Being unwell is distressing enough at home, but for those suffering an illness or injury abroad, the situation can easily turn from a problem into a disaster. Not only is the patient faced with a whole new system for accessing medical treatments and facilities, but language difficulties are a barrier and costs can be extortionate.
“An international PMI policy can offer peace of mind and comfort,” says Judith Latham, intermediary at Cheshire-based Private Medicine Intermediaries. “Knowing that your health is covered gives people who are abroad a lot more reassurance.”
Managers in the small corporate market are as concerned as those in large companies that the health of their employees, especially key staff, is adequately covered. Intermediaries are an essential part of the process as they ascertain the company’s needs and determine appropriate levels of cover.
It is a sector which offers enormous potential as smaller companies stretch their business ventures overseas and links with Europe are becoming stronger. “The international healthcare market is very buoyant,” agrees Richard Mills, marketing manager at BUPA International. “And smaller companies are feeling a lot more comfortable about setting themselves up abroad, especially in Europe.”
Intermediaries too have noticed a growing interest in the international PMI among smaller groups, as Latham confirms. “Our international base has really expanded over the past four or five years and much of the international business was gained from our existing client base,” she says. “It is definitely a chance for brokers to maximise business and there is lots of business out there to be gained.”
James Cooper, sales director at specialist international PMI provider William Russell, also stresses that the sector has potential for broker prosperity, explaining: “Although it is rarely an intermediary’s main source of income, it is definitely a way in. It is a door opener for brokers.”
An added incentive for brokers is that many individuals also seek advice on their international PMI when they leave or retire from the company. And with an ever-increasing number of people retiring abroad, brokers are in a prime position to advise group leavers on individual policies for expatriates. “If you have offered a good service when the client was part of the group, they are likely to approach you again when they move on,” says Latham. “So there are opportunities to service group leavers as well as the groups themselves.”
Additionally, larger providers have made it easier for brokers to sell an international plan to existing policyholders and most will accept a transfer from a UK product with no further underwriting. And the growing number of small companies means that providers, eager to promote the benefit, are focusing on intermediary sales. “There is a marked swing towards the use of intermediaries as is shown when we look at group figures,” says Bill Ward, managing director, BUPA International. “Intermediaries can and do play an important role in aiding groups make the right choices for their employees.”
Of course one reason that providers are so motivated towards the small group sector is that they see the successful small groups as one day becoming successful large groups. As Sheldon Kenton, CIGNA’s director, international sales and client management, Europe, explains: “Profitability in this area is mixed, to be honest, but many of the small corporate clients we take on are rapidly growing. So the fact that they are becoming bigger makes them an even more attractive product.” Indeed, CIGNA is so enthusiastic towards this area of the international market, that it has just reduced the minimum size of group for which it will write. “Although in the past, we have generally quoted for groups of 10 and above, we are very interested in the smaller groups and are about to start quoting for groups of three and above,” confirms Kenton. “Domestic business at CIGNA is usually for the large corporate sector and our international business has, to a certain extent, been tarred with the same brush.”
Another incentive for providers is that small group business is relatively simple to write, as William Russell’s Cooper explains: “We prefer to sell to small corporates. The business is very easy to administer and simple to service. Plus, there is a 99 per cent chance of renewal.”
Whatever the scheme, intermediaries who sell it should equip themselves with extensive knowledge to explain why an international policy is so important, as well as details of what policies do and do not cover. In the past, many companies have naively bought travel insurance, believing it would provide adequate medical cover. “People are more aware of the issues involved with needing healthcare abroad,” says Kenton. “Five years ago, there were many small companies who thought that travel insurance may be enough. Now, there is a heightened awareness and so small groups are more readily interested in talking about international PMI.”
Latham agrees: “Travel insurance only offers cover for emergencies, and, quite often, people don’t think beyond emergency cover. But if people live abroad then a full healthcare policy is necessary and employers need to know the distinction between travel insurance and international PML”
So what does international PMI provide?
Most insurers aim to market their international products with as many features as their UK products. While all provide full refund for in-patient treatment, including hospital charges, surgeon’s and anaesthetist’s fees, most will also pay out for a private ambulance and some outpatient treatments such as radiotherapy, chemotherapy and MRI scans. In addition, the majority of products have a helpline open 24 hours a day, 365 days a year and will either repatriate or evacuate an ill or injured customer. While evacuation takes the patient to the nearest hospital, repatriation will ensure that the patient is taken home. The majority of providers will supply cover for groups of three and above and some specialist insurers, such as Crispin Speers, do not state a minimum.
However, certain providers have particular exclusions and restrictions on international cover and it is imperative that intermediaries are aware of which policies are affected. Most cover falls into three categories, providing insurance while the client is either in Europe, anywhere in the world except the USA and Canada, or any country worldwide. Coverage of the USA and Canada can entail the client paying up to double the premium and those wishing to stay in the USA for longer than a year will not be able to renew their international policy as they are ranked a temporary US citizen after 12 months. Additionally, some insurers will not cover any client for treatment in Saudi Arabia due to the high costs of medical facilities and treatments.
Unique benefits are also available. CIGNA, for example, not only provides for the treatment of HIV, but is the only insurer to cover pre-existing and chronic conditions, which, as Kenton explains can be brought on by a foreign environment. “If an employer sends a member of staff to Athens and the clients suffers from asthma, for example, the climate may exacerbate the condition. At CIGNA, we will pay out for this occurrence,” he says. “We are developing a holistic approach to international PMI”
Companies who wish to purchase a bespoke product can use one of the specialist insurers. Latham explains: “Some insurers, such as Crispin Speers, offer tailoring services, so clients can purchase a very specific product. Other providers, like Morgan Price, will allow elective treatment for when the company prefers treatment in a different country from where they are staying.”
Providers are expressing keen interest in the international PMI market and their efforts are discernible. For example, BUPA has seen a policy increase of 10 per cent year on year, and CIGNA, over the last two years, has reported an uptake of 30 per cent on its international side. The opportunities for intermediaries are copious with the number of small groups requiring international cover steadily increasing and providers eager to provide for their needs. “We usually get involved in this area through brokers,” says Cooper at William Russell, “And we always encourage intermediaries to look after this business.”