The U.S. health care system is complex and very expensive. International students and scholars (and their dependent family members) must obtain adequate coverage while in the U.S.
Student Health Insurance
Massachusetts law requires all college students to show proof that they have health insurance coverage while they are attending a higher education institution in the Commonwealth.
Consult Babson Health Services for detailed information on student (and dependent) health insurance. »
J-1 Exchange Visitor Health Insurance
In addition to the Massachusetts State health insurance requirements, the U.S. Department of State mandates specific health coverage for all J-1 Exchange Visitors (students, scholars and J-2 dependents). This is a separate requirement monitored by the Glavin Office through the exchange visitor's completion of the J-1 Health Insurance Verification Form 100814.
Types of Health Insurance Plans
The following information is provided to help you understand the different types of insurance programs and how they work.
Health Maintenance Organization (HMO)
If you choose to purchase insurance through an HMO, you will be required to select a Primary Care Provider (PCP) to manage your care. If your PCP determines that your condition requires the evaluation and care of a specialist, the PCP will refer you to the appropriate specialist. HMOs require that you get your care from within the network of their providers and receive a referral from your PCP before you are seen by another provider. For most HMOs the cost to you at each visit is your co-pay and the remaining cost is paid at 100% by the HMO. If you become ill while you are outside their network coverage area, HMOs will only pay for emergency services.
Preferred Provider Organization (PPO)
If you choose to purchase insurance coverage through a PPO, you are not limited to which providers you can see. Instead, your benefits are paid at different levels based on whether you access care within a particular network or outside of a particular network.
PPOs require that you meet individual calendar year deductibles before your benefits start. If you have three or more family members covered under the same policy, there is usually a maximum deductible per family per calendar year. Once this deductible is met, the PPO will pay a percentage of your benefit. This is called co-insurance. You are then responsible for any remaining balance. In-network and out-of-network providers are usually paid at different benefit levels (i.e. 100% in-network—80% out-of-network or 90% in-network—70% out-of network) and co-pays may apply.
If you use a provider who is within the network, that provider will submit a claim for payment to the insurance company. The insurance company pays a portion and the provider will bill you for your responsibility for that service. If co-pays apply you will pay the required co-pay at the time of the visit. If you use a provider outside of the network, that provide may require the payment at the time of your visit and that you should submit your bill to the insurance company to be reimbursed later.