Health Care

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In the United States, there is no national health care system therefore, health care can be very expensive for the average person. An accident or illness can end up costing hundreds or thousands of dollars. Patients are required to pay for all of their medical services and that is why it is necessary to have health insurance in order to reduce the costs.

Health insurance is an agreement between you and the insurance company that says that the company will pay a portion of your medical expenses if you get sick or hurt and have to visit a medical provider. How much of the expenses the insurance company will cover and where you can seek treatment is dependent on the type of insurance you have.

Your Fulbright Health Benefits

Fulbright's Accident and Sickness Program for Exchange (ASPE)

The U.S. Department of State provides essential accident and sickness coverage for Fulbright Scholars under a self-funded group policy called the Accident and Sickness Program for Exchanges (ASPE). This policy is not intended to cover preventative care such as annual examinations or check-ups.

Your ASPE health benefits policy is administered by:

Seven Corners, Inc

303 Congressional Blvd.

Carmel, IN 46032

Telephone: (800) 335-0611

Website: https://www.sevencorners.com/about/gov/usdos

The complete Your ASPE Guide to Health Care Coverage may be found online here.

Important ASPE Basics

Please note that the ASPE Health Benefits Plan is not a comprehensive insurance plan; scholars are urged to retain or obtain their own health insurance to cover ongoing or potential medical requirements.

 $25.00 co-pay for office visits

$75.00 co-pay for ER, Hospitalizations and Urgent Care (waived if admitted)

$15.00 co-pay for all brand name drugs with a generic equivalent available

Pre-certification: This healthcare plan requires pre-certification for all inpatient hospital admissions, skilled nursing, outpatient chemo and radiation therapy, outpatient surgeries and procedures, pregnancies, physical or occupational therapy, dialysis, plasmaphoresis, MRI, PET scans, CT scans, home health, and home infusion therapy.

 You or your physician must call the pre-certification phone number, (800) 461-0430, to obtain pre-admission approval at least one business day before a planned hospitalization in the United States. Certification for emergency admissions or admissions due to an unexpected illness or injury must be obtained within two business days following the admission. Pre-certification is not a guarantee of coverage. A $300 penalty will be applied if pre-certification is not obtained.

Mental Health Counseling and Support: ASPE Assist

As a Fulbright Visiting Scholar, you also have access to a virtual resource called the ASPE Assist hotline which is a 24/7 counseling and support service available to all Visiting Scholar grantees while they are on program. ASPE Assist is operated by The ANVIL Group, in partnership with Seven Corners.

ASPE Assist services will augment the health benefits that are concurrently provided through the Accident and Sickness Program for Exchanges (ASPE) plan administered by Seven Corners. Grantees needing assistance with medical and dental services should continue to contact Seven Corners.

ASPE Assist is accessible 24 hours a day and is available to provide support to Exchange Participants, including grantees on the Fulbright Visiting Scholar Program, in urgent and non-urgent situations, including identification and referral of mental health conditions requiring in-person or Telemedicine treatment, and crisis intervention. The medical staff responding to grantee calls are trained to handle serious situations such as sexual assaults and mental health crises. They can also provide medical advice.

When contacting ASPE Assist for the first time, please be prepared to provide your full name, ID card number, program name (Fulbright Visiting Scholar Scholar), and your host country. This information will allow ANVIL staff to verify your status as a Fulbright Visiting Scholar grantee with the ASPE Health Benefits Plan.

ASPE Assist 24/7 Contact Information
24/7 Telephone Hotline: +1-833-963-1269
Worldwide: +44-20-3859-4463
Email: ASPEAssist@anvilgroup.com or anvil_aspesupport@everbridge.com

ASPE Identification Card

Prior to your arrival, IIE will send you an email outlining how to access your ASPE benefits card and information. It’s recommended that you download and print a copy of your benefits card to keep with you at all times. Visit the Seven Corners website for health care provider information. Coverage will begin when you report to your host institution to start your grant activities. Your coverage continues while you are in the United States until your grant end date.

ASPE is not intended to replace insurance you may already have. If you want coverage for situations or conditions that are not covered by ASPE, you should keep any private insurance you may already have, purchase coverage through some other plan or both. If you choose to maintain an existing plan or purchase another policy, you will not be reimbursed for this expense.

Your Fulbright grant includes ASPE health benefits for the grant period only. You must purchase insurance for yourself any time that you are in the United States before or after the grant period, anytime that you are outside the United States during your grant period and for your accompanying dependents for the duration of their stay in the United States.

Going to the Doctor with ASPE

If you require medical attention during your grant, you must find a physician within the ASPE policy directory and make an appointment. To identify a participating physician or facility, use the online health care provider directory at https://www.sevencorners.com/about/gov/usdos (click on “First Health Provider Search” in the toolbar on the right side of the screen). Choose a physician based on the area of specialized medicine and/or the proximity of the office to your residence or campus.

At the time of your appointment, take your photo identification, ASPE identification card, a claim form and the Your ASPE Guide to Health Care Coverage with you. You can download a claim form from https://www.sevencorners.com/about/gov/usdos (click on “Forms” in the toolbar on the right side of the screen). The doctor’s office or hospital you choose will help you fill out the form. They will advise whether you should pay for the care at the time of your visit and be reimbursed later by Seven Corners, or have the doctor’s office or hospital submit the bill to the claims administrator for reimbursement.

Amount of Coverage

You will pay a portion of the expenses for each illness or medical emergency; this portion is called the co-pay. Under ASPE, the co-pay is $25 per accident or illness. The ASPE policy will pay the rest of the expense incurred up to a certain amount for each illness or injury sustained. Please refer to Your ASPE Guide to Health Care Coverage for specific details. If you have another health insurance provider, the ASPE policy pays benefits after your other policy has paid its full benefits.

Urgent Care vs. Emergency Care

In the United States, there are many options available to get treatment. Be aware that some options are more expensive than others and insurance may not cover all the costs, depending on where you go.

Urgent Care Centers
These are minor emergency clinics where appointments are not required and are open on weekends. These clinics are able to treat non-life threatening conditions such as cuts, sprains, and colds. Be aware that while these centers can accept insurance, typically they require immediate payment for services. However, these costs will be significantly less than going to a hospital.

Emergency Care
In case of serious emergency, call 911 and go to the nearest hospital emergency room -- by ambulance if necessary. Hospital emergency rooms are typically the most expensive place for medical care as they treat life-threatening conditions.

If you need to use a medical facility, but are uncomfortable with your English skills, ask a friend to go with you. Proper communication is very important! Be sure to have a list of emergency contacts on your cellphone or wallet in case of an emergency and you are unable to respond. Make sure to have the university’s emergency phone number if you have an emergency while on campus.

You should visit a hospital emergency room only when there is a serious or life-threatening condition that requires immediate medical attention, as ASPE will not cover emergency room expenses for non-emergency situations. If you are hospitalized for a serious medical condition, contact IIE as soon as possible.

General Health Information

What You Need To Know About Health Insurance

When you seek health care, make sure to bring your insurance card and a form of identification. Based on your insurance, you may be required to pay for a part of the service up front or a bill will be mailed to you. Therefore, make sure to have all contact information available and up-to-date.

In your insurance policy, there is a full description of all the services your insurance company will pay for. You may have co-pays where every visit you will be required to pay a set amount. You may also have a deductible and co-insurance where you are required to cover all office visits, up to a certain amount, and then the insurance company will cover a certain percentage of future visits and you will owe the rest.

On some health insurance plans, you will also be charged a higher rate to see a doctor that is “out of network”. Most health insurance companies have a website where you can look up a doctor that is in network, so be sure to do your research before setting up an appointment.

If you are required to have supplemental insurance, here are some important terms that you may come across:

Premium: The premium is the amount that you pay to purchase the insurance coverage. This amount is paid once and it guarantees health insurance for a certain amount of time. Be aware of when your coverage date begins and ends.

Deductible: The deductible is the amount that the insured person must pay before the insurance company starts paying. For example, if your deductible is $200, you must pay $200 out of pocket before your insurance company begins to pay at the rate that is in your policy. Costs for certain treatments can vary however, these costs can be greatly reduced through your insurance.

Co-Insurance/ Co-Pay: Co-Insurance is the percentage that the insured person pays after the deductible is paid. For example, if co-insurance equals 20 percent, then the insured person pays 20 percent for the service and the insurance company pays 80 percent. For some services, a co-pay is required which is a fixed amount you need to pay at the time of the visit.

In-network provider—a health care professional, hospital, or pharmacy that is part of a health plan’s network of preferred providers. You will generally pay less for services received from in-network providers because they have negotiated a discount for their services in exchange for the insurance company sending more patients their way.

Out-of-network provider—a health care professional, hospital, or pharmacy that is not part of a health plan's network of preferred providers. You will generally pay more for services received from out-of-network providers.

Explanation of benefits—the health insurance company's written explanation of how a medical claim was paid. It contains detailed information about what the company paid and what portion of the costs you are responsible for.

Mandatory University Insurance

At some U.S. host universities, Fulbright Scholars and their dependents are allowed to or even required to enroll in the university insurance program. In such cases, you may be responsible for paying the premiums.

IIE requests insurance requirements when they confirm an affiliation and will inform you accordingly. The Fulbright organization in your home country will receive this information through the Institutional Reply Form (IRF).

Prescription Medication

If you require maintenance medications, you are strongly encouraged to research the availability of these medications in the United States. Due to regulations regarding controlled substances and/or prescription medications, drugs available in your home country may not be available in the United States and vice versa. If you have any questions as to whether a specific medication may be brought into the United States, please contact the U.S. Food and Drug Administration at (1-888-463-6332, or at https://www.fda.gov/.

If you are here for more than 60 days and need your medication sent to you, ask your physician in your home country to write a letter explaining:

▪ You are undergoing medical treatment, and s/he has prescribed the medication for your use;

▪ Your country of citizenship; and,

▪ You are in the United States temporarily on a Fulbright grant and need a prescription refill.

Please note that while the package is addressed to you, the letter should be addressed to the customs officer and written in English. This letter along with a copy of your passport must b included in the package containing your medication. The package could be detained for up to 30 days by Customs for examination. Please send the package using a courier service such as FedEx or DHL that offers package tracking. Consult with your courier on how best to identify the package, so that the U.S. customs officer will be able to process your package properly.

Medical Claim Process

Prior to receiving treatment, it is important to verify with your insurance that your medical services will be covered.

Important Questions to Consider When Selecting Insurance:

Does the health insurance plan cover both accidents and illnesses?

Does the plan cover costs incurred outside of a hospital setting?

Which doctors or hospitals does the plan recognize?

What exactly are the exclusions and limitations?

Sample Insurance Companies

You must purchase insurance for all accompanying J-2 dependents, as family members of Fulbright Scholars do not receive medical coverage from the U.S. Department of State. You may also wish to purchase supplemental insurance for yourself and are strongly encouraged to do so especially if you have pre-existing conditions that require ongoing treatment. Below is a list of some companies in the United States with health insurance plans that are available to you and your dependents. Some plans offer enrollment and payment via the Internet. It is a good idea to compare thoroughly benefits and prices of at least two plans.

Please note that this list is for informational purposes only, it does not represent any endorsement by the Fulbright Program. To determine if plans are available to meet your needs, contact the insurance provider or check their websites.

Associated Insurance Plans International, Inc.

Cultural Insurance Services International

Global Benefits Group

Global Underwriters

The Harbour Group

HTH Worldwide

International Student Organization in America (ISOA)

UnitedHealthcare Global

Seven Corners, Inc.

Travel Insurance Services

Wallach & Company, Inc.

Additional Resources