You are required to have health insurance coverage while you are on your J-1 program in the U.S. If you purchased your insurance through MAST, you either have CISI Insurance or ATG Insurance. Information about using both insurance policies is outlined below.
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Using CISI Insurance
CISI Insurance Policy
You can download the complete CISI insurance policy at z.umn.edu/CISIpolicy. Below are some important details about the CISI policy:
General Expenses
- Co-pay for in-network and out-of-network providers: $200 per accident or sickness
- Co-pay for emergency room visits: $250 if not admitted to the hospital
- Coinsurance 20% after $10,000 of coverage
After you pay the $200 deductible, CISI insurance covers medical expenses which they deem “reasonable and customary charges” related to accidental injury or sickness. This policy is not meant to cover routine health care and there are many exclusions, some of which are explained below.
Dental Care
- Dental care is only covered for emergency dental repair as a result of an accident or injury. Any other dental issues will not be covered by the health insurance.
Eye Care
- There is no coverage for eye care unless it is result of treatment for complications of an accident or injury that the insurance company is already paying for.
Physiotherapy and Chiropractic Care
- Physiotherapy must be prescribed by a doctor and administered by a licensed physiotherapist to be covered. Chiropractic care coverage is limited to $150 per visit with a maximum of 10 visits, with a maximum overall coverage of $500.
Exclusions (this is not a comprehensive list)
- Any pre-existing conditions you had in your home country
- Routine medical exams, immunizations, physicals, etc. when you are not sick or injured
- Disease of any kind
- Intentionally self-inflicted injuries
- Any jaw/temporomandibular joint issues
- Any hearing-related care: normal ear tests, hearing aids, hearing implants
- Eye exams, glasses, contact lenses, etc. unless related to an accident or injury
- Injuries in connection with committing a felony
- Any dental care other than related to an accident (see Dental section above)
- Weak, strained or flat feet, corns, calluses, or toenails
- Acne
- Injuries from mountaineering with ropes or guides, hang gliding, parachuting, bungee jumping, horse racing, motor vehicle or motorcycle, and parasailing
Finding a Doctor or Clinic
The best way to make sure that the health insurance company pays for your medical bills is to go to a doctor or clinic that is in the insurance companies “network,” which means that the insurance company has a pre-existing relationship with the doctor or clinic.
You can find the doctors and clinics in the CISI network through this link: z.umn.edu/CISInetwork
Paying the Deductible
You will be required to pay a $200 deductible before the insurance company will pay for your medical bills. You may be required to pay this the day that you visit the doctor or you may be sent a bill.
Submitting an Insurance Claim
When you visit a doctor or clinic, you should give them your insurance card and they will submit your bills to the insurance company for you. If they do not submit your bills to the insurance company, you can do so yourself by filling out a Claims Form. You can download the CISI claims form here: z.umn.edu/CISIclaim
Questions about Insurance and Coverage
If you can, it is always a good idea to double check with the insurance company if they will pay for your medical care before you go to the doctor or clinic. You can check your insurance policy packet, contact CISI at +1 203-399-5130, or contact MAST and we can help you.
Additional Resources
Using ATG Insurance
ATG Insurance Policy
You can download the complete ATG insurance policy at https://z.umn.edu/ATGPolicyBelow are some important details about the ATG policy:
General Expenses
- Co-pay for in-network and out-of-network providers: $0
- Co-pay for emergency room visits: $250 (except in cases of admission to the hospital)
- ATG charges $250 for all visits to the emergency room. If they determine that your visit to the ER was not an emergency, the medical bills will not be covered by the insurance and you will be required to pay the ENTIRE COST.
ATG insurance covers medical expenses which they deem “reasonable and customary charges” related to accidental injury or illness. This policy is not meant to cover routine health care and there are many exclusions, some of which are explained below. Don't use an Emergency Room (ER) unless you are having a serious or life-threatening medical problem!
Pre-authorization is required for certain services. The following treatments and/or supplies must always be pre-authorized:
- In-patient hospitalization
- Outpatient Surgery
- All CAT scans, MRIs, PET scans
- Air ambulance (this service will be coordinated by the underwriter's air ambulance provider)
- Specialty treatments and highly specialized drugs
- Physical therapy and rehabilitation services
Failure to pre-authorize may result in 50% reduction of eligible expenses up to $1000 maximum penalty. Please submit a pre-authorization request form at least 5 days prior to the scheduled procedure or treatment date. In case of medical emergency, no pre-authorization is required. However, medical emergency notifications must be received within 48 hours of the admission or procedure.
Dental Care
- Dental care is only covered as the result of an accident through “external contact with a foreign object.” This means that something must hit your mouth and damage your teeth for the insurance to pay for the dental care. All other dental issues will not be paid for by the insurance.
- Emergency dental/dental accident coverage is limited as follows: policy length - less than 3 months: $200; 3 to 6 months: $400; 6 months or more: $800 (only for emergency treatment for pain relief to sound natural teeth or infection of the gums)
Eye Care
- There is no coverage for eye care unless it is result of treatment for complications of an accident or injury that the insurance company is already paying for.
Physiotherapy and Chiropractic Care
- Physiotherapy must be prescribed by a doctor and administered by a licensed physiotherapist. Chiropractic care to relieve back pain must be prescribed by a doctor based on x-rays and other images to confirm that the chiropractic care is necessary.
- Physiotherapy and chiropractic care coverage is limited as follows: policy length - less than 6 months: $200; 6 months or more: $400
Exclusions (this is not a comprehensive list)
- Any pre-existing conditions you had in your home country
- Routine medical exams, immunizations, physicals, etc. when you are not sick/injured
- Any visits to the emergency rooms that are not an emergency
- Any jaw/temporomandibular joint issues
- Any dental care other than related to an accident (see Dental section above)
- Any hearing-related care: normal ear tests, hearing aids, hearing implants
- Eye exams, glasses, contact lenses, eye surgery, etc.
- Any treatment in connection with alcohol, drug, or chemical abuse; any injuries sustained while under the influence of alcohol, drugs, or chemicals
- Intentionally self-inflicted injuries or illnesses
- Injuries in connection with committing a criminal or legal offense
- Injuries sustained while taking part in recreational sports, including firearms/hunting
- Pregnancy or illness resulting from pregnancy, childbirth, or miscarriage
- Any treatment for skin issues, including acne, moles, skin tags, etc.
Finding a Doctor or Clinic
The best way to make sure that the health insurance company pays for your medical bills is to go to a doctor or clinic that is in the insurance companies “network,” which means that the insurance company has a pre-existing relationship with the doctor or clinic.
You can find the doctors and clinics in the ATG network by calling +1 317-655-4500.
Submitting an Insurance Claim
When you visit a doctor or clinic, you should give them your insurance card and they will submit your bills to the insurance company for you.
If they do not submit your bills to the insurance company, call ATG at +1 317-655-4500, or go to https://z.umn.edu/ATGClaim. They will open a file for you and have you submit a Claims Form.
Questions about Insurance and Coverage
If you can, it is always a good idea to double check with the insurance company if they will pay for your medical care before you go to the doctor or clinic. You can check your insurance policy packet, contact ATG at +1 317-655-4500, or contact MAST and we can help you.
Additional Resources