J-1 Summer Work and Travel Health Insurance: Minimums, Gaps and What Happens Without It

The exchange rules set insurance minimums in dollars, and your sponsor has to enforce them. This page lays out those minimums, who must be covered, what a policy may leave out, and what a sponsor does when a participant has no coverage. The living hub has the rest of the settling-in guides.

The short version

1. Get a plan with at least $100,000 of medical cover per accident or illness.
2. Check that the deductible is no more than $500.
3. Check the plan pays $25,000 to send a body home and $50,000 to move you for care.
4. Match the plan dates to your program dates in SEVIS.
5. Agree to a payroll deduction for insurance only in writing.

The J-1 minimum coverage, item by item

The rule is in 22 CFR 62.14. Minimum coverage must provide the four items in the table.

Repatriation means transporting a body to the home country after death, and evacuation means transporting an injured person for medical treatment. A university J-1 office notes you may need to buy repatriation and medical evacuation cover separately. The State Department lists the same four figures as the rule in force from May 15, 2015.

Who must be covered and for how long

Your sponsor must require that you have insurance for sickness or accidents in effect while you take part in its program. The period of required coverage is the actual length of your participation as recorded in SEVIS, using the Program Begin Date and, as applicable, the end-date fields. Accompanying spouses and dependents must be covered in the same amounts, and the sponsor must tell you so in writing before you arrive.

You carry the responsibility. Getting and keeping the coverage is the participant’s job, as Yale’s J-1 office puts it. After you buy a plan, you contact the insurer about coverage and claims.

Your sponsor must also tell you about health care and insurance before you leave. The pre-arrival information must describe the costs and requirements of health care and insurance. Orientation covers available health care, emergency assistance and insurance coverage. Sponsors must also tell you that you may be subject to the Affordable Care Act.

Who pays, and what a sponsor may charge

Sponsors may not charge fees for providing insurance beyond demonstrable and justifiable staff time. A sponsor may offer optional “entry to exit” coverage, from the day you leave home until you return, but is not required to.

Insurance may be taken from your pay only with your permission. If the sponsor arranges insurance through payroll deduction at the host organization, you must authorize it voluntarily in writing and be able to arrange other insurance instead. The sponsor keeps those authorizations on file.

Which insurers and policies count

A policy must meet at least one of these tests:

• It is underwritten by an insurer with an A.M. Best rating of A- or above, a Fitch rating of A- or above, a Moody’s rating of A3 or above, or another rating the State Department specifies.
• It is backed by the full faith and credit of your home-country government.
• It is part of a group health benefits program offered by a designated sponsor.
• It is offered through a federally qualified Health Maintenance Organization (HMO).

Government agencies and public colleges may self-insure if permitted by law.

What a policy may include and what it may leave out

The rules allow limits that can cost you money:

• A waiting period for pre-existing conditions that is reasonable by current industry standards.
• Co-insurance, under which you may pay up to 25% of covered benefits per accident or illness.

A policy must not unreasonably exclude coverage for perils inherent to the activities of the exchange program.

Some care is outside most policies. Elective care such as eyeglasses or dentistry is not ordinarily covered and can be very expensive in the US. Check that local providers accept your plan before you rely on it: one university J-1 office cannot guarantee that providers near it accept plans other than its own.

Deductible and co-insurance in plain words

A deductible is the amount you pay for covered services before your plan starts to pay. With a $2,000 deductible, you pay the first $2,000 of covered services yourself. Plans with higher monthly premiums usually have lower deductibles. J-1 rules cap the deductible at $500 per accident or illness.

Co-insurance is the percentage of a covered service’s cost you pay after you meet the deductible. If the allowed amount is $100 and your co-insurance is 20%, you pay $20 once the deductible is met, but the full $100 before it is met. The out-of-pocket maximum is the most you pay for covered services in a plan year.

A checklist before you buy or accept a policy

Hold any plan up against the rule before you pay.

• The medical benefit is at least $100,000 per accident or illness, and the deductible is no more than $500.
• Repatriation of $25,000 and medical evacuation of $50,000 are included, or bought separately.
• The insurer meets one of the rating tests, or the policy is backed by your home-country government.
• The dates match your program dates in SEVIS, with no gap at the start.
• Any payroll deduction was authorized by you in writing.
• You know the insurer’s contact details for coverage and claims questions.

The gap at the start of your stay

Coverage is required for the whole program. If you buy a US policy after you arrive, buy traveler’s insurance to cover the gap until it starts. Check that it covers accidents and illness while you travel, not only cancellation of the trip. If you enter the US before the start date on your DS-2019, a university office recommends temporary health insurance, even though it is not federally required.

On arrival, J-1 exchange visitors are asked to attest that they are covered by insurance that meets the rules.

What happens if you go without insurance

Exchange visitors who willfully fail to keep the required coverage, or who misrepresent it to the sponsor, violate the rules and are subject to termination. The sponsor must terminate your participation if it finds that you willfully fail to comply. The termination rule lists the willful failure to maintain 62.14 coverage among the reasons a sponsor shall terminate a participant.

Insurance also affects any extension. A university J-1 office states that the rules prohibit extending J-1 status past the DS-2019 dates without insurance. Summer Work Travel does not permit extensions in any case.

Health coverage beyond the J-1 policy

The required policy is not the only health-coverage rule you may meet.

• Affordable Care Act. J exchange visitors may be subject to the Affordable Care Act, and sponsors must tell you so.
• HealthCare.gov. Certain lawfully present immigrants can get Marketplace coverage. Other immigration statuses may be eligible for Marketplace coverage, but not savings.
• Bills you did not expect. The No Surprises Act, a federal law in effect since January 1, 2022, protects you from unexpected out-of-network bills for emergency room visits. If you do not use insurance, providers must usually give a good faith estimate of your cost if you ask for one or schedule care at least 3 business days ahead. You may be able to dispute a bill that is at least $400 more than the estimate.

For emergencies and safety, read health and safety. Costs for the whole season are in program cost, and the first week checklist lists what to do on arrival.