J-1 Student Family Health Insurance Compliance Form ‐ International Student & Scholar Services

Instructions to complete the form

Fill out Page 2 with the requested insurance information. If dependents have different health insurance policies, submit one copy of the form for each dependent.
Submit the completed form to the front desk in Laurel Hall or by email to isss@colostate.edu .

Health Insurance Information:

J-1 students must submit this form for any J-2 dependents who are accompanying them in the U.S.
Federal regulations require all J-1 Exchange Visitors and their J-2 dependents to maintain comprehensive medical insurance meeting specific minimum requirements from the start date of the J-1 program (indicated in item 3 of the DS-2019) and continuing to the end of the J-1 program.
J-1 students are automatically enrolled in the CSU student health insurance plan, which meets all the J-1 requirements. However, their J-2 dependents are not eligible to enroll in the CSU student health insurance plan (unless the J-2 dependent is also enrolled as a CSU student.)
As per the regulations, CSU is required to terminate the SEVIS record of any J-1 student whose J-2 dependents do not maintain the appropriate health insurance for the duration of the program.
Please note that ISSS does not review specific policies to determine compliance or appropriateness for your situation. We recommend that you consult directly with your insurance company regarding compliance with J-1/J-2 regulations. Furthermore, ISSS does not endorse or recommend one insurance program over another.

22 C.F.R. §62.14 describes exchange visitor health insurance requirements as follows:

Medical benefits of at least $100,000 per person per accident or illness;
Repatriation of remains in the amount of $25,000;
Expenses associated with the medical evacuation of exchange visitors to his or her home country in the amount of $50,000; and
Deductible not to exceed $500 per accident or illness.

Insurance policies secured to fulfill the requirements:

May require a waiting period for pre-existing conditions that is reasonable as determined by current industry standards;
May include provisions for co-insurance under the terms of which the exchange visitor may be required to pay up to 25% of the covered benefits per accident or illness; and
Must not unreasonably exclude coverage for perils inherent to the activities of the exchange visitor’s J-1 program.

The following is a list of companies offering health insurance online:

*AMA & Associates www.amaofsa.com Associate Insurance Plans International, Inc. www.AIPInternational.com

*CMI Insurance www.cmi-insurance.com Compass Benefits Group www.compassstudenthealthinsurance.com

*Co-ordinated Benefit Plans, Inc. www.cbpinsure.com

Cultural Insurance Services International (CISI) www.culturalinsurance.com

*GatewayConnexions International Plans www.gatewayconnexions.com

Health Benefit Concepts, Inc. www.hbcstudent.com

*Insurance for Students, Inc. – IFS www.insuranceforstudents.com