Expatriate Healthcare

Since the explosive growth of the past decade in global telecommunications and the Internet, more expatriates are working on contract overseas, than ever before. More families and couples are retiring abroad at an earlier age, being very familiar over the years with foreign holidays to such as Spain and Portugal, or Florida. Private Medical Insurance, Income Protection and Critical Illness cover are becoming vital pre-requisites of the expatriate, particularly if one has a young family. Overseas tours are well paid, but few companies offer the benefits of a decade or so ago. Expat tours are often only a 1-3 years. Thus, keeping fit AND having Healthcare Insurance is often essential for peace of mind.

There are two matters, apart from premium costs, where potential expats often have little information. The first are the costs of medical services. For example, the cost of a fully supported emergency evacuation to Europe from Saudi Arabia can be at least £25,000. A simple hernia operation costs about £1,500 in the UK today, probably 2-3 times more in the USA, with a hip replacement costing anywhere from £5,000 to £50,000 depending on the complications of such surgery. A major operation such as heart surgery or multiple pinning of bones following accidents can be many thousands of pounds in surgery and aftercare. Claims totalling £100,000 are no longer unusual. Thus, the costs of even a minor operation is often a big shock in itself. The second matter is definitions regarding Insurance Company Plans and Policies. What does it mean in benefit terms, to have a SpecialCare Plan or a Deluxe Plan, an UltraPlan, Standard or Budget Plan?

At Medibroker, Independent Healthcare Insurance Advisors, we provide clients who visit our Website, with free quotes, comparing benefits of major specialist expatriate insurers against cover levels offered for such benefits. Secondly, we look at premiums to suit the client’s budget. Generally, a Comprehensive or Ultra/Premier/Special/Deluxe Plan will cover both Inpatient care whilst offering a series of add-on options. These can range from routine dental/optical/ routine maternity, emergency evacuation, travel cover elsewhere and personal accident. Some Plans even include a period of Income Protection in their Options. Standard or Budget Plans are usually basic emergency and hospital care Plans. They do not offer Outpatient cover, Options, specialist Outpatient cover, nor Complimentary Medicine care.

The majority of expatriate Plans expose clients to paying the bill themselves (for Outpatient costs) and later arguing about settlement with the Insurance Company. Nevertheless, a few insurers are now opening their eyes to global advances in telecommunications (digital satellite) and electronic mail (e-mail) allowing their medical insurance staff to quickly contact doctors and hospitals abroad. Thus "pre-authorisation" systems are now offered by companies such as InterGlobal Insurance Services Limited, where clients only have to call their International Help line to take care of financial negotiations and settlement with hospitals surgeons etc. Inpatient hospital costs are always pre authorised by insurers.

Moving on to the minefield of how to compare and assess premiums. The Insurance Companies and their Underwriters have split the world broadly into three zones. The first zone is Europe, the second ‘the rest of the world’, excluding the US/Canada/Carribean, and the third is Worldwide, including the USA/Canada and Carribean. The exception being IHI danmark who have an international blanket Plan. As International Brokers, we find it is most important to find out which zone the client falls into and how often, how long, and to where the client travels to from that zone. For example, if we have a client executive who spends three weeks in Bermuda and three weeks with his wife and family in his home base of Malta, he also has frequent trips to USA. The Options are:

1) To place the whole family on global cover;

2) To cover the husband single Worldwide, with the family on cheaper European cover only, with a Travel Option;

3) To place the whole family on European cover with special Travel Options as required, e.g. business and family to the USA.


If one travels "out of zone" for periods of any time, some Plans often limit medical cover and restrict time scales. This needs careful study as the worst case scenario would be to have cover in Frankfurt and London, go to New York for a week without USA cover, and suffer an accident or illness. Deductibles or excesses are another way to reduce costs of premiums, but it must be emphasized that you will be paying the first £250 or £500 of any specialist visit or hospitalisation, if you have elected for this Option. Outpatient mandatory excesses can range from £25 to £100 to be paid by the client for each "condition or treatment" claimed for, not necessarily for each and every visit to the Doctor.

It is important for the potential expatriate or resident abroad, to take advice from an independent healthcare advisor or broker, who is not a tied agent, (selling only one insurer's products). In this way you can obtain "best advice" on the company product which is most suitable both for your zone of future base and your travel plans. If you are looking for value for money and a broad range of benefits, call/email or contact an independent healthcare insurance Advisor. Their advice is usually free, they have a wider choice of insurance plans and they will be be paid commissions by the insurer where your application is placed. You do not get a plan cheaper, by going direct to insurers yourself.

As the personal finance and healthcare insurance global market expands for expatriates, more Insurance Underwriters are entering the market, offering increasingly better terms. Additionally, expatriates are becoming more discerning as national health schemes gear themselves more towards emergency service only. The new insurance Medical Plans are competitive and offer increased benefits such as Personal Travel Plans, Personal Accident and Dental Plans. One must choose carefully and know exactly what one is getting for your money, so as not to be disappointed or misled.

To end on a positive note, premiums are covering a great deal more today than a decade ago and, pre-Authorisation systems coupled with good quality global telecommunications has helped to put many expatriates’ minds at rest. Medical emergencies and claims handling is now a professional international business and mostly runs smoothly and efficiently, often in the most inaccessible places.

Expatriates, those retired as residents abroad and the international global traveller, are now a serious portion of the healthcare insurers client portfolios.

International Health and Medical Insurance is one major component of the expatriates insurance protection blanket. The others to consider are term life cover, income protection and critical illness cover or personal Accident/dismemberment insurance. Highly paid contract employees worldwide, can be very vulnerable if they do not consider the consequences of "Who pays?" for illness and accident time off when overseas. The financial cost can be tens of thousands of dollars.

Leslie Smith B Sc Econ (Hons) Associate IEE
Founder, Medibroker Limited
December 2000