International Medical Insurance, How To Choose Group Cover

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Group international medical insurance to cover employees of different nationalities in different locations can be highly complex to organise and manage. Ed Watling, at independent international medical insurance expert Bellwood Prestbury, considers the issues involved.

When a company decides to open an international office or employ people outside their own country there is a moral, if not legal, responsibility to provide employees with suitable healthcare. However the variety of international medical insurance options, the way cover works, local legislation and the inevitable jargon that accompanies it all can be daunting for non-specialist HR or benefits managers.

What level of international medical insurance is needed?
There is a wide spectrum of international medical insurance options available. You can limit your cover to access to hospital services in the event that employees might need hospitalisation abroad, or you can opt for more comprehensive packages that cover all eventualities.

The typical packages available cover:
Inpatient cover only †responding to emergencies
Inpatient ...
... plus specialist consultations and diagnostic tests  helping people to get timely medical support should they fall ill or develop health problems
Inpatient plus outpatient treatments (either with or without medicine), providing the comprehensive health support that employees from developed nations expect at home
Additional options include medical evacuation, repatriation and routine dental care. Insurance providers typically offer companies a choice of a range of benefit packages †bronze, silver, gold for example, or a menu driven approach allowing you to tailor the table of benefits to suit your specific needs. However, your choice of provider may also be influenced by local legislation where your employees are based.

Local legislation
Five years ago, choosing group international medical insurance was relatively simple. That all changed when a number of key expatriate locations brought in legislation not only making medical insurance compulsory for expat workers but also limiting providers to locally licensed companies.

As a result, building a multinational international medical insurance policy has become very complex †with only a few providers able to boast authorisation across most jurisdictions. Many local regulations make it virtually impossible for international health insurers to obtain licenses in their own right so they are forced to negotiate with local insurers for “fronting” arrangements.

Geography
Not all insurers are willing to underwrite expatriates wherever they are. Some won’t accept clients in Iraq or Afghanistan. Others have war risk exclusions or premium extras. Many are only willing to provide cover for expats in the USA for a maximum of 12 months and some will not accept expatriates living in Germany because of local legislation.

Healthcare costs vary dramatically across the globe, so insurers tend to offer geographic cover options that provide regional limits and reasonable costs based on where claims are likely to occur.

The most obvious example of this is the exclusion of the USA, which is the most expensive country for treatment. Costs for including the USA can be double those for other territories.

Each provider offers their own options but in general terms they are:
Worldwide including USA
Worldwide excluding USA
Worldwide excluding USA and other expensive regions (Hong Kong for example)
Regional (for example, cover limited to Europe)
Underwriting
Again insurers offer a variety of options based on their own underwriting procedures and the number of employees to be covered.

For groups of less than 10 employees there are usually only two choices:
Full underwriting †each employee completes an application form and provides details of their personal medical history. Depending on the insurer’s stance pre-existing conditions will either be excluded or covered with an additional premium being charged.
Moratorium †this only requires the employee to complete a simple application form. Any pre-existing conditions are excluded during the moratorium period (usually 24 months) but will be covered after that period provided no treatment has been received.
For larger groups a third option is available: ‘Medical History Disregarded’. This enables the group to be insured without any details of personal medical history, and all pre existing conditions are covered. Often the insurer just needs names and locations of the insured in order to put them on risk.

Pricing
For group schemes with up to 80 employees, international medical insurance will generally be offered on a ‘community rated’ basis. This means that premiums are calculated on the basis of the risk profile of lots of companies that are included in the same pool. This has the advantage of ensuring that your individual claims history does not cause a direct hike in premiums because its effect is smoothed out across the insured pool.

For larger groups there is an option for ‘experienced rating’ where the cost of insurance is derived from the claims paid in the previous year, plus the administration costs of running the policy. In our experience of providing international medical insurance for multinational companies this approach tends to produce a lower premium per head than ‘community rating’ and gives the insured company more control over the cost of cover.

Providers
There are about 25 companies that offer international health insurance for expatriates. These range from “household names” such as Bupa International, AXA PPP and Aetna Global Benefits to smaller niche players like Interglobal, William Russell and A La Carte.

With all the above factors needing to be taken into consideration when purchasing (or renewing) group international medical insurance it is vital that clear independent advice is obtained. Bellwood Prestbury’s international health care audit can ensure that HR and benefit managers are getting the best level of cover for employees at the most competitive price.

To find out more about Bellwood Prestbury’s global employee benefit options, call our experienced team on 44 (0) 1242 584 558.

†Ends â€
Editors
For more information:
Ed Watling at Bellwood Prestbury: ew@bellwoodprestbury.com
Alan Thompson at Bellwood Prestbury: at@bellwoodprestbury.com

Bellwood Prestbury Limited
4 Imperial Square, Cheltenham, GL50 1QB, United Kingdom
44 (0)1242 584 558 F: 44 (0)1242 588 688
www.bellwoodprestbury.com
About Author:
Bellwood Prestbury is an international medical insurance expert offering international medical insurance for multinational companies, as well as international health care audits