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INTERNATIONAL STUDENT HEALTH INSURANCE

 

Navigating the United States' health insurance system can be difficult or confusing even for U.S. citizens. Nevertheless, it is a requirement that all international students have a U.S. health insurance plan, regardless of whether they are studying in-person or remotely.  ISPO created this page to give you tips, advice and resources to make sure you are adequately covered while studying at UC San Diego.

What is the University of California Student Health Insurance Plan (UC SHIP)?

UC SHIP is a student-focused package for UC San Diego graduate and undergraduate students, including strong medical, behavioral health, pharmacy, dental, and vision care benefits. Since health insurance is mandatory for enrollment, all registered students are automatically enrolled into UC SHIP. Students can complete a waiver application if they want to opt out of this plan. More information available HERE.

Overview of U.S. Health System (Video)

This video created by an insurance provider called International Student Insurance. It is a very helpful, brief summary that answers many basic questions that an international student might have.

Key Terms

  • Coinsurance - The amount you are required to pay for medical care in a fee-for-service health plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the health insurance company pays 80 percent of the health claim, you pay 20 percent. 
  • Confidential - Patients of health care in the U.S. (including mental health care) are protected by law from having information about their medical care/condition shared with any others in almost all cases, except if under the age of 18 in which case information can be shared with their parent/legal guardian. This protection is referred to as ‘confidentiality.’ 
  • Coordination of Benefits A system to eliminate duplication of benefits when you are covered under more than one group health insurance plan / medical insurance plan. Benefits under the two health insurance plans usually are limited to no more than 100 percent of the health claim. 
  • Co-payment / Co-payAnother way of sharing medical costs. You pay a flat fee every time you receive a medical service (for example, $5 for every visit to the doctor). The health insurance company pays the rest. 
  • Covered Expenses Most health insurance plans, whether they are fee-for-service, HMOs, or PPOs, do not pay for all health care services. Some may not pay for prescription drugs. Others may not pay for mental health care. Covered health care services are those medical procedures the health insurer agrees to pay for. They are listed in the health insurance policy. 
  • Customary Fee - Most health insurance plans will pay only what they call a reasonable and customary fee for a particular health care service. If your doctor charges $1,000 for a hernia repair while most doctors in your area charge only $600, you will be billed for the $400 difference. This is in addition to the deductible and coinsurance you would be expected to pay. To avoid this additional cost, ask your doctor to accept your health insurance company's payment as full payment. Or shop around to find a doctor who will. Otherwise you will have to pay the rest yourself. 
  • Deductible - The amount of money you must pay each year to cover your medical care expenses before your health insurance policy starts paying. 
  • Emergency Services/Emergency Room A medical emergency is an illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm. Emergencies required immediate care, and the emergency room at the hospital is for those kinds of situations. Emergency room treatment is extremely expensive, and therefore should only be used for true emergencies. 
  • Exclusions Specific conditions or circumstances for which the health insurance policy will not provide benefits. 
  • HMP (Health Maintenance Organization) - Prepaid health insurance plans. You pay a monthly premium and the HMO covers your doctors' visits, hospital stays, emergency care, surgery, checkups, lab tests, x-rays, and therapy. You must use the doctors and hospitals designated by the HMO. 
  • Inpatient Care - Health care that you get when you're admitted as an inpatient (requiring an overnight stay) to a health care facility, like a hospital or skilled nursing facility. 
  • Managed Care - Ways to manage costs, use, and quality of the health care system. All HMOs and PPOs, and many fee-for-service plans, have managed care. 
  • Maximum Out-of-Pocket Expenses The most money you will be required pay a year for deductibles and coinsurance. It is a stated dollar amount set by the health insurance company, in addition to regular premiums. 
  • Non-cancellable Policy A policy that guarantees you can receive health insurance / medical insurance, as long as you pay the premium. It is also called a guaranteed renewable policy. 
  • Network The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Using the providers in your network will make your costs lower. Insurers use approved providers who agree to cost controls, in their networks to keep costs down. 
  • Outpatient Care In the U.S., outpatient care for most conditions, illnesses, and injuries is the norm. Out-patient care means your treatment is done in a short time, and no overnight stay is needed. Out-patient care is usually done in public medical clinics, or in doctors’ private practice clinics, by appointment. 
  • Out-of-Network This refers to care that you receive that is not provided by a doctor or health care facility in the network your insurance is part of. Out-of-network care will cost you more, as your co-insurance, deductible, and maximum out-of-pocket costs will all be higher. 
  • Out-of-Pocket - A term used to refer to the amount that you may have to pay on your own for health care or prescription drug costs. Insurance plans have ‘out-of-pocket’ maximums, estimates, etc. Note that U.S. health care almost always has some out-of-pocket cost to the person seeking care. 
  • Preferred Provider Organization (PPO) - A combination of traditional fee-for-service and an HMO. When you use the doctors and hospitals that are part of the PPO, you can have a larger part of your medical bills covered. You can use other doctors, but at a higher cost. 
  • Pre-existing Condition A health problem that existed before the date your health insurance / medical insurance became effective. 
  • Premium The amount you or your employer pays in exchange for health insurance / medical insurance coverage. 
  • Preauthorization (Prior Authorization) Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan. 
  • Preventive Services Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems. 
  • Primary Care Doctor/Physician/Provider Usually your first contact for health care. This is often a family physician or internist, but some women use their gynecologist. A primary care doctor monitors your health and diagnoses and treats minor health problems, and refers you to specialists if another level of health care is needed. In many health insurance plans, health care by specialists is only paid for if your are referred by your primary care doctor. An HMO or a POS plan will provide you with a list of doctors from which you will choose your primary care doctor (usually a family physician, internists, obstetrician-gynecologist, or pediatrician). This could mean you might have to choose a new primary care doctor if your current one does not belong to the health insurance plan. PPOs allow members to use primary care doctors outside the PPO network (at a higher cost). Indemnity plans allow any doctor to be used. 
  • Provider Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care. 
  • Referral A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services. 
  • Schedule of Benefits The schedule of benefits section of your insurance plan outlines what services are included and excluded in your plan. 
  • Specialist A medical professional who specializes in a certain specialized area of care, such as a dermatologist (a skin doctor). To see a specialist, your insurance may require you to get a referral from your primary care doctor. 
  • Third-party Payer Any payer for health care services other than you. This can be a health insurance company, an HMO, a PPO, or the Federal Government .
*Terms and definitions taken from the the University of Colorado- Colorado Springs International Affairs Website.

Minimum Requirements

Minimum insurance coverage must provide: 

  1. Medical benefits of at least $100,000 per person per year or accident. 
  2.  May include provision for co-insurance under the terms of which the exchange visitor may be required to pay up to 25 percent of the covered benefits per accident or illness. 
  3. Medical evacuation of the Exchange Visitor to his or her home country in the amount of $50,000. 
  4. Repatriation of remains in the amount of $25,000. 
  5. Deductible not to exceed $500 per accident or illness. 
  6. May require a waiting period for preexisting conditions (but cannot exclude altogether coverage for preexisting conditions). 

Additionally, the insurance corporation underwriting the policy must have one of the following ratings: 

  • A.M. Best rating of “A-” or above. 
  • Insurance Solvency International, Ltd. (ISI) rating of “A-i” or above. 
  • Standard & Poor’s Claims paying Ability rating of “A-” or above. 
  • Weiss Research, Inc. rating of B+ or above. 
  • Coverage backed by the full faith and credit of the government of my home country. 
  • McGraw Hill Financial/Standard & Poor’s Claims-paying Ability rating of “A-“ or above. 
  • Moody’s Investor Services rating of “A3” or above. 

List of Health Insurance Companies

While we do not endorse one company over another, we do want to provide you with a resource list of different companies that students will often use. It is up to the student and their family to decide which company and plan is right for them.  

  1. ISO Care Plan
  2. PSI Platinum Plan
  3. Student Medicover
  4. Compass Student Insurance
  5. IMG
  6. International Student Insurance
  7. Insurance for Students
  8. PGH Student
  9. AETNA
  10. GeoBlue