OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
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HEALTH INSURANCE GUIDE FOR
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What You Need to Know About Healthcare in the U.S.:
I. INTRODUCTION
This guide was written for individuals who are unfamiliar with the U.S. healthcare system, and the complex and
sometimes overwhelming process of selecting the right health insurance plan and accessing medical care.
Our most important piece of advice is this: Do not be afraid to ask questions. You must ask questions at each
step of the process to ensure that you are making the best choices for yourself and your family. This guide is not
intended to answer all your questions, but it should give you enough background about healthcare in the U.S. so
that you feel comfortable requesting the additional information you need.
Throughout this guide, terms that have a special meaning in a healthcare setting are highlighted in italics. All
italicized terms are defined in the Glossary of Terms at the end of this document.
We hope that you find this guide a useful introduction to the U.S. healthcare system. We invite you to contact
us with comments and suggestions, share your own experiences with medical care in the U.S., and follow up
with any questions that are not addressed here.
II. AN OVERVIEW OF HEALTHCARE IN THE UNITED STATES
SYSTEM, WHAT SYSTEM?
Many commentators have observed that the U.S. healthcare system is not really a system at all. Rather, it is a
patchwork of health care providers who practice in various configurations and of multiple payers -- primarily
private, but public as well.
Providers consist of *primary care providers, specialists, and the nursing and administrative staff that support them
who often serve as a patient’s initial point of entry into the healthcare system. Primary care providers are often
physicians who have been trained as General Practitioners (GPs) or in internal or family medicine. Nurse
Practitioners also provide primary care. Specialists are physicians who are trained and certified in a particular
medical specialty, such as cardiology (heart and circulatory system), dermatology (skin disorders), or oncology
(the treatment of cancer). Often, a patient is required to obtain a referral from his or her primary care provider
before s/he will be able to seen by a specialist. Healthcare providers may practice independently of a larger
organization as solo practitioners or in partnership with one or more other providers. They may also be part of a
clinic that employs many providers, or be an employee of a medical group that is directly affiliated with a
hospital or network of hospitals.
*Please refer to the Glossary of Terms for more detailed definitions of primary care providers and specialists.
HEALTHCARE IN THE U.S. IS VERY EXPENSIVE
You have probably heard that healthcare in the U.S. is very expensive, but you may not realize exactly what this
could mean for you and your family. Here are some examples that illustrate the serious financial consequences
that an unexpected injury or illness could have for you:
If you got sick and had to be hospitalized, the daily hospital charge for your room, board, and doctor’s fees could
easily be $2,500 a day, not including any medication, surgery, medical tests, laboratory costs, and other related
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
INTERNATIONAL VISITORS
expenses. Furthermore, if you were in very serious injury, you might be sent to an Intensive Care Unit (ICU),
which can cost you as much as $30,000 a day!
Having a baby in the United States is expensive too. A routine delivery can cost around $6,000. For a cesarean
delivery with no complications, you may be charged well over $12,000. If there are complications, costs can
quickly escalate by thousands of dollars.
III. MEDICAL INSURANCE
Unlike many countries where the government provides and/or pays for the healthcare needs of its citizens, and
sometimes non-citizens living within its borders, individuals in the U.S. are responsible for their own healthcare
costs unless they are elderly or have a very low income. Individuals can pay for healthcare by purchasing health
insurance that covers certain medical treatments and hospital stays, by paying for healthcare services out-of-pocket,
or by combining health insurance coverage with out-of-pocket payments.
Private healthcare insurance works by taking a group of people (for example, all of those who are employees or
who are the immediate family members of employees of a particular company) and pooling the money that the
company and/or the employees pay for insurance policies (premiums). Then, when an individual who is a
member of that group visits a doctor or goes to the hospital, the bill -- or at least a portion of the bill -- is paid for
out of the pool of money collected from each member’s premiums.
It is common for individuals and families in the U.S. to obtain health insurance through their employers. In
2016, an estimated 57 percent of Americans under age 65 received health insurance through their employers or
family members’ employers.
Because health insurance has traditionally been obtained through an employer, people who are self-employed or
who do not have a job do not have easy access to health insurance. Unlike other wealthy, industrialized
countries, not everyone in the U.S. has healthcare coverage. According to the U.S. Census Bureau 9.1 percent,
or nearly 29 million, of Americans did not have healthcare insurance in 2015.
YOU MUST HAVE MEDICAL INSURANCE!
U.S. immigration regulations require many non-immigrants to carry medical insurance, either as a condition
of maintaining status or as a part of their financial certification. If you are in J-1 status, you are required by
law to have a certain level of medical insurance and to have insurance that covers medical evacuation and
repatriation of remains. This includes any family member(s) who accompany you. If you are in F-1 status,
your University likely requires you to purchase medical insurance.
Do NOT wait to purchase insurance until you or a family member gets sick because insurance companies often
exclude “pre-existing conditions.” This means that an insurance company will refuse to cover treatment for an
illness or injury that you had before you bought insurance. To protect yourself and your family, you must have
adequate healthcare coverage in place from the moment you arrive in the U.S. until after you leave the country.
Paying for necessary treatment without adequate medical insurance could cause serious financial hardship,
depending on the severity of the injury or disease. This is not an idle warning. The burden of healthcare costs
not covered by insurance causes very grave financial difficulties for many people in the U.S. According to many
sources, half of all bankruptcies in the U.S. are due to medical bills that people cannot afford to pay.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
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VISION AND DENTAL INSURANCE
It is important to understand that medical insurance often does not include vision or dental insurance coverage,
which are purchased separately and generally considered supplemental insurance. Vision insurance helps offset
the costs of routine eye exams and helps pay for vision correction wear, like eyeglasses, that may be prescribed by
physicians or eye-care specialists. Dental insurance is an insurance coverage designed to pay a portion of the costs
associated with dental care. It insures against some of the expenses of treatment and care of dental disease and
accident to teeth. Make sure to check with your medical insurance provider to determine what, if any, vision or
dental coverage is included in the plan.
OBTAINING MEDICAL INSURANCE
In some cases, the organization that you will be working for will provide health insurance for you, and may
include your dependent family members who accompany you. If your employer does not offer medical insurance
as part of your employment benefits package, you will be responsible for purchasing your own health insurance.
You can ask your employer or sponsor for advice; visit the National Association of Health Underwriters at
www.nahu.org/ to find and compare health insurance plans.
If your employer does offer medical insurance to you and your dependents, you will be able to enroll within a
certain period after your employment begins. Each year, you will be able to change your policy during your
employer’s open enrollment period, usually at the end of the calendar or fiscal year.
In addition, you will have the opportunity to modify your insurance plan if certain events happen to you or your
family. Depending on the event, these special enrollment periods can last either 30 or 60 days from the date of
the event. For example, if you get married, you will be allowed to add your spouse to your insurance plan. If you
or your spouse have a baby, you will be allowed to add the new child to your existing plan.
Only the most expensive medical insurance policies cover 100 percent of all healthcare services. Be aware that
medical insurance in the U.S. does not usually cover services that are considered “alternative treatments,” such as
massage, acupuncture, or herbal remedies. Nor does it cover over-the-counter drugs. If you use alternative
treatments or take medications that do not require a doctor’s prescription, you should first inquire with your
medical insurance provider, but you often have to pay for them yourself.
In the U.S., many medications (drugs) are only available through a prescription from a physician. Be aware that
some of the drugs that you could buy in your home country without authorization from a doctor will require a
prescription here. Most likely, your doctor will require that you schedule an appointment to be seen in-person
before s/he will write a prescription.
CHOOSING A PLAN
Even when your employer buys insurance for you, you may have to select from among a number of different
plans available. Several broad categories of plans are outlined below.
Fee-for-Service plans pay a fee for covered services received from a medical provider. This type of coverage allows
you to choose which doctors you want to see, including specialists. If you need to see a specialist, you will be
able to choose whom you want to see yourself and will not need to get a referral from a primary care provider.
However, you will only be reimbursed for covered services that are listed in the plan’s benefits summary. Even
then, you may not be reimbursed for all of the cost. You will be responsible for any portion of the bill that is not
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
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paid for by the insurance company. Fee-for-service plans generally charge a higher premium for the ability to
select your own doctors.
Preferred Provider Organizations (PPOs) require you to choose the doctors you see from a list of physicians
who have agreed to provide services under the plan. You may choose your own specialists, as long as they are on
the PPO’s list of providers. The premium will be lower than a fee-for-service plan because of this restriction.
Point of Service (POS) plans require your primary care provider to choose a specialist for you. The other
features of POS plans are the same as PPO’s.
Health Maintenance Organization (HMO) insurance plans restrict whom you can see and where you can obtain
services, but they offer the least expensive type of medical insurance.
Below is a list of ten factors you may want to consider when choosing a specific plan. Even though some of
these factors may be difficult to assess if you are not in the San Antonio, Texas area, it may be helpful to be
aware of them before you arrive.
1. Access to Doctors: Some health care plans require you to use their network of doctors. If there is a specific
physician that you would like to be able to see, check first to see if your doctor is included in the health care plan
you are considering.
2. Access to Specialists: If you have specific medical conditions or anticipate needing a specialist, you will want
to find out the procedures required to use a specialist under the plan. Check to see if you need a referral from
your primary care provider before seeing a specialist. Also, ask how long a referral remains active. If you have a
specific specialist in mind, you will want to find out if that specialist belongs to the plan’s network of doctors.
3. Pre-Existing Conditions: Coverage of pre-existing conditions can vary widely between plans. Some plans
completely exclude pre-existing conditions. For example, if you have diabetes, a plan may refuse to pay for any
medical treatment related to your pre-existing diabetes. Some plans will fully cover pre-existing conditions.
Other plans fall somewhere in-between, and may cover only a certain percentage of the cost associated with a pre-
existing condition or may cover it only after you have been on the plan for a specific amount of time. The Health
Insurance Portability and Accountability Act (HIPAA) guarantees coverage for pre-existing conditions if you are
joining a new group plan from your employer and were insured the previous twelve months.
4. Emergency and Hospital Care: You will want to find out what emergency rooms and hospitals are covered on
your plan. In addition, find out how the plan defines “emergency.” Sometimes your definition of an emergency
may not be the same as the health care plan you are considering and you could seek emergency treatment only to
find out that it was not covered under the plan. Also, check to see if you need to contact your primary care
provider before seeking emergency care.
5. Regular Physicals and Health Screenings: If you get regular physicals and health screenings, you will want to
make sure they are covered. Most managed care plans cover one check-up a year (also known as an annual
physical), but some independent insurance plans do not cover these types of preventative services at all. Also, if
you have young children, verify that well-baby check-ups and immunizations are covered.
6. Prescription Drug Coverage: If you currently use prescription drugs on a regular basis or think you may need to
in the future, you will want to look for a plan that offers good prescription drug coverage. Be aware that coverage
can vary enormously from plan to plan. Some plans do not cover prescription drugs at all, while others cover all
types of prescription drugs. Still others require varying co-pays for different types of drugs.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
INTERNATIONAL VISITORS
Also, if you are unwilling or unable to use the generic forms of prescription drugs, find out how that will affect
the price of prescription drugs under the plan.
Let’s say that your insurance plan does not cover (pay for) prescription drugs. If you go to the doctor because
you have a persistent sore throat and cough, and the doctor prescribes antibiotics to treat your illness, you will
have to pay for the medication yourself, because the cost of prescription drugs is not covered by your policy.
Compare that to an insurance plan that covers prescription drugs, but requires a $15 co-pay. If your doctor
prescribes a medication that costs $60, you will have to pay $15 yourself, but your insurance company will pay
the remaining $45, either by reimbursing the pharmacy directly or by reimbursing you when you file a claim.
7. Obstetrician-Gynecologist (OB-GYN): If you regularly see an Obstetrician-Gynecologist, find out if the doctor
you want to see is covered in the plan. Also, if you are pregnant or may become pregnant while you are in the
U.S., find out how much you will have to pay out-of-pocket for pregnancy care and childbirth under the plan.
8. Additional Benefits: Consider what additional services are covered when comparing health plans. Some
examples of additional services that may be important to you include: dental and/or vision benefits, health savings
accounts, mental health care, counseling, experimental treatments, alternative treatments, or chiropractic care.
9. Costs: Once you have decided what you want in your health care plan, you must compare costs. Both
premiums and out-of-pocket costs should be considered as you are evaluating the cost of insurance.
Premium
– This is the monthly cost that you will have to pay for insurance coverage. If you obtain
insurance through your employer, the employer may pay all or a portion of the premium. It is more and
more common, however, for individual employees to have to pay at least part of the monthly premium.
Co-insurance
– This is the percentage of overall total for a medical service that the policy-holder must
pay out of his or her own pocket. For example, if the insurance policy pays 80 percent of all medical
services, your co-insurance percentage would be 20 percent. Because healthcare is so expensive, even 20
percent of the total can be significant.
Co-payment
– A co-payment (also called a co-pay) is the fee you must pay yourself when visiting your
doctor, hospital, or emergency room. A co-payment can vary according to what type of medical
appointment or procedure you are having done. For example, the co-pay for a routine medical check-up
may be $30 while the co-pay to see a specialist may be $35. You have to pay the co-pay amount when
you check-in for your medical appointment, and the insurance company will not reimburse you for this
amount.
Deductible
– Many insurance policies may require you to pay a certain amount out-of-pocket before
medical services will be covered under the insurance policy. For example, you may be required to pay
the first $500 of medical expenses that you and your family incur each year. After you have paid $500
worth of medical expenses, your policy will cover any subsequent healthcare expenses for the rest of the
year. The higher the deductible, the lower your insurance premium may be. In addition to finding out
the amount of the deductible, you will also want to know if your deductible needs to be paid before any
services can be used. Also, find out what percent the insurance will pay after your deductible, as well
what percent they will pay if you need to use a doctor, hospital, or specialist that is out of network.
Note that any amount you pay for co-payments does not count toward your deductible.
10. Exclusions: You will want to review each plan’s exclusions list to find out what is not covered and to see if any
condition you currently have or expect to have in the future, is included on that list.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
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11. Limitations: Some plans have lifetime limits on how much the healthcare plan will pay and some have
lifetime limits along with yearly limits. Given how expensive medical care can be, most experts recommend a
plan that provides coverage for at least $1 million in healthcare costs.
Often, the plans from which you can choose are laid out in a schedule that makes it easier to compare the
varying features of each plan. It might look something like this:
Plan Name
Provider Coverage
Prescription Drug
Covered
Co-Pay Required
Monthly
Premium
Plan A
Services from all
providers is covered.
All prescription
drugs covered
with $15 co-pay.
No co-pay for preventative
check-ups, $20 for all
other services.
$220
(individual)
$275 (family)
Plan B
100% of in-network
providers, 80% for
doctors outside the
network.
100% of generic
prescription drugs
covered; 80% of
non-generics
covered.
Co-pay of $20 for all
services.
$200
(individual)
$250 (family)
Plan C
80% of services provided
by in-network. Covers no
services by providers
outside the network,
except in an emergency.
No prescription
drugs are covered.
Plan members are
responsible for 20% of the
cost of all services
received.
$150
(individual)
$200 (family)
IV. ACCESSING MEDICAL SERVICES IN THE U.S.
YOUR INSURANCE CARD IS EVERYTHING!
The insurance company from whom your policy was purchased will send you an insurance identification card.
You should show this card to service providers to prove that you have insurance. Keep in mind that the card will
be valid only as long as the required premiums are paid. Keep your insurance card with you at all times if
possible.
PAYMENT VERSUS REIMBURSEMENT
Some healthcare providers will work directly with your insurance company to obtain payment. Others will
require that you pay the full amount at the time service is provided, and then seek reimbursement yourself from
your insurance company by filing a claim.
If you are required to file a claim for reimbursement, be sure to complete the claim forms accurately (call the
insurance company if you have any questions about the information that is required). If the insurance company
contacts you for additional information, respond immediately to the request. Failing to fill out claim forms
correctly and/or failing to respond quickly to a request for additional information could result in a delayed
payment to you or to your doctor or other provider.
CANCELLATION POLICY
Before selecting a plan, make sure to inquire with the health insurance provider about the cancellation policy.
Some plans will include language in the policy that prohibits you from receiving a refund of the premium paid if
you decide that you no longer want the plan and cancel prior to the validity date of the insurance coverage.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
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WHERE TO GO FOR MEDICAL TREATMENT
Primary Care Provider - For medical check-ups or other routine doctor visits that you have time to schedule in
advance, you will want to see a Primary Care Provider. The practitioners who provide these services include
General Practitioners (GPs), Physicians who specialize in Internal Medicine, and Nurse Practitioners. For
women, OB-GYN’s may often be designated as Primary Care Providers. If your insurance plan is not a Fee-for-
Service plan, you should refer to the list of providers that the insurance company gave you to select a physician.
Specialist – In the U.S., any provider who is not a primary care provider is considered a specialist. Specialists
include OB-GYNs, Orthopedic Surgeons, Cardiologists, Oncologists, etc. Unless you have Fee-for-Service health
insurance, you will need to obtain a referral from your Primary Care Provider before you can make an
appointment to see a specialist.
Prescription Drugs – Retail pharmacies in San Antonio, Texas are located in drug stores including Walgreen’s,
H.E.B., Target and Wal-Mart, and in most supermarkets. You should shop around for the best prescription
prices, especially if you have an insurance plan that does not cover prescription drugs or requires you to pay a
certain percentage of the cost. Prices can vary significantly among pharmacies.
Urgent Care Facilities - are designed to provide immediate medical care during evenings or weekends when your
doctor’s office or clinic is not open. Often, you can obtain services on a walk-in basis, although you may be able
to set a specific appointment time at some locations. You may have to wait to see the doctor or nurse
practitioner depending on the number of other individuals waiting. Urgent care facilities treat a variety of non-
life and limb threatening injuries and illnesses for children and adults, including:
sports injuries, sports physicals, and sports medicine
school, daycare, and camp physicals
colds, flu, H1N1
sprains and strains
strep and sore throat
headaches, abdominal pain/stomach aches
infections and wounds
non-life threatening cuts requiring stitches
There are two important advantages to being treated at an urgent care facility instead of an emergency room for
the types of conditions listed above: 1) You will often be seen faster; and 2) you will likely have to pay much less
for treatment. In the San Antonio Area, several providers offer urgent care facilities. You can type in “Urgent
Care near Me” online and find several locations close to you. Make sure to check with your health insurance
plan to determine if specific urgent care facilities are covered.
Emergency Room (ER) – If you have a medical condition that is a life or limb threatening emergency, call 911
for an ambulance or go immediately to your nearest hospital emergency room. Emergency room treatment is
required for conditions like extensive bleeding, broken bones, or a severe allergic reaction. There are a number
of hospitals in the San Antonio Area.
In addition to emergency services, hospitals provide other types of care, such as certain medical tests, in-patient
procedures that require an overnight stay, and out-patient procedures that require you to be in the hospital for
only a part of the day.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
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MENTAL HEALTH SERVICES
Health is not just about your physical condition, but also about your mental well-being. Moving, starting a new
job, and adjusting to a new culture are very stressful. During your initial few months in the United States, you
should be especially mindful of how you are feeling and take steps to take care of both your physical and mental
health.
An Employee Assistance Program (EAP) may be offered as part of your health insurance benefits. EAP’s are
intended to help employees deal with personal problems that might adversely affect their work performance,
health, and well-being. EAP services generally include assessment, short-term counseling, and referral services for
employees and their family members.
The Student Counseling Center provides free and confidential services to all Health Science Center students.
You can make an appointment by calling (210) 567-2648 or visiting the Student Counseling Center between the
hours of 8:00 am – 5:00 pm, Monday through Friday. In addition, the UT Employee Assistance Program (EAP)
provides free and confidential counseling to all UT Health San Antonio employees, faculty, staff members and
their families. Visit www.uteap.org/ for more information or call (800) 346-3549.
IV. INSURANCE FOR MEDICAL EVACUATION AND REPATRIATION OF REMAINS
If you are in J status, you are required to have insurance coverage for medical evacuation and repatriation of
remains. We strongly encourage students and scholars in other non-immigrant visa categories to purchase this
type of insurance coverage as well.
Medical evacuation coverage allows you to return to your home country to obtain medical treatment and
hospital care in the case of a serious accident or illness. Insurance that covers repatriation of remains will pay for
all or part of the cost of returning the body of the covered individual to his or her home country for funeral or
burial.
Visiting students and scholars are eligible to purchase the UT System Visiting Scholar health insurance plan
that is administered through Academic Health Plans (AHP), and this plan meets the minimum requirements
mandated by the Department of State for J-1 exchange visitors.
For more information regarding this plan, please visit: UTHSCSA.myAHPcare.com or refer to the 2017-2018
Brochure.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
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GLOSSARY OF TERMS
INSURANCE, A LANGUAGE ALL ITS OWN
Cesarean Section Delivery – A Cesarean section (C-section) is a surgical procedure to deliver a baby. The baby is
taken out through the mother's abdomen. In the United States, about one in four women have their babies this
way.
Claim – The notification that you or your doctor send to your insurance company to receive reimbursement
after you have seen a medical provider and incurred a covered medical expense.
Co-insurance – The amount you must pay for medical care after your expenses reach the amount of your
deductible. Often, a plan will pay 80% and your co-insurance amount will be 20% after you reach your
deductible.
Copayment (also called a co-pay) – The amount that you are required to personally pay when you see a medical
provider. After you have paid your co-pay amount, the insurance company will generally pay any remaining
portion of the bill. Typically, the co-pay amount ranges from $15 to $40 per visit.
Deductible – The amount of money you must pay yourself for medical services during the course of a year before
your insurance policy will begin to pay for medical services. The higher the deductible, the lower the premium.
Enrollment Period – The limited period of time after beginning a job with a new employer when a new
employee can enroll in employer-sponsored health insurance.
Exclusions – Services that are not covered by a particular plan. This means that the insurance company will not
pay for these services, and you will be completely responsible for their cost.
Formulary – The list of drugs that are covered under a specific insurance plan.
Health Maintenance Organization (closed panel) – In a closed panel Health Maintenance Organization (HMO),
all of the physicians and other medical practitioners that provide care work directly for the HMO. As a result,
the HMO and its staff must provide all services in order to be covered under the healthcare plan. If you seek
services outside the HMO, you will have to pay for them yourself.
Health Maintenance Organization (open access) – A Health Maintenance Organization (HMO) with open
access requires that you first see a “primary care provider” that you have selected from a list of physicians the
HMO will give to you or, more likely, give you access to via a website. Your insurance will pay for visits to your
primary care provider and for most of the services (visits to specialists, tests, medications) that he or she
recommends. If you independently seek services from another provider without first consulting your primary
care provider, any expenses you incur will generally NOT be covered.
Health Savings Account – An account established at the beginning of the year using pre-tax dollars, which the
employee then uses to pay for qualified medical expenses during the year.
Indemnity Plan – A type of insurance plan where you pay an insurance premium and then choose your own
physician and other health care providers, refer yourself to specialists, and otherwise make independent
decisions about what type of care you need. Under this plan, the insurance company pays a fixed percentage (for
example, 80%) and usually requires you to pay a deductible and co-payments.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
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Intensive Care Unit (ICU) – A specially-equipped area of a hospital where care is provided to severely injured or
seriously ill patients. Once the patient’s condition stabilizes, s/he is generally transferred to another unit of the
hospital.
Medical Evacuation – A type of insurance that covers the cost of evacuating a sick or injured individual to his or
her home country.
Nurse Practitioner – A healthcare professional who is not a medical doctor, but who has the training necessary
to perform many of the routine duties performed by physicians.
Obstetrician-Gynecologist (OB-GYN) – A medical doctor who specializes in women’s health, including the care
of the female reproductive system and care related to pregnancy. This physician serves as a consultant to other
physicians, and as a primary physician for women.
Open Enrollment Period – The once-a-year window of opportunity when companies allow you to change your
health benefits even without a “qualifying event” such as a marriage, divorce, or the birth of a child.
Out-of-Pocket – refers to medical expenses paid out of one’s own personal funds.
Outpatient Clinics – A medical facility that provides medical care or treatment that does not require an
overnight stay.
Over-the-Counter Drugs (OTC Drugs) – Medications, such as aspirin, that are available without a doctor’s
prescription.
Plan – Distinguishes different levels of medical insurance coverage from the same company. For example, a plan
called “Blue Cross Full Coverage” may be a bit more expensive, but provide unlimited access to healthcare
specialists, limit the co-payments you are required to make out-of-pocket, and pay for prescription drugs. In
contrast, a plan called “Blue Cross Health” may be less expensive, require that you obtain a referral from your
primary care physician before seeing a specialist, require a larger co-payment at the time you receive service, and
exclude prescription drugs.
Pre-existing Condition – An illness or injury that you already have before you purchase healthcare insurance.
Preferred Provider Organization (PPO) – This type of insurance plan provides incentives for insured
individuals to seek care from practitioners who are designated as “preferred providers” by the insurance
company. Under a PPO plan, the insurance company will generally cover a higher percentage of the medical
costs you incur, and may sometimes allow you to pay a lower deductible, if you choose a physician or other
medical practitioner who participates as a “preferred provider.”
Premium – The amount that the employer and/or the individual pay to belong to an insurance plan. The price
is usually calculated on a monthly or pay-period basis.
Prescription Drugs or Prescription Medication – Medications that can only be obtained with a doctor’s
prescription. Generally, you will first need to see your physician so that s/he can evaluate your symptoms. The
doctor will then give you a “script” that you can take to a pharmacy to obtain the medication you need.
OFFICE OF INTERNATIONAL SERVICES | Mail Code 7971 | 7703 Floyd Curl Drive | San Antonio, TX 78229
Tel 210.567.6241 | Fax 210.567.6240 | www.uthscsa.edu/ois
HEALTH INSURANCE GUIDE FOR
INTERNATIONAL VISITORS
Primary Care Provider (also referred to as a Primary Care Physician or Primary Care Practitioner) – Usually a
family practice doctor, internist, OB-GYN, or pediatrician. He or she is your first point of contact with the
health care system, particularly if you are in a managed care plan.
Referral – Permission obtained from your Primary Care Provider that allows you to see a specialist. You may
need to obtain such permission to ensure that the specialist’s services are covered under your healthcare plan.
Repatriation of Remains – A type of insurance that covers the cost of returning the body of a deceased
person to his or her home country for a funeral and/or burial.
Well-Baby Check-Ups – Periodic pediatric examination for infants and toddlers to verify that the child is
developing normally.
