ࡱ> :<9 9$bjbjVV .2<<0$$ggggg{{{8${z(rggg4^ggA{yj J0z^gXhVJ<?Apz$ -: J-1 INSURANCE NOTIFICATION FORM Sickness and accident insurance is mandatory for all J- 1 Exchange Visitors and J-2 dependents during the period of time that an exchange visitor participates in the sponsors exchange visitor program. See page 2 for a full listing of the insurance requirements. U.S. Department of State regulations state that if the sponsor determines that the exchange visitor or any accompanying spouse or dependent willfully fails to remain in compliance with the insurance requirement, that the sponsor shall terminate the exchange visitors participation in its program. The International Services Office at FGCU does not have the authority to waive these Federal insurance requirements for any Exchange Visitor or dependents. NOTE 1: If you currently have insurance in your home country, please review it to determine whether or not it meets the minimum requirements. If you believe your current insurance meets the requirements, have your insurance company complete and return the Sickness and Accident insurance Verification Form to the FGCU International Services. NOTE 2: If you wish to purchase health insurance upon arrival, please note that a semester/year health insurance policy is available for purchase through the FGCU Student Health Services. This policy meets all federal requirements for health insurance. NOTE 3: If you wish to purchase short-term insurance for a period shorter than one semester, contact FGCU International Services Office for other Insurance resources. NOTE 4: A visitor who will be covered by FGCUs employee insurance will most likely have to purchase supplemental insurance to ensure coverage of the full dates of the program (i.e., to cover that period of time from when the program starts to when the insurance benefits begin, usually a one-month period); in addition, separate coverage for medical evacuation and repatriation will be required since these features are not part of the universitys policy. It is the responsibility of the exchange visitor to provide proof to the FGCU International Services that insurance is maintained during the entire J-1 program. Failure to maintain coverage on the J-1 visitor and the J-2 dependents may result in termination of the visitors program. Please read and sign the statement below, then return it to the International Services Office. I, (print name) ______________________________________________ have read the above information on the J1 health insurance requirements and I pledge to maintain insurance coverage meeting all these requirements for myself and for any accompanying dependents; throughout the duration of my participation in my Exchange Visitors Program. I further understand that failure to obtain and maintain such coverage may result in termination from the Florida Gulf Coast Universitys Exchange Visitor Program. Signature ______________________________ Date: ____________________________ For the Departmental/College Sponsor: I understand the federal requirements regarding insurance for my visiting scholar. I agree to assist the FGCUS International Services in helping monitor my scholars compliance. ___________________________ ____________________________ _____________________ Name (Dept/College Sponsor) Signature Date Insurance Requirements for Participants of the Exchange Visitor Program (a) Sponsors shall require each exchange visitor to have insurance in effect which covers the exchange visitor for sickness or accident during the period of time that an exchange visitor participates in the sponsors exchange visitor program. Minimum coverage shall provide: (1) Medical benefits of at least $50,000 per accident or illness; (2) Repatriation of remains in the amount of $7,500; (3) Expenses associated with the medical evacuation of the exchange Visitor to his or her home country in the amount of $10,000; and (4) A deductible not to exceed $500 per accident or illness. (b) An insurance policy secured to fulfill the requirements of this section: (1) May require a waiting period for pre-existing conditions which is reasonable as determined by current industry standards; (2) May include provision for co-insurance under the terms of which the exchange visitor may be required to pay up to 25% of the covered benefits per accident or illness; and (3) Shall not unreasonably exclude coverage for perils inherent to the activities of the exchange program in which the exchange Visitor participates. (c) Any policy, plan, or contract secured to fill the above requirements must, at a minimum, be: (1) Underwritten by an insurance corporation having an A.M. Best rating of A- or above, an Insurance Solvency International, Ltd. (1ST) rating of A-i or above, a Standard & Poors Claims-paying Ability rating of A- or above, a Weiss Research, Inc. rating of B+ or above, or such other rating as the Agency may from time to time specify; or (2) Backed by the full faith and credit of the government of the exchange visitors home country; or (3) Part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor; or (4) Offered through or underwritten by a federally qualified Health Maintenance Organization (HMO) or eligible Competitive Medical Plan (CMP) as determined by the Health Care Financing Administration of the U.S. Department of Health and Human Services. (d) Federal, State or local government agencies, state colleges and universities, and public community colleges may, if permitted by law, self-insure any or all of the above-required insurance coverage. (e) At the request of a non-governmental sponsor of an exchange visitor program, and upon a showing that such sponsor has funds readily available and under its control sufficient to meet the requirements of this section, the Agency may permit the sponsor to self-insure or to accept full financial responsibility for such requirements. (f) The Agency, in its sole discretion, may condition its approval of self-insurance or the acceptance of fill financial responsibility by the non-governmental sponsor by requiring such sponsor to secure a payment bond in favor of the Agency guaranteeing the sponsors obligations hereunder. (g) An accompanying spouse or dependent of an exchange visitor is required to be covered by insurance in the amounts set forth in Sec. 514.14(a) above. Sponsors shall inform exchange visitors of this requirement, in writing, in advance of the exchange visitors arrival in the United States. (h) An exchange visitor who willfully fails to maintain the insurance coverage set forth above while a participant in an exchange visitor program or who makes a material misrepresentation to the sponsor concerning such coverage shall be deemed to be in violation of these regulations and shall be subject to termination as a participant. (i) A sponsor shall terminate an exchange visitors participation in its program if the sponsor determines that the exchange visitor or any accompanying spouse or dependent willfully fails to remain in compliance with this section.     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