This insurance plan for international students is divided into three categories: Study USA Standard Plan, Study USA Preferred, and Student Secure - Elite. The policy maximum increases and deductible decreases according to the type of Study USA Plan selected by the candidate. The coverage benefits of the insurance plan include covid-19, pre-existing diseases, emergency services, medical evacuation or repatriation, terrorism, general check-up, maternity, mental illness, and dental care. Substance abuse coverage is not included for the elite plan, and surgical treatment is not covered for the elite and preferred plans. This health insurance plan has also been rated A by AM Best.

Information Required While Applying for an Insurance Plan

The mandatory information a policyholder needs to provide when applying for an insurance plan are:

• Name of the candidate
• Date of Birth
• The candidate's student ID
• Gender/Sex
• Permanent address of the candidate
• Email address of the candidate
• Details of family(If applicable)
• Coverage dates