International Students in Practice · 2 of 4
Who does what on student healthcare
In short
- Some coverage arrangements need a waiver.
- A waiver may be voided if bills go unpaid for 90 days.
- A lapse in required insurance has its own sequence of steps.
1. A shared responsibility
Healthcare for international military students is spread across several parties, and the Security Assistance Management Manual gives each a defined role (SAMM C10.9.8). The Defense Security Cooperation Agency (DSCA) is the Department’s designated authority for security cooperation training and education (SAMM C10.9.8.1). It writes the healthcare policy, oversees how the military departments, combatant commands and security cooperation organizations (SCOs) apply it, and approves exceptions after coordinating with the military departments. Combatant commands make sure their SCOs understand and follow the policy (SAMM C10.9.8.2). What coverage a student needs is covered in how a student’s healthcare is covered.
2. The military departments
Where commercial insurance is required, each military department sets procedures to review students’ policies against the manual and its own directives (SAMM C10.9.8.3). If it uses a contractor for the reviews, the contract cost may be built into the tuition rate as an incremental cost, the same for every student. If the review is not part of the student office’s duties, a separate line goes on the case and the country is charged.
The departments also enforce the rules, in coordination with the combatant command (SAMM C10.9.8.3.1). If a student’s required insurance lapses and the problem cannot be resolved, the department works with the student’s government on paying outstanding bills. If the government will not pay for the insurance or the bills, the department withdraws the student from training and sends the student home (SAMM C10.9.8.3.1.1).
A lapse in dependents’ required insurance has its own sequence (SAMM C10.9.8.3.1.2). The department directs the SCO to remove the non-compliant dependents from the travel order, and the student office collects their identification cards and asks the student to send them home. If the student has not done so within ten working days, the student is withdrawn from training and returned home.
3. The SCO before departure
The SCO in the embassy decides which coverage and payment method applies to the student and any dependents (SAMM C10.9.8.5.1). Where commercial insurance is required, it sends an English copy of the policy and the proposed travel order to the student office. They are due at least 30 days before the report date for an unaccompanied student, and at least 60 days before for an accompanied one. The student also carries an English copy of the policy to deliver on arrival at the first training site (SAMM C10.9.8.5.4). It must get the military department’s agreement that the coverage meets policy before signing the travel order (SAMM C10.9.8.5.2).
Some arrangements need a waiver (SAMM C10.9.8.5.3). Examples are a country plan that makes the student pay outpatient costs and claim them back, or a country that wants to guarantee medical evacuation or repatriation costs instead of insuring them. The SCO sends the request through the combatant command to the Defense Security Cooperation University, which coordinates approval with the military departments. An approved waiver is kept on file and noted on the travel order, and it may be voided if bills go unpaid for 90 days.
The SCO also briefs the student before departure (SAMM C10.9.8.5.6.1). The briefing covers eligibility for care in military facilities and the consequence of letting required insurance lapse, which can be removal from training. It also covers the bar on non-emergency use of taxpayer-subsidized medical programs. The student acknowledges the policy in writing. Any special medical conditions are noted on the travel order without details that would compromise privacy (SAMM C10.9.8.5.5).
4. The student
The student acknowledges in writing the healthcare insurance policy, including the consequences of lacking pregnancy coverage (SAMM C10.9.8.6.1). The acknowledgment also covers the rule against applying, without the military service’s approval, for financial assistance, welfare benefits, a social security number, a driver license or non-emergency taxpayer-provided care. The student presents the policy, in English, to the student office and to medical facilities (SAMM C10.9.8.6.2). The student must tell the student office at once of any medical care needed or received, including pregnancy (SAMM C10.9.8.6.3). Private details need not be shared if they do not affect training, but the office must know a bill may be coming.
5. The student office and regional centers
The International Military Student Office (IMSO) at each school checks the travel order and keeps a copy of any required policy in the student’s file (SAMM C10.9.8.7.1). Where directed, it reviews the policy before travel is authorized and reports gaps to the military department and the SCO at once (SAMM C10.9.8.7.2). If minimum coverage is not met, dependents do not receive identification cards. The office briefs the student on the procedures, including for pregnancy, and obtains a signed acknowledgment (SAMM C10.9.8.7.4). If unauthorized dependents arrive, it asks the military department at once for advice on access and coverage (SAMM C10.9.8.7.5).
Regional centers make sure participants meet the healthcare rules of the country hosting each event (SAMM C10.9.8.8.1). For events in the United States, the specific requirements are set as part of the Fast Track Program (SAMM C10.9.8.8.2).
6. Students on a sales case
A Foreign Military Sales case may include the purchaser’s funds for medical care of its students at military and commercial facilities, and for dependents if the purchaser asks (SAMM C10.9.8.9). A case should not be used only to obtain medical care unless three DSCA offices approve in writing before the offer is developed. Cases funded by Foreign Military Financing may not cover dependents’ care (SAMM C10.9.8.9.1). Every sales case student training in the United States, and every authorized dependent on the order, must have coverage stated explicitly on the travel order (SAMM C10.9.8.9.2).
Key terms
| International Military Student Office (IMSO) | The school office that reviews travel orders and policies and briefs students. |
|---|---|
| Invitational travel order | The order authorizing a student’s travel, which states the healthcare arrangement. |
| Modified medical coverage arrangement | A coverage plan that departs from policy and needs a waiver. |
| Lapse | A gap in required insurance, which can lead to removal of dependents or the student. |
| Fast Track Program | The regional center process that sets health requirements for events in the United States. |
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
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