As international PMI has grown in popularity, providers have come under increasing pressure from clients and intermediaries to create specialised policies to cover both the needs of individuals and the idiosyncrasies of the countries in which they stay.
The approach of companies to this has varied, with some opting to increase the range of their basic plans, and others offering top up policies to keep down the cost of core cover.
Judith Latham of Private Medicine Intermediaries, winner of the Health Insurance International PMI Intermediary Award, has seen clients become increasingly choosy over the past few years as the PMI market has grown. She points to elective treatment as just one area where clients like to have choice.
“Some clients don’t want treatment in the country they are residing in, for example, a lot of people in the Far East prefer to go to Australia for treatment,” she says. “Deciding on this option often depends on the facilities that are already available in the country. In the case of dental care, the need for it depends on how long the company or individual is out there. If it is three to 12 months it is not crucial, but any longer than that and it becomes important.”
Many providers have introduced niche products as a way of catering to specific needs. In some cases, the definition of a niche product has been as straightforward as the provision of cover for pregnancy or dental care, while other providers have seen a market in specialist groups, such as the crews on international yachts. However, whatever the requirement, Latham finds that insurers are increasingly willing to be flexible to clients’ needs.
“For large groups insurers will work to attain what they want, although the larger companies tend to be less flexible than the smaller,” she says.
Increasingly, niche products are being incorporated into insurers’ main schemes, with some offering what are effectively top-ups to the core schemes.
In the case of Danish company International Healthcare, elective treatment is offered as standard, with customers able to choose not only the country in which they want to be treated, but also the hospital and specialist. In addition to this, the company offers dental and optical insurance and medical evacuation insurance as supplements to its three core plans – Principal, Top Up and Hospital.
“We offer totally worldwide cover and people can elect to be treated wherever they like,” says marketing co-ordinator Sue Lord. “We are targeting high net worth individuals and people are asking for more sophisticated policies. The world is becoming a smaller place and people are moving around a lot so they want that freedom.”
At Morgan Price International, the company tries to accommodate clients’ needs whatever their complexity, particularly for company policies, according to managing director John Carpenter.
“We tend to send out information on our standard plans for individuals, and some companies buy these as they stand – but others don’t,” he says. “Some companies, particularly those based in the US, have asked for extra cover when travelling outside the country and others ask for medical histories to be disregarded. We get an idea of what they want and try to supply it.”
Requested options include maternity cover from day one, which is provided with a small loading and cover for pre-existing conditions.
Carpenter admits that such flexibility does not always come cheap. “All risks have a price – it just depends on what they want to pay, but we would rather offer it with a cost than say no outright,” he says.
He admits that for some requests – notably routine dental cover – it is a struggle to find an insurer who will cover the risks. Morgan Price is currently investigating a capitation scheme with a dental provider to get around this problem which it hopes to launch as an add-on later this year.
Carpenter also believes clients are getting more choosy, but says that adopting a flexible and informed approach can lead to a satisfactory outcome for all parties.
“Customers are more aware of what is available – and more aware of the conditions that are applicable in the countries they are working in. If outpatients’ services are available at a reasonable price in the country, they may opt for inpatients only and pay for the rest. But in other countries this is not appropriate,” he says.
Carpenter also believes intermediaries should seek the advice of providers when helping decide on the right product. “The key thing is to have an insurer who understands your markets and can match your needs if you ask them to,” he says.
At William Russell, the company is confident that the three core products in its International Corporate Healthcare Plans range offer the flexibility that clients require. The company’s Premier Plus Plan covers chiropractic, osteopathy and acupuncture, as well as maternity care after 12 months and all dental treatment. Although the company. can come up with tailored policies for groups of 50 or more, sales manager Tina Pollard claims this is seldom necessary. “Customers don’t generally expect tailored policies,” she says. “We have three schemes to choose from and most important things are covered. It’s about what people find is most important for them someone of 45 won’t want pregnancy cover but will want dental, for example.”
As with most insurers, William Russell examines its policies each year and aims to include things that people requested. “The last big niche thing we added was chiropractic and osteopathy which have been added within the last five years,” she says.
CIGNA Healthcare is another company which believes its core products offer the range customers need.
“Our position generally is to go for a high level of cover and not tailor backwards or forwards on that,” says director of international sales Sheldon Kenton. “We have found it more sensible to offer the package and say why people should have it. We have started from a high common denominator, and things like pregnancy are already covered, whereas if the policy is basic, people want to tailor up.”
As it is, the company says it rarely gets requests to extend its plans. “More often we are asked to tune things down and we try to do this through cost shifting with excesses and deductibles. Our experience is that employers are shifting towards comprehensive cover,” says Kenton.
He claims the company has responded to what the market wants, and the inclusion of alternative therapies is now routine.
“There is a movement towards.alternative therapies and we will cover on the basis of a GP referral – doctors tend to refer for legitimate and accepted treatments and these are covered,” he says.
“It is not for us to argue with doctors about the validity of treatment and compared to a back operation, osteopathy or physiotherapy is very cheap.”
Another provider, Primary International Healthcare is aware that the requirements of international PMI customers can vary dramatically according to location and circumstance.
Its Platinum Plan covers all the areas that could result in costs for expatriates, including dental treatment, pregnancy and childbirth.
The company also offers very specialised products, the most recent of which is Crewcare, aimed at professional crew members. This policy offers global medical assistance for crew members on board, on shore, changing boats or travelling.
Another niche product from the company is the Premiere and Premiere Plus policies for expatriates living in France – these are not full-blown medical insurance but mirror the top-up policies that French nationals buy to supplement the French healthcare system. It also has specialised plans tailored to the specific needs of the Spanish and Portugese markets.
Primary International Healthcare managing director Paul O’Sullivan believes that this particular section of the market needs both specialist knowledge and a co-operative approach between insurer and intermediary.
“You can’t simply dip your toe in the water of the international PMI market because it looks attractive,” he says. “It takes time to build the relationships and knowledge necessary to make the whole thing work well.”
So, in an increasingly complex market, it pays intermediaries to do their homework to ensure that international PMI clients’ needs are met.
In helping clients to decide on the best policy for them and the country they are staying in, Judith Latham reckons it is important for the intermediary to look at the facilities available in the destination country as some are obviously better catered for than others.
“You need to read as much as you can and speak to insurers as they will help with the information you don’t know,” she says.
Because if you don’t, you can be sure that your clients will exercise their choice yet again – and take their business elsewhere.