Guide to expat healthcare insurance -A care in the world

There are many things in life that we, in the west at least, take for granted; clean running water, electricity, England failing to win a major soccer competition... the list is endless.

Should we recover, many of those promises we made to lead a healthier lifestyle and take better care of ourselves go the way of many New Year’s resolutions.

Good health, therefore, is a commodity and like any other commodity it can be bought and sold. And like any other kind of good or service operating in a free market, there are varying degrees of quality and price.

But one old maxim tends to ring true in the Expat Healthcare Insurance market - you get what you pay for.
However, this is a pretty vibrant market with a lot of players and innovation and the first-time buyer may very well be bamboozled by the choice of products on offer.

Before buying a policy, make sure you are clear about the cover you want and understand its limitations.

International Healthcare policies are based on a number of factors. The first is geography. Because the cost of Healthcare in the US, Canada and the Caribbean is so prohibitive, worldwide cover that includes these areas will cost you more. Cost of cover depends on where in the world you are living: Europe including the United Kingdom, not including the Commonwealth of Independent States is one geographical boundary. Worldwide, not including the USA, Canada and the Caribbean is another with everywhere else classified as worldwide cover.

Of course, as with any kind of Insurance, personal circumstances will be taken into account (health, age and so on). Policies that cover ongoing conditions will cost more. Above and beyond these factors, cost of cover will depend on what you want to include, or what you are willing to exclude.

Private Medical Insurance (PMI) will not generally cover you for existing medical conditions requiring ongoing treatment, for accident or emergency treatment, or for cosmetic treatment. Normal pregnancy and childbirth is also generally excluded from cover, but otherwise the extent of cover depends on how much you can afford to pay.
There are usually three main price bands.

These three groupings are often referred to as Platinum, Gold and Silver.
A basic plan - and this will vary according to which insurer you choose - might cover in-patient and daycare treatment and evacuation and repatriation to the UK, The next level up will cover outpatient treatment and dental cover and the top of the range should cover you for all eventualities.

But there can be wide variations within these categories, for example; with emergency evacuation and repatriation, does the benefit include both travel and accommodation costs? Some policies only cover travel costs - not accommodation costs. Does the policy cover both outward evacuation costs as well as the return costs? Some policies only cover you one way. Does the policy cover travel and accommodation costs of family members or a business colleague to accompany you? Some policies do, some don't.

Biting the PMI bullet means paying for cover that lets you sleep peacefully at nights. The more bespoke the policy, the more you will pay for it. The idea of having insufficient cover when an emergency occurs thousands of miles away from home doesn't bear thinking about from a health point of view - nor should it from a cost standpoint. Which is why, despite premiums rising by as much as 35 per cent a year in the UK, it is increasingly the more comprehensive policies that expatriates are choosing.

You need to know that if anything should happen to you or a member of your family, high standard help - encompassing international rescue - will be on hand straightaway. There is little point in cutting corners and policy documents should be examined for all exclusions.
"The price thing is all relative," says Peter Rousseau at InterGlobal Insurance services.

"There are schemes out there that are cheap but offer little in the way of cover. People should read the fine print. The price you pay is the price of the peace of mind for you and your family."
The cost of cover moves in line with rises in medical inflation, which can range from between 5-15 per cent a year depending on geographical location.

Last year saw huge increases in medical inflation in the US and Canada - partly as a consequence of 11 September when a number of underwriters decided to exit the Healthcare market.
Goodhealth Worldwide is a specialist PMI provider for expatriates since 1890 operating in UK, Europe, USA, Hong Kong, Dubai and Jakarta.
It claims to offer "value for money rather than cheap" products providing first class comprehensive cover for clients in a cost-effective manner.

It has aimed to differentiate itself by offering several locally-developed products that match the local environment. Its Premier product is specifically designed for expatriates in France, for example.
Most product providers, however, stick to the tried and tested formula of having banded products.

PPP Healthcare offers Standard; Comprehensive and Prestige international Healthcare cover.
Standard cover provides evacuation/repatriation and regular inpatient treatment at £48.19 a month for a 30-year-old male.
Its most popular product is the Comprehensive which for £60.52 a month you get outpatient treatment.

Prestige is available at £89.04 per month for a 30-year-old male. It includes extras like travel Insurance, a disability lump sum payout, dental cover and pregnancy/childbirth.
Senior marketing controller Sarah Marfleet says: “It depends on where the client is going and what their individual needs are.”
But John Brown, chairman of Insurance intermediary JBI Associates says the big providers are ignoring individuals’ needs.

“A certain degree of complacency has crept in. They bring out products with different benefit levels but won’t offer a bespoke product. Benefits go to the brokers who bring in the business.”
His company offers a bespoke worldwide service to the many of thousands of expatriate teachers – both to groups and individual teachers - and he claims to beat the price of other product providers.

“Our product is more competitive and has greater benefits. Where others tag on an extra 15 per cent for individuals, we charge them the same price as group cover. A person wants to feel special – they don’t want a product off the shelf,” he says.
You can cut costs of the more comprehensive policies by agreeing to pay some of the costs yourself, from £50 a year right up to £5,000.

The last point is whether or not to fill out a full health questionnaire before taking out a policy. If you do, you will know exactly which conditions are excluded from cover. If not, you will not know for certain whether you are covered for a particular course of treatment until you make the claim. Some providers offer a choice, others do not.

There is plenty of choice out there. Take a look at the check list below, decide what cover you require and then go to www.medibroker.com which can provide you with a quote on over 150 PMI products.

PMI Checklist

Choice of Hospitals and Clinics
Does the policy allow you and your doctor freedom to choose the hospital or clinic in which you are to be treated? Some policies operate a restricted list of hospitals and clinics, limiting the choice you and your doctor have.
Direct payment
Does the policy offer automatic direct payment to Hospitals and Clinics in full settlement of all your eligible in-patient treatment claims, regardless of location (provided of course you are covered)? If not, you could be out of pocket while your claim is being processed.

Pre-existing medical conditions
Does the policy cover pre-existing medical conditions or exclude them? Some policies exclude pre-existing medical conditions permanently from cover. Some policies postpone cover for five years and some postpone only for two years. After these periods of postponement (moratoriums), the pre-existing medical conditions may become eligible for cover - provided the medical conditions have not recurred in the interim.

Emergency Evacuation and Repatriation
Some policies only cover travel costs - not accommodation costs. Does the policy cover both outward evacuation costs as well as the return costs? Some policies only cover you one way. Does the policy cover travel and accommodation costs of family members or a business colleague to accompany you?

Out-Patient Medical Treatment Cover
Do consider a policy that covers out-patient medical treatment - unless you have a specific reason for excluding it. Some policies will restrict the level of benefit, others will provide full cover.

Doctors' charges
From the wording contained in the various product brochures, it is easy to assume that Doctors' / GPs' charges are included and covered only to discover - usually after the event - that not all policies will cover you. Others place a limit on the amount payable.

Out-patient claims: delays
Does the policy give any undertaking to limit delays? Some policies contain guarantees of maximum turnaround time on claims. Some will even pay you a penalty if they exceed their guaranteed turnaround time. Going for settlement guarantees makes sense.

Dental treatment
In the event of an accident in which a person's natural teeth are damaged, the actual cost of dental treatment could be significant. It is advisable to consider a policy which provides full cover or at least a high level of benefit.

Compassionate emergency travel home
In the event of death or critical medical condition of a close family member of yours in your home country, will the policy cover you for the cost of a return airfare to travel to and from your home country? It might be well worth selecting a policy that includes this benefit.

Home country cover
What happens if you return to your home country? Will the policy cover you while you are in your home country? Some do, some don't. Select a policy that covers you in your home country.

Legal expenses and personal legal liability cover
Inclusion of these two benefits in a policy can provide you with a distinct enhancement. Were you to suffer accidental bodily injury caused by a third party, your policy will not only cover your medical expenses, but will also indemnify your legal costs in pursuit of a claim against any third party responsible.

Voluntary deductible (excess)
If you consider yourself particularly healthy and the likelihood of your claiming for medical treatment is low, then it could be worth your while taking a closer look at policies which offer you a reduction in premium if you are prepared to accept a voluntary excess.

No Claims Bonus
If you consider yourself particularly healthy, do have a look at those policies which offer you some benefit for the years your policy may remain claims-free.

Cancellation
Does the policy allow you a "cooling off period" in which you may cancel the policy if, for whatever reason, you feel it does not meet your precise. And if so, will the premium be returned in full?

International HelplineDoes the policy provide around the clock personal service? Does it give you access to a multi-lingual international helpline 24 hours a day, 7 days a week? Make sure it does.

ADVICE TO READERS
While this website is checked for accuracy, we are not liable for any incorrect information included. We recommend that you make enquiries based on your own circumstances and, if necessary, take professional advice before entering into transactions.
 

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