Health Insurance
UNM Paid Employees
If you are being paid in the U.S., it is likely that your employer (your UNM department in most cases) will cover a majority of your insurance costs and a smaller percentage of the cost will be deducted from each of your paychecks before taxes. To enroll in medical insurance at UNM, you must first choose New employees have 60 days after hire to enroll in one of these two plans, otherwise, you must wait until the "Open Enrollment" period to enroll. Open Enrollment is usually a 2-3 week period of time, once a year, in which you can enroll in a plan or make changes to an existing plan. Be sure to choose the plan that best suits your needs. Remember, after initial enrollment or a qualifying change in status, you cannot change your insurance carrier until Open Enrollment, which usually occurs in May every year. Paid employees cannot receive health services at the student health center on main campus and should go to LoboCare, UNM Hospital, Lovelace or Presbyterian Hospital (depending on your plan some hospitals are recommended as in-network providers). Information on the insurance plans for paid UNM employees (and other benefits)can be found on the HR webpage.
Non-UNM Insurance
Scholars and dependents on J visas are required by US law to have insurance with certain MINIMUM coverage (listed below). ALL scholars who are not covered by health insurance are in violation of UNM policy, could be subject to tax penalties, and are financially responsible for all medical charges incurred in the U.S. Since health care in the U.S. is extremely expensive, you need to take these requirements seriously, think carefully about the kind of health care coverage you need while in the U.S., and purchase the appropriate insurance for your situation. Internationals who are “residents for tax purposes” must have insurance that meets the U.S. Affordable Care Act (ACA) requirements. J Scholars who have been in the U.S. more than 2 calendar years in the last 6 are typically “residents for tax purposes” and need to meet these requirements or pay tax penalties. If you are a tax resident, you need to ask your insurance company if your policy meets the ACA requirements below. The following companies offer health insurance plans for international students and scholars in the US that meet basic J1 legal insurance requirements. These plans are emergency plans and do not cover much in terms of routine care. Since information about individual plans changes frequently, please consult the websites and call the company to be sure that you have accurate information about exactly what the plan covers. Your policy must meet the minimum requirements below. $100,000 per person per accident or illness $25,000 for repatriation of remains $50,000 for medical evacuation No more than $500 deductible per accident or illness Coinsurance must not exceed 25% payable by the exchange visitor or sponsor Policy Rating requirements (ask the company about these requirements): The policy must be underwritten by an insurance corporation with an A.M. Best rating of "A-"or above; a McGraw Hill Financial/Standard & Poor’s Claims-paying Ability rating of “A-“ or above; a Weiss Research, Inc. rating of “B+” or above; a Fitch Ratings, Inc. rating of “A-“ or above; a Moody’s Investor Services rating of “A3” or above. ISO International Student Insurance Short-term Travel Medical Plans: If you need to buy a short-term travel medical plan to cover you until your insurance policy starts, you can research plans on the Internet or try one of the following:
International Student Insurance
International Student Protection
Basic Insurance Terminology
This Basic Insurance Terminology guide below should help you better comprehend your health insurance policy. Accidental Death and Dismemberment Benefit: The amount of money the insurance company will pay your family if you die or the amount they will pay you should you lose bodily parts in an accident. Congenital Defects: Medical problems you are born with. Co-payment: The percentage of costs for services, which you must pay (e.g., if the company pays 80%, your "co-payment" is 20%). Deductible:The amount you must pay for treatment of an injury or illness before the insurance company will begin to pay for you. Exclusions: Illnesses or services the insurance company will not pay for. Health Maintenance Organization (HMO): A type of Health Benefit Plan under which the Member receive all medical services through a specific group of Participating Providers. Inpatient Care: Services provided while staying for a period of time in a hospital. Limitations: Limits on the amount the company will pay or the services they will pay for. Medical Evacuation Benefits (Medevac): The amount the company will pay if you need to be transported long distance for health care. Medical Expense Benefit: Services and amounts the company will pay for your medical coverage. (Also called your "Payment Limit") Outpatient Care: Medical services provided while you are not staying in a hospital (e.g., at a doctor's office). Policy: Specific contract or agreement between you and the insurance company, in which you pay to receive certain benefits. Pre-existing Conditions: Illnesses or injuries you had before your policy began. Premium: Monthly or yearly fee or cost which you pay to the insurance company for medical coverage. Primary Care Physician (PCP): A doctor selected by the member to be the first physician contacted for any medical problem. The doctor acts as the member's regular physician and coordinates any other care the member needs, such as a visit to a specialist or hospitalization. Provider: A licensed health care facility, program, agency, physician or health professional that delivers health care services. Referral: A written recommendation by a physician for a Member to receive care from a specialty physician or facility. Repatriation Benefit: The amount the company will pay to transport your body back to your home country if you die. Right of Subrogation: The insurance company has the right to sue others for your injuries even if you don't agree
