Question: Are there medical insurance requirements for Canadian TN Visa holders?

Answer: There is no federal immigration law or regulation that requires TN visa status holders to obtain health or medical insurance. Generally, the business of insurance is governed by state laws. Federal laws cannot invalidate, impair or supersede any state law regulating or taxing the business of insurance. Nevertheless, under the argument that they do not purport to regulate the business of insurance, a few immigration rules do exist regarding medical insurance coverage for foreign citizens. But none of these apply to TN visa holders.

The J-1 exchange visitor rules require that exchange visitors be covered by health insurance providing certain minimum coverage levels and that the insurance be underwritten by insurance corporations meeting certain nationally or internationally recognized financial ratings. 22 C.F.R. § 62.14. The F-1 student visa rules require that students provide proof of their financial ability to support themselves and the cost of their education. While not expressly provided in the F-1 regulations, the majority of schools consider medical insurance an integral part of the students ability to support themselves. The H-1B visa regulations do not require that an H-1B visa worker possess medical insurance coverage. However, the law does provide that employers must offer an H-1B visa worker the same benefits (including the opportunity to participate in health, life, disability, and other insurance plans) as the employer offers its U.S. workers. INA § 212 (n) (2) (C) (viii).

I cannot write with any authority on the status of state laws mandating health insurance coverage for foreign citizens. At the moment, I believe only Massachusetts has a law on its books requiring residents to obtain health insurance coverage. I have not yet examined this law to determine if it applies to foreign citizens working temporarily in the state. In October 2007, California governor Arnold Schwarzenegger introduced a proposal that would require all state residents to obtain health insurance, through employers, the individual coverage market or public programs. I am not aware where this proposal stands at the moment, nor of the extent it applies to foreign citizens working temporarily in the state.