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Insurance in the U.S.


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Insurance in the U.S.

Insurance can help you lower your medical bills. Insurance policies allow you and your insurer to share the cost of your medical care. It's important to understand how your policy works and what it covers, before you need to use it. Be sure to read your policy carefully. Below are some important basic facts about insurance:

  • Insurance won't pay everything. Insurance will help you pay your medical expenses, but it won't cover everything. You will be responsible for paying a portion of your medical costs. How much you pay will depend on the plan--some plans will require you to pay a fixed dollar amount, and others will require you to pay a percentage of the cost.
  • Insurance pays for "covered" expenses only. An insurance plan will pay only for services, procedures, and providers that are "covered" by the insurance policy. The policy will state clearly what the covered expenses are. When you receive medical treatment, the insurance company will first determine what part(s) or your treatment is a covered expense, and then apply the policy to determine how much the company will pay, and how much you will pay. In addition, you are responsible for any costs that are not covered expenses.
  • Vision and Dental Care. Most health insurance plans in the U.S. don't cover vision or dental care (though some provide minimal dental coverage if you have an injury to your teeth). If possible, go to your eye doctor or dentist before you come to the U.S.

Health insurance for Knox International Students

Knox students are automatically enrolled in accident insurance, but there is no automatic health insurance coverage. Knox international students should ensure that they are covered by a health insurance plan in the U.S., as an illness or injury can be very expensive without insurance. International students can find several health insurance options for the 2022-2023 academic year through iNext International Insurance, International Student Insurance, or Visit Insurance.

Insurance companies use very specific vocabulary. Below* is a list of important terms you'll see in insurance plans:

*The terms above are excerpts from a glossary provided by WebMD, an online health resource. A full glossary is available. Please note that most F-1 students are not subject to the Affordable Care Act (ACA), a recent health care law in the U.S. If you're an F-1 student and have been in the U.S. fewer than 5 years, please disregard any information pertaining to ACA. F-1 students who have been in the U.S. more than 5 years may be subject to ACA. Talk with the international student advisor if you have questions about health care or health insurance in the U.S.

What should I look for when choosing an insurance plan?

Don't choose a plan only by its premium (the monthly fee you pay to be part of the plan). A low premium may mean low levels of coverage that could be insufficient in a medical emergency. Here are some things to keep in mind as you're looking for a policy:

Low deductible: The deductible is what you must pay before the insurance company will begin paying for any of your covered expenses. Look for a policy with annual deductibles of $500 or less. Also consider whether the plan has other deductibles--for example, for prescription drugs.

Annual out-of-pocket maximum: Look for a plan with an annual out-of-pocket maximum. Medical care in the U.S. is expensive, and bills can add up quickly if you have a serious illness or emergency. Many plans share costs between the individual and the company, but your portion of the cost could be quite high--thousands of dollars, or more--if you become seriously ill or injured. Some insurance plans specify an annual out-of-pocket maximum, which is usually a fixed dollar amount. Once you pay that amount, the insurance company will cover remaining costs for covered expenses. Plans without an out-of-pocket maximum could mean very large medical bills if you have a serious illness or injury.

Coverage levels: Some plans offer coverage at specific dollar amounts for certain services--for example, these plans might pay $1000/day for hospital room and board, or $2000/incident for surgery. If you were hospitalized or needed surgery, this coverage might not be sufficient, and you would be responsible for paying everything beyond those dollar amounts. Look for plans that offer coverage of Usual Reasonable & Customary (URC) or preferred allowance. URC coverage means the insurance company will pay for covered expenses at the rate which is standard for the procedure in the area where you received treatment. The preferred allowance rate means the company will pay for covered expenses at a rate that has been pre-negotiated by the company and the provider. In the case of URC and preferred allowance, the insurance company will pay a percentage of the cost for covered expenses, and you'll pay the rest. It's always cheaper for you to receive care at an in-network provider.

Exclusions: Make sure you read the list of exclusions and consider whether there are any exclusions which could negatively affect you. For example, do you have any pre-existing conditions that the policy won't cover?


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Printed on Friday, December 8, 2023