Popo21

Hi,

I have been working with my current company for over 8 years now in the last couple of years I have been working closely with contacts in the USA Dallas and Australia Melbourne.
Both regions have now offered positions in either location, on the face of it Australia seems the better move but I have always loved the USA.
Getting to the question in hand I would prefer the USA but can anyone give me guidence on:
1) how do the visa's work? I.e. My employer would arrange mine but how would my wife get one?
2) having been some spoilt by the NHS, how does medical cover work in Texas and can anyone give me an idea of monthly cost?

Kind regards
David

Noorah101

1. Your wife fills out a visa application and goes with you to your visa interview. She just has to prove you're legally married and that you're getting an L visa.

2. I assume your employer is providing health insurance, and there are a million different plans, so that would be something to ask the company's US Benefits Department.

Rene

ian-mstm

US immigration is a 2-step process. As you know, the employer starts the process on your behalf by submitting an I-129 petition. This establishes the relationship between you and the company. Once the petition is approved, you'll then be invited to apply for a visa. Your wife can apply for a visa on her own and submit the paperwork when you submit yours. She will receive a derivative visa.

Important: Not all visas allow the spouse to work, so it is vitally important that you know what visa the company is sponsoring you for. If, for example, it's an L visa, then your wife will be able to work after she receives permission. If it's an H visa, your wife will never be able to work. Keep in mind that different visas have different rules.


As Rene notes, there are a lot of health care insurance plans available. If you're negotiating a transfer with your present company, then get them to cover your health care insurance premiums. If that's not possible, then budget about $500-$1000 per month for coverage. If you have children, that cost will likely double. Whatever else you do, make sure you read the fine print on the insurance contract before you sign. The US is a litigious society.

Important: You do not want to be medically uninsured in the US - because a single hospitalization could, quite literally, bankrupt you.

Ian

ChocolateBabz

We were really lucky, hubby's employers took care of all the visa work for all 3 of us. It was just a case of paper signing and then going to the interview in London.

Health Insurance is so variable it is hard to give you an idea of cost. Ours is employer based (through hubby's work) and runs around $440 per month but that is not everything paid for. You will most likely have deductibles and co-pays so get the information up front from your employer so you don't get sticker shock.

We made a spreadsheet before we came of all costs and between British Expats and city-data had best and worst case scenarios for all monthly costs. Other big ticket items that cost significantly more that the UK were car insurance, cell phone plans, electricity (a/c sucks it up in the summer months). If you are renting you will only have to have renters insurance to cover your 'contents' but if you are buying Property Tax is very expensive but made up for somewhat by not having state income tax (you will still pay federal income tax) and home insurance can be pricey if you require hurricane insurance.

Rete

Actually you don't say that it is a company transfer but rather that you have been offered employment by "contacts" made through your present employment. So there is little known about which type of visa you would be applying for if you chose to come to the US. L visas are the easiest but if it is not a company transfer then it is not an L visa. An H-1B visa will have other requirements that you, as the employee, must fulfill to qualify, i.e. education and/or number of years work experience. Unless it is a cap exempt profession there is also the issue of the H-1B being part of the lottery system which means the application has to be entered by a certain date in April and if you are chosen then you can't start until sometime in October. So would be nice to know what visa your prospective employer will be using to get you to the US. There are others and other members can expound on them as I have limited knowledge.

Others have outlined the healthcare expenses but being that you would be working for a US Company it is reasonable to assume that you will be covered under the company's healthcare plan which will greatly reduce your monthly premiums. Normally, this option will also include coverage for your family.

Pulaski

Health insurance is a massively complex issue, but fundamentally depends on what sort of insurance policies your employer subsidizes. .... Bear in mind that 94% of employers with shares on the stock exchange "self insure", meaning they determine the premiums, and pay out for treatment, and only use a health insurance company to manage the scheme. ..... I will guarantee that this is news to a large majority of people in the US covered through their employer's health insurance as they think they are being insured by whoever is managing the scheme!

For someone coming from the UK with health care provided by the NHS, what I am about to say may be shocking, and probably counter-intuitive: you will likely be better off choosing insurance with a relatively low premium and a high deductible (UK speak: "excess") - look for a "high deductible" plan, and then paying for your basic healthcare yourself. You can do this using a "health savings account" (HSA) which works a bit like a private pension - you can fund it using pretax income, and your employer will probably chip-in some money too, then draw funds at any time for legitimate healthcare expenses.

Preventive treatments, such as vaccinations, and screenings, including an annual physical are free, paid for by your insurance (that is required under US law), but the cost of occasional trips to the doctor and prescriptions such as antibiotics and other commonly prescribed drugs, will cost you less over all if YOU pay for them rather than if you pay a higher premium for insurance with a low deductible, which may still be $500-$1,000.

What pushed us over to HD insurance was realizing that we used so little medical services that we weren't even exceeding the LOW deductible! What we realized was that we were paying high premiums and receiving no benefit from them!

If you don't use the funds in your HSA they roll up year on year. The aggregate balances in the HSA's that my wife and I have are very substantial, and as we continue to fund them each year to the maximum allowed by the IRS, they will likely provide a very usefull cushion for medical expenses in our retirement.

vikingsail

With the greatest respect and I know P and I disagree on this point. I offer the following alternative caution, especially to UK residents, moving of the first time to the US who have little if no experience of the complex healthcare system that exists in the US, and the way it can all of sudden go very wrong and cost you thousands of $$.

Gambling with health insurance is precisely that. When you take a circumspect look at your situation and say we are relatively healthy so perhaps saving for a 'rainy day' event is a good idea in one of the 'vehicles' Pulaski describes above. Consider the alternative. All it really takes is one visit to the doctor to discover an unforeseen event. Most cancer treatments end up costing $100K +, thus on a 20% deductible thats 20K you now have to find when the bill becomes due. Routine checks think MRI's, X ray scans etc cost thousands and add up fast. Surgery even minor outpatient can leave you easily with a 10K bill, if its major, kidney, gall stones, a fracture of some kind etc its a lot more than 10K. Pregnancy you will be lucky to escape at 15K without any complications.

Thus, if you are a family of two adults in rude health who stay at home and read all day, possibly you can gamble, if you have kids, imho don't even think about it. Take the lowest guaranteed deductible insurance you can get.

Pulaski

With the "greatest respect" that is not how our HD insurance works. So long as we are "in network" we are covered by our HD insurance to exactly the same degree as with "traditional" (low deductible) after the annual deductible has been met, except that with low deductible insurance we wouldn't have the money salted away in our HSA, so a substantial copay would really hurt.

The maximum family deductible on our HD policy is about $7,000 more than on the alternative traditional insurance, but we save over $6,000 in premiums, so the additional risk, in terms of "worst case scenario" (all the family have four-figure medical bills in the same year) is only $1,000-$2,000, a figure which is now dwarfed by our HSA balances.

@vikingsail: I don't think you have fully thought this through, because it was immediately after a hospital stay which created a four-figure copay for me, that I Iooked at all the numbers - what were paying in premiums and copays, and what insurance paid for, and I realised what a terrible deal traditional insurance is - not least because as I said in my previous post, in most years we weren't even reaching the (low) deductible on the traditional insurance that we had at that time.

Several colleagues have realized the same thing, unprompted by me, including one who has a child who broke an arm during the first six months of moving to HD insurance, and he still says that switching to HD was a good move.

carcajou

I lived for a long time in the United States but now live in Australia.

As others have said, more information from you is needed. Would these be temporary or permanent visas, and do you have kids?

Permanent vs temporary visa means different sets of considerations as to which is better. For instance with a permanent visa, you would be potentially looking at purchasing property - you will get vastly more for your money in Dallas than in Melbourne, where you would be buying at the leading edge of an insane property bubble. With a temporary visa - you would be renting so that's not really a consideration.

If you have children, on a permanent visa, you would have schools and university access to consider. On a temporary visa, those issues take on very different parameters and priorities.

Be wary of assuming, as some seem to do, that Australia is a South Seas version of England just with better weather, or that the country is an extension of the UK. It is not, and in fact is a very, very different place and culture from the UK.

One other note - if you decide on Dallas, insist that health insurance be included as part of your compensation package. That is very standard in the US, not just a perk for senior executives like it can be in other countries.

kodokan

That's not my high deductible insurance works, the open-ended percentage basis you mention. I've had three different HSA-compliant HD policies, and they all have a fixed amount max out of pocket for the year. So it's a known liability.

For example, my current plan has deductibles of $1,300 individual/ $2,600 family (applies to both in and out of network; my plan doesn't distinguish). After that, I pay 20% of costs up to a max of $3k/ $6k. So my maximum liability even if two or more of us have a major medical event is $6k in a calendar year; I could then choose to switch to a different policy if I wanted to. Like Pulaski, I have significantly more than $6k in my HSA as we max it out each year.

Our medical costs normally run to a couple of hundred a year if that, for random kid things; the most expensive year has been $2k for a broken ankle and physio.

Pulaski

Please note that "health insurance is included" does not mean that there won't be thousands of dollars of insurance premiums to pay, and copays and deductibles in the event of you making a claim.

In any case employers are required to provide health insurance if they employ more than 50 people, and to all employees who work more than 50 hours per week or are salaried.

ChocolateBabz

Ours is different too, we have a $3000 family deductible (no individual deductible) then 20% co-insurance up to out of pocket maximums of $5000 per person or $10,000 as a family. So I know the worst case scenario is coming up with $10,000 (which we have squirreled away as emergency funds).

Only once did we actually pay our full deductible and it was when we were on a different plan - so $26,000 bills for a broken clavicle run us in the region of $2,600. Every other year we have been better off in the high deductible plan. If a long term illness cropped up we could change to a different plan.

Also your plan resets at the end of each year - so you could essentially pay your out of pocket max in December and then be on the hook for it again in January if you were really unlucky.

I think the thing to remember is every plan is different and also (for us anyway) it has changed every single year and never for the better

kodokan

Our current plan is a dream. Low potential expenses as outlined above, and we don't pay anything towards the premiums. They even add $1k to the HSA for us annually, without any wellness screening hoops

The one with the previous company was much more costly - premium contributions of about $550 a month, and deductibles/ max OOP of more than double our current ones.

vikingsail

I agree the described plan works. And i see the advantage of saving in a HSA. Please, if you are a newbie coming here you have to check very carefully and ensure you know what your out of pocket yearly max deductible is.

kodokan

Sometimes the whole thing is moot anyway. Hubby's first employer - the $550 a month premium - only offered a HD plan, so the choice was to join that, or pay non-group rates on the private market.