Health insurance as an international student or intern

The "right" plan here depends almost entirely on your status — and for a lot of people it isn't really optional. Figure out which path applies to you first; everything else follows from that.

The three paths

• Employer-sponsored plan — the default for interns once your employer's coverage kicks in.
• University-mandated Student Health Insurance Plan (SHIP) — most schools auto-enroll international students and bill for it automatically.
• ACA marketplace plan — for gaps: before a job starts, between programs, or if neither of the above applies to you.

If you're a student: understand your school's waiver rules

Most universities enroll international students in SHIP by default and charge for it on your student account — whether you want it or not — unless you actively file a waiver proving you already have comparable coverage, by a strict deadline. How strict, and how early, varies a lot by school: UC Berkeley's recent waiver deadline sat in mid-July with a late window to mid-August, while Stanford's ran to mid-September with no exceptions and no refunds after. Don't assume your school matches either example — look up your specific school's deadline the moment you enroll, since missing it generally means paying for SHIP regardless of what other coverage you already have.

If you're an intern: questions to ask HR before you pick a plan

• When does coverage actually start — is there a waiting period?
• What's the cost split between employer and employee per pay period?
• Can dependents or family be added, and at what cost?
• What happens to your coverage if the internship ends early or doesn't convert to a full offer?

If you're covering a gap: Covered California

California's ACA marketplace is called Covered California. Losing job-based coverage (internship ending, program gap) is a qualifying life event that opens a 60-day special enrollment window from the day coverage ends — miss it and you're generally waiting for the next Open Enrollment period. One thing to plan for: an increasing share of special-enrollment applications are now asked to submit proof of eligibility before coverage is approved, not just self-attest — have documentation of your coverage-loss date ready rather than assuming a quick sign-up.

US health insurance terms worth learning first

US plans are described in terms that don't map cleanly onto most other countries' systems:

• Premium — what you pay regularly just to have the plan.
• Deductible — what you pay out of pocket before the plan starts covering costs.
• Copay / coinsurance — your share of the cost per visit or service.
• Out-of-pocket maximum — the most you'll pay in a year before the plan covers everything.
• In-network vs. out-of-network — using non-network providers can cost dramatically more, or not be covered at all.
• HMO vs. PPO — HMOs are usually cheaper but require referrals to see specialists; PPOs cost more but give you direct access.

What to check before you commit

• Whether prescriptions you already take are covered, and at what tier.
• Whether mental health and counseling visits are included.
• Whether the plan covers care if you travel outside the Bay Area or leave the US temporarily.
• How pre-existing conditions are handled under the specific plan.

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