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Health Insurance Explained "Where expatriate men are married, it most often falls to wives to organise health insurance," observes Shona Farrell of Expat Network. Finding a healthcare plan that best meets your needs can be confusing, particularly for the first time buyer. What do you need, what questions should you ask, and how much will it cost? Complex needs Expatriates have complex needs so it it's important to get specific, individual advice before taking out a plan. An independent medical insurance advisor is the best first point of call. They can also look at long term considerations, if you're likely to be a serial expatriate family. "55 per cent of enquiries to our website are from expatriate women," comments Leslie Smith, CEO of Medibroker International. Medibroker always reviews at least three quotes for clients from their portfolio of over thirty insurers, many of whom are specialists in expatriate insurance. It also offers comparison tables and informative articles including one on maternity on it's website. "Shop around," advises David Pryor of Expacare. "Health insurance is not a product you buy on price alone, you need to look for value and service." As well as analysing services and costs of specialist companies, your best source of information is of course, other expatriate spouses. Level of cover? First of all, you need to consider the level of cover you and your family will need. This will largely be decided on the basis of where you're going. Insurers' websites often detail potential hazards of a destination. "Health care plans divide loosely into basic or standard, comprehensive and fully comprehensive, "all bells and whistles' with names such as "Gold', "Prestige' and "Platinum'," says Leslie Smith. A standard plan covers membership of a local private health clinic for conditions requiring day care, but little in the event of an emergency or in-patient care. DIY policies Women who are accompanying their spouses for a couple of years, with or without children usually opt for at least a comprehensive policy which offers expatriate-specific "add ons'. These can include in-patient care and emergency repatriation for dependants, maternity care, complementary medicine, routine dental treatment and extra regional cover. Ask yourself what's important to you before you decide what to add on. You may end up spending more on a basic plan with add ons, than on a fully comprehensive one, so calculate the costs and benefits carefully. Fully comprehensive plans can include additional preventive health measures such as routine maternity care and well-woman checks, but tend to be very expensive. Emergencies It is vital, particularly in developing countries, that emergency evacuation be included in any expatriate policy. "After witnessing my father struck with dysentery in Iraq, I feel evacuation insurance should be a given," says Claudine Gingell of Tradewinds. "But with some policies you need to ask for it'. "People comment on our compassionate emergency return for death or illness of a relative back home," says Peter Rousseau of Interglobal Insurance Services. "And in the case of evacuation, we take the whole family out too, because we have found the patient recovers more quickly." Every quality insurer should offer a 24-hour worldwide medical assistance line for emergency situations. Most of these operate via International SOS clinics, located in the remotest of places. "A nun who developed Bell's Palsy on a cargo boat was saved from blindness by medical assistance via the captain's radio," says Leslie Smith. Is everything included? Insurers rarely list what you're not getting so look carefully at exclusion policies. Policies may not include routine maternity cover, sports injuries or personal accident and prescription drugs (except Tradewinds), preparation for a trip (except International Health Insurance Denmark), legal cover and home leave. "Expatriates have to remember that health insurance is not a maintenance plan to be depended on for all health needs," says Corinne Harris. Women talk "I first went abroad at 10 months old and had an expatriate childhood," says Claudine Gingell. "I've worked in Africa and I understand what women need when in the middle of nowhere." Whilst treatments such as hormone replacement therapy are covered by policies as part of regular health care, standard preventive tests for women such as smears and mammograms are not. There are also the complex issues of pregnancy and birth. Women's expectations are partly determined by the country they're from. In America, elective caesarians are commonplace, but elective operations are not covered by most UK-based policies. Shell has found that expatriates have different expectations of healthcare depending on their country of origin. "Being an Anglo-Dutch company, IVF, part of healthcare in The Netherlands, is something we're looking into possibly including in the future," says Andy Swordy of Shell. Family matters Nigel and Sarah took out healthcare insurance for a posting to Germany. Sarah was pregnant at the time, and naturally presumed she'd have the baby there. But pregnancy is not an illness, and they were upset and surprised to find no hospital bed forthcoming. If you are planning a family, it is worth considering that maternity cover is usually only effective if a plan is taken out a minimum of ten months before you get pregnant. "Advance planning is more necessary for expatriate families," says Leslie Smith. "Maternity is often a problem as a lot of women abroad prefer to have their baby at home. Women can get around this by taking out a policy that covers two destinations, such as Europe if they're going to Asia, so they will be covered in both. Cover is usually offered for £3000 to £5000. As maternity care is so expensive, it is important to check the fine print carefully as "maternity care' can mean a myriad of things. Make sure it covers your particular needs. "Most of our enquiries from expatriate spouses are about maternity," says Corinne Harris of Medicare International. "We have offered full maternity cover in our Executive International Plan for a long time." Children's health Spouses with young children may be especially concerned about health matters, particularly if going to the developing world. Shell, like most global companies, offers a secondary healthcare plan to their 4,000 expatriate employees and their families through PPP Healthcare. "We notice that spouses and family tend to make more claims than the employee," says Andy Swordy. Some countries have more sympathetic family health care policies, Scandinavia, for instance. "Children are covered free of charge on their parents' policy until the age of ten," says Katherine Stagetorn of International Health Insurance Denmark. "We also provide room and board for parents if the child is hospitalised and if a baby is born with congenital disease, it will be covered." Parents may also worry about older children's health, particularly when they are out of sight. "We had a couple with children at boarding school in the UK who took out private policies for their children," said David Pryor of Expacare. "This meant the children were covered for holidays in the UAE, but they also had access to a private doctor at school." Added extras Quality providers offer an information line for members, such as PPP Healthcare's "Health at Hand', where they can speak to a doctor, nurse or midwife whenever they need to. BUPA International has been offering complementary medicine in the form of chiropractic treatment, osteopathy, hom"opathy and acupuncture, where available, since the 1970s. More healthcare providers are now following suit. But before you start dreaming of Thai massage to get these treatments, you usually need to be referred by a doctor. Paying out It is wise to look at the insurer behind the policy. What is their claim paying ability? How are claims handled and settled, and in what currency? And, importantly, how easy is it to authorise treatment in a foreign country. The long haul If it looks as if you're going to be a serial expatriate family, you need to look at the road ahead. It's worth spending time choosing a health insurer carefully and sticking with them in the event that a chronic condition develops. Most providers do not cover chronic conditions such as diabetes or asthma. "If you were to develop Multiple Sclerosis during your time abroad, you have to ask, what would the provider do?' says David Pryor of Expacare. "Many providers still only support acute treatment of a chronic condition." There is also the sticky issue of pre-existing illness, which only some insurers will consider taking on. With some providers, such as the Exeter Friendly Society and Expat Network, charges don't increase with age. "We offer a no claims bonus of 5 per cent discount on renewal. This is not standard in the industry," says Claudine Gingell. Is it worth it? With health insurance costs between £400 to £1,500 a year, you may not think it's worthwhile. In the Middle East, expatriates may not have a choice. As of January this year, you won't get a work permit for Saudi Arabia without it, and it is predicted that other countries in the area will follow suit. "I generally advise people who are long term expatriates and speak the language to just get basic emergency cover, as they can use the local services for day to day health needs," says Leslie Smith. "But a wife and children accompanying her husband overseas for two years would require more comprehensive health cover." "Fifty per cent of expatriates have no cover at all," says Leslie Smith. If you are one of these, getting health insurance has never been easier. Most insurers offer free quotations over the Internet and many have interactive websites so cover can be set up immediately, as long as original signed documents follow. The low down The big boys such as BUPA and PPP Healthcare offer reputation, interactive websites and plenty of health information and support. These are often the choice of global companies, and can often add on the spouse and family at a discount. But if you need to source your own insurance, it's worth taking a look at the smaller companies such as William Russell and Tradewinds, who offer a more personalised service and being privately owned, can sometimes offer more competitive rates. No two companies are the same and each have different strengths and weaknesses. A single sports enthusiast will have different needs from a married expectant mother. Cybermedicine GP consultations online need to be approached with caution, and buying prescription drugs over the Internet may endanger your health. It may also surprise you to know that "cybermedicine' is currently more expensive than real time care. However, exciting new developments in the US are set to revolutionalise healthcare abroad, not through putting you in touch with "teledoctors', but through providing bona fide resources locally. One site can tell you the generic names of drugs worldwide, their names in every language and which pharmacies in which town you can obtain them. Currently operating domestically, it will soon be able to tell you the top five gynaecological specialists, from Baku to Bejing. Medibroker International is hoping to provide a link by the end of the year. Using the Internet, in the near future we'll be able to find the right drug, the right person, in the right place, at the right time. Action Plan
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Getting Insured:
Medibroker International Healthcare providers:
Expat Network's Expat Healthcare Plan
Expacare
BUPA International
PPP Healthcare
Interglobal Insurance Services
William Russell
Tradewinds
Medicare International
International Health Insurance Denmark
Goodhealth
Exeter Friendly Society Case Studies
Rooting for dental care The wine merchant's wife A spouse 14 weeks pregnant with her third child and moving to France as the wife of a wine merchant, found her current insurance didn't cover her for maternity. The couple, like many, hadn't looked at the policy properly when taking it out. They found us on the Internet and because I have direct access to underwriters, I was able to cover her maternity at no additional premium. However, in the event of a claim they had to pay the first US$2000 instead of the usual US$250. As it happened, the labour went pear shaped. She haemorrhaged and ended up needing care worth US$10,000. If someone has an awkward situation they're more likely to get covered if they go to the independents who can look at their situation on a personal basis. - Tradewinds Once bitten In early August 2000, 37 year old Monica McGrath was bitten by a mosquito in Georgetown, Guyana, South America where she lived with her husband Shaun McGrath, director of Cara Hotels. After various unpleasant symptoms culminating in a very high temperature, lip swelling and itchy red welts on her body a month later, Monica visited her GP who suspected severe, life-threatening, malaria. Monica had been a member of a BUPA International group policy for Cara Hotels for five years. They were contacted and an evacuation aircraft was placed on standby, just in case. "All of the BUPA International staff were extremely helpful, patient and very caring," said Monica. Consequently, it was found that Monica had contracted Dengue Fever, a viral illness spread by the bite of the Aedes mosquito which resolves on its own. "Guyana is a developing country and medical facilities are limited for the treatment of malaria," said Monica. "It was a great comfort that I was covered under BUPA International medical care it helped me and my family to remain calm during my ordeal. It also made me realise how necessary it was to have high quality health cover'. -BUPA International Publication: Nexus Expat News.
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