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Insurance

When an F or J student enrolls in classes each semester, a fee is assessed to cover the cost of insurance for that semester. Students are required to pay for this fee with their tuition. F or J students who have insurance questions or would like to apply for a waiver must go to Student Development Services ( University Center room 113) and they will advise you of your options.

Why should you have health insurance?
Medical care in the US is very expensive. Although in many countries the government bears the expense of health care for its citizens or visitors, people in the United States are responsible for these costs themselves. To stay in the hospital for one day in the US may cost more than $2,500 and a routine pregnancy could cost anywhere from $8,000-15,000. Most international students would be financially ruined if they had to pay for such expenses. Americans rely on health insurance to get access to better and more timely health care and to protect themselves against the enormous costs of health care in this country— you should do the same!! Without health insurance, many doctors would even refuse to treat you unless it was a life-threatening emergency. It also is a violation of immigration law for F1, F2, J1 and J2 students and dependents to accept public assistance, even for medical care. Maintaining health insurance helps you avoid worrying about unexpected medical costs while in the United States.

How insurance works in the U.S. ?
When you purchase health insurance, the premium you pay is combined with the premiums of others to form a pool of money. That money is then used to pay the medical bills of those participants who need health care. Your coverage remains valid only if you continue to pay your premium. Once you purchase insurance, the company will send you an insurance identification card. Keep this with you at all times and use it as your proof of insurance when you seek medical treatment. To receive payment from the insurance company, file a claim form to report the expenses. The insurance company evaluates the claim and makes the appropriate payment for coverage under the policy. Sometimes the insurance company will pay the doctor or hospital directly and other times the company reimburses the policy holder after they have paid the bill. aspx

How to use your insurance?
Make sure to present your insurance ID card as proof of insurance each time you visit a doctor. With most insurance plans, after you receive treatment the doctor or hospital files a claim with the insurance company for you. This form is reviewed by the insurance company and if the treatment is covered they will make payments to the hospital or doctor. The company will notify you of their decision on the claim. The doctor or hospital will send you a bill for the remaining expenses. Most insurance companies do not cover 100 % of treatments, so you will be responsible to pay what the insurance company will not. Make sure you fill out all forms from the doctor or insurance company carefully and completely. If you disagree with the decision of the company about payment of a claim, you have the right to file an appeal. Your insurance company can explain the appeal process.

Dependent Insurance?
Health insurance for your family is just as important as is it for you! It is required that F1 or J1 students who have dependents with them in the U.S. have sufficient financial resources to cover the insurance costs. Dependents of J1 students are required and dependents of F1 students are encouraged to purchase insurance through the UAH designated plan. You may refer to this website www.uhcsr.com or call 1-800-237-0903 to get more information on UAH’s designated insurance plan.

If you choose not to purchase insurance through UAH, there are many available health insurance plans in the U.S. and picking the right one is an important decision. Look at the features of a few plans to decide which one is best for you. Here are a few points to consider when picking a health insurance policy :

• Reliability/experience of the company
• Deductible amount-look at the amount for the deductible and note whether it is paid annually or each time you have an illness or injury.
• Co-payment-find out whether this is a fixed amount or if it changes depending on the treatment.
• Specific limits-some policies state limits on the amount they will pay for a particular service. Make sure the limits are not too low for a serious illness.
• Exclusions or Pre-existing conditions-Some policies exclude coverage for certain conditions. Make sure the exclusions and think about the likelihood that you will need treatment for something listed as an exclusion
  

PPO vs. HMO
PPO-means 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-means 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 facilitiy.

KEY 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 medical bill that must be paid by the insured person before the insurance covers expenses. Low deductibles and co-pays decrease an individuals out-of pocket expenses. If the deductible is $100, then you pay the first $100 of covered medical costs before the insurance will pay.

Exclusion: Any condition or expense excluded from coverage under the terms of the insurance policy, therefore no payment will be made. If you have received an exclusion notice you always have the right to appeal the decision of the insurance company.

Insurance premium: The amount of money you have to pay to get coverage with an insurance company for a given period of time.
Preexisting condition: A medical condition that existed before an insurance policy was purchased.

Reasonable and Customary: Insurance companies will only cover costs they consider to be reasonable and customary. Which is defined as the fee or expense that is the smallest of: (a) the actual charge; (b) the charge usually made for a covered service by the provider who furnishes it; (c) the negotiated rate, if any; and (d) the prevailing charge made for a covered service in the geographic area by those of similar professional standing.