Understanding Insurance and Healthcare Options in the U.S.

The U.S. Department of State (DOS) determines Health Insurance Requirements for J-1 and J-2 Exchange Visitors. As we are sure you are aware, the U.S. healthcare system can be very complicated and coverage is expensive. For a brief overview of the U.S. healthcare system, go to the international student insurance website. Although the video is student-focused, a great deal of the information is applicable to scholars as well. Please note that while APM 430 students at UCSF 3 months or longer are able to access UCSF’s Student Health and Counseling Services (SHCS), postdoctoral scholars and researchers in alternative UC titles are typically unable to access campus clinics for medical care. Postdocs and researchers in other UC titles must check with their insurance provider in advance of seeking care to determine where they are eligible to request appropriate medical attention.

Two considerations we hope you keep in mind as you select a health insurance plan:

  1. Cost of U.S. Health Care Healthcare in the U.S. is very expensive. Without full medical health coverage, the cost of medical treatment is extremely high. If you are not eligible for UCSF-sponsored health coverage, J-1 scholars typically purchase travelers’ insurance which is less expensive and very different from full medical health coverage in the U.S. With traveler’s insurance, scholars typically must pay for all medical services up front and are then responsible for submitting claims to their insurance company for reimbursement consideration. Requesting reimbursement does not obligate insurance companies to pay for the entirety of treatment given, especially if using out-of-network providers. Be prepared to have a source of income readily available (such as a credit card with a high spending limit) to pay for treatment such as accidents, illnesses or pre-existing conditions. Contact your specific insurance provider as soon as possible to request a list of in-network health providers and details about the type of care that is covered under your insurance plan.
  2. Pre-existing Conditions A pre-existing condition is any health condition or illness for which you or your J-2 spouse have received medical advice or treatment during the twelve months prior to obtaining health insurance. Most U.S. health insurance policies do not cover pre-existing conditions. Please note that pregnancy is considered a pre-existing health condition, and it is unfortunately highly likely that J-1 scholars/J-2 spouses who arrive pregnant may not be able to secure non-UCSF insurance coverage within the U.S. If you will not be covered by UCSF health insurance, scholars should be prepared to pay up-front for treatment and medications throughout the pregnancy (please note that an uncomplicated delivery can cost $20,000 or more without insurance). Unfortunately, ISSO is unaware of non-UCSF insurance providers that offer coverage while pregnant. Additional common health insurance terms can be found online.

Urgent Care vs Emergency Care in the U.S.

As soon as you arrive in the U.S., contact your specific insurance company for a list of approved in-network primary care doctors, urgent care facilities and emergency rooms. If you see a doctor, or seek services at an urgent care facility or emergency room that is not in-network, it is likely that you may have to pay out-of-pocket for support. The cost for urgent or emergency care that is out-of-network, depending on the type of care needed, could cost thousands of dollars, even if you have insurance coverage.

Urgent Care

You would seek medical care at an urgent care facility in the U.S if you have an immediate (not emergency) need that cannot wait until an appointment becomes available at your primary care doctor's office. For example, you may have a minor sprained ankle but cannot get into your primary care doctor right away, or you may have an illness that requires antibiotics but cannot get in to see your doctor immediately. Seeking support at an in-network urgent care facility is typically less expensive than seeking support at an emergency room, and can be a less lengthy wait time. Contact your insurance provider for in-network urgent care facilities.

Emergency Room (ER)

You would seek medical care at an emergency room in a hospital if you have a major illnesses or accident. A few examples, that are not meant to be exhaustive, might be if you have severe abdominal or chest pain, serious eye or head injuries, if your baby needs immediate care. Seeking support at an in-network emergency room is typically more expensive than seeking medical care at an urgent care facility. Depending on the severity of the medical care needed, you could be waiting a very long time (a few hours) or a very short period of time. It is best to go to the emergency room if you believe you'll need x-rays, an ultrasound or more specialized medical devices to identify the cause of the medical concern. Please note that if you have a life threatening emergency that will not allow you to safely drive yourself or a dependent to the emergency room, call 911, and you will be transported to the nearest emergency room by ambulance.

A few urgent care and emergency room facilities are available online, but may not be considered in-network which will require that you pay out of pocket. ISSO does not vouch for, nor do we endorse the options provided on the aforementioned website.

For a brief overview of the U.S. healthcare system, go to the international student insurance website.

Health Insurance Requirement for J-1 and J-2 Visitors

All J-1 Exchange Visitors and their accompanying J-2 dependents are required by government regulations to have health and accident insurance during the entire period of time participating in UCSF’s J exchange visitor program. These regulatory requirements and a few insurance options can be found at J-1 and J-2 Health Insurance Requirements and Options.

Postdoctoral Insurance

At UCSF, health insurance is arranged through the sponsoring department. Please discuss health insurance coverage with your UCSF department administrator. Please note that if you are an international Postdoctoral Scholar and you enroll in the UC Postdoctoral Scholars Benefits Plan, then your PI is required to pay most of the cost of your benefits.

International Students

Students registered in a degree earning, professional school or graduate division program are automatically enrolled in the system-wide University of California Student Health Insurance Plan (UC SHIP). This plan meets the J-1 Visa requirements and is billed directly to your student fee statement. Students who have access to an employer-sponsored health insurance plan or an individual health insurance plan that meet all minimum benefit requirements will be eligible to waive the UC SHIP.