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J-1 Health Insurance Attestation

The U.S. Department of State (DOS) requires that all J-1 Exchange Visitors and their dependents have adequate insurance coverage during their stay in the United States.  This is mandated due to the high cost of medical care in the United States.  
While it may be possible for you to purchase a health insurance plan in your home country or to have it provided by your sponsoring program, please be sure it meets the minimum requirements as indicated below.  
The required minimum basic coverage is:
•        Medical benefits of at least $50,000 per accident or illness;
•        Repatriation of remains in the amount of $7,500;
•        Expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $10,000; and
•        A deductible not to exceed $500 per accident or illness.
For more information on health insurance requirements as well as insurance providers, please refer to our website: http://www.ois.pitt.edu/immigrat ... f/health-insurance/

Please indicate below how you will meet the health insurance requirement:

_______        As a University of Pittsburgh employee, my health insurance will be provided by the University.

_______        I will purchase a health insurance plan for myself and for my dependents (if applicable) immediately
                          upon arrival in the United States and maintain coverage for the duration of the J-1/2 program.

_______        I have purchased a health insurance plan from my home country that meets Department of State minimum requirements, including medical evacuation and repatriation.

_______            The sponsoring organization is providing health insurance that meets Department of State minimum requirements, including medical evacuation and repatriation.

_______        (IF BRINGING DEPENDENTS) I will ensure my dependents have the above level of insurance for the duration of our/their J-1 program.


Exchange Visitor¡¯s Name: ___________________________________________________________________________

Exchange Visitor¡¯s Signature_________________________________Date:____________________________________
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