J-1 Scholar Insurance Confirmation Form

First Name

Last Name

RIT Email (if you have one)

Alternate Email

SEVIS ID Number (ex: N0012345678)

Per federal J regulations at 22 CFR 62.14, all J-1 exchange visitors and J-2 dependents must hold insurance to meet specific Department of State requirements, for the duration of their stay in the US in J-1/J-2 status.

The J minimum requirements are:

Medical benefits of at least $100,000 per accident or illness
Repatriation of remains in the amount of $25,000
Expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $50,000
A deductible not to exceed $500 per accident or illness.

By submitting this form, you confirm the following:

I have read and understand the J insurance minimum requirements.
I will comply with these regulations by enrolling myself and my J-2 dependents (if applicable) in a plan that meets or exceeds the above minimum requirements, for the duration of J status within the US.
I understand that willful failure to obtain and maintain insurance that meets the J requirements is grounds for termination of my J-1 program.
I understand that it is my responsibility to verify whether my insurance meets the J-1 insurance requirements.
I understand I (and my dependents) may also be subject to requirements of the Affordable Care Act.