Medical Insuarance
MEDICAL INSURANCE
You have medical insurance that meets Department of State regulations as part of your program. You are required to keep this insurance in effect throughout the time that you are on a J-l visa program. If you need insurance in addition to the dates shown on the card, you should contact WISE in order to purchase an extra month or two of insurance.
The specific details of the insurance coverage, schedule of benefits, Exclusions, and how to file a claim is provided in your insurance booklet sent to you with your arrival package.
If you are hurt while working, Worker's Compensation insurance which is paid for by your company and not the insurance provided to you by WISE will pay for your medical treatment. Your employer will be able to assist you with this.
Any illness or condition beginning before your arrival in the United States is not covered by insurance here. This is called a "Pre-Existing Condition" and is defined as "an illness or an accident that has been treated in the 12 months prior to the effective date of your coverage." Therefore, anything you were treated for in the 12 months before the start of your program would not be covered.
Dental care is not covered by this insurance, unless emergency treatment is necessary due to pain or injury. Since you will be in the United States for an extended period, it is recommended that you have a dental check-up before leaving home. Be sure to read the insurance booklet in detail for complete information on what is, and what is not covered, (http://www.wisefoundation.com/)
Claim Procedure
To claim benefits you must complete a claim form.
One claim form must be completed for each accident or illness. The claim form should then be returned to the address indicated on the form, along with the itemized bill.
KEEP A PHOTOCOPY FOR YOUR RECORDS OF THE INFORMATION YOU SEND TO PROCESS A CLAIM INCLUDING THE COMPLETED CLAIM FORM AND RECEIPTS
Claim for payment should be filed as promptly as possible and no later than 90 days form the date of service.
Helpful Hint: When in the doctor's office, request a super-bill or standard health insurance bill. When in the hospital, request a form UB-92. Or its equivalent. For prescription drugs, the company requires the date, name of drug, person for whom prescribed, and the charge. This is often attached to the bag by the pharmacist but may come in other forms.
Required Forms and Bills
Claim Form
A claim form is required for all claims you submit throughout your stay in the United States. If possible, a claim form should be brought along with you to all medical visits. The provider can then submit all bills and claim form together. A claim form should also be submitted with any prescription receipts or medical bills you are submitting. In this case, a doctor's signature is not necessary if the provider has already submitted a claim form. Indicate to whom the payment should be made. If you have paid the provider, then make sure you have noted this on the claim form.
Provider Bills
All bills must be original, no photocopies, with diagnosis, date of service, provider's name and amount. If you or someone else other than the provider submits the claim form, verify that all this information is on the bill before mailing it to the processing center. The claim will not be paid until bills with all required information are submitted.
Prescription Requests
An original pharmacy receipt with doctor's name, name of medication, cost, and pharmacy name must be submitted to receive payment. Cash register receipts are not considered originals. Make sure your pharmacy receipt includes all requested information.
Frequently Asked Questions
Question: Do I have to go to any particular doctor or hospital?
Answer: No. You can go to any doctor or hospital. The hospital emergency room, however, should be used only in the case of serious injury or illness. You can look in the telephone book (yellow pages) under medical clinic, family medicine to find a medical provider. You can also discuss with the staff of your site, as they should be familiar with doctors in the community.
Question: What do I do in case of an emergency?
Answer: For a life-threatening emergency you should go to the nearest emergency room. For less serious accidents or illnesses you should go either to a minor emergency clinic or make an appointment with a doctor at his or her office. Hosptial emergency rooms treat the most serious cases first. Because of this, people with minor emergencies sometimes experience long waits for attention. Hospital emergency rooms are also more expensive than other places to receive treatment.
Question: Does this policy pay for prescription drugs?
Answer: The policy pays for prescription drugs used to treat an accident or illness incurred while in the United States. It does not pay for vitamins or over-the-counter medications. It also does not pay for prescription drugs prescribed for reasons other than the treatment of an illness or accident. (Examples: Birth control pills, weight loss medication, and aids to quit smoking).
AIDS and other sexually transmitted illnesses:
You may decide to have a sexual relationship with another adult while you are in the United States. If so, you will need to consider how to protect yourself from sexually transmitted illness. Understand that AIDS is a rapidly expanding epidemic in the United States and in many countries around the world, and there is currently no cure for this disease, which attacks the body's immune system.
Other common diseases include herpes, syphilis, gonorrhea and yeast infections. The only "safe sex" is no sex. However, if you choose to be sexually active, be certain to protect yourself from illness. Do not take a chance on statements such as, "I know I have no diseases." We strongly recommend that you avoid starting a sexual relationship with someone you meet during your program, as the chances of this developing into a long-term commitment may not be great. The chances of taking home an unwanted health problem are greater.
Remembering what you need and where things are when you are ill can be difficult. Keep a medical claim form with your passport along with your insurance booklet. You will then have everything you need in one place.
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