The sluggishness of the domestic PMI market over recent years has obscured the opportunities within the private medical insurance market internationally.
The complex nature of targeting international consumers direct, and the task of tailoring the right policy, has led to this aspect of medical care being largely undervalued. But a thorough understanding of the specifics of international PMI could open many avenues for those intermediaries wishing to broaden their PMI portfolio.
Estimates suggest that as few as 45% of expatriates have any kind of PMI cover. Assessing the exact figures for this category of insurance is traditionally troublesome. The general consensus is that there is room for expansion in the international PMl industry but relatively little research exists to show if this is really the case.
There is no European requirement to monitor the movement of expatriates. The collation of figures involves going to each embassy and chamber of commerce throughout the continent – hardly the type of market research an intermediary can undertake.
And then there is the problem of expatriate terminology. Some companies call all their employees overseas expatriates, whereas other firms may only define long term appointees as expatriates. Staff working abroad may all have different managers, with no-one exactly aware of the corporation’s total number of people in foreign offices.
While the potential is unchecked, it is also untapped, and some background research can reap rewards. Most important to remember when selling a scheme is that the employee about to head off for foreign climes needs to feel comfortable with the IFA’s breadth of knowledge and expertise. It is therefore worth the time and effort for intermediaries to personalise a global healthcare plan which can be tailored to meet the needs of a range of overseas workers.
A seasoned expatriate will tend to have an in-depth awareness of the type of cover he or she requires. But there are many people travelling to work overseas who have little or no idea what will best suit their health care needs.
For example, young, fit and healthy workers may only anticipate wanting emergency treatment while an older employee will probably demand a comprehensive package in case of illness. It is up to the broker to inform the client of all the eventualities they face and what type of cover is most suitable.
Chris Moore, business development manager at Mondial Assistance, an international medical assistance provider, identifies the expatriate’s principal health insurance concerns. He breaks it down into three key geographical areas: Western Europe and the USA, the Second World and the Third World.
The quality of medical care in well-developed countries – that is Western Europe and the USA – is not the chief issue as standards tend to be quite high, although cost maybe a consideration. It is more important to be aware of what procedures are not covered by the insurance policy.
PMI in the Second World, according to Moore is, in general, not up to acceptable standards. Ex-Soviet Union countries and most of Eastern Europe have pockets of adequate care but Moore believes that it is often a case of “touch and go”. Insurance requirements Vary depending on where the policyholder is living.
Clearly, medical provision in many third world countries is inadequate. But, that said, even in the most developed countries there can be problems.
The majority of insurers, including BUPA and Guardian Health, do not offer cover for chronic conditions such as asthma, diabetes and forms of cancer. And it is common for the policyholder to realise this only when they need it most.
But if this cover is required, it is worth intermediaries shopping around to find those which do.
Jessica Hanslip, CIGNA’s international sales manager, says her company has offered corporate chronic cover for over three years. She explains the impetus behind this: “If you are selling a policy to a company, especially for the US market which has no local state system, the employee is severely disadvantaged when they are without chronic cover. It is an important gap to plug.”
Medicare, part of Lloyd’s broker Steel Burill Jones, goes one step further and has chronic treatment policies for the group and individual markets, providing there are no pre-existing conditions. Sangita Ladwa, marketing manager at Medicare, thinks they may be the only company to do this. Medicare offers the offers two levels of cover, one aimed primarily for in-patient treatment for the individual and their family, and secondly, an executive plan which covers out patient treatment subject to a £25 excess a claim.
A new policy has been launched for the United Arab Emirates, a common destination for many ex-patriates. Underwritten by Al Ain Ahlia Insurance Company, it also offers the two cover options.
The provision of out-patient treatment in the western world is a high priority for many, although it can push the cost of a policy up. Some policies restrict the level of benefit to as little as £1,000 a year or even less. But some, like Guardian Health, offer a full refund of the costs as standard on all specialist consultant and diagnostic procedures.
It is vital too not to forget the spiralling costs of prescribed medicines and drugs. Clients may become disgruntled if they are not informed that their policies only cover out-patient care if it is a result of in-patient treatment. Peter Rousseau, international consultant at international PMI provider, Healthsave, warns against taking too much cover for granted.
“It’s the little things you have to watch for. Very few policies cover GP fees and more often than not, these specific charges could represent the bulk of the customer’s actual expenditure in out-patient treatment costs. From the wording contained in the various product brochures, it is easy to assume that GPs’ charges are included and covered,” he explains.
And beyond hospital and GP services, back-up services can be of paramount importance when the local healthcare system is unreliable. Firms like Mondial Assistance are renowned for their extensive databases of information on the local medical network and in the most extreme cases can arrange repatriation.
The assistance company is therefore able to keep up with the standards of care in far flung corners of the earth and in many cases assess them at the touch of a button. This is supported by the network of correspondents stationed around the world who are on hand to provide expert medical opinion.
The intermediary should make the expatriate customer aware that assistance is readily available. Many providers, such as Sussex-based Goodhealth Worldwide, which is a specialist healthcare broker, have a multi-lingual helpline service which operates throughout the year. Medical advisors can arrange admission to hospital, ambulance transfers and air evacuation if necessary. This is part of its Expatriate Healthcare Plan, which is underwritten by Lloyd’s.
Evacuation is essential for expatriates living in the Third World where healthcare is usually well below acceptable stands. Rousseau asserts evacuation and repatriation should be a standard benefit, not an optional extra. Emergencies can happen at any time and expatriates need to be safe in the knowledge that their healthcare is in safe hands should the worst happen.
Clearly the intermediary’s role is in ensuring a PMI international scheme for each customer has the right structure to support them when they need it most. And this does not just apply to someone living and working abroad.
Many expatriates who return to Britain find their international policy cannot be transferred into a domestic plan. Even if it is possible, this is not always on a no-worse terms basis. Hazel Berrill, head of marketing at Dutch-owned insurer, OHRA, is enthusiastic about the comprehensive nature of OHRA’s Medios International Policy.
“Customers who want to switch to a UK policy can do so, it is not underwritten again. And we have no age-related premium increases. Anyone joining at age 25 will always be treated as a 25 year old even when they reach 70,” she says.
Berrill goes on to explain how OHRA is intending to further promote its international PMI plan, particularly the “pick and mix” element. Berrill says she knows of no other company who allows its expatriate clients to tailor make their own policy, using a menu principle. OHRA’s progressive policies and its plans for the future highlight the extent to which the industry is changing.
The expatriate who expects all their needs to be taken care of is now just a stereotype. People are more business-minded and choose to travel and work overseas, but they may well be expected to organise their healthcare themselves, or prompt their employer to make sure the cover is adequate.
The amount of foreign workers is increasing all the time. When this is combined with governments across the globe rationalising national healthcare systems, the growth of international PMI looks set to rocket. We are living in a world where personal and job mobility is flourishing. The broad and scattered nature of the international health insurance community means it is impossible for one company to have a stranglehold on the business and there are now numerous products aimed at the expatriate market. The opportunities for brokers of all sizes are there to be seized. The world is your oyster.