Health Benefits
Participate Learning is pleased to offer a variety of benefits for our Ambassador Teachers, including requisite health benefits, optional dental insurance, and a no-cost life insurance policy.
The U.S. Department of State requires J-1 visa-holders on cultural exchange programs to have medical insurance coverage. Participate Learning arranges this coverage for its Ambassador Teachers and is pleased to also offer other types of coverage as a benefit to program participants.
This page is a summary of general information regarding health insurance and related benefits. Actual terms may be amended or modified at any time. Please consult the applicable governing documents for specific questions.
Health Benefits
Participate Learning has negotiated an affordable group rate for a comprehensive health benefits plan that meets the U.S. State Department’s insurance requirements for the J-1 visa program. As your visa sponsor, Participate Learning requires that you purchase this coverage for yourself and any J-2 dependents. The plan is annual and runs from July 1 to June 30 of the following year.
Participate Learning’s health benefits are administered by United Healthcare (UHC). For the most up-to-date information and an overview of the plan, please refer to the 2023-24 Benefits Digest. A brief summary of the health care plan is provided below.
UHC Choice Plus Network
Healthcare providers participating in the UHC Choice Plus Network are referred to as “in-network.” Healthcare providers that are not affiliated with UHC Choice Plus Network are referred to as “out-of-network.”
There is a significantly lower cost for providers who are part of the UHC Choice Plus network. You may choose providers who are not part of the UHC Choice Plus network, but the charges will be considerably higher than those for in-network providers.
Through the UHC Choice Plus Network, Ambassador Teachers have access to no-cost virtual telehealth through Virtual Visits. Virtual Visits are a convenient option for minor illnesses, injuries, mental health, and dermatology care. There is no copay for Virtual Visit appointments for in-network providers; virtual telehealth visits are not covered for out-of-network providers.
Premiums
Premiums are the portion of the cost of health benefits that the Ambassador Teacher pays. Premiums are paid for the Ambassador Teacher’s own health benefits as well as for any covered dependents. Premiums are paid monthly and are automatically drafted from Ambassador Teachers’ bank accounts.
Copayment
A copayment is a set fee you pay when medical services are rendered. Copayments do not count toward the deductible.
The copayment for office visits to a general practitioner or primary care provider is lower. Visits to a specialist, emergency room, or urgent care provider have higher copayments.
Deductible
The deductible is the portion of a member’s health care expenses that must be paid out-of-pocket each plan year before any covered services are paid by UHC. Please refer to the Benefits Digest for deductible amounts for individual and family plans.
Deductibles typically apply to inpatient and outpatient hospital expenses and certain diagnostic services. It does not include copayments and coinsurance.
Coinsurance
Coinsurance refers to costs for medical services shared between the patient and the insurance provider (UHC). Once the deductible has been satisfied, patients will be required to cover coinsurance amounts for some inpatient and outpatient hospitals and certain diagnostic services.
The amount for which the patient is responsible is typically calculated as a percentage of the cost amount UHC covers. As an example, if UHC covers 70 percent of the cost of an in-network medical service, the coinsurance for which the patient is responsible is the remaining 30 percent. The amount the patient pays in co-insurance is counted towards the annual out-of-pocket maximum (OOP).
Out-of-pocket maximum
The out-of-pocket maximum is the maximum amount of medical services costs for which a patient is responsible during a plan year (July 1 to June 30). The out-of-pocket maximum includes office visits, prescription copays, deductibles, and coinsurance.
Once a patient has reached their out-of-pocket maximum for a benefit period, the insurance plan will cover all remaining covered in-network healthcare services during that coverage period. The out-of-pocket maximum increases significantly for out-of-network healthcare services.
The maximum amount a plan will pay for a covered health care service may also be called “eligible expense,” “payment allowance,” or “negotiated rate.” If an out-of-network provider charges more than the plan’s allowed amount, you may have to pay the difference (balance-billed charge).
Please refer to the Benefits Digest for amounts for the out-of-pocket maximum for individual and family plans.
Mental Health
The J-1 Visa Exchange Visitor Program’s Office of Private Sector Exchange Administration (OPA) has seen a recent rise in mental health cases and encourages sponsors to provide mental health resources to their exchange teachers. Virtual Visits and the Employee Assistance Program (both detailed on this page) are two such resources Participate Learning offers to our Ambassador Teachers to support mental health.
As of July 16, 2022, all calls and messages to “988” route to a 988 Suicide and Crisis Lifeline call center. The 988 Suicide and Crisis Lifeline provides 24/7, confidential support to to people in suicidal crisis or mental health-related distress.
Additional resources for finding mental health-related support and treatment are available at the Substance Abuse and Mental Health Services Administration (SAMHSA) website.
Finding a Provider
There are multiple ways to find a UHC Choice Plus Network provider or hospital in your area:
- Call the UHC member phone number (833-410-2787), provide your policy number (928036) and the member ID number listed on your insurance card, and a UHC representative will assist you.
- Register and sign into your United Healthcare myuhc account to use the Find Care & Costs tool.
- Contact Health Advocate at 1-866-695-8622 or through their website at no cost, 24/7
Enrolling Dependents
J-2 dependents
In accordance with Participate Learning policy requirements, any J-2 dependents will be enrolled in the Participate Learning health plan effective on the date their DS-2019 is issued. J-1 visa-holders become responsible the associated health insurance premiums for J-2 dependents upon validation of their program at Participate Learning arrival orientation OR upon J-2 addition approval.
Participate Learning Ambassador Teachers begin paying premiums for the entire month on the date the DS-2019 form is issued. The monthly premiums for family benefits are detailed below.
Non J-2 dependents
For family members that are not J-2 dependents, there are two windows of opportunity to add or remove them from medical and dental insurance. The first is during the annual open enrollment period, typically occurring in the spring.
The second is within 30 days of a qualifying life event, such as marriage, divorce, or birth of a child. If necessary benefits changes are not made within the 30-day window of a qualifying life event, coverage for family members that are not J-2 dependents may not be dropped or added until the next open enrollment period.
Paying for Health Benefits
Each month from September through May, the Ambassador Teacher’s portion of the health benefits costs are automatically drafted from their bank account.
Participate Learning does not make deductions from your paycheck with your school district, but directly from your bank account on file with us.
The nine-month premium will cover each teacher from the arrival date in the U.S. through June 30 of the following year.
Benefits Tiers
2023-24 Premium per Month for 9 Months:
- Teacher only: $98.85
- Teacher and spouse: $469.65
- Teacher and child(ren): $270.52
- Teacher and family: $483.68
More information about this will be provided at Participate Learning arrival orientation.
Filing Claims
When you check in for your appointment at your provider’s office or clinic, you will be asked to present your insurance card to ensure your correct benefits information is on file. Physicians will then file the appropriate claim(s) with the insurance carriers on your behalf following your visit.
In the event that your provider’s office or pharmacist does not automatically file the claim for you, you can request that they process the claim under your insurance information. This is the most efficient process for medical and dental claims. If, for any reason, you need to file a claim yourself, please see the How to submit a claim information page on the UHC website to learn about filing your claim(s) for reimbursement.
Health Advocate
Participate Learning encourages you to call Health Advocate prior to seeing your provider or going to the hospital (non-emergency services). A representative from Health Advocate will help you find the best providers and hospitals in your area that participate in the UHC “Choice Plus” Network.
In addition to finding a provider, they can also assist you with a variety of services including:
- Answering questions about your health benefits.
- Scheduling an appointment for you or a family member.
- Assistance with claims or billing concerns regarding your UHC medical and dental coverage.
You can call Health Advocate at 1-866-695-8622, 24 hours per day/7 days per week.
The health advocacy program offers a comprehensive spectrum of programs to help you navigate healthcare and insurance questions. THIS IS NOT INSURANCE. Health Advocate is here to help you and be your advocate for your health care. All calls are completely confidential in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations. Read more about HIPAA and patient privacy laws.
Dental Benefits
Participate Learning offers a competitive dental insurance policy for all Ambassador Teachers and their eligible dependents. This comprehensive plan, operated by United Healthcare, covers 100 percent of the costs for preventative dental procedures provided by an in-network dentist, including initial consultation, basic cleanings, some x-rays, and other applicable services.
After a $50 deductible, the plan covers 80 percent of the cost of simple extractions, fillings, root canals, gum disease treatment, certain x-rays, and other applicable services. It also covers 50 percent of the cost of crowns, complex extractions, oral surgery, anesthesia, and certain other services after the deductible. The maximum covered benefits per person per calendar year is $1,500.00. This is the maximum amount that the insurance will pay per benefit period, once you have met the deductible.
Dental benefits are deducted directly from Ambassador Teachers’ bank accounts at the end of each month, September through May. The nine-month premium covers Ambassador Teachers from their arrival in the U.S. through June 30 of the following year.
Enrollment
Ambassador Teachers choosing to enroll in the dental policy will be given additional information, an enrollment application, and instructions at Participate Learning arrival orientation and during open enrollment each year. Once the benefit has been elected it cannot be canceled or changed except during the annual open enrollment period or within 30 days of a qualifying life event. Likewise, if benefits are declined at Participate Learning arrival orientation, Ambassador Teachers will not be able to enroll again until the next annual open enrollment period or within 30 days of a qualifying life event.
Dental Benefits Tiers
2023-24 Premium per Month for 9 Months:
- Teacher Only: $26.25
- Teacher and Spouse: $52.91
- Teacher and Child(ren): $58.28
- Family: $85.17
COBRA
The Consolidated Omnibus Budget Reconciliation Act of 1986, or COBRA, is a U.S. law that requires employer-group health plans to offer covered employees and their families the opportunity to temporarily extend health coverage in instances where plan coverage would normally end. COBRA requires continuation coverage to be offered to covered employees, their spouses, former spouses, and dependent children.
COBRA coverage allows former employees to stay on their job-based health insurance for a limited time after the job ends (usually 18 months). The former employee pays the full premium (both the employee and the employer subsidy), plus a small administrative fee.
You will receive additional information regarding your COBRA rights at Participate Learning arrival orientation.
2023-24 Premium per Month:
Medical
- Teacher only: $403.67
- Teacher and spouse: $807.32
- Teacher and child(ren): $726.60
- Teacher and family: $1,251.36
Dental
- Teacher only: $26.73
- Teacher and spouse: $53.88
- Teacher and child(ren): $58.77
- Teacher and family: $85.88
Why are COBRA premiums so expensive?
Employers do not contribute towards or subsidize premiums for the cost of former employees’ COBRA coverage. Under COBRA, the individual is responsible for both the employee and employer portions of premiums, which makes COBRA coverage expensive.
Additional Benefits Sponsored by Participate Learning
Participate Learning is pleased to offer additional benefits at no cost to program participants. These sponsored plans are included in the benefits package and provide specific coverage and services to you and your eligible family members.
We encourage you to use these benefits for assistance with routine mental healthcare, finding behavioral or social support, navigating the U.S. healthcare system, and seeking financial assistance if necessary.
Employee Assistance Program
The Employee Assistance Program, or EAP, provides professional support services to identify and assist employees in resolving personal challenges that may adversely affect their performance professionally. The EAP also provides support for overall health, well-being, and life management.
The EAP offers confidential support, guidance, and various resources to help participants navigate and address personal challenges such as marital, financial, or emotional circumstances, family concerns, or substance or alcohol abuse.
These optional EAP benefits are available to all covered Ambassador Teachers and family members, regardless of location. Refer to myassistanceprogram.com/rsl or call 855-RSL-HELP (855-775-4357) for more information.
Life Insurance
Ambassador Teachers are covered under Participate Learning’s Life & Accidental Death insurance plan. This provides a $15,000 life insurance policy for Ambassador Teachers, a child policy of $500 for infants 14 days to 6 months, and a $5,000 policy for children 6 months to age 19 (or age 26 if they are full-time students). Spouses also have a $5,000 policy under the plan.
The Life & Accidental Death benefit helps protect you and your loved ones financially in the tragic event of the loss of life of a family member. Life insurance provides a payment, also known as a death benefit, to beneficiaries you select after the insured person’s death. It also provides a benefit payment to you in the event of a loss of limb.
There is no additional cost to you for this coverage. New Ambassador Teachers will enroll and select their beneficiaries as part of the benefits enrollment process during arrival orientation. Once an Ambassador Teachers is no longer a part of the program, this benefit is no longer available.
Travel Assistance
Participate Learning offers a travel assistance program through On Call International that provides immediate support and assistance in case of an emergency medical evacuation. This includes hospital transport and repatriation of remains to one’s home country. Such assistance is not available to the extent that other insurance coverage is available or the current hospital can provide adequate treatment.
You or your family should contact Participate Learning immediately in the event of any medical emergency or family death that may require medical evacuation or repatriation of remains to your home country. On Call International will review the request for the medical necessity for medical evacuation.