Healthcare for International Students
International Student Insurance Federal Regulations
What are the insurance requirements under federal law for international students?
Insurance for both J-1 students and their J-2 dependents is a federal requirement. It is each student’s responsibility to maintain valid health insurance at all times. The Code of Federal Regulations states that if J-1 students and the J-2 dependents do not have Health and Accident Insurance coverage, the student’s program and visa status will be terminated.
Although the insurance requirements at your school can vary, some of the most common international student insurance requirements include:
Your university may require a minimum amount of medical coverage on your insurance plan. This dollar amount sets the minimum limit of eligible medical expenses that your insurance plan will pay. It can range anywhere from $50,000 worth of coverage to an unlimited amount.
Repatriation of Remains
Repatriation of Remains, also known as the Return of Mortal Remains, provides financial assistance in the event of death while outside of your home country. In an unfortunate event like this, shipping your remains to your family back home can be difficult, time consuming, and expensive. This coverage will provide the proper planning, logistics, and financial coverage for your family members.
Emergency Medical Evacuation
Another important aspect of international student health insurance is emergency medical evacuation. This type of coverage provides financial assistance in the event that the local facilities in which you fall injured or ill do not have the capacity to give you proper care. If deemed necessary by the acting physician and your insurance company, this coverage will provide transportation to the nearest facility that can properly treat your condition. This type of coverage does not guarantee travel back to your home country in this situation unless deemed necessary by your attending physician.
Insurance Requirements under the Affordable Care Act (ACA)
As a full-time international student, I am required to have health insurance by law while studying in the US? How will the Affordable Care Act (ACA) affect international students & our insurance options?
If you have insurance coverage through a policy at your school, that should satisfy the requirement. If you are in the United States on a student visa, you are also eligible to purchase insurance through the Health Insurance Marketplace.
Minimum Essential Coverage
Will a school’s student health plan meet the requirements of minimum essential coverage under the ACA?
An HHS Final Rule effective April 20, 2012 defined “student health insurance coverage” as a type of “individual health insurance coverage” under the ACA. A student health plan that meets the requirements specified in the HHS rule will: 1) Constitute “minimum essential health coverage” that satisfies the individual mandate; 2) Receive more favorable “phase-in” exceptions than other types of individual coverage.
The supplementary information that precedes the 2012 final rule discusses the variety of student health plans currently offered, and identifies plans that qualify for the above purposes and those that do not. Under a subsequent HHS final rule effective August 26, 2013, self-funded college or university health plans or policy years that begin on or before Dec. 31, 2014 will be deemed to constitute “minimum essential coverage.” Sponsors of self-funded plans that begin after that date will be able to apply to HHS for recognition as minimum essential coverage, as described later in this practice resource.
The Individual Mandate
How will the individual mandate apply to international students?
The individual mandate is the requirement built into the law that everyone must have qualifying health insurance (“minimum essential coverage”), or pay a penalty. As non-resident aliens, international students on F, J, M and Q visas are not subject to the individual mandate for their first 5 years in the US. All other J categories (teacher, trainee, work and travel, au pair, etc.) get a 2 year pass (out of the past six). The individual mandate applies to US citizens, green card holders and resident aliens, but not to non-resident aliens (regardless of their need to file a return). Alien tax status (resident or non-resident) is determined by the green card test or substantial presence test.
F, J, M and Q visas are exempt from the substantial presence test for 5 years, and therefore are non-resident aliens for first 5 years in the US. After that, students can apply for an exception to continue their tax status as “non-resident alien.” As non-resident aliens, F, J, M and Q visa holders are not subject to the individual mandate. Since they are not subject to the mandate, international students are free to acquire insurance coverage more targeted to their specific needs, without concern as to whether their plan meets PPACA requirements. The other J visa categories (teacher, trainee, work and travel, au pair, high school, etc.) generally get a 2 year exemption from the substantial presence test, but the exemption looks back 6 years.
Are all individuals living in the US are subject to the individual mandate?
US citizens and permanent residents are subject to the mandate, as well as “foreign nationals who are in the United States long enough during a calendar year to qualify as resident aliens for tax purposes.” Foreign nationals that don’t qualify as resident aliens, even if they have to file a tax return, are not subject to the mandate.
Anyone “temporarily in the United States on an “F”, “J”, “M”, or “Q” visa for the primary purpose of studying at an academic institution or vocational school, and who substantially complies with the requirements of that visa,” is exempt from being treated as a resident alien, and is automatically a non-resident alien.
That exemption holds for 5 years. After 5 years, a student is no longer exempt, and the substantial presence test can begin. There are helpful examples here: http://www.irs.gov/Individuals/International-Taxpayers/Alien-Residency-Examples.
What is the difference between an immigrant and nonimmigrant visa?
An immigrant visa is the visa issued to persons wishing to live permanently in the U.S. A nonimmigrant visa is the visa issued to persons with a permanent residence outside the U.S. but who wishes to be in the U.S. on a temporary basis (i.e. Tourism, medical treatment, business, temporary work, or study.
Exempt or Nonexempt from the Individual Mandate
A nonexempt individual must have minimum essential coverage or pay a tax penalty. The question then becomes whether nonimmigrants are “exempt” or “nonexempt.”
If exempt, they do not need to carry minimum essential coverage or pay the shared responsibility payment under the ACA. Since the shared responsibility payment is connected to the tax process, the categories of individuals exempt from the requirement to maintain minimum essential coverage or pay the penalty.
A nonresident alien for tax purposes for the taxable year that includes the month being counted; or
An individual who is not lawfully present on any day in the month
For lawfully-present aliens such as nonimmigrants, then, it is the alien’s tax status that determines whether he or she is subject to the requirement to carry ACA-compliant insurance or to pay the tax penalty for not carrying it.
Immigration statuses that qualify for Marketplace coverage
Are immigrants eligible to enroll in the US health care system under the Affordable Care Act and what are the qualifications?
Lawful Permanent Resident (LPR/Green Card holder)
Paroled into the U.S.
Conditional Entrant Granted before 1980
Battered Spouse, Child and Parent
Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
Temporary Protected Status (TPS)
Deferred Enforced Departure (DED)
Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance)
Lawful Temporary Resident
Administrative order staying removal issued by the Department of Homeland Security
Member of a federally-recognized Indian tribe or American Indian Born in Canada
Resident of American Samoa
For naturalized citizens and green card holders who have been in the country for five years or more, they will be able to enroll in the health care program just like U.S.-born citizens. These immigrants will also qualify for Medicaid, which is income-dependent.
Legal permanent residents who have lived in the US for less than five years with incomes up to 400 percent below the federal poverty level can qualify for subsidized health care coverage. Those who have been in the country less than five years do not qualify for Medicaid.
Refugees, asylees, immigrants exempt on humanitarian grounds. All of these individuals who qualify for health insurance coverage and Medicaid, even if they have lived in the United States for less than five years.
Individuals who are on work or student visa (H-1B, F-1, J-1) and have been in the country for less than five years are eligible to buy insurance through the health care exchange, but they do not qualify for Medicaid.