J-1 Student Family Health Insurance Compliance Form
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 firstname.lastname@example.org .
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
*Gallagher Koster www.gallaherkoster.com
*GatewayConnexions International Plans www.gatewayconnexions.com
Health Benefit Concepts, Inc. www.hbcstudent.com
HTH Worldwide www.hthworldwide.com
*Insurance for Students, Inc. – IFS www.insuranceforstudents.com
*International Medical Group (IMG) www.imglobal.com
*International Student Insurance www.internationalstudentinsurance.com
On Call International www.oncallinternational.com
*The Harbour Group www.hginsurance.com
*Trawick International, Inc. www.studentinsure.com
*T.W. Lord & Associates Electronic mail to: email@example.com
*VISIT www.visitinsurance.com Wallach & Company www.wallach.com
*These companies offer repatriation and medical evacuation insurance that you can purchase separately