Multiple employees, different territories, one policy.
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As the name suggests, it’s a form of private health insurance specifically designed for the needs of international businesses. In one policy, a business can insure the health of its whole workforce across different territories, rather than invest in separate individual policies for each country.
In practice, this means employees can:
It’s more comprehensive than a regular private health insurance policy encompassing services such as maternity care, house doctor visits, multi-lingual helplines and much more.
International Business Health Insurance is also commonly referred to as Group International Health Insurance and Global Business Health Insurance among other variations.
The worldwide International Health Insurance market (also referred to as International Medical Insurance, International Private Medical Insurance (IPMI) or Worldwide Health Insurance), is the 6th largest private medical insurance market in the world, and growing at a pace, outstripping most other domestic markets.
The largest and fastest growing segment of the International Health Insurance market is small-to-medium-size enterprises (SMEs).
The businesses we work with have implemented a International Business Health Insurance plan for a variety of reasons, including:
Engage International offers an expert level of consultancy to implement, or review any existing arrangements, and ensure that the best International Business Health Insurance policy is in place.
International Medical Insurance coverage is richer than the private health insurance policies which you typically find in domestic markets.
As well the core, In, Day and Out-patient benefits that are covered on domestic health insurance plans, there are a range of key additional benefits which are included in a company International Health Insurance either as standard, or as an optional add on:
Most Group International Health Insurance providers also offer a range of additional benefits which can be valuable for all employees. These include:
The International Business Health Insurance market is a competitive one due to its global nature. We work across the whole of the marketplace and the following are all recognised providers:
All these insurers offer a range of International Private Medical Insurance products and optional add-ons. There are also different suites of products designed for different parts of the world which have territory-specific requirements, like the Middle East, USA and parts of Asia. Consequently, there are hundreds of International Business Medical Insurance products available, offering varying levels of cover, via providers with differing levels of capability in different countries.
The complex nature of International Health Insurance means that all businesses are strongly recommended to seek out independent, expert advice. International Health Insurance represents a sizeable investment, so it’s vital that the scheme you buy represents real value.
As experts in the company International Health Insurance market, we will be able to help navigate the complexities by providing clear advice to simplify your decision making, lower your risk and maximise your coverage. This is true whether you are looking to review an existing scheme, or conduct a global benefits audit.
Outstanding client service is at the core of Engage Health Group. We will help review/audit, source and manage your group International Health Insurance plan, whatever the requirements you have. And when the policy comes up for renewal we can review the policy and negotiate a better deal than the provider may initially offer.
The cost of an International Health Insurance scheme is calculated based on several factors and is offered in two main funding mechanisms:
Generally speaking, for groups of 3 to 100 employees, you will be offered a community rated pricing model.
This means that your scheme will be placed in a pool with lots of other businesses in this size range and the claims experience and risk will be spread across the entire pool. Therefore, when it comes to renewal, your pricing will be based on the performance of a large book of businesses, rather than the performance of your scheme.
This provides a more stable platform and your pricing increases will remain fairly stable whether you many or few claims in the year.
For group of around 100+ employees you are likely to be offered an experience related (sometimes called claims related) pricing model by most Group International Medical Insurance providers.
This means that the premium you pay each year will be based on the claims experience of your particular scheme from prior years. You are still fully insured, but if you have a lot of claims one year, your price is likely to increase further at renewal. Meanwhile, if you have less claims then it will be a smaller increase.
In both funding mechanisms, there are still some core factors at play when it comes to pricing your International Business Health Insurance scheme:
Group International Health Insurance is a global market, which makes it both large and complex. There are a variety of important issues to consider, including:
► The quality and availability of healthcare facilities in the locations that your employees are based.
► The location that the insurance contact is to be formed, ensuring payment of premiums and claims can be made across borders, in line with regulation.
► The meeting of visa requirements for your employees.
► Demonstrating that there is suitable hospital choice available in the required locations and that, where possible, bills can be settled directly between the hospital and insurer.
► The varying cost of treatment around the world and the interaction of your International Business Medical Insurance plan with the state healthcare system in place, if there is one.
► Certainty that the Group International Health Insurance solution you put in place has the correct licensing for the areas they are being purchased for, and that they meet any local state mandatory health insurance requirements. Not meeting these obligations correctly can potentially mean penalties for individuals and businesses or being refused entry to certain countries.
There are many differences between Group Travel Insurance and International Business Health Insurance. However, the main differing principle is that Travel Insurance only covers you while you are travelling outside your country of residence and does not cover any planned treatment.
It is also either bought for a single trip or an annual plan, allowing trips of up to between one to three months. Group International Health Insurance is designed to provide an ongoing benefit in both your country of residence and through your region of cover so you can also benefit from it while you are travelling.
The cover is much broader and covers planned treatment along with pre-existing conditions, if you have MHD underwriting applied.
All worldwide health insurance providers offer at least two regions of cover which can be selected, including, or excluding the USA. The high cost of medical treatment in the US means that, by excluding the US from cover, you can achieve a more competitive premium. Many Group International Health Insurance products also allow you to choose one specific region. For example, you may choose a Europe-only scheme if that region meets your requirements, thereby achieving a cost saving.
All International Business Health Insurance plans offer a choice of any recognised medical facility within your region of cover, rather than being limited to certain hospital lists. Although, some insurers do allow you to restrict breadth of choice in order to lower the premium.
Assuming you don’t choose to limit facilities, employees can access the very best private medical facilities and specialists for their treatment, anywhere in the area of covered. Though it’s worth noting that they would have to cover the cost of travel to that facility, unless they were unable to access suitable treatment where they were (see the evacuation / repatriation questions below).
Most Group International Health Insurance providers also offer a network within which they can guarantee to settle In and Day patient (sometimes also Out-patient) bills directly with the medical facilities. This arrangement is called Direct Settlement and means that employees avoid paying out large sums for medical treatment before it’s claimed back via the insurer.
If the insurer offers a direct ‘quick pay’ network, they will often provide online tools and apps to help you search for medical facilities close to you and detail what specialisms they offer.
Generally, you can choose between British Pounds, US Dollars and Euros within the International Health Insurance market. Note that some insurers require that the premium payment currency aligns to the benefit currency.
Yes it can. However, the degree to which local nationals can be covered varies greatly country-to-country and insurer-to-insurer.
For example, many company International Health Insurance providers are happy with 100% local nationals in the UK. However, for companies with a footprint in Nigeria some insurers limit local nationals to 10% of the insured population. Meanwhile, for companies with locations in the US, many International Health Insurance providers are not able to cover US nationals on their plan at all.
Don’t worry, however. As international insurance specialists, we can source International Business Health Insurance for US nationals in the US.
The reason there is no straightforward answer to this question comes down to the sheer complexity of the international insurance market. There are a variety of factors at play:
► Government regulation and legislation: For example, the reason why many insurers struggle with providing compliant Group International Health Insurance for US nationals in the US, is that the US government requires any insurance for US nationals to be provided by an onshore, US entity.
This is a challenge as most International Health Insurance providers are headquartered in Europe, even the large US Insurers like Cigna, and United Healthcare Global, base their international divisions in Europe rather than the US.
► Insurance companies’ business/tax structure: For example, are they offering cover as an off-shore entity, an on-shore entity, or via a partnership with a local insurance business? The reality is that most International Business Health Insurance providers use a combination of these strategies for different countries. How they choose to operate depends on the local regulation, their business penetration and risk appetite.
► Commercial considerations: There is also cold, hard business logic at play. Broadly speaking most actuarial teams specialising in International Health Insurance will see that local nationals tend to have a slightly higher claims spend per head, than expatriates, although this varies in different countries and cultures.
Limiting access to local nationals in certain countries, can impact the performance of their book.
There are three types of underwriting commonly used for International Business Health Insurance:
► Full Medical Underwriting (FMU)
This is where your employees will each need to complete a form which asks 12–15 medical questions.
This form will be reviewed by the underwriting team at your chosen International Private Medical Insurance provider and any pre-existing conditions will be excluded from cover.
Some insurers will allow exclusions to be reviewed each year, if you feel the exclusion is no longer relevant.
When assessing your form, the insurance provider may request further information or a doctor’s report, which you would have to provide at your expense.
► Moratorium Underwriting (Mori)
Not all International Health Insurance providers offer this type of underwriting as it doesn’t provide the upfront clarity which FMU underwriting does. However, moratorium underwriting can work better for some people and it also makes the upfront administration easier when setting up the scheme and adding employees during the year.
Moratorium Underwriting means signing an agreement to accept that that any conditions you have had treated or sought advice on in the last five years are not covered for the first two years of the plan, but are covered after that point, so long as you have not had any treatment or symptoms in those two years.
If you do have treatment or symptoms, then the two years starts again from that point. Some insurers offer variations on this, so it is worth confirming exactly what the requirements are with your insurer if you want to consider this type of underwriting. A further consideration is that when you do make a claim, underwriting is completed at that point to assess whether you have met the criteria, and it can sometimes take longer to get a claim agreed.
► Medical History Disregarded (MHD)
MHDs is the most generous underwriting available on a International Business Health Insurance scheme. It’s also the most administration-friendly as no forms are required and employees are taken on cover without any exclusions for pre-existing conditions.
All it requires to set up is a list of employees and their main details.
As you would imagine there is a loading to be paid to access this type of underwriting and all group International Health Insurance providers have a minimum group size before it becomes available. Most Insurers start offering MHD underwriting to group of 10+ employees while a few offer it from 5+ employees. Loadings generally start at 20% but goes down the larger the group is, normally to around 5%.
If you have a Group International Health Insurance scheme which includes an evacuation and/or repatriation benefit, then this may be an option in some situations.
Keep in mind, the cost of transport to access treatment is generally borne by the employee, even if the treatment itself is free.
Most schemes include medical evacuation as standard or have it as an optional add-on. This means that if your employee is unable to receive appropriate medical treatment where they are situated, then the benefit would cover the cost for them to be medically evacuated. They will then be taken to the closet place that can provide the required treatment.
This may mean evacuating the employee to their home country if it is close to the employee’s location – or if it’s the same cost as transporting to the closest location (and providing it has the facilities to treat the member appropriately). However, it is unlikely.
Once the treatment is complete, the employee is also covered for the cost of returning to their country of residence via an economy flight. Some International Health Insurance providers also allow a flight back to their country of nationality.
Not all company International Medical Insurance providers offer this repatriation benefit and for most it is an optional add-on. You should also consider that if you are in a serious medical condition, you may not be allowed to take a long-haul flight, based on medical grounds. In that case, you would be taken to the closest place where you can safely get appropriate treatment.
There are two sides to this question: what is mandated and what is recommended.
Almost all Group International Health Insurance products require mandatory pre-authorisation for some of their benefits, with some insurers requiring it more than others.
Generally, all company worldwide Health Insurance products require pre-authorisation for high-cost treatment like medical evacuations and repatriations, and maternity benefits. Many insurers have a blanket requirement for all ‘In’ and ‘Day Patient’ care to be pre-authorised along with any transportation.
We would always recommend you check your policy literature to see what the pre-authorisation requirements are and don’t assume one insurer will be similar to another, as they can vary greatly. Remember, if the insurer requires a benefit to be pre-authorised, and you don’t comply, you are at risk of not having your claim paid.
Despite a variety of mandatory requirements, all International Business Health Insurance providers recommend pre-authorising all ‘In’ and ‘Day Patient’ treatment and transportation. This is so they can confirm you have coverage for your treatment up-front, so you don’t risk paying and then finding out it isn’t covered. It also allows them to send a Guarantee of Payment to the medical facility and so, in a lot of cases, the insurer can settle the payment directly with the facility without you having to pay out at all. It is generally a better experience all-round if you do pre-authorise.
A couple of other key points:
Yes, all group worldwide Health Insurance products will allow you to add members during the year, as and when you wish to add them to your plan. They don’t have to be working or you for a certain period of time, unless you wish to apply that requirement yourself as an employer.
When a new employee is added – and you are on FMU or Mori underwriting – they will need to complete and return a form (see above question for underwriting explanation). For MHD underwriting, employee details will just need to be sent to the insurer.
Depending on your premium payment frequency your International Health Insurance Provider will invoice you a pro-rata’d premium from the date of joining to the next group invoicing date.
A Group International Health Insurance scheme is an annually renewed 12-month contract.
While you can cancel your contact during the year, you may still be liable to pay up the premium for the remainder of your contract, however that varies between insurers.
If you pay annually, some will reimburse you a pro-rata amount, providing claims haven’t exceeded your paid premium, others will not provide any refund and charge you in full for the year.
It’s common to have a choice between British Pounds, US Dollars and Euro’s. Some insurers require the payment currency to align with the benefit currency, so if you pay in USD then your benefits will be provided and measured in USD.
You can also generally choose to pay your group International Health Insurance policy either quarterly or annually, with some insurers offering a discount for annual payment and others allowing a monthly payment also.
Most Group International Health Insurance products require a minimum of three employees to set up a group, however a couple of insurers offer this from one or two employees, so long as you can prove they are a genuine employee of your business.
Yes, employees enrolled on your company’s International Health Insurance scheme are covered in their resident country and worldwide (depending on your region of cover) so this would cover them while they are travelling for business or leisure. Keep in mind, they need to be travelling within the region covered by your insurance.
If employees are travelling for work, we would always recommend having a Group Travel Insurance scheme in place too. A Group Travel scheme provides coverage for cancelled trips, baggage, personal accidents, laptops and more.
Most insurers provide some online access for employees and company group administrators. This allows them to log in, view and download details of their International Health Insurance plans. Most also provide a membership app through which employees can access their documents.
There is quite a wide spread of capability between insurers when it comes to how sophisticated their online access is. Some International Private Medical Insurance plans will allow employees to submit and track claims in real time, live chat with customer service and view the remaining balance of their benefits, all via their web portal. Others are less integrated and just host policy information.