Intealth ECFMG

Educational Commission for Foreign Medical Graduates

General Requirements


Selected Regulations


All applicants for ECFMG J-1 sponsorship are advised that sponsorship eligibility should not be presumed and cannot be determined until a complete review of an individual’s application has been conducted.

The J-1 exchange visitor visa is a temporary, nonimmigrant visa reserved for educational training purposes. As such, all ECFMG-sponsored physicians must accept the foundational requirements of J-1 visa status:

  • All J-1 physicians sponsored by ECFMG for clinical training are subject to the two-year home-country physical presence (foreign residence) requirement of §212(e) of the Immigration and Nationality Act, as amended. It requires that J-1 physicians and accompanying J-2 dependents reside in the home country for an aggregate of at least two years before being eligible for certain changes or adjustment in visa status in the United States. A Statement of Need from the physician’s country of last legal permanent residence is a J-1 sponsorship requirement and serves to evidence home country support for U.S. training and provide assurance of an applicant’s commitment to return home.
  • Approval of the J-1/J-2 visa depends in part upon the applicant’s ability to prove strong ties to the home country and a clear intent to return home upon completion of or early withdrawal from training, as mandated by §214(b) of the Immigration and Nationality Act, as amended .

Prospective and current J-1 physicians can find additional information in The Spirit and Intent of the Exchange Visitor Program for Physicians learning module.

The following are key regulations outlined in the U.S. Code of Federal Regulations, Section 22 CFR Part 62 for J-1 physicians participating in clinical training programs in the United States:

  • J-1 physicians and dependents must maintain required levels of health, accident, medical evacuation, and repatriation of remains insurance during their stay in the United States. See Mandatory Medical Insurance for more.
  • ECFMG J-1 visa sponsorship authorizes a specific training activity, location, and associated financial compensation. Federal regulations do not permit any additional activity or compensation outside of the defined parameters of the approved program. Unauthorized employment, or “moonlighting,” is prohibited.
  • The maximum duration for ECFMG sponsorship for clinical training is generally limited to seven years. Furthermore, duration of participation is limited to the time “typically required to complete a program,” as defined by the Accreditation Council for Graduate Medical Education (ACGME) and/or Member Board of the American Board of Medical Specialties (ABMS) .
  • A J-1 physician may once, within the first two years of J-1 sponsorship, change his/her designated medical specialty, as defined by the ABMS Member Boards. ECFMG is authorized to issue a change in program specialty before commencement of the third year of sponsorship. Once an exchange visitor physician enters the third year of sponsorship, a change in specialty is no longer permitted.
  • J-1 physicians are expected to advance through progressive levels of training. Regulations limit ECFMG sponsorship for repeat/remedial training to a maximum of 12 months, based on strong support from the program director.
  • J-1 physicians must depart the United States within 30 days of completion of full-time participation in a training program, as defined by the dates on Form DS-2019 . While there is a “30-day grace period during which J-1 physicians and J-2 dependents can remain in the United States, there is no employment or training authorization during this time.
  • A sponsor shall terminate an exchange visitor’s participation in its program when the exchange visitor violates the Exchange Visitor Program regulations and/or the sponsor’s rules governing the program if, in the sponsor’s determination, termination is warranted. In cases of termination, a 30-day grace period does not apply.

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Statement of Need


U.S. Public Law 94-484, effective January 10, 1978, requires that J-1 physician applicants provide a letter of need from the Ministry of Health of the country of most recent legal permanent residence. Such a letter must provide written assurance, satisfactory to the Secretary of the United States Department of Health and Human Services, that there is a need in that country for persons with the skills the alien physician seeks to acquire.

If the applicant is a permanent resident of a country other than that of citizenship, the Statement of Need (SoN) must come from the Ministry of Health of the country of most recent legal permanent residence.

In cases in which a new or updated SoN is required, an original, official SoN issued directly from the Ministry of Health in the country of most recent legal permanent residence must be submitted directly to ECFMG. SoN letters can be submitted EITHER by mail/courier service OR electronically as described below.

Regardless of submission method, per the U.S. Code of Federal Regulations (CFR), all SoNs must:

  • Be issued by the federal/central office of the applicant’s country of most recent legal permanent residence
  • Be issued on official Ministry of Health letterhead and addressed to ECFMG
  • Exactly follow prescribed wording outlined in the CFR §62.27 (see Statement of Need Instructions for Ministry of Health Officials)
  • Specify a need that exactly matches the name of the training specialty/subspecialty being pursued
  • Contain the official stamp or seal of the issuing government and dated signature of issuing official on the SoN
  • Be issued in English; if not issued in English, a certified word-for-word English translation is required (again, please note that the SoN and any translation must follow regulatory prescribed language)

Requirements for Submitting an SoN by Mail/Courier Service

  • To be accepted by ECFMG, the original SoN must be received in the original, sealed envelope of the Ministry of Health. In addition, the Ministry of Health official issuing the letter must place it in a Ministry of Health envelope and stamp the outside flap with the issuing government seal.
  • SoNs in sealed Ministry of Health envelopes must be mailed directly to ECFMG either by the Ministry of Health or the applicant. If sent by an applicant, the applicant must place the sealed envelope containing the SoN in an envelope. The document should be forwarded directly to ECFMG; if the sealed envelope is opened, ECFMG will not accept the SoN. In all cases, use of a courier service is recommended. The mailing address is: EVSP/ECFMG, 3624 Market Street, Philadelphia, PA 19104 USA.

Requirements for Submitting an SoN Electronically

  • To be accepted by ECFMG, the electronic SoN must be submitted as a PDF file from an official and recognized Ministry of Health e-mail address, to ECFMG at MoH@ecfmg.org. The electronic SoN must be a scanned version of the original SoN, which has been fully executed with a hand signature and official stamp or seal. Electronic SoNs must meet all other specifications of a qualifying SoN as listed above, like signatory, letterhead, and text requirements.
  • Do not send the original physical copy by mail if an electronic SoN is submitted.

Any SoN that does not meet all of the above-specified requirements will not be accepted. If the original SoN is not issued in English, the Ministry of Health may provide a copy of the SoN to the applicant for the purpose of obtaining an English translation. The certified English translation may either be submitted in the sealed envelope with the original SoN, electronically by e-mail to MoH@ecfmg.org, or it may be submitted to ECFMG separately. Both the original SoN and a certified English translation, if applicable, are required as part of the application.

Statement of Need Instructions for Ministry of Health Officials

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Mandatory Medical Insurance


The U.S. Code of Federal Regulations (22 CFR § 62.14) mandates that all J-1 exchange visitors and accompanying J-2 dependents secure comprehensive health insurance effective on the program start date indicated on Form DS-2019 and maintain coverage, without interruption, for the full duration of stay in the United States in J-1 status. Any J-1 exchange visitor who willfully refuses to comply with insurance requirements will be considered to be in violation of his/her status and subject to termination from the J-1 program.

Please note that most ACGME-accredited residencies and fellowships provide health insurance options as a benefit of the training program. It is each J-1 physician’s responsibility, however, to ensure that the offered plan(s) meet(s) J-1 regulatory insurance requirements. If health insurance is not provided as part of the training program, J-1 physicians must secure adequate insurance coverage meeting J regulatory parameters for themselves and all accompanying J-2 dependents.

J visa holders are also required to hold medical evacuation and repatriation of remains insurances for the full duration of their stay in the United States. ECFMG provides required levels of both medical evacuation and repatriation of remains coverage for all J-1 physicians and accompanying J-2 dependents under its sponsorship.

Additional details about the regulatory insurance requirements can be found below.

Minimum Required Coverages:

  1. Medical benefits of at least $100,000 per accident or illness;
  2. Deductible that does not exceed $500 per accident or illness;
  3. Co-insurance paid by J-1 not to exceed 25% of covered benefits per accident or illness;
  4. Minimum repatriation of remains in the amount of $25,000;
  5. Minimum medical evacuation expenses in the amount of $50,000.

REMEMBER: J-1 physicians are responsible to ensure that they and their J-2 dependents have health and accident insurance that, at minimum, meets requirements #1, #2, and #3 above. ECFMG provides medical evacuation and repatriation of remains insurances, #4 and #5, to all J-1 physicians and J-2 dependents under its sponsorship.

Additional Information Regarding Health and Accident Insurance Requirements
Any policy, plan, or contract secured to fulfill J visa health and accident insurance requirements:

  • May require a waiting period for pre-existing conditions that is reasonable as determined by current industry standards; and
  • Must not unreasonably exclude coverage for the perils inherent to the activities of the exchange program in which the exchange visitor participates.
  • All J-1 exchange visitors and any accompanying J-2 dependent(s) may also be subject to the requirements of the Patient Protection and Affordable Care Act (see http://www.hhs.gov/healthcare/ ).

Furthermore, any policy, plan, or contract secured to fulfill J visa health and accident insurance requirements must at minimum be:

  1. Underwritten by an insurance corporation having an A.M. Best rating of “A−” or above; a McGraw Hill Financial/Standard & Poor’s Claims-paying Ability rating of “A−” or above; a Weiss Research, Inc. rating of “B+” or above; a Fitch Ratings, Inc. rating of “A−” or above; a Moody’s Investor Services rating of “A3” or above; or such other rating as the U.S. Department of State may from time to time specify; or
  2. Backed by the full faith and credit of the government of the exchange visitor’s home country; or
  3. Part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor; or
  4. Offered through or underwritten by a federally qualified Health Maintenance Organization or eligible Competitive Medical Plan as determined by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services.

The full text of 22 CFR § 62.14 outlining J visa insurance requirements can be found at http://j1visa.state.gov/wp-content/uploads/2014/10/Subpart-A-Federal-Register-publication-8893_PublishedFR_10-6-2014.pdf .

General Insurance Information Links:

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[Last update: March 17, 2021]

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