Why You Need Health Insurance
New Premium Rate Effective September 1, 2019. GeoBlue will continue to be the recommended vendor for Duke University Sponsored J scholars and dependents not eligible for a Duke Employee Insurance Plan or a Duke Student Medical Insurance Plan (SMIP).
It is unwise to be in the U.S. without adequate health insurance. Although in many countries the government bears the expense of health care for its citizens, and sometimes even for visitors, individuals and families in the U.S. are responsible for these costs themselves. Often, but not always, the employer provides an opportunity to purchase insurance coverage at a special reduced group rate. A single day of hospitalization and medical treatment can cost thousands of dollars. Many hospitals and doctors refuse to treat uninsured patients except in life-threatening emergencies. Insurance gives you access to better and more timely health care and provides the only protection against the enormous costs of health care in the U.S.
How Medical Insurance Works
The following information explains insurance policies available to those affiliated with Duke as students, employees or international scholars. Remember that the J EVP requires 3 kinds of insurance:
- “Health” insurance to help pay for usual medical care, illnesses, and injuries.
- “Repatriation” insurance to help pay the cost if you die in the U.S. and your remains need to be returned home.
- “Medical Evacuation” insurance to help pay if you have a serious illness or injury and must end your program and be returned home under medical care.
When you purchase health coverage, the money you pay, called your premium, is combined with the premiums of others to form a pool of money. The insurance company invests that money and uses it and the income from investments to pay the medical bills of those participants who need health care. Your coverage remains valid only as long as you continue to pay your insurance premiums.
Once you purchase insurance, the company will provide you with an insurance identification card for use as proof of your coverage when you are seeking health care from a hospital or doctor. The company also will provide written instructions for reporting and documenting medical expenses, called “filing a claim.” The company will evaluate any claim that you file, and make the appropriate payment for coverage under your particular policy. In some cases the company pays the hospital or doctors directly; in others the company reimburses you after you pay the bill.
Choosing an Insurance Policy
Choosing a policy can be confusing. The following information will help you understand the policies, but you decide not to purchase an GeoBlue Insurance plan, the following information can assist you.
Some insurance policies specify that they will not pay for certain conditions or events, especially if you are engaged in high risk activities. Check your policy carefully for exclusions and be sure any activities in which you are likely to engage are covered. The J regulations require that if a particular activity is a part of your EVP, your insurance must cover illness or injuries resulting from your participation in that activity. The insurance cannot contain an “exclusion” for that activity. Examples: If you are studying or doing research in marine biology that requires you to do scuba diving, then your insurance must cover illness or injury connected with diving; it cannot exclude that activity from coverage. If you are working in environmental studies and need to fly as a passenger or crew member in airplanes, helicopters, balloons, etc. to get aerial views of areas, the policy cannot exclude illness or injuries related to such flying. Read the list of exclusions of your insurance policy carefully so that you understand exactly what is not covered by the policy.
Pregnancy and Child Birth
Some of the “less expensive” policies completely exclude coverage for pregnancy and child birth. Good and consistent pre-natal care is important for the health of the mother and the new baby. A premature baby or a difficult labor can result in very high medical bills in a very short time. If there is any chance at all that anyone in your family might become pregnant while in the U.S., we strongly recommend that you make sure that pregnancy and child birth are covered in your policy.
This is the amount that you must pay to purchase and maintain the insurance policy. The policy is only effective if your premium payments are up to date.
The deductible is the amount you must pay before your insurance will pay anything at all for health care. Look carefully at the deductible amount and how it is managed. Under some policies the deductible is annual, and you pay only once each year if you use the insurance. Under others, you pay the deductible each time you have an illness or injury. Some policies may offer a lower, more advantageous deductible rate, but the premium may be higher. In choosing insurance, you should think carefully about how much you can afford to pay out of your own pocket each time you are sick or injured, and weigh the deductible against the premium before you decide.
Usually, even after you have paid the deductible, an insurance policy pays only a percentage of your medical expenses. For example, the policy might pay 80% of the cost of care. You would have to pay the remaining 20%, which is called the co-insurance. Thus, if you were injured and incurred $3,000 in medical expenses, a policy with a $400 deductible and 20% co-insurance would cover $2,080 ($3,000 - $400 deductible = $2,600. 80% of $2,600 = $2,080). You will be responsible for paying $920.
Some policies state specific dollar limits on what they will pay for particular services. Other policies pay "usual" or "reasonable and customary" charges, which means they pay what is usually charged in the local area. Be very careful in evaluating policies with specific dollar limits; for serious illnesses the limit might be far too low and you might have large medical bills not covered by your
The policy may establish a waiting period before it covers health problems you had before you bought the insurance, called pre-existing conditions. Insurance companies are permitted to do this, as long as the waiting period is reasonable by current standards in the insurance industry. Pregnancy is a common pre-existing condition that insurance companies will usually not cover, however, the GeoBlue Insurance plan does not treat pregnancy as a pre-existing condition.
Many insurance policies limit the amount they will pay for any single individual's medical bills or for any specific illness or injury. Exchange Visitors must have insurance that will pay up to $100,000 for each specific illness or injury. This amount may be enough for most conditions. Major illnesses or injuries, however, can cost many times that amount, well into the hundreds of thousands of dollars.
Some insurance policies limit the amount of time they will pay for each illness or injury. In that case, after the benefit period for a condition has expired, you must pay the full cost of continuing treatment of the illness, even if you are still insured by the company. A policy with a long benefit period provides the best coverage.
An agent is an individual who represents one or several insurance companies and sells insurance to individuals and groups. When working with an agent you should feel free to ask questions and take the time to learn about and understand several choices before you make a decision. If you are uncertain or confused, don't sign anything.
Other Helpful Information
- J Exchange Visitor Health, Medical Evacuation, and Repatriation Insurance
- J Exchange Visitor Health Insurance Plan Eligibility
- Required Insurance Specifications For A Waiver Of The GeoBlue Insurance Plan
- ISOS-Repatriation and Medical Evacuation insurance (For scholars who qualified for at Duke Employee insurance plan.)