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Expatriate Insurance, Medical & Health Insurance

Guide

For new ex-patriots, leaving our Countries 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 just 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 both mentally, physically and financially of falling seriously ill when overseas,

can become. Private Medical Insurance when abroad is like a parachute when flying. You may not need one

but it better be there, as you and your family would may not survive without one. e.g.: Being evacuated

from the Gobi desert, following a car accident resulting in broken bones, coupled to a suspected fractured

skull is not an easy matter at any time.

The medical insurance plans you may need are readily

available through a worldwide network of specialist Brokers, Independent Financial Advisors, or via the

Plan Insurers themselves, who advertise extensively through magazines and expatriate media. Several

specialist independent Brokers now have their own websites, offering multiple choices of health insurance

plans. The taking of independent advice is always recommended, in order that you not only buy the right

plan, but 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 then complete

all application forms fully, to the best of your ability.

The Premium/Benefit

Trade Off

Too frequently, a potential customer or new client will look to lowest

price or premium cost comparisons, before really considering the specific benefits and area of cover they

may actually need. The ex-patriot client should carefully review benefits of cover offered, check out any

limits to that cover and 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 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. Our motto is for clients to "define their needs" first, particular Area of

cover they need, then their annual healthcare insurance budget. Then, they should look to premium

comparisons, last of all.

Many new entrant expatriate Insurers are taking a much easier line on

HIV and AIDS issues as well as offering chronic conditions cover, if such conditions develop during the

plan lifetime. Post September 11th 2001, many expatriates are now considering the purchase of income

replacement insurance, term life and kidnap insurance, or travel insurance, in addition to their Health

Insurance Plans.

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 this 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.)

For larger groups of expatriates

and large corporate plans, Insurers will frequently offer cover on a "Medical History

Disregarded" basis, meaning that a new plan member might even be in hospital for a triple bypass, but

still have that condition included in the total corporate plan. Clearly with larger numbers of people in a

plan, insurers are prepared to take higher risks and offer lower premiums. Company plans can have premiums

some 15% to even 40% less than individual plans, due to the larger numbers of employees and higher annual

premium overall, charged by that Insurer.

Vital Questions for 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 (free phone)? 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. Or all and any Nationalities accepted or are

there restrictions applying to local nationals? Some Insurers will only take expatriates abroad and not

local nationals into an overseas plan (e.g.: - They may cover six British Nationals in Zambia, not the 100

Zambian local national employees)

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. I.e.: - Once a customer, you may remain a customer, although

premium rates charged can increase dramatically with old 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. (I.e.: pre qualified claim or

placing of a bond with a specific hospital by Insurance Company)

8. Does the Insurer provide for

direct settlement of bills presented by hospitals worldwide, regardless of location? (Or do I 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 I just pay and claim? How long before I get my [spam word detected] 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 add to premiums for

such as Winter Sports or diving holidays.

Nomenclature, names and Plan

Titles

The Product Providers and Insurers delight in launching new plan names with

"exclusive" qualities in their brand names over those of their direct competitors. However,

international medical insurance plans broadly have three key components, which are in-patient or daycare

treatment, outpatient treatment, and then and add-on options.

In this way, a basic or standard

plan usually includes in-patient and daycare, 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,

outpatient with routine dental. Possibly maternity, evacuation, personal accident cover and even chronic

conditions cover in certain cases. (All the bells and whistles plan) We tend to ignore the names of plans

but ensure we have clear ideas of benefits specifically, capping, area of cover and any exclusions, when

comparing plans against a clients requirements. 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

Worldwide 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 USA or Canada should such be needed. Elective care in 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, working out their

own premiums, at the end of this mix and match.

Emergency, Evacuation and

Repatriation

1. Does the Plan include evacuation and repatriation and mortal

remains repatriation or are these benefits 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, but particularly 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 during a tour of duty. You need to know that GP costs will be fully reimbursed, or

that you know the level of deductible, which will be made from any and all outpatient claims. (Each and

every claim or an amount, which cumulates annually) Read your Plan carefully.

1. Many Insurers

offer a limit or budget Outpatient benefits and these issues should be carefully studied in the new plan.

Note any restrictions

2. Check the wording of drugs and dressings offered 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 once the patient has symptoms or is ill. They do not offer preventative checks or Health Checks

at the control of the client. (Some larger company plans do offer well man checks)

Outpatient Cover, Complementary Medicine, Dental plan or Routine Maternity

plan

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 a 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 will give Full

Cover for this benefit.

Many plans do offer benefit for accidental damage to teeth by accident,

but not routine elective dental healthcare Routine Dental treatment is mostly quoted as an optional extra,

as is any option to take out routine maternity treatment. Thus, if you break a tooth you are 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 re

imbursement when a woman is pregnant actually taking out the plan. Almost all Insurers will consider an

existing pregnancy as a pre-existing condition, but will cover emergency in pregnancy. If a couple have

held medical insurance for one year, the Insurer may offer an option, with CO-insurance for routine

maternity costs to a budget limit. Talk this over with a specialist Advisor in Expatriate Health Insurance

More Insurers are now taking a more enlightened approach to the subject of complementary care and

costs of such as 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 across the

world, across a vast premium spectrum, several new benefit cost areas are mentioned below, which are not

always available from all Insurers, but can be quoted selectively in certain Plans.

Well Child

care, well man and well woman checks, all can be quoted

Prosthetic Appliances, can be quoted but

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 on some top plans

Hazardous Sports, quoted on some plans.

Legal

Costs after accidents abroad, quoted in some plans

Complaints

All Insurer Plans should clearly stipulate the complaints and disputes procedures they follow

together with any Regulator. They should illustrate how you may contact the right adjudicators in their

company or contact your independent Advisor for help) There are also independent Regulatory Authorities

available n most Western countries, such as the UK, who can assist you with a dispute with an Insurer (who

is being difficult when settling your claim) If you have bought your Plan through the offices of an

independent Broker or Specialist Advisor they will almost certainly be glad to help in legitimate disputes

with an Insurer. If you are right, have proper records, the Insurers will pay up.

Overview

Generally, as with most Insurance services, you

get what you pay for. Read the documentation carefully, particularly the benefits and exclusions clauses.

International Medical Insurance is a complex and difficult field. Many Insurers are competing for your

long-term business. They all will argue, "Their Plan is Best." Certain strategic insurance

considerations have been also affecting the expatriate market since the World Trade Centre disaster. Many

ex-patriots are now looking for international term life and income replacement cover, as well as medical

insurance. Time will tell how long term insurance growth is affected in this expanding expatriate global

market place.

If you purchase a comprehensive plan from a reputable Insurer, via an independent

Broker, you are usually not disappointed. However, if you buy what is clearly a cheap cut plan, without

advice, beware when trying to make a claim. (They may well have pages and pages of exclusions in the small

print)

It is also important for your budget to choose the correct geographical area of cover.

Routine travel options can be taken at much less cost than full-blown USA cover, 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 best to have at your side so that "you may sleep at night abroad" rather than to

think of ways to 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 differing Insurers, or have a review done by an independent Broker

specializing in the Healthcare Insurance field. All the material needs attention and careful reading.

Understand what you are committing to, what the contract actually states, not what you may think it states

(or some salesman told you) and what geographical limitations are set giving your area do cover.

You may not need to read this contract again until the moment you need medical aid. Remember, that

Brand name alone does not necessarily indicate good service, but that in 2002, 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

lines 24 hours a day, these vital help-lines are the first port of call, prior to any treatment being

arranged, with the exception of emergencies. Establish contact as soon as you can, then let the Insurers

assistance teams do the rest.

Article Prepared By

J Leslie Smith B Sc Econ Honours

Associate IEE
Chairman and Managing Director
Medibroker International


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