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INTRODUCTION Many expatriates
are not aware when they go Overseas for the first time, that National Health
policies, country to country, can be quite different to Healthcare Services
back home. They often exclude foreigners and those not normally resident
in that country, (i.e. not paying local taxes). In addition,
today's expatriates can frequently be hired on contract for employment
abroad, thus losing out on any employment rights or benefits from
their home country; these are compensated for by higher salaries/consulting
fees from their international employers. Therefore, tax efficient
investment/pension plans are of concern to any expatriate, as are
healthcare insurance plans. These can be medical insurance, income
protection insurance, term life cover, or critical illness insurance
plans. The newly arrived expatriate is exposed to considerable risk until he/she places both their financial and healthcare insurance affairs in order, if their companies do not offer such services to them. International Medical Insurance is something you never wish to use, but always hope to have when an emergency or sudden illness arises, when one is far from home, overseas. Who do you call? How will you pay? Where will you go? SO WHAT IS PRIVATE INTERNATIONAL MEDICAL INSURANCE? Private Medical insurance is designed to cover the costs, or majority of such costs of private medical treatment for curable short-term illness or injury, commonly known in the industry as acute conditions. Most people overseas buy such cover as they are in difficult or inaccessible locations or do not know the standard of existing local national health facilities, or what is available to foreigners. They want speedy access to international Helpline facilities and, when necessary, to be flown home or elsewhere, for treatment and recuperation. Others, such as IT Contractors in Europe, cannot take part in local national health schemes as their work moves them about frequently so they also become candidates for Private International Medical Insurance. The advantages are speed of service, quality and location of treatment. As an international private patient you can often choose WHEN treatment will take place, the SPECIALIST who treats you, and the hospital LOCATION. You will usually have the privacy of an en-suite room, together with TV and other home comforts. For an expatriate undergoing treatment, it may prove important to be at home with family members, if at all possible. Your insurer may fly you home for treatment. Some illnesses or treatments may not be covered under your Plan and the exclusions should therefore be carefully read and digested. International Medical Insurance cover is usually offered via premiums throughout three zones of the world, being Western Europe as Area 1, World-wide (excluding the USA/Canada) as Area 2 and then full global cover (including the USA/Canada) as Area 3. Options are offered for routine dental and maternity cover, travel and personal accident COMMON EXCLUSIONS FROM INTERNATIONAL MEDICAL INSURANCE War or Civil
War risks, Drug Abuse, Self Inflicted Injury, HIV/Aids, Infertility,
Normal Pregnancy
HOW DO I BUY INTERNATIONAL MEDICAL INSURANCE AND WHERE DO I SEEK ADVICE SO AS TO ENSURE THE RIGHT COVER? You may buy such cover directly form a specialist expatriate insurer, or alternatively seek advice from an independent intermediary or broker. Medibroker International offers such a FREE service online from www.medibroker.com or in UK from www.medibroker.co.uk. It costs you no more to use an intermediary/broker, as they are remunerated by commissions from the insurer, when placing your business. The insurance provider will charge you exactly the same premium as offered by an independent broker. A cooling off grace period is usually offered by insurers of between 14-30 days where you may cancel a new Plan and get your money back, without penalty. The important things to look for with an insurer are a good range of full coverage benefits, clear exclusions, value for premiums paid, excellent customer services, major underwriting to ensure long term security and good clear claims procedures supported by 24 hour, 7 days a week, multilingual helplines, preferably free of charge. The only time you want to be assured of good medical insurance is the moment you wish to use it. Thus check helplines and claims procedures when you buy. CATEGORIES OF COVER - DEFINITIONS When looking for cover the expatriate can easily be confused by brochure literature mentioning standard cover, or comprehensive, or fully comprehensive. The important definitions of categories of cover follow below. Find out if one or all three of these are included in your International Plan. IN-PATIENT This is when you go into hospital for private treatment or investigations and stay for one or more nights. DAY-PATIENT This is sometimes refered to as Day-care or Day-case. It is when you go into hospital for private treatment or investigations, but do not need to stay in the hospital overnight. However, you may take up a bed. OUT-PATIENT This is when you receive treatment or investigations or consultations which DO NOT need you to stay in hospital, either as an in-patient or day-patient There are a very large variety of plans available. These range from low cost schemes, offering limited cover (and voluntary excesses on claims), to those which offer wide-ranging cover and benefits. The majority offer in-patient and day-patient cover, but not always out-patient cover. WHAT AM I COVERED FOR AND WHAT IS NOT INCLUDED? Please note that medical insurance is designed to cover only treatment for curable, short-term illness or injury, ( commonly know as ACUTE conditions). Some illnesses and treatments are never covered, and that is common with many Insurers. (See exclusions paragraph above). A Standard or Basic international scheme will usually cover in-patient or day-case/day care treatment, hospital cash benefit, post hospital treatment, nursing at home, emergency evacuation, repatriation or burial of mortal remains, emergency dental and complications of pregnancy. It will NOT cover such as out-patient, routine maternity, or dental costs. A Comprehensive international scheme will cover all of the above PLUS out-patient care and specialists, complementary care, organ transplants, routine maternity, routine dental (sometimes), and generally has higher budget limits than a Standard Plan. It is not usual for any Plans to include pre-existing conditions which may go back 2-5 years or even longer with some insurers (exceptions for company schemes). WHAT AFFECTS PREMIUMS? Whatever Plan you take, it is likely that your premiums will rise above the average rate of inflation. Medical Inflation in the United Kingdom, for example, is running at some 10% with economic inflation at 4%. Also, each year, more and more people claim on their medical insurance, raising premiums for all. A straightforward hip replacement today can cost £6,000 sterling, or almost $US 10,000 dollars. The sophistication of both treatment and testing procedures are also increasing - for example, Magnetic Resonance Imaging (MRI) scans cost around $US 1,000 each. As Plan holders get older, they are more likely to need treatment and thus premiums also rise with age bands, usually 4-5 year periods. WHAT DETAILS OF MY HEALTH MUST I PROVIDE TO INSURERS? As mentioned earlier, there are a number of medical conditions which you may not be able to have covered under insurance Plans. Apart from some Company Plans and large Group Plans, you normally would not be able to secure cover for an illness from which you are presently suffering, or have already had in the recent past. These are known as pre-existing conditions. Insurance Companies may accept your application in one of two ways: MEDICAL HISTORY DECLARATION COVER You will be asked to fill out a form, giving details of your medical history. Sometimes previous medical reports may be required. It is essential that you provide all the information asked for by Insurer to avoid future questions or worse, rejection of future claims made on them by you. If you are not sure, then declare anyway. If you have a medical condition that is likely to come back, the insurance company may cover you, but exclude that condition, and any related to it, reviewing its possibility for inclusion into the Plan in later years. MORATORIUM COVER Here you are asked to complete a form, but with no details of medical history given. Instead, the insurance company does NOT cover any medical condition which has existed in the last 2-5 years. Such conditions may automatically become eligible for cover only when you do NOT have symptoms, or receive treatment, medication, tests or advice from your General Practioner or Specialist, for that condition, for a continuous period of (usually) two years, after your policy has been made effective. HOW DO I MAKE A CLAIM ? Most international insurance providers will send a client pack, with Insurance Certificate, Claims Forms and Helpline Card, with a range of international contact numbers. Many international insurers now PRE-AUTHORISE any in-patient treatment, meaning that you must contact their Helplines before seeking treatment and incurring costs. Out-patient costs are usually dealt with by routine Claim Forms (i.e. you pay first). If in doubt, always call the Helplines before seeking treatment and committing to costs. CHECKLIST Before purchasing an International Medical Insurance Plan, you need to understand the following: A) You agree to give the insurers all the information they need. If you do not do this, or provide inaccurate details, your insurance company may refuse a claim, or could cancel cover altogether; B) You agree to pay monthly, quarterly or annual premiums, as long as you require cover. If you do not pay premiums, cover will stop. Your insurer will only pay for legitimate costs you have paid, or agreed to pay, up to the last date covered by your premiums; C) The cost of your premiums is likely to rise once a year, when you review your cover. Medical inflation is rising at approximately 10% annually and if you change age bands, your premium costs for the same Plan could rise. Only by taking voluntary excesses, or downsizing one's Plan can you keep premiums constant, or subject to small annual increases. For example, changing from fully comprehensive to a standard Plan as one gets older; D) If the insurance Plans change during the year, you will be informed in advance. They will not prevent you continuing cover even if you have made claims; E) If you do change from one insurer to another, you may not necessarily be covered for conditions or treatment that your existing Plan covers now. MEDICAL INSURANCE CONTROL AND COMPLAINTS PROCEDURES All international insurers of repute have proper client liason teams and complaints procedures, properly documented in their client packs. Your application form is a vital document as it forms the basis of your contract with the insurer. Always complete these forms accurately and fully, signed and dated. If you do not, your insurer may refuse to pay certain claims in the future. By Law, in the United Kingdom, all insurance companies have to treat personal information, especially medical information, with absolute confidentiality. Only occassional anonymous statistical information may sometimes be used. The vast majority of international insurers are well developed with client service procedures and claims handling. Both they and their underwriters will always pay legitimate and properly covered claims. However, if fraudulent claims are made, they will not pay and may cancel the policy. A lot of international cover is thus based on trust and common sense frequently prevails. Mr J Leslie
Smith, BSc Econ (Hons)
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