TraiNet and Visa Compliance System Support United States Agency for International Development

Submission of files from TraiNet to VCS to obtain DS 2019 form for U.S.-based programs

This is the first of several notices related to the submission of files from TraiNet to VCS to obtain a DS 2019 form for a U.S.-based program. During the past few months hundreds of files have been rejected for various reasons. It is imperative that everyone who enters original data, verifies the data or approves information on behalf of USAID read the documentation and make sure it is complete and accurate.

HEALTH AND ACCIDENT COVERAGE

During this past month, multiple files have been delayed because the proof of HAC coverage has not been uploaded into VCS by the R2 or R3 or the coverage that has been uploaded does not meet ADS 252 requirements. If there is no documentation to confirm HAC coverage or the coverage does not meet ADS 252 requirements, the file will not be submitted to the Department of Homeland Security, and no DS 2019 will be forthcoming.

R3's ARE NOT TO APPROVE A NEW FILE UNLESS ALL 5 REQUIRED DOCUMENTS HAVE BEEN UPLOADED. IF THE MISSION ORDER (MO) REQUIRES ADDITIONAL DOCUMENTATION THEN ALL OF THE MO INFORMATION MUST ALSO BE UPLOADED BEFORE THE R3 CAN APPROVE. USAID WASHINGTON CANNOT SUBMIT ANY FILE UNTIL THE 5 REQUIRED DOCUMENTS LISTED BELOW ARE VISIBLE IN VCS.

  • COPY OF PASSPORT FACE PAGE
  • CONDITIONS OF SPONSORSHIP SIGNED BY THE PARTICIPANT
  • BIODATA INFO
  • PROOF OF HEALTH AND ACCIDENT COVERAGE
  • SECURITY RISK AND FRAUD INQUIRY THAT MEETS ADS REQUIREMENTS

In addition to missing information, a number of files have had locally purchased coverage uploaded. None of the locally secured insurance coverage recently reviewed meet USAID or Federal requirements to use for a U.S.-based program. In some cases the coverage level of $150,000 has been easy to secure, but the deductible has exceeded the USAID maximum of $50. Some companies had no coverage for repatriation of remains or medivac coverage or used language that provided no dollar amount but stated it would cover actual costs. The text related to actual costs does not meet Federal requirements in 22 CFR 62.14. None of the locally secured coverage appeared to meet Federal guidelines related to underwriter standards.

Some locally secured coverage also covers items not required by USAID such as $1000 cancellation coverage or $500 to replace a passport. These funds would be payable to the participant.

Based on recent reviews of locally purchased health and accident coverage we can no longer permit locally secured coverage to be used for U.S. programs. R2's and R3's are responsible for reviewing the information to make sure the insurance coverage was purchased from a U.S.-based provider and that the coverage meets all of the requirements, or reject the file until appropriate coverage is uploaded. Locally purchased coverage may be used for third country programs.

The Affordable Care Act has been incorporated into coverage provided within the U.S. by U.S. based providers. In discussions with current providers we understand that they are applying current industry standards related to pre-existing conditions. We may amend the ADS as appropriate in the near future to clarify after further discussions within USAID. As it now stands, the text in the ADS that mentions current industry standards covers a U.S. based participant, regardless of the issue of a condition being considered pre-existing as well as the statement related to any waiting period to cover a pre-existing condition.

Sponsoring units should also be aware that not all U.S. providers meet the Federal requirements related to the underwriter's ability to cover the cost of claims. Sponsoring units and their implementer must make sure the underwriter meets the following guidelines established by the Department of State. The ratings listed below were developed by companies used by the insurance industry to rate an underwriters ability to cover claims:

Underwritten by an insurance corporation having an A.M. Best rating of "A-" or above, an Insurance Solvency International, Ltd. (ISI) rating of "A-i" or above, a Standard & Poor's Claims-paying Ability rating of "A-" or above, a Weiss Research, Inc. rating of B+ or above, or such other rating as the Department of State may from time to time specify.

252.3.6.2 Health and Accident Insurance

Effective Date: 07/03/2011

Sponsoring Units must enroll EVs in health and accident insurance coverage that meets or exceeds the Federal requirements established to implement the Mutual Educational and Cultural Exchange Act of 1961, as amended, Public Law 87-256, 22 U.S.C. 2451, et seq. (1988) as set forth in the Code of Federal Regulations, Title 22, Part 62.14 (22 CFR 62.14), as periodically updated. Additionally, Sponsoring Units must ensure that certain aspects of minimum coverage meet the following Agency minimum coverage requirements:

  • Medical benefits of at least $150,000 per accident or illness; (USAID has set this amount which is higher than the current amount in 22 CFR)
  • 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;
  • A deductible not to exceed $50 per accident or illness;
  • A 1-year waiting period for pre-existing conditions or other waiting period which is reasonable as determined by current industry standards; (this covers the new requirements under the Affordable Care Act and we may amend the ADS in the near future)
  • No requirement for co-insurance under the terms of which the EV may be required to pay a percentage of the covered benefits per accident or illness;
  • No unreasonable exclusion of coverage for perils inherent to the activities of the program in which the exchange visitor participates.

When selecting appropriate health and accident insurance coverage, Sponsoring Units must also comply with these additional coverage considerations:

  • EVs may be enrolled in health and accident coverage offered by a U.S. college or university, or by a private insurance provider that is typically used by the activity implementer or identified through a search of qualified insurance providers. Selected insurance provider coverage must meet or exceed the coverage requirements specified in this ADS chapter.
  • Health and accident insurance must cover the “usual, customary, and reasonable” charges for required medical services.
  • Health and accident insurance coverage must begin the day the EV departs his or her home country to travel to the U.S. and must remain in effect through the day the EV returns to his or her home country.
  • USAID is not responsible for any medical claims in excess of the coverage provided by the EV's health and accident insurance or for medical claims ineligible for coverage under the EV’s health and accident insurance.
  • Coverage for HIV/AIDS-related medical claims must be confirmed by the Sponsoring Unit and EV through contact with the individual health care provider. Sponsoring Units must not assume that coverage for HIV/AIDS is provided unless it is contained in the individual health and accident insurance policy.
  • An EV must be repatriated to his or her country of origin if diagnosed with a mental or physical disease or disorder while in the U.S. that will unduly delay or prevent the EV’s successful completion his or her sponsored activity. The Sponsoring Unit may waive this requirement only if both the Agency RO and the Mission Director or Washington Office Director provide the Sponsoring Unit with concurrent approval.
  • In cases of terminally ill or incapacitated EVs, the health and accident insurance must cover medical costs only until the point of repatriation at an EV’s home country port of entry. If repatriation is delayed for medical reasons, health and accident insurance coverage must terminate as of the first date a treating physician deems the EV medically able to travel.
  • The EV is ultimately responsible for ensuring that all claims for medical services are submitted to the insurance provider. All claims should be submitted within the time frame set forth by the insurance provider.
  • The Sponsoring Unit must submit premium payments within the deadline established by the provider. Non-payment of premiums may trigger automatic suspension of all health and accident insurance under the EV's enrollment agreement until full payment is received by the insurance provider.

Sponsoring Units must also ensure that approved J-2 dependents are enrolled in health and accident insurance coverage during the period that the dependent is in the U.S.

Questions related to this guidance should be directed to Linda Walker.


Announcement Date: March 6, 2014