DRAFT Health Care & Insurance
- Elizabeth Clevenger
How do I embed this video here? https://www.internationalstudentinsurance.com/explained/us-healthcare-system-video.php
Mandatory Health Insurance
Federal regulations require all J-1 students and scholars and their dependents to be enrolled in health insurance for the duration of their programs in the United States. Health insurance coverage must meet minimum requirements, including:
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The University of Tennessee requires all international students to have health insurance while enrolled. All international students are automatically enrolled in the UT Student Health Insurance Plan (SHIP) each semester. Charges for the student health insurance will be placed on student accounts. The UT SHIP does not include dental or vision benefits; additional coverage for dental and vision can be purchased separately.
It is essential for each student and dependent to enroll in health insurance so that each person can receive the necessary medical care. Without health insurance, health care in the United States is prohibitively expensive and could cause financial catastrophe. It is a violation of federal regulations for F-1 and J-1 students and their dependents to accept public assistance, even for medical care.
Waiver of Student Health Insurance
Some students are eligible for a waiver of the university plan because they will be covered in other ways. This includes:
students have purchased other insurance coverage that meets minimum requirements. (Travel insurance will not meet minimum requirements!)
Graduate Assistants/Associates (GA/GRA/GTAs).
Students who are eligible for a waiver must complete a waiver form at the beginning of each semester.
More information on the waiver request process is available from the UT Student Health Center. https://studenthealth.utk.edu/international-students/
Dependent Health Insurance
Students may enroll their dependent spouses and children in the UT Student Health Insurance Plan within 30 days of the dependents' arrival in the United States. It is very strongly recommended to enroll dependents as soon as possible. To enroll dependents, visit the UT SHIP website: https://www.studenthealthprograms.com/.
How To Use Your Health Insurance
As a student at the University of Tennessee, you have an excellent resource for your health care in the Student Health Center (SHC). Many of the services offered at the Student Health Center are completely covered by the UT SHIP with limited additional co-pays. If you have a health care need and are covered by the UT SHIP, we strongly recommend beginning your care with an appointment at the Student Health Center. Their team will refer you to additional specialists if more care is needed. You can read more about how your students health insurance works at the SHC on their website. https://studenthealth.utk.edu/how-your-health-insurance-works/ Unfortunately, the SHC is not able to provide care to dependents.
Once you have enrolled in a health insurance policy, you will receive a health insurance card from your insurance company. If you have a plan other than the SHIP or if your dependents need care, you will be able to choose a doctor or clinic from a list of in-network providers that partner with your insurance company. Most insurance companies have a provider directory on their website that will help you find in-network care in your area. Your costs will be much lower when you choose in-network providers.
When you attend a medical appointment, present your insurance card to the provider. After your visit, your medical provider will bill your insurance company for your treatment. Your insurance company will determine what expenses are covered by your plan and if any network discounts apply and send any applicable payments to the provider as well as sending you an explanation of benefits document about what was paid and what costs are outstanding. If the insurance company does not cover the entire cost, your medical provider will send you a bill for the remainder.
Most insurance plans require that you first meet an annual deductible, which is the portion of your costs that you must pay before your insurance company will begin to cover your care. It is important to review your plan and be aware of your deductible. Your plan may also require you to pay a co-payment, which is a specific amount you must pay for each visit or service. You may also be required to pay co-insurance, which is your portion of the costs after your deductible is met. Information about your deductible, copayment, and coinsurance will be available in the summary of benefits for your specific policy.
Key Insurance Terms
Claim: A written request for payment by the insurance company of medical expenses that are covered under an insurance policy.
Co-payment: After the deductible is paid, this is the portion of a covered expense that must be paid by the insured individual. For example, you might have to pay a $20 co-payment each time you see a doctor.
Deductible: The portion of a covered expense that must be paid by the insured person before the insurance company pays its portion of the expense. (Ex. If the deductible is $100, then you must pay the first $100 of covered medical costs before the insurance will pay anything).
Exclusion: Any condition or expense for which, under the terms of the insurance policy, no coverage is provided and no payment will be made.
Insurance Premium: The amount of money you have to pay to receive coverage with an insurance company for a given period of time.
Pre-existing Condition: A medical condition that existed before an insurance policy was purchased.
PPO (Preferred Provider Organization): With a PPO plan, the insurance company will generally pay a high percentage of the cost if you choose one of their “preferred providers” (a doctor who is “in network.”)
HMO (Health Maintenance Organization): With an HMO, you are required to seek care first from a selected physician (the “primary care provider”) before you can go to any other doctors or health facilities.