Patriot Exchange Program (PEP)
Comprehensive medical insurance for J1 exchange visitors and J2 spouses and/or dependents
Designed for participants of J1 cultural exchange programs and students studying abroad in the U.S. Most plan options (except for the $50,000 plan) are designed to meet the U.S. J1 / J2 visa medical insurance requirements.
Whether your trip takes you to the U.S. for a few weeks, a few months, a year or more, your cultural exchange experience should be enjoyable. You have enough to worry about when you’re traveling. Don’t let your medical coverage be an uncertainty, not to mention that it is required for your J1 program. The Patriot Exchange Program administered by IMG offers a complete package of benefits available 24 hours a day.
Cultural exchange participants, students and scholars in the U.S. can access the UnitedHealthcare healthcare network which is a longstanding reputable Tier 1 network in the U.S. that gives you access to a quality network of doctors and services. Students and scholars can also access the Student Health Center.
How PEP meets or exceeds all J1/J2 Visa Insurance requirements
| J1/J2 Visa Insurance Requirement | Plan Benefits | Meets or Exceeds | J1/J2 Compliance |
|---|---|---|---|
| Medical benefits (per accident/injury or illness) of $100,000 or more | Medical benefits (per accident or illness): $100,000, $250,000 or $500,000 Maximum total limit : $5,000,000 Warning: $50,000 plan does not meet J1/J2 requirements | Meets or exceeds (except for $50,000 plan that does not comply) |  |
| Deductible of $500 (or less) | Deductible options (per illness or Injury): $0, $100, $250, or $500 | Meets or exceeds | |
| Coinsurance of 75% (or more) | Coinsurance (after deductible) : 90% In-Network, 80% Out-of-Network, 90% Outside U.S. | Exceeds | |
| Expenses for medical evacuation to home country in the amount of $50,000 (or more) | Medical evacuation benefits: up to $50,000 | Meets | |
| Repatriation of remains in the amount of $25,000 (or more) | Repatriation of remains: up to $25,000 | Meets | |
| Coverage of pre-existing conditions after a reasonable waiting period | Coverage of pre-existing conditions after 12 months (reasonable) | Meets | |
| Financial Strength of underwriter (A.M. Best rating of A-) or better | Underwriter SiriusPoint has A.M. Best rating of A- | Meets | |
DISCLAIMER: Please note that this table is provided as an overview and for comparison only. For more detailed information on Plan Benefits, please refer to the Plan Brochure and the Sample Certificate of Insurance. If there are discrepancies between the summary of Plan Benefits provided anywhere by J1VI and the wording in the Certificate of Insurance, the wording in the Certificate of Insurance will always prevail.
Highlights
- Medical insurance for students studying abroad or participants of cultural exchange programs
- Deductible options from $0 to $500
- Maximum limit of $5,000,000
- Most plan options are designed to meet the U.S. J1 and J2 visa travel insurance requirements
Coverage Information
Conditions of Coverage
- Coverage and benefits are subject to the deductible, limites and coinsurance, and all terms of the Certificate of Insurance and Master Policy
- Coverage under this plan is secondary to any other coverage
- Coverage and benefits are for eligible medical expenses which are medically necessary and usual, reasonable, and customary
- Charges must be administered or ordered by a physician
- Charges must be incurred during the period of coverage or benefit period
- Claims must be presented to IMG for payment within 180 days from the date the claim was incurred
Eligibility
To be eligible to apply to the Patriot Exchange Program plan, you must:
- Be an active participant in a study or exchange program (i.e. student visa, exchange visa, visitor visa), the spouse of the participant, or a dependent traveling with the participant
- Reside outside the country of residence for the purpose of pursuing international educational activities for a temporary period of time.
- Be physically and legally residing in host country with the intent to reside there for at least 30 days on the effective date and at renewal
- Not be hospitalized, disabled, or HIV+ on the initial effective date.
Renewal of Coverage
Eligible insureds can request coverage under the plan be renewed monthly for up to 12 month periods, for a maximum of 48 continuous months, as long as the premium is paid when due and the insured continues to meet the eligibility requirements of the plan.
How Does the Affordable Care Act (ACA) Affect My Coverage?
Non-U.S. citizens: As non-resident aliens, international students, scholars, and people involved in cultural exchange programs on F, J, M and Q visas (and certain family members) are not subject to the individual mandate for their first five years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate for two years (out of the past six). Since international students are not subject to the mandate, they are not required to purchase a plan that meets PPACA requirements and can purchase Student Health Advantage.
U.S. citizens: Under ACA, all U.S. citizens, nationals and resident aliens are required to purchase minimum essential coverage (ACA compliant coverage), unless they are exempt. Exempt U.S. citizens include U.S. citizens who reside outside of the U.S. for 330 of any 365-day period, or have a tax home (main place of work or employment, or if you don’t have a main place of work or employment, your main residence) in a foreign country, and is a bona fide resident of a foreign country.
Summary of Benefits
All amounts in U.S. dollars
Coverage limit / Maximum amount for Eligible Medical Expenses
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Maximum Limit | $5,000,000 | $5,000,000 | $5,000,000 |
| Deductible Options | $0, $100, $250, or $500 (per Illness or Injury) | $0, $100, $250, or $500 (per Illness or Injury) | $0, $100, $250, or $500 (per Illness or Injury) |
Coinsurance for Eligible Medical Expenses
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Coinsurance (in addition to Deductible) | Plan pays 90% Insured pays 10% | Plan pays 90% Insured pays 10% | Plan pays 90% Insured pays 10% |
| Out of Pocket Maximum | $1,000 | Up to the Maximum Limit | $0 |
Pre-certification
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Interfacility ambulance transfer | No coverage if pre-certification requirements are not met | No coverage if pre-certification requirements are not met | No coverage if pre-certification requirements are not met |
| Emergency medical evacuation | No coverage if pre-certification requirements are not met | No coverage if pre-certification requirements are not met | No coverage if pre-certification requirements are not met |
| All other treatments & supplies | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met | 50% reduction of Eligible Medical Expenses if Pre-certification requirements are not met |
Pre-existing conditions
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Charges resulting directly or indirectly from or relating to any Pre-existing Condition that existed within 36 months prior to the Effective Date are excluded until the Insured Person has maintained 12 months of continuous coverage under this insurance | Period of Coverage Limit (after 12 months): $500 Maximum Limit: $1,500 | Period of Coverage Limit (after 12 months): $500 Maximum Limit: $1,500 | Period of Coverage Limit (after 12 months): $500 Maximum Limit: $1,500 |
Student Health Center
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Copayment per visit: - Not subject to the per Illness or Injury Deductible Copayment is not applicable if the Declaration states a $0 Deductible | $5 | $5 | $5 |
Inpatient / Outpatient benefits
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Eligible Medical Expenses | 90% | 80% | 100% |
| Physician / Specialist Visit: - Maximum Visits per day: 1 (unless visit is for a different medical/surgical specialty) | 90% | 80% | 100% |
| Urgent Care: - Not subject to Deductible - Copayment: $50 - Copayment is not applicable if the Declaration states a $0 Deductible | 90% | 80% | 100% |
| Walk-in Clinic: - Not subject to Deductible - Copayment: $20 - Copayment is not applicable if the Declaration states a $0 Deductible | 90% | 80% | 100% |
| Hospitalization / Room & Board Average semi-private room rate Includes nursing, miscellaneous and Ancillary Services | 90% | 80% | 100% |
| Intensive Care | 90% | 80% | 100% |
| Bedside Visit: - Not subject to Deductible - Maximum Limit: $1,500 - Hospitalized in an Intensive Care Unit - Refer to the BEDSIDE VISIT provision for further details | 90% | 80% | 100% |
| Outpatient Surgical / Hospital Facility | 90% | 80% | 100% |
| Laboratory | 90% | 80% | 100% |
| Radiology / X-ray | 90% | 80% | 100% |
| Pre-admission Testing | 90% | 80% | 100% |
| Surgery | 90% | 80% | 100% |
| Reconstructive Surgery: - if incidental to and follows Surgery that was covered under the plan | 90% | 80% | 100% |
| Assistant Surgeon - 20% of the primary surgeon’s eligible fee | 90% | 80% | 100% |
| Anesthesia | 90% | 80% | 100% |
| Durable Medical Equipment | 90% | 80% | 100% |
| Chiropractic Care: - Medical order or Treatment plan required | 90% | 80% | 100% |
| Physical Therapy: - Maximum Visits per day: 1 - Medical order or Treatment plan required | 90% | 80% | 100% |
| Extended Care Facility: - Upon direct transfer from an acute care Hospital | 90% | 80% | 100% |
| Home Nursing Care: - Provided by a Home Health Care Agency - Upon direct trasnfer from an acute care Hospital | 90% | 80% | 100% |
Prescription Drugs and Medication - The following Prescription Drugs and Medication Period of Coverage limit accumulates toward the Maximum Limit
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Prescription Drugs and Medication: - Period of Coverage limit: $250,000 per person - Obtained through Retail Pharmacy, Inpatient and Outpatient Surgery, Emergency Room and Outpatient Office Visits - Dispensing maximum for Retail Pharmacy: 90 days per prescription | 90% | 80% | 100% |
Mental or Nervous / Substance Abuse
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Inpatient Mental or Nervous / Substance Abuse: - Maximum Limit: $10,000 - Not covered if incurred at the Student Health Center | 90% | 80% | 100% |
| Outpatient Mental or Nervous / Substance Abuse: - Maximum Limit per day: $50 - Maximum Limit: $500 - Not covered if incurred at the Student Health Center | 90% | 80% | 100% |
Emergency Services
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Emergency Local Ambulance: - Subject to Deductible - Injury - Illness resulting in a Hospitalization admission | 100% | 100% | 100% |
| Emergency Medical Evacuation: - Maximum Limit: $50,000 - Must be approved in advance and coordinated by the Company | 100% | 100% | 100% |
| Interfacility Ambulance Transfer: - Up to the per Injury or Illness limit - Services rendered in the United States - Transfer must be a result of an Inpatient Hospital admission | 100% | 100% | 100% |
| Political Evacuation and Repatriation: - Maximum Limit: $10,000 - Must be approved in advance by the Company | 100% | 100% | 100% |
| Repatriation for Medical Treatment: - Maximum Benefit: $100,000 - Approved in advance and coordinated by the Company - Refer to the REPATRIATION FOR MEDICAL TREATMENT provision for further details | 100% | 100% | 100% |
| Return of Mortal Remains: - Maximum Limit: $25,000 - Local Burial / Cremation at place of death - Maximum Limit: $5,000 - Return of Insured Person’s Mortal Remains to Country of Residence - Must be approved in advance by the Company | 100% | 100% | 100% |
Other Services
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Terrorism: - Maximum Limit: $50,000 | 100% | 100% | 100% |
| Dental Treatment: - Period of Coverage Limit: $350 - (Treatment due to Unexpected pain to sound, natural teeth) - Period of Coverage Limit per Injury: $500 (Non-emergency Treatment at a Dental Provider due to an Accident) | N/A | 90% | 100% |
| Traumatic Dental Injury: - Subject to Deductible and Coinsurance - Up to the Maximum Limit - Treatment at a Hospital Facility due to an Accident - Additional Treatment for the same Injury rendered by a Dental Provider will be paid at 100% | 90% | 80% | 100% |
| Accidental Death & Dismemberment: - Accidental Dismemberment - Accidental Death - Principal Sum Maximum: $25,000 Refer to the Accidental Death & Dismemberment provision for further details | - Accidental Death: 100% of Principal Sum - Death must occur within 90 days of the Accident ----------- Accidental Dismemberment: - Loss : Percent of Principal Sum - Sight of 1 eye: 50% - 1 hand or 1 foot: 50% - 1 hand and loss of sight of 1 eye: 100% - 1 foot and loss of sight of 1 eye: 100% - 1 hand and 1 foot: 100% of Principal Sum - Both hands or both feet: 100% - Sight of both eyes | ||
| Incidental Trip: - Maximum days: 14 - Country of Residence is outside the United States Refer to the INCIDENTAL TRIP provision for further details | 90% | 80% | 100% |
Optional Add-On Rider
| Plan Details | In-Network | Out-of-Network | International |
|---|---|---|---|
| Personal Liability: - Injury to third party: $2,000 per period of coverage limit after $100 deductible - Damage to third party’s property: $500 per period of coverage limit after $100 deductible | 100% | 100% | 100% |
| Lost Personal Property: - $250 per period of cover age limit | 100% | 100% | 100% |
| Limited High School and College Sports: - Company pays 100% after deductible is met | 100% | 100% | 100% |
| Legal Assistance | Period of coverage limit: $500 | Period of coverage limit: $500 | Period of coverage limit: $500 |
DISCLAIMER: This benefits table is provided as an overview only. For more detailed information, please refer to the Plan Brochure and the Sample Certificate of Insurance. If there are discrepancies between the summary of plan benefits and the wording in the certificate of insurance, the certificate of insurance wording will always prevail.