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WebChat 線上對談記錄

Understanding Medical Insurance in the USA: Your Rights and Responsibilities

Our speakers are Mr. Moon Chen and Ms. Alice Chou, from the American International Education Foundation (AIEF).

Understanding Medical Insurance in the USA: Your Rights and Responsibilities
Friday, May 20 2005 (1:00 PM - 2:30 PM)

Please note: Portions of this transcript have been edited for clarity

Host: (Moon Chen):

Hi, this is Moon Chen from International American Educatuion Foundation. I am very delighted to chat with you through the web today. Hopefully, Iill be helpful to you all. Thanks.

 

Host: (Alice Chou)

Hello everyone, I am Alice from American International Education Foundation. Welcome to today’s webchat. We will be talking about medical insurance in USA.


Start of Chat


 

Host: (Moon Chen)
Q
What kinds of insurance are international students eligible for?
A
International students in the U.S. are required to have medical/health insurance. It is not a matter of eligibility; it is a must for international students in the U.S.. Of course, you are eligible to subscribe to medical insurance in the U.S.. (2005-05-20 13:09)
 
Host: (Alice Chou)
Q
Are there many different levels for medical insurance?
A
是的。通常會有不同的選擇,不同處是保額高低的差異及保障項目的多少。 (2005-05-20 13:10)
 
Host: (Alice Chou)
Q
請問從何處可以得知在學當地美國醫療服務的資訊 ?
A
你可以向學校的國際學生辦公室 (International Student Office)、保健室(Student Health Service)、及學生諮詢中心(Student Counseling Center)洽詢校內及鄰近社區可供利用的醫療資源。他們會告訴你有那些設施可用,何時到何處治療,並回答有關你在美國境內的醫療相關問題。 (2005-05-20 13:12)
 
Host: (Alice Chou)
Q
Can I buy my insurance by the time I get to the U.S. ?
A
是的,如果是購買學校的保險則到校之後再購買即可。 (2005-05-20 13:13)
 
Host: (Moon Chen)
Q
Should I stop Taiwan's medical insurance before I go?
A
It depends on what is your insurance policy in Taiwan. For instance, if your insurance company in Taiwan allows you to claim for your medical expenses, why you should stop. If it is not allowed, you should stop it without any doubt. Again, because international students in US are required to have medical insurance, if required by the school to subsribe to the school medical insurance. Thus it is your choice to stop your insurance in Taiwan or not. (2005-05-20 13:14)
 
Host: (Moon Chen)
Q
為何美國學校都要求國際學生保醫療險?
A
要求國際學生買了保險才能入學的美國大專院校正日益增加。此種保險要求之所以變成強迫性質,部分歸因於國際學生常常不了解美國醫療系統的運作。許多人相信就讀的大學或美國政府會為他們付醫藥費。在美國,每個人都有責任為自己的醫療付費。除了少數低收入的美國公民及永久居民,政府並不會為需要醫療而無力付費的人提供資助。醫療費用乃是當前美國增長最快的花費。由於多數美國人付不起高昂的醫藥費,他們在緊急治療時只能仰賴保險。對國際學生而言,一次嚴重的疾病、受傷、或災難性的緊急醫療,可能意味著財務困境,使他(她)不得不中斷深造的夢想。醫療保險在美國實有其絕對的必要性。 (2005-05-20 13:14)
 
Host: (Alice Chou)
Q
可否舉例美國當地所需的醫療費用?
A
紐約 - [每日住院食宿] $339 , [剖腹生產] $3,669, [盲腸切除] $1,815。 亞特蘭大 - [每日住院食宿] $198 , [剖腹生產] $1,547, [盲腸切除] $860。 芝加哥 - [每日住院食宿] $300 , [剖腹生產] $1,837, [盲腸切除] $1,036。 洛杉磯 - [每日住院食宿] $453 , [剖腹生產] $1,430, [盲腸切除] $1,189 (2005-05-20 13:19)
 
Host: (Alice Chou)
Q
Can you briefly describe what would be coverd in standard medical insurance provided by the school?
A
最基本的保險項目包括門診、住院、懷孕、藥房購藥等。 (2005-05-20 13:19)
 
Host: (Moon Chen)
Q
One question I have is to understand how the whole healthcare system works in the US. It is obviously very different from that of Taiwan, which relies heavily on the government for subsidies. I don't know if that's available in the U.S..
A
Healthcare provided by the state and federal governments are for permanent residents and U.S. citizens over 65 years old. If you are not US permanent residents or U.S. citizens, you don't have the right to apply. Remember, it's for senior citizen. (2005-05-20 13:21)
 
Host: (Alice Chou)
Q
語言學校的學生保險與正式學生之學生保險有何差異?
A
保險內容並無差異。不同之處只在於保險期間的長短,例如:寒暑假期間上短期語言課程的學生只需購買數月的醫療保險即可。 (2005-05-20 13:23)
 
Host: (Alice Chou)
Q
學生保險是否有給付懷孕分娩?
A
一般來說都有包括懷孕分娩,但必須在懷孕之前就買好保險。 (2005-05-20 13:23)
 
Host: (Moon Chen)
Q
Do we have to pay for our medical insurance? Since I have a physical disability, I am not eligible for any nongovernmental insurance. Am I eligible for insurance in the U.S.?
A
I am sorry to say that you will not have the benefits the state/federal governments provided for disabled people, if you are not US citizens or permanent residents. (2005-05-20 13:24)
 
Host: (Alice Chou)
Q
請問需要看病時 一定要先給校醫看嗎?可以直接預約我們希望看的某位專科醫師呢?專科醫師可以直接自己和醫院預約,還是有轉診制度呢?
A
以費用及方便性為考量的話,學校的學生健康中心是較好的選擇。學校的學生健康中心是不需先行掛號就可前往就醫,而且也無需再付費,因為在繳交註冊費時已經包括在內了。如果有必要的話學生健康中心的醫生會幫你轉診到適當的診所或醫院。 (2005-05-20 13:25)
 
Host: (Moon Chen)
Q
If I buy an insurence from outside company, shoud I buy it before I go to the U.S.?
A
It is better to do so. For example, if you leave on August 1st for US, you buy your medical insurance in Taipei which becomes effective on August 1, then the first day you arrive in US, you are already insured. (2005-05-20 13:28)
 
Host: (Moon Chen)
Q
If I buy an international student health insurance from the school, are visits to the doctor still very expensive?
A
No, I don't think so. Because the insurance company will pay your medical expenses according to your insurance plan. (2005-05-20 13:31)
 
Host: (Alice Chou)
Q
我在台灣的保險,已經包含國外的醫療及意外險,那麼,美國的醫療險不就是多餘的嗎?
A
你最好問清楚在台灣的保險公司最高保額是多少?是否足夠支付在美國的醫療費用?因為美國的醫療費用比台灣高出很多 。另外要問清楚如何支費?是否要先自己全額付清再回台灣跟保險公司要回這筆錢? (2005-05-20 13:32)
 
Host: (Moon Chen)
Q
醫療保險的專有名詞有那些?
A
1. 抵減額(Deductible Amount): 多數保險計畫都會要求投保人在保險公司給付以前,先付部分醫療費用。你必須付出的金額就稱為「抵減額」。有些公司有年度抵減額(Annual deductible),亦即每年你都要先付抵減額。另有些公司則有每一病痛抵減額(per occurrence deductible),即每一次生病或受傷,你都要付抵減額,每一次病痛抵減額通常比年度抵減額低,但如果你一年內生病或受傷數次,你每次都要付每一病痛抵減額。2. 共付比率(Co-payment percentage) : 多數保險計畫在你付出抵減額以後,會給付你所付醫療費的一定百分比。例如有些保險計畫付百分之八十,你自己付百分之二十。多數保險計畫會對某些特定的疾病提高共付比率,而對另一些病降低共付比率。 另有一些公司在你自付額達到一定限度(out of pocket maximum)以後,會給付百分之百。萬一醫療費很高,此種辦法可以保護你,因為如果保費成千上萬,以百分之二十算下來,多數學生會付不起。 3. 特殊限制(Specific limits) : 有些保險計畫對某些特殊服務,有給付限額。例如,他們會對住院(食宿)費、醫師費、手術費、心理治療(或分析)費、麻醉費等作限制。如果面對一個有特殊金額限制的保險計畫,你就要查出未來居住地區的平均費用,以確定萬一將來需要此種服務時,此一限額足夠付費。4. 終身或每一病痛最高給付額(Lifetime/per-occurrence maximums):許多保險計畫,對每一投保人的醫療費用有給付總額的限制。有些計畫的最高額是個人終身適用(保險公司為此一投保人付出達到最高額以後即不再給付)。有些計畫則為每一病痛設定給付限額﹔一旦此一病痛的費用達到限額,保險公司不再繼續付款。最高限額越低,投保人所冒危險越大﹔這是因為醫療費極為高昂,平均住院費用動輒成千上萬。5. 受益期間(Benefit period) : 有些保險計畫限制他們為傷病給付的期間。例如,某一計畫有五十二週受益期,在某一病痛發生五十二週以後即不再給付,而不管投保人是否需要繼續治療。慢性疾病和嚴重意外傷害往往需要比五十二週更長時間去治療。在受益期間失效後,學生只好自行付費繼續治療。6. 延長受益(Extention of benefits)--延長受益條款使你能在不符合繼續投保條件時仍能接受治療。許多保險計畫在一定限期內會繼續給付。7. 排除給付(Exclusions)--多數保險計畫訂有在某些條件下則不給付的規定。你應小心閱讀被排除給付的名單,以便確實了解那些項目不在保險給付範圍內。8. 出院及歸國(Medical Evacuation/Repatriation)--對於在美求學的 國際學生,有關出院及歸國給付極為重要。如果你的保險有出院給付,在你因接受治療而需回家時,它會付給你必要的交通費。如果有歸國給付,萬一你死在美國,保險公司會支付運送回老家的費用。雖說不太可能有此情形,但這種事的確發生過,而且國際學生的家人也不會想到這種相關支出。多數美國保險計畫未包含這種可能發生的事件,但某些接受國際學生投保的公司則有此種給付。9. 保費負擔(Premium cost)--比較不同保險計畫之保費負擔誠然重要,但千萬要記得,應以它們提供的可以比較的給付作為評斷標準。一般而言,保費低的保險計畫,給付也較低。你投保多少,就只能享受多少利益,不會更多。因此,費用不應成為你做決定的唯一因素。更重要的是,要確定你買的保險能適度的保護你,以支付意外的醫療費。由以上各點來看,保險計畫的比較可能並不單純。你應花點時間,仔細閱讀保險計畫,有問題時要找人幫忙。其中用小字體(fineprint)印刷的部分,可能就是你需要知道的最重要的部分。 (2005-05-20 13:33)
 
Host: (Moon Chen)
Q
As an international college student with disability, will I be eligible for subsidies or discounts of any kind?
A
No, I don't think so. Disability subsidies are for US citizens or permanent residents. Some schools do have disability scholarships or grants, international students can apply. (2005-05-20 13:37)
 
Host: (Alice Chou)
Q
如果不買學校的,在台灣就要先買嗎?要怎麼買?
A
您可上網查詢或到美國教育基金會查詢。 (2005-05-20 13:38)
 
Host: (Alice Chou)
Q
請問學生健康中心的醫生會幫你轉診到適當的診所或醫院,一般來說需要多久的時間才能看到專科醫師呢?
A
依各案情況而言,醫師會審查情況再作決定。 (2005-05-20 13:40)
 
Host: (Moon Chen)
Q
美國的學生保險,是以學期來分的嗎?還是以年當單位呢?
A
If it is provided by the school, it's on a year basis. If you buy insurance from private insurance company, it's more flexible. You may buy from one month to one year. (2005-05-20 13:40)
 
Host: (Alice Chou)
Q
我的右腿現在還在醫院作復健,但是我今年8月仍想出國,如果我想在國外繼續我的復健,醫療保險上應該注意什麼呢?
A
醫療保險通常會有保前排除期條例,凡是在保險生效前發生的病症或傷害皆排除在保障之外。 保前排除期通常為期六至十二個月,有慢性疾病需長期服藥者或已懷孕者更要特別注意。 (2005-05-20 13:41)
 
Host: (Alice Chou)
Q
聽說有人因為在美國因為看牙醫太貴,即使飛一趟回台灣看都還便宜的多,這是因為那個人沒有保到這一部分的險,還是即使保了險,在美國看牙醫還是比台灣貴很多?
A
在美國光洗牙大約要美金六、七十元,而補牙、拔牙大約要美金一佰多到二佰八左右,就是因為費用偏高所以一般醫療保險不包括此兩項保險,但是如果只為留學期間這幾年再另外為牙齒及眼睛買保險是很不划算的。建議你在出國前先作好牙齒的檢查及修補並多配一副眼鏡備用。 (2005-05-20 13:43)
 
Host: (Alice Chou)
Q
I am a new student of Uni. of Penn. 2005. I'd like to know if I HAVE TO get the school insurance. Or it's ok to get other insurance outside school. Is it better to get U Penn's insurance? But it seems to be more expensive than other ones. Thank you for your assistance.
A
其實只要符合學校的醫療保險要求,的確有很多學校會接受校外的醫療保險。但是最好先與學校確認好再行動。 (2005-05-20 13:46)
 
Host: (Moon Chen)
Q
Any official websites have introduction about US medical system?
A
You are welcome to visit American International Education Foundation or go on web site regarding international student handbook for information on insurance. (2005-05-20 13:49)
 
Host: (Alice Chou)
Q
我在報紙上看到有關不在國內六個月以上,就可將台灣的健保停保,如果我已將買好美國的醫療保險,停保台灣的健保,是否不會影響到我的權益?
A
如果考慮到會回台灣看病那最好保留台灣的健保,你得自己評估。 (2005-05-20 13:50)
 
Host: (Moon Chen)
Q
My future college's Health Office lists the cost of "Office Visit" to a physician as $70. Will that be covered by the student insurance plan?
A
It depends on what insurance plan you have. Some covered, some not. (2005-05-20 13:52)
 
Host: (Alice Chou)
Q
若我有一些獨特的疾病,但學校的醫療保險條款無法更改時,該怎麼辦?
A
如果需要長期葯物治療,那得從台灣持續提供葯物治療。但是美國保險公司是不會支費在保險生效前發生的病症或傷害。 (2005-05-20 13:53)
 
Host: (Moon Chen)
Q
What general guidelines should we keep in mind when seeking medical help in the States?
A
Please read your insurance policy carefully and see what are your rights to have from your insurance. It's very important. (2005-05-20 13:54)
 
Host: (Alice Chou)
Q
我聽說美國也有一些醫療費用便宜的醫院可以看病,是真的嗎?
A
這應該是當地居民才符合資格,國際學生並不能享有這種服務。 (2005-05-20 13:56)
 
Host: (Alice Chou)
Q
請問如果想要看醫學中心的醫生(非診所),一定要經由轉診制度,還是可以自行預約?
A
可自行預約,不過因為有些保險公司有特約醫生或診所,所以預約前你得先與你的保險公司查詢到當地的簽約醫生後再去預約。 (2005-05-20 14:12)
 
Host: (Moon Chen)
Q
請問學生醫療中心會給藥還是要去藥房拿呢?
A
Physicians at school clinic give prescription by which you buy medicine at drugstores. it is not the same as it is in Taiwan. (2005-05-20 14:12)
 
Host: (Moon Chen)
Q
請問眷屬一定要買保險嗎?
A
Not necessarily. But you are advised to do so. Just think about the medical expenses and the possibilities to see the doctor, it is safe to buy insurance for your dependents. (2005-05-20 14:21)
 
Host: (Alice Chou)
Q
請問如果眷屬可不可以也買學校保險?
A
一般而言保險公司都會提供加保眷屬及小孩的保險,但是費用通常會比學生保險費的費率高出許多。 (2005-05-20 14:21)
 
Host: (Moon Chen)
Q
請問美國是否有很多醫療保險公司?如果是,跟每一家購買的保障都會相同嗎?
A
Not necessarily. But you are advised to do so. Just think about the medical expenses and the possibilities to see the doctor, it is safe to buy insurance for your dependents. (2005-05-20 14:29)
 
Host: (Alice Chou)
Q
如果去私人診所診療 是否會比去醫院便宜?
A
美國人的醫療服務使用方式與我們不同,一般人都有自己的家庭醫師.有任何問題會先看自己的家庭醫師,再由家庭醫師視情況來轉診到專科醫師處.在美國診所與醫院的功能也不同,除非緊急狀況或需要住院,否則醫院不會是就醫的第一個選擇。 (2005-05-20 14:30)
 
Host: (Moon Chen)
Q
請問美國是否有很多醫療保險公司?如果是,跟每一家購買的保障都會相同嗎?
A
No, they are not the same regarding premiums and insurance policy/plan. You may choose any plan you see fit for you. Generally, the better plan, the higher premiums you pay. (2005-05-20 14:32)
 
Host: (Alice Chou)
Q
請問我們可以在美國有自己的家庭醫生嗎?
A
是的,如果你的保險公司沒有特約醫師或診所,那你可以請當地人推薦一位好口碑的醫師給你。不然的話,你必須從保險公司的特約醫師或診所找一位當你的家庭醫師。 (2005-05-20 14:32)


End of Chat


 

 

Host: (Moon Chen)

It's my pleasure to chat with you on the web today. If you need any more information about going to study in US, you may visit my office at 5F-1, 237 Fu Hsing South Road, Section 1, Taipei the American Education Foundation, Taipei Office. We provide free service and application information and materials, such as Peterson's publications. Again, hope to chat with you on the web soon. Good luck.

 

Host: (Alice Chou)

很高興今天有這個機會回答各位同學的問題,如果之後同學們還有更多醫療保險或留學美國的相關問題,歡迎與美國教育基金會聯絡,我們會儘量為您解答‧