Required Insurance Specifications NAFSA by alicejenny


									                                                                                                           205 Bradley Hall
                                                                                                  Lexington, KY 40506-0058
                                                                                                       Phone: 859.257.4067

                                   J-1 Student Intern Verification
Complete the following form by checking the correct box and signing your name. This must be submitted to the
sponsoring department of the University of Kentucky before your application process can begin.

  Yes/True         No/False        Qualification Criteria
                                    I am currently enrolled full-time in my chosen career field at a degree or certificate-
                                   granting post‐secondary academic institution outside the US or graduated from such an
                                   institution no more than 12 months prior to the beginning date of my internship
                                   program at the University of Kentucky.
                                   I have a sufficient grasp of the English language to function on a day to day basis.
                                   (Confirmation of language ability will be confirmed by department/sponsor via
                                   recognized language test, video conferencing or telephone interview.)
                                   This internship program will be in the field of my academic study. My dean or academic
                                   advisor will write a letter of support which confirms this.

                                   If I will be on the University of Kentucky payroll, my dean or academic advisor must give
                                   approval and will include this in the letter of support.

                                   I can show that I have sufficient funds to support myself for the duration of my stay,
                                   through employment in the U.S., support from my home institution or personal funds.
                                   (The University of Kentucky requires evidence of at least $1,500/month per month.)

                                   I have a passport valid for six months after the date of my intended entry to the United

                                   The primary objective of my trip is to engage in a full‐time internship of at least 32 hours
                                   per week. If I wish to take a class at UK it is limited to a maximum of 6 undergraduate
                                   credits during a regular term and 3 undergraduate credits during a summer term. I will
                                   be responsible for enrolling as a non‐degree seeking student.
                                   The maximum duration of my internship is 12 months, and I am expected to depart the
                                   U.S. with 30 days of the completion of my program.

                                   I must have health insurance that meets the requirements set by the University of
                                   Kentucky when I arrive in the US, or agree to purchase such insurance through the
                                   University upon arrival. I have read and understand the attached information about
                                   health insurance.

Name: ____________________________________________

Revised 09/2010
                           HEALTH INSURANCE FOR J-1 VISA HOLDERS

Health Insurance Requirement

The U. S. Department of State requires all J-1 Exchange Visitors and their J-2 dependents to carry health,
repatriation and medical evacuation insurance with a reputable company during the period of time they are
participating in the Exchange Visitor program.

Exchange Visitors do not have to buy insurance prior to arrival at the University of Kentucky; however, they
should have funds available to purchase it for themselves and their dependents after their arrival on campus. J-1
Scholar/Student Interns will be eligible to participate in the insurance plan offered to all University of Kentucky
international students, Humana Student Health Insurance. The fees are listed below.

Government regulations stipulate that if Exchange Visitors do not comply with the insurance requirements for
themselves and/or their dependents, the University must terminate the program and report the termination to
the Bureau of Educational and Consular Affairs in Washington.

Required Insurance Specifications
The University of Kentucky has minimum benefits for the type and amounts of coverage for all international
scholars. These exceed those of the U.S. Exchange Visitor Program. The policy must be payable in the U.S. and
the insurance company must have an A.M. Best financial rating of at least “A.” The requirements are as follows:
       80% of covered medical expenses paid by insurance
       Medical benefits - $200,000 per accident or illness
       Maximum deductible of $500 per accident or illness
       Outpatient surgery - $10,000
       Coverage of Pregnancy
       Repatriation of remains - $7,500
       Medical evacuation to home country - $10,000


Annual Insurance Costs
J-1 Scholar/Intern/Student - $1,064 per year
J-2 Spouse - $2,868 per year
J-2 One child - $2,264 per year
Two or more children (no additional charge for more than two children) - $4,258 per year

For further information regarding cost, please see:

Below is a breakdown of costs per period. Keep in mind that you must have insurance to cover your entire stay in the U.S.,
so if your visit overlaps two or more periods of insurance coverage, you must buy the entire block of insurance. You may
want to consider this when planning your internship dates.
                                  st              nd               rd              th              th
                Annual           1 Period        2 Period         3 Period        4 Period        5 Period
                8/26/10-         8/26/10-        10/29/10-        1/1/11-         3/26/11-        6/11/11-
                8/26/11          10/29/10        1/01/11          3/26/11         6/11/11         08/26/11
Student         $1162            $203            $203             $272            $242            $242
Spouse          $3133            $548            $548             $733            $652            $652
One Child       $2473            $433            $433             $579            $514            $514
2+ Children     $4651            $815            $815             $1087           $967            $967
                                                                                                        Revised 09/10

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