International Health Insurance
It is important to investigate the standard and type of healthcare available in your chosen destination, especially if you or a member of your family suffers from a medical condition which requires ongoing treatment or medication. Most countries have at least adequate basic healthcare facilities, but more advanced treatments and procedures might not be available in some less-developed locations. If this is the case, consider whether this might be a problem in the future, and how to cover the cost of travel home or to another country for treatment.
In many countries you will have to pay for medical care, although emergency treatment in public hospitals may be free of charge. If you are going to live in a country where healthcare is expensive you should take out private medical insurance, even if this is not a requirement of residence.
For short-term trips within the EU/EEA, there are reciprocal arrangements for free or low-cost healthcare on presentation of a European Health Insurance Card (EHIC). However, it is important to note that you are not covered by this arrangement if you are living outside your home country – in this case the country’s own regulations for the provision of healthcare to foreign residents will apply.
When taking out health insurance, be sure to check factors such as the annual and lifetime policy limits, whether there are any exclusions which are likely to affect you, whether you are limited to treatment from specific types of healthcare providers, and whether the policy covers emergency evacuation for medical treatment. For more detailed information about choosing expatriate health insurance see the following sections.
Before travelling to your destination, make sure you find out which inoculations or health certificates are needed for entry. Soon after arrival, find out about the local vaccination programme and make sure that all members of your family are up to date with the local requirements. Bear in mind, for example, that the BCG immunisation is given to children at an earlier age in some countries than in others.
Enquire about any specific health risks in the country you are planning to move to, especially those which might affect children. Diseases such as malaria, dengue fever, tuberculosis, Hepatitis A and B, various forms of encephalitis, typhoid and cholera are common in many countries, but the risk of being infected may vary considerably between different areas of the country, and between urban and rural areas. Although it is important to be aware of the risks and take sensible precautions, try not to let exaggerated concerns about health risks worry you unnecessarily.
The British Foreign and Commonwealth Office (www.fco.gov.uk) and the U.S. Department of State (www.travel.state.gov) both provide up-to-date information on the health and other risks associated with travel to countries around the world. On specific local health issues, it may be more helpful to seek advice from doctors or other health professionals in the destination country rather than in your home country, as the former will be more familiar with specific health problems, levels of risks and the most effective treatments or preventative measures.
Ask your doctor, optician and other healthcare providers for up-to-date prescriptions and medical notes before you leave home, and make sure you take adequate supplies of any medicines that are needed by you or your family members, especially prescription medicines, as they may not be readily available at your destination. In some countries, such as Germany, you cannot even buy aspirin over the counter. You may find, conversely, that it is possible to buy drugs over the counter in your new country which were only available on prescription at home, such as some antibiotics. It is important to note that different names are used for various drugs and medications in different countries, so take extra care to ensure that you obtain the right medication.
The range and types of health service providers varies a greatly between different countries, including the relative availability of public and private health care services. You may find that you are able to consult any doctor or specialist without referral, or alternatively that there is a more restrictive system in place whereby you have to register with a family practitioner, cannot switch doctors without good reason and may have to obtain a referral to see a specialist. Systems of dental care, and the cost and quality of this service, also vary considerably between countries.
The United States of America does not require mandatory insurance cover for its residents, although it is wise to have private medical insurance in place as healthcare costs can be significant. Expats who go to work in America may have the option of a company healthcare scheme that would usually cover themselves and their families. If this has not been specifically stipulated as part of a relocation package then the situation should be clarified before leaving and alternative arrangements made if necessary.
In contrast, the Netherlands operates with a requirement that all residents have health insurance. This must be purchased within 4 months of arriving in the country (as an official resident) otherwise residency status may be at risk. Spain, on the other hand, offers retired, unemployed or registered self-employed expats the same treatment as Spanish citizens. However, there can be lengthy waiting lists for treatment so private medical insurance is often obtained in order to receive treatment more quickly.
The system in France is again slightly different; one must be registered with a GP in order to access the healthcare system. An expat who is not working or is below retirement age cannot get free healthcare from the state. The state system in France pays 70% of healthcare bills; the rest of the bill is the responsibility of the individual. If the status of permanent resident is required then proof of healthcare insurance is a necessity.
Those travelling to some areas within the Middle East may find that their destination operates a ‘No Insurance- No Visa’ policy (expats in the United Arab Emirates, for example, may be unable to open a bank account, register their children at a school, rent a house or get a work permit without proof of medical insurance).
Following the rapid rise in globally based companies over the past decade, coupled to vast improvements in telecommunications and the expansion of Internet services world-wide, the availability of private healthcare insurance services to the expatriate community has never been better. However, of the 30-40 million estimated expats living or working globally, less than half of these individuals and families hold valid healthcare insurance plans. As this market for expat cover is growing at over 10% annually, globally, several new plan providers and new insurers have launched new plans over recent years, offering clients increased choices.
For new expatriates leaving the USA or western Europe to be based in a developing country, perhaps for some years, it is often a shock to discover that medical treatment of a reasonable quality is either not available, or very expensive, in their new location. Conditions can differ vastly from Baku to Beijing to the Bahamas. Many documented case histories sadly indicate the devastating experience (mentally, physically and financially) which falling seriously ill when overseas can become.
The medical insurance plans you may need are readily available through a worldwide network of specialist brokers and Independent Financial Advisors (IFAs) or via the Plan Insurers themselves. Several specialist independent brokers now have their own websites, offering multiple choices of health insurance plans. Taking independent advice is always recommended, in order that you not only buy the right plan, but also pay premiums appropriate to your new country area. Do not buy a plan without studying the policy wording carefully, particularly underwriting conditions, benefits, etc. If in doubt, ask, and only when completely satisfied complete all application forms fully, to the best of your ability.
Too frequently, potential buyers of health insurance look only for the lowest cost of premiums before really considering the specific benefits and areas of cover they may actually need. The expatriate client should carefully review the benefits of cover offered, check out any limits to that cover and note any exclusions made by the insurer. Some plans are cheaper for a reason. Often they include large voluntary deductibles on any claim you might make in the future and may severely cap the benefits received under the plan. Cover limits can vary from £50,000 total cover to as much as £5,000,000 total cover. Any major operation in the USA or perhaps an organ transplant can soon eat up a “capped cover” plan. Exclusions to the policy should also be read carefully and advice taken from an independent advisor. Clients should define their needs first, establish the particular area of cover they need, then determine their annual healthcare insurance budget. Only then should they look to premium comparisons, last of all.
Underwriting Terms of Plans
For the individual expatriate or family there are usually only two ways to take out international medical insurance. By means of a “moratorium” application or a “full underwriting” application. It is important to understand these rather jargonised phrases as claims can be rejected if you have inappropriate underwriting. A moratorium plan means that any “pre existing” condition, for which you have had treatment, advice or consultation upon during the last 2, 3 or even 5 years in some cases, will be EXCLUDED from cover. Should you then not have any treatment, advice or consultations for such conditions for a further two years, your insurer may add that condition to your policy. Full underwriting applications mean that all medical history questions have to be completed (not needed on a moratorium plan) and that most insurers may then exclude any particular stated condition which they feel will lead to claims upon them. Full underwriting schemes are a little more complex as sometimes confirmation and clarification letters may be needed from your Doctor in order to have a specific condition covered under your new plan, or for that insurer to offer cover at all (e.g.; HIV or AIDS conditions cover or other long-term endemic/chronic conditions.)
Questions to ask the Insurance Provider:
1. Does the plan allow for cooling off periods, cancellation and then repayment of premium in full?
2. Does the plan offer “Moratorium” or is it “Full underwriting” and do I need to have a medical examination before joining?
3. Does the new insurer offer a 24 hour help line, 7 days a week, available from anywhere in the world (freephone)? Most insurers now offer this facility
4. Are my pre-existing conditions excluded when joining and if so, for how long are such conditions excluded?
5. Are all and any nationalities accepted or are there restrictions which apply to local nationals? Some insurers will only take expatriates abroad and not local nationals into an overseas plan.
6. Does the plan allow you to continue cover unbroken through your lifetime? In most cases insurers will continue to offer existing clients cover year on year, irrespective of age or claims history, although premium rates charged can increase dramatically with age.
7. Does the insurer allow for any doctor or consultant or hospital within the plan? Are there any restrictions in this respect? Most international plans do not place restrictions on either hospitals or doctors, but almost all demand that their help lines are called first, prior to approval of any inpatient care.
8. Does the insurer provide for the direct settlement of bills presented by hospitals worldwide, regardless of location (or do you have to pay first)?
9. What are the insurers procedures for outpatient claims? Do these require any pre-authorization or if stated in the plan can you just pay and claim? How long before you get money back from the insurer? 14 days? 28 days?
The vast majority of expatriate health plans DO NOT exclude certain occupations as do many UK based insurance plans. Expatriate plans do however involve increased premiums for activities such as winter sports or diving holidays.
Nomenclature, Names and Plan Titles
Product providers and insurers delight in launching new plan names with “exclusive” qualities mentioned in their brand names. However, international medical insurance plans broadly have three key components: in-patient or daycare treatment, outpatient treatment and finally add-on options.
A basic or standard plan usually includes in-patient and daycare treatment, but no outpatient or other cover. Comprehensive plans mostly cover outpatient in addition to the inpatient costs, often with a capped limit, whilst “deluxe”, “platinum” or “Premier Plus” plans offer a full cover range of inpatient, daycare and outpatient with routine dental care (possibly maternity, evacuation, personal accident cover and even chronic conditions cover in certain cases). When comparing plans it is important to have a clear idea of benefits, specifically capping, area of cover and any exclusions. For example a USA passport holder living in Paris, who never needs cover in the USA apart from the occasional holiday trip, could take Area 1 European cover, which is often half the price of full world wide cover including the USA. Area 2 is usually described as “world wide cover excluding the USA or Canada” with Area 3 being the most expensive, offering global cover including the USA, all year round
A small travel add-on option can often help with up to 30 days emergency cover in the USA or Canada should it be needed. Elective care in the USA can also be added for just thirty days a year too, at a substantial discount to full Area 3 cover premiums. Some insurers now offer modular benefit packages where clients can “pick and choose” benefits and work out their own premiums.
Emergency, Evacuation and Repatriation – questions to ask
1. Does the plan include evacuation and repatriation and mortal remains repatriation or are these benefits classed as add-on extras?
2. What costs are included in the evacuation or repatriation cover? Some plans only cover travel costs, not accommodation; some plans only give cover one way.
3. Does the plan cover both your outward journey and pay for you to return from where you started?
4. Does the plan cater for one person or can a business colleague or a family member accompany the plan holder when travelling for treatment after evacuation? Emergency treatment when abroad can be very stressful at the best of times and being accompanied can be a huge comfort.
Outpatient Costs and General Practitioner Costs
Expatriates with families and small children will know that outpatient costs and visits to the local doctor are usually the main cost area at home and this is even more likely to be the case whilst abroad. Expats in developing countries are more prone to ill health and most will have at least one or more visits to a GP (general practitioner doctor) during a tour of duty. You need to know if GP costs will be fully reimbursed or if not, the level of deductible which will be made from any and all outpatient claims. Read your plan carefully.
1. Many insurers limit outpatient benefits and these issues should be carefully studied in the new plan. Note any restrictions.
2. Check the wording of how drugs and dressings are covered to note whether “Full Cover” or financial limits are set in the plan.
3. Few plans offer “Elective” or “Well Woman/Well Man” checks. Most international plans cater for healthcare only once the patient has symptoms or is ill, they do not offer preventative checks or health checks at the request of the client. Some larger company plans do offer such checks, however, so if this is an important area for you it is worth asking for clarification.
Outpatient Cover, Complementary Medicine, Dental Plans and Routine Maternity Plans
If you are able to afford the premiums, outpatient cover added to in-patient/daycare cover makes sense. In-patient care gives catastrophic cover or hospital cost cover, but gives no cost cover if you are “walking wounded”. A medium range comprehensive plan may well limit the amount you may claim on the outpatient costs, but a deluxe or fully comprehensive plan will give full cover for this benefit.
Many plans do offer benefit for accidental damage to teeth, but not routine elective dental healthcare. Routine dental treatment is mostly quoted as an optional extra, as is any option to take out cover for routine maternity treatment. Thus, if you break a tooth you will be covered but if you visit the dentist for a crown, beware - you may have to pay. Routine maternity care cover can be a valuable part of overseas family planning, yet many women and families overseas, unfortunately, only contact their broker or insurer when already pregnant. Few insurers will allow routine maternity costs reimbursement if a woman is pregnant when actually taking out the plan. Almost all insurers will consider an existing pregnancy as a pre-existing condition, but will cover an emergency in pregnancy. If a couple have held medical insurance for one year, the insurer may offer an option for routine maternity costs up to a budget limit. Talk this over with a specialist advisor in expatriate health insurance if necessary.
More insurers are now taking a more enlightened approach to the subject of complementary care and the costs of chiropractioners, osteopaths, homeopaths, acupuncturists and the like. These benefits are usually severely “budget capped” by the insurers, however.
Other Cost Considerations and Options
With the growing range of plans available world wide, across a vast premium spectrum, several new benefit cost areas are available which are not always available from all insurers, but can be quoted selectively in certain plans. These include:
· Well child care, well man and well woman checks - all can be quoted
· Prosthetic appliances - can be quoted but are capped
· Eyeglasses and tests - quoted on many deluxe and top plans
· Crowns, dentures and bridges, routine dental - quoted on top plans
· Death of close relative - round trip costs covered on many plans
· Treatment in USA, elective or emergency - usually can be quoted
· Vaccinations - quoted on some plans
· Annual health checks - quoted on some top plans
· Organ transplants, AIDS and chronic cover - some top plans
· Hazardous sports - quoted on some plans.
· Legal costs after accidents abroad - quoted in some plans
All insurer plans should clearly stipulate the complaints and disputes procedures they follow together with details of any regulator. If your claim is fair and you have proper records, the insurers will pay up.
Expat Health Insurance - Summary
If you purchase a comprehensive plan from a reputable insurer via an independent broker, you will usually not be disappointed. However, if you buy what is clearly a cheap plan, without advice, beware when trying to make a claim – there may well be pages and pages of exclusions in the small print.
It is also important to choose the correct geographical area of cover. Routine travel options can be taken at much less cost than full-blown USA cover, for example, if you do not really need elective USA cover. Voluntary excesses on claims can substantially reduce premiums, as can co-insurance payments (sharing risk costs with the insurer.)
In the final analysis, international expat medical insurance is as much about being able to sleep peacefully at night, secure in the knowledge that you are covered should something happen, as it is about making a claim. If both parties fully understand the contract and deal in good faith, insurers very much want to keep clients for the long term. It is always better however, to compare and study at least three packs of brochures from different insurers, or have a review carried out by an independent broker specialising in the healthcare insurance field.
A well known brand name alone does not necessarily indicate good service, many lesser-known expatriate specialist insurers offer excellent premiums, wide benefits, good claims records and fast efficient electronic client services. Professional support teams are vital in overseas emergencies. Your “helpline” card is the key to medical help and assistance 24 hours a day whilst overseas. Make sure that you have it to hand and that you know how to use it. With most insurers now offering toll-free global numbers 24 hours a day, these vital helplines are the first port of call prior to any treatment being arranged, with the exception of emergencies.
Expat Health Insurance Partners
Article content received from: Expat Focus,