How a student’s healthcare is covered

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1. Three ways a government can cover its students

A foreign student training in the United States needs healthcare coverage, and the Security Assistance Management Manual sets out who must provide it. Students outside an American-funded program, and the authorized dependents of all students, must have coverage provided by their government (SAMM C10.9.1). The government chooses one of three routes: an indemnification letter, payment through a Foreign Military Sales case, or proof of a commercial insurance policy.

Students in an American-funded program are treated differently. Their program pays for emergency or non-elective medical and dental care, and their government need not choose one of the three routes for them (SAMM C10.9.1). One rule applies to everyone. Whatever coverage exists, each student remains personally responsible for unpaid healthcare bills, including co-payments and deductibles. The allowance side of student support is covered in living allowance, healthcare and dependents.

2. Paying through a training case

A training case funded with national money may pay for a commercial policy covering the student and authorized dependents (SAMM C10.9.1.2.1). A government group plan need not meet the individual coverage standards if it meets the indemnification criteria. If the country wants the line to cover pre-existing conditions, maintenance medication, non-emergency dental care or elective procedures, that must be written into the case and noted on the travel order. The manual’s examples of such conditions include pregnancy, blood pressure, diabetes, cardiac conditions and allergies. The student’s government must still indemnify pre-existing conditions, including pregnancy, special needs, prescriptions and dialysis.

3. What grant programs will pay

Some grant programs pay emergency or non-elective medical and dental costs for the student only (SAMM C10.9.1.3.1). They include International Military Education and Training (IMET), Foreign Military Financing (FMF), the Regional Defense Fellowship Program and section 333 programs. The manual defines that care narrowly, as only the treatment needed to return the student safely to training or home. It also covers emergency care when a student travels to another country as part of the course.

The money comes from a charge on each training line. The manual’s example is the IMET factor of $35 per student training line, which pays that country’s IMET students’ medical costs (SAMM C10.9.1.3.1.1). Dependents of grant-funded students need a separate country or student-funded policy, or indemnification. FMF may use an approved medical line for students but may not cover dependents (SAMM C10.9.1.3.1.2). On section 333 and other Title 10 capacity building cases, the implementing agency may add a separate medical line, and the case may be amended if it runs short (SAMM C10.9.1.3.1.3).

Grant programs never cover pre-existing conditions, including pregnancy (SAMM C10.9.1.3.2). The student’s government is still expected to pay for them, with or without an indemnification letter, and that responsibility is noted on the travel order. Failure to pay can mean the student is sent home, dependents are removed from the order and lose access, and their visas are recommended for revocation. The manual warns that non-payment will jeopardize future training allocations for the country. Unpaid emergency bills for IMET students follow a tiered scale of approval and penalty (SAMM C10.9.1.3.3).

4. Military and civilian facilities

Care at a Defense Department medical treatment facility generates a bill that is a personal debt of the student to the United States (SAMM C10.9.2.1). When a treatment is not available there, the student or dependent needs a referral before going to a civilian facility, except in an emergency or when the military facility is unavailable, for example on a weekend (SAMM C10.9.2.2.1). Civilian providers usually want to know how they will be paid, and a properly prepared travel order meets that need (SAMM C10.9.2.2.2). Where insurance is required, the patient shows the card, with an American contact, and may owe a co-pay and deductible.

5. NATO and reciprocal agreements

Students from NATO and Partnership for Peace countries may be covered in part by a status of forces agreement. Under it, outpatient medical and emergency dental care at a military facility is free to the student and authorized dependents, though some treatments are for the student only. Inpatient care is reimbursable (SAMM C10.9.3.1.1 and SAMM C10.9.3.1.2). Referred civilian outpatient care is covered by TRICARE Select, with a co-pay and deductible (SAMM C10.9.3.2.2). Civilian inpatient care is reimbursable, and supplemental insurance is required (SAMM C10.9.3.2.4).

Reciprocal healthcare agreements vary by country and do not give full coverage (SAMM C10.9.4.1.1). The student is covered only if named in the agreement’s Article III. For dependents, they provide care at no cost only in military facilities, so they do not help at an installation without one. They never cover civilian care for students or dependents (SAMM C10.9.4.2). Dependents relying on such an agreement must buy supplemental insurance meeting the manual’s standards (SAMM C10.9.4.3).

6. Dependents and the remaining rules

Dependents of a student in grant-funded training need a separate supplemental policy, funded by the country or the student, unless the government guarantees payment in writing (SAMM C10.9.1.3.4). The student should check with the International Military Student Office that the policy covers local school requirements, such as physicals, immunizations, care for pre-existing disabilities, and pregnancy care. The Defense Department does not support students or non-citizen dependents using non-emergency federal, state or other taxpayer-subsidized medical programs (SAMM C10.9.2.2.3).

Where training takes place in a third country, coverage must meet that country’s requirements (SAMM C10.9.5.2.11). Security cooperation organizations (SCOs) are told to check the status and limits of any NATO or reciprocal agreement with the combatant command’s training contact (SAMM C10.9.1.4). The minimum dollar standards and coverage requirements for policies are reviewed every year by the Defense Security Cooperation University, to keep them in line with the cost of American healthcare (SAMM C10.9.5.2.12).

Key terms

Indemnification letter	A government’s written commitment to pay its student’s and dependents’ healthcare bills.
Emergency medical care	Only the treatment needed to return a student safely to training or home.
IMET medical factor	A charge per student training line, $35 in the manual’s example, that pays students’ medical costs.
Pre-existing condition	A known condition, including pregnancy, that grant programs never cover.
Reciprocal healthcare agreement	A country agreement giving limited care in military facilities, which varies by country.

Every statement above links to the document behind it. The full source list for this piece is on the sources page.

This page describes public United States government programs for general information. It is not legal, regulatory or procurement advice, and it does not address the facts of any particular case.

How Sentfore supports this

Health and welfare arrangements matter wherever people are sent to work or train. Sentfore works at the delivery end of defense programs in difficult environments, providing secure movement, protective security, facilities and life support. Requirements can be sent through the contact page.