International Private Health Insurance (Company)
Engage International offers an expert level of consultancy to implement, or review any existing arrangements, and ensure that the best group International Health Insurance is in place
What is International Private Medical Insurance
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 (SME’s).
The businesses we work with have implemented a group International Health Insurance plan for a variety of reasons, including;
- A requirement to consolidate, harmonise, or audit the employee benefits offered across their international footprint to provide a consistent offering, drive efficiencies and leverage economies of scale.
- Having expatriate employees or staff on international assignment to which they have a particular duty of care, and require a group International Health Insurance solution to meet the needs of those employees and their families.
- A desire to ensure that they are offering the very best level of private health insurance to key sections of the workforce, to provide a compelling benefits package, particularly for C-Suite positions. Studies over the last few years have shown that International Health Insurance is one of the most sought after employee benefits, particularly for expatriate and board level employees.
Engage International offers an expert level of consultancy to implement, or review any existing arrangements, and ensure that the best group International Health Insurance is in place, while all the complexities of the market are fully considered, advised on and resolved.
What benefits are covered by group International Health insurance quotes
International Medical Insurance coverage is richer than the private health insurance policies which you typically find in domestic markets, as all eventualities need to be catered for.
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;
Private doctor visits
Accident & Emergency
Routine maintenance for Chronic conditions
Congenital and hereditary conditions
Preventative wellness screening
Travel vaccinations and child immunisations
Emergency evacuation and repatriation
24/7 multi-lingual medical helpline
Security advice and services
The majority of group International Health Insurance providers also offer a range of additional benefits which can be valuable for all employees. These include;
- Independent second medical opinion
- Telemedicine / Virtual GP
- International Employee Assistance Programme (iEAP)
What currency are the benefits based on in a group International Health Insurance plan?
Generally you are able to choose the currency that your benefits are based on.
A choice between British Pounds, US Dollars and Euro’s is common across the International Health Insurance market. Note that some insurers require that the premium payment currency aligns to the benefit currency.
Does group International Health Insurance cover employees for treatment anywhere in the world?
All Worldwide Health Insurance providers offer at least two regions of cover which can be selected, generally worldwide cover either 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.
Numerous group International Health Insurance products also offer a wider choice of regions, for example to cover you in Europe only, again to provide a cost saving if that region meets the requirements you have.
What hospitals and healthcare facilities can you access via group International Health Insurance?
All company International Health Insurance plans will 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 this down yourself for a premium saving.
This means that employees can access the very best private medical facilities and specialists for your treatment, anywhere in your area of cover, although you would have to cover the cost of travel to that facility, unless you were unable to access suitable treatment where you are (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 don’t need to pay out large sums for medical treatment and then claim it back via the insurer.
The insurers offering a network also often provide online tools and apps to help you search for medical facilities close to you and detail what specialisms they offer..
What additional factors need to be considered when reviewing a company International Health Insurance policy?
Group International Health Insurance is a global market, which makes it both large and complex. Depending on your circumstances there are important considerations around;
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 company International 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 have 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
Can group International Health Insurance cover both local nationals and expats?
Yes it can, however the degree to which local nationals can be covered varies greatly from 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, whereas for companies with locations in the US, many group International Health Insurance providers are not able to cover US nationals on their plan at all. Although don’t worry, as specialists we are able to source group International Health Insurance for US nationals in the US.
The reason that there is such a broad spectrum of answers to this questions, is due to the fact that the company International Health Insurance market is complex and there are a number of factors at play;
Government regulation and legislation is an important factor, 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.
How the International Health Insurance providers implement their market entry to certain countries is also a factor.
For example, as 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 group International Health Insurance providers use a combination of these strategies for different countries, depending on the local regulation, their business penetration and risk appetite.
There is also a commercial consideration in some decision making by International Private Medical Insurance providers, on the percentage of local nationals they cover.
Broadly speaking most actuarial teams specialising in International Health Insurance will see that local nationals tend to have a slight higher claims spend per head, than expatriates, although this varies in different countries and cultures.
Therefore limiting access to local nationals in certain countries, can impact the performance of their book.
What underwriting options are there for company International Health Insurance?
There are three type of underwriting commonly used for group International Health Insurance;
Full Medical Underwriting (FMU)
This is where your employees will each need to complete an 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 can be reviewed each year, if you feel the exclusion is no longer relevant and request it to be reviewed.
When assessing your form the International Health Insurance provider may request further information or a doctors’ 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 consideration to this is that when you do come to 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 company International Health Insurance scheme, and the most administration friendly as no forms are required and employees are taken on cover without any exclusions for pre-existing conditions.
A list of employees and their main details just need to be provided to the insurer to set up the plan.
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 reduce down the larger the group is, normally down to around 5%.
If an employee falls ill, or is injured while on assignment, will they be transported home for treatment?
If you have a group International Health Insurance scheme which includes benefit for evacuation and/or repatriation, then this may be an option for particularly situations.
While a company International Medical Insurance policy covers for treatment anywhere in the world, or within your region of cover. The cost of getting to that treatment is generally borne by the employee.
Most schemes include medical evacuation as standard, or have it as an optional add on. This benefit means that if your employee is somewhere where the level of healthcare facilities available means that they can’t receive appropriate treatment for their condition, then the benefit would cover the cost for them to be medically evacuated to the closet place that could provide appropriate treatment. This may mean evacuating the employee to their home country if it is close to the employees location, or 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 return to their country of residence via an economy flight, or some International Health Insurance providers, also allow a flight back to their country of nationality.
If you want to guarantee having the option of being repatriated back to you home country, again should you not be able to receive appropriate treatment locally, then you should ensure that your plan has a repatriation benefit which offers this choice. 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 again you would be taken to the closest place where you can safely get appropriate treatment.
Does treatment need to be pre-authorised upfront with an International Health Insurance provider, if an employee falls ill or is injured on assignment?
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. A number of insures have a blanket requirement for all in and day patient 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 has a requirement for 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 company International Health Insurance providers recommend pre-authorising all in and day patient treatment and transportation. The reason they recommend doing this, is so they can confirm that you have coverage for your treatment up front so you don’t risk paying and then finding out that it isn’t covered, it also always 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;
- You don’t have to pre-authorise any out-patient treatment
- If you have a medical emergency and are incapacitated when you are admitted into hospital, the insurers generally ask that someone contacts them within 48 hours of the admission.
Can I add new employees to a group International Health Insurance plan during the year?
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; if 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 HealthInsurance Provider will invoice you a pro-rata’d premium from the date of joining to the next group invoicing date.
Can I cancel a company International Health Insurance scheme during the year?
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.
What currency can you pay them premium in for a company International Health Insurance plan?
Being able to choose the currency that you pay your premium, between British Pounds, US Dollars and Euro’s is common across the International Health Insurance market. 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.
How is a group International Health Insurance scheme priced?
The pricing for a company International Health Insurance scheme is calculated across a number of factors and is offered in two main funding mechanisms.
Community rated pricing
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.
This means that your pricing each renewal will be based on the performance of a large book of business, rather than just your scheme.
This provides a more stable platform and your pricing increases will remain fairly stable whether you claims lots or a little in the year.
Experience (or claims) rated pricing
For group of around 100+ employees you are likely to be offered an experience related (sometimes also 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, if you have less claims then it will be a smaller increase.
In both of these funding mechanisms, there are still some core factors at play when it comes to setting the price for your company International Health Insurance scheme;
Age of the employees covered
The level of cover you have selected
If you have selected to include an excess/deductible or co-pay on your scheme, which the employees need to pay prior to claiming
Medical inflationary costs are factored in each year as new, more effective, but more expensive drugs and treatments are released. Due to this medical inflation rates run above RPI and CPI indexes and vary country to country.
International Private Medical Insurance is also priced based on the country that your employees are based in. For example an employee based in Egypt will attract a significantly lower premium that an employee based in Hong Kong for the same level of cover. This is due to the varying cost of treatment in those countries for the same procedure. Most insurers apply zonal pricing, so countries are categorised into pricing bands with other countries with similar costs.
How many employees do I need to cover to take out a group International Health Insurance?
Generally speaking, most group International Health Insurance products require a minimum of 3 employees to set up a group, however a couple of insurers offer this from 2 or even 1 employee, so long as you can evidence that they are a genuine employee of your business.
Are employees covered by a company International Health Insurance scheme while they are travelling for business and on holiday?
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, so long as the travel was within the region of cover you have selected.
If employees are travelling for work, we would always recommend also having a Group Travel Insurance scheme in place. These are quite different insurances and if you have employees travelling for business you are going to want to make sure that cover is in place for cancelled trips, baggage, personal accidents, laptops etc.
Can I manage my group International Health Insurance plan online?
The majority of insurers do have some online access for employees, and also the company group administrators, to log in, view and download details of their International Health Insurance plans. Most also provide a membership app where 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 company International Private Medical Insurance plans will allow employees to submit and track claims in real time, live chat with customer service, view the remaining balance of their benefits, all via their web portal. Others are less integrated and just host policy information.
What is the difference between group Travel Insurance and group International Health Insurance?
There are a host of differences between group Travel Insurance and company International 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 and also pre-existing conditions, if you have MHD underwriting applied.
What is the best group International Health Insurance?
The company International Health Insurance market is a competitive one due to its global nature, we work across the whole of the market place and the following are all recognised providers;
- Aetna International
- ALC Health
- Allianz Worldwide Care
- April International
- Axa Global Health
- Bupa Global
- Cigna Global
- Freedom Worldwide
- Generali Global Health
- Global Benefits Group
- Healthcare International
- IMG Europe
- Integra Global
- Morgan Price International
- Now Health International
- United Healthcare Global
- William Russell
All of these insurers offer a range of International Private Medical insurance products and optional add on’s. There are also different suites of products for different parts of the world, which mandate particular requirements like the Middle East, USA and some part of Asia. These factors mean that there are many hundreds of group International Medical Insurance products available, offering varying levels of cover via providers with differing levels of capability in different countries.
This is why accessing independent, expert, advice is so important for group International Health Insurance, coupled with annual market reviews and premium negotiation.
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, whether you are looking to review an existing International Health insurance scheme, or conduct a global benefits audit.
Outstanding client service is at the core of Engage Health Group. We will be able to help review/audit, source and manage your group International Health Insurance plan, whatever the requirements you have.
To find out more, discuss your specific requirements, or request some initial pricing, please get in touch via our contact form below.
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