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2 2 Contents International PMI contents Page 3-17 International PMI industry 3 New country, new life British expats can find that even the simplest health problems become nightmares writes Sarah Marfleet of AXA PPP healthcare 7 Global business Mark Coleman of CIGNA International Expatriate Benefits outlines the vital questions intermediaries should ask their clients 9 10 reasons why There are 10 reasons why intermediaries should be looking into international PMI explains Ron Buchan of Allianz Worldwide Care 13 Top 10 tips for relocating to foreign shores BUPA International s Anthony Cabrelli suggests 10 top tips for relocating to foreign shores 15 Global challenge - Norwich Union Healthcare s Shah Rouf says expats need reassurance that their health is protected Page World 19 Expanding market Healthcare systems around Europe differ from the UK s NHS but, writes AXA PPP healthcare s Sarah Marfleet, expatriates need quality care 20 Cutting the cost Gregory Cain of CIGNA International Expatriate Benefits explains what s driving the change to the US healthcare system 21 Anyone for Gulf? - Many expats can put pressure on the local health service, writes Ron Buchan of Aliianz Worldwide Care 22 Out of Africa BUPA International s Anthony Cabrelli explains why Africa s vastness means an expat would need emergency evaluation cover 23 Asian opportunities - Norwich Union Healthcare s Amber Chable says that SARS has highlighted the importance of PMI Page Profiles 25 Allianze Worldwide Care 26 AXA PPP healthcare 27 BUPA International 28 CIGNA International Expatriate Benefits 29 InterGlobal 30 Norwich Union Healthcare International Medical Insurance was produced by Health Insurance and sponsored by Allianz Worldwide Care, Axa PPP healthcare, Bupa Interntional, Cigna International and Norwich Union Healthcare Health Insurance, Informa Publishing Group, Informa House, Mortimer Street, London W1W 7RE fax: tel: extensions as below, unless stated Editor Sylvia Waycot 4155 Deputy editor Barbara Cockburn 4154 Editorial consultant Andrew Green Technical editor Andy Couchman Design Lisa McMahon Head of production Maria Stewart 5819 Sales executive Emma Goodwin 4189 Sales executive Kelvin McManus 4702 Events director Rebecca Griffiths 4220 Circulation manager Alison Hunt 4168 Publisher Matthew Brookes Member of the Audit Bureau of Circulation Average net circulation for the period 1 July 2002 to 30 June ,253 Health Insurance is published by Informa UK. Printer: St Ives Annual subscription: 109 HealthInsurance The Guide to International Private Medical Insurance 2004

3 3 New country, new life Despite the failings of the NHS, anyone working in the UK will take it for granted. But once they are sent abroad expats can find that even the simplest health problems become nightmares writes Sarah Marfleet, senior marketing controller at AXA PPP healthcare Anew country, exotic cuisine, languages to be explored, generous remuneration packages and add to this the challenge of a new role and you can easily see the appeal of the expat lifestyle that draws a significant percentage of the UK s workforce abroad each year. In a climate of political instability on a global scale, the expat workforce remains undeterred. Figures show that over 91,000 British citizens left the UK in 2002 (Office for National Statistics 2003), adding to the estimated 1.1m British working expats already scattered across the globe (AXA PPP healthcare). COUNTING THE COST A large multinational, a small business or any company sending employees on an overseas assignment, be it for a few weeks, months or years holds an additional responsibility for the welfare of their expat employee and their family. Employers must be well equipped to prepare their staff about their impending destination from accommodation and food hygiene, to schooling options and healthcare. Large multinationals who are supporting a network of offices around the world tend to have their own in-house functions to deal with expatriate services. They may even employ their own doctor to carry out pre-travel health checks. Smaller enterprises are more likely to outsource their occupational health requirements. Clearly, international assignments incur substantial costs for the employer in relation to the relocation of the employee. Consequently, the costs of failure are also high. Choosing the right health insurance scheme is a key factor in the remuneration package, and intermediaries can play a key role in ensuring the expat assignment remains a healthy one. HEALTH ISSUES Understanding the diversity of the expatriate profile and the types of companies that are sending them is essential for intermediaries to recommend the most appropriate type of medical insurance. The location of their destination will have a direct impact on the healthcare needs of the working expatriate and their family. For some expatriates, their destination may not even provide basic medical amenities locally. In areas of South East Asia, or parts of West Africa, for example, a local clinic may be considered a luxury but the nearest doctor could be an hour s plane ride away. In other locations, the standard of healthcare may be exceptional and indeed far superior than what they may be used to back in the UK. It is likely, International PMI AXA PPP healthcare The Guide to International Private Medical Insurance 2004 HealthInsurance

4 4 International PMI AXA PPP healthcare in this scenario, that the corresponding cost of healthcare is substantial. Neither the employee nor the employer would be comfortable with shouldering the cost of medical treatment in this instance. UNTANGLING LEGISLATION In countries where quality healthcare does exist and the state system provides reputable medical facilities, there is an increasing amount of legislation which impacts both the extent to which the expat is eligible to receive state healthcare and the corresponding cost. Intermediaries can guide companies through the minefield of healthcare legislation that exists globally. Increasingly, different countries are tightening their healthcare regulations for foreign nationals. In Switzerland, for example, expatriates must produce a certificate of insurance, signed by their PMI provider, confirming that they have adequate health insurance. In France, the introduction of couverture maladie universelle (CMU) in 2000 requires all residents to register with the French state system. Saudi Arabian legislation is due to be enforced, making it compulsory for all expatriate residents to purchase PMI cover, to avoid an excessive burden on its state health system. Intermediaries who are well read on these varying legislations are a valuable tool for any individual or employer who is considering international PMI. TAILORED SOLUTION Medical insurance is a fundamental part of the expatriate benefit package. With it, the expat is reassured that they have access to quality healthcare at an affordable price. Being ill abroad can be unnerving - but quick access to private healthcare facilities will increase their chances of avoiding a prolonged period of sickness absence, or even worse, returning home prematurely. The demands of a corporate client are wide and varied and health insurers are continuing to enhance their corporate medical insurance packages in the changing international marketing. Intermediaries are well placed to help their corporate clients to find the best healthcare solution for their employees. The following key factors should be considered: Varying costs of healthcare around the world Intermediaries who are well read on these varying legislations are a valuable tool for any individual or employer who is considering international PMI THE PRODUCT On top of the usual cover for inpatient, day patient and out patient medical treatment, corporate clients are placing increasing value on a variety of options, including: Evacuation & repatriation should an expat employee become seriously ill, this service provides crucial emergency help and advice, to evacuate the patient to the nearest centre of medical excellence. Chronic conditions many chronic conditions such as asthma, diabetes and high blood pressure, should not have a significant effect on employee ability to take on overseas assignments provided they are kept well under control. Pregnancy & childbirth with extortionate medical costs, this is considered by many employees as a crucial benefit, to ensure employees and their families have the support they need. Dental & optical these added value services become increasingly valuable outside of the UK, where the costs of dental and optical treatment can soon stack up. Health checks - provide reassurance to the employee and employer alike, to ensure that the employee remains fit and healthy throughout their international assignment. Vaccinations, drugs & dressings providing support to the expat employee who may be faced with higher costs for items such as prescription drugs or travel vaccinations. ADDED VALUE In addition to the product offering, corporate clients understandably demand high service levels to ensure that their expat employees are well provided for. Equally, they want to minimise their involvement in administration or claims queries. Intermediaries can identify insurers who can provide the following added value services to its core product: international expertise - a medical provider who backs up its product proposition with real international experience - with an understanding of the market diversity. local knowledge - a provider who has invested the time to build relationships globally, ensuring that networks of hospitals and third party administrators exist on the ground health support ensuring that whatever their healthcare query, members can speak to a healthcare professional - whatever the day or time zone. dedicated helplines - enabling the corporate expat to phone their customer service team directly and get help and advice that is relevant to their medical policy. claims helpdesk - a dedicated team of claims assessors who are experienced in paying international claims, whatever the currency or condition. direct settlement of bills - ensuring that wherever possible, inpatient bills are settled by the medical insurer directly with the hospital, to avoid the patient being out of pocket and having to seek reimbursement for costly medical treatment. online services - providing additional support to the expat by enabling them to view their corporate policy details online through a passworded extranet site. Intermediaries also need to understand the variety of pricing options available to their corporate clients. Pricing will obviously vary according to product type, any additional benefits, underwriting and area of cover. In addition for larger corporate schemes, the option of bespoke claims related pricing adds even more value. THE INTERMEDIARY The recognition and reward that an intermediary can receive from international medical insurance matches the extra complexity compared to the UK market. Whether commission or fee based, the increased premiums that are incurred from international products will generate healthy commission levels, to compensate the effort made. Whilst the international health insurance market demands an in-depth knowledge of the environments, health concerns and circumstances of an expatriate client and their employers, intermediaries who are bold enough to take on this challenge will discover a diverse and rewarding market. Greece Hong Kong Spain USA Colonoscopy 1, ,400 Caesarean 2,800 4,288 n/a 6,000 Hernia Repair 800 1,870 1,030 1,250 The above figures represent an example of average benefit paid out for these procedures for comparison purposes only. Costs may vary largely in each location. N/a indicates no data available. For further information about international medical insurance from AXA PPP healthcare, call our International Corporate Sales Team on or HealthInsurance The Guide to International Private Medical Insurance 2004

5 For multinational organisations, expatriate assignments can be vital to their success in new, emerging markets, or in expanding an existing overseas market. Mark Coleman, international sales director for CIGNA International Expatriate Benefits, outlines some of the questions intermediaries need to ask their clients Global business When companies invest as much as $1.3m on the average three-year expatriate assignment, the financial implications of having assignments fail is significant. But the implications for a firm s business and reputation can be even greater. There s no doubt that safeguarding the health of expatriates and their families is a key factor in the success of international assignments for any multinational organisation, and research* shows a firm s investment in international assignments is most likely to be safeguarded when expatriates and their families are culturally prepared. Yet more than half of expatriates feel lack of company communications about health and security issues is detrimental to their peace of mind and prospects for success. Having bought the best healthcare provision, it seems too few employers are reaping the rewards by telling their people about it. The question intermediaries will have to answer is: What makes the best healthcare provision for expatriates? How can intermediaries add value to the decision making process by helping their clients maximise the potential success of those all-important overseas assignments, and safeguard their firm s investment? The answer is that an employee benefit is only valuable if it performs when it s needed. And in an increasingly globalised business world, in order to perform, employee benefits have to be as mobile as the workforce they serve. For many intermediaries this means quizzing the provider on the nature of its service. It s easy to arrange healthcare cover for a single country of destination, but most expatriates will be mobile within a region, which means localised healthcare can be at best expensive for their employer (picking up the bill for additional cover for business travel on a piecemeal basis), or, at worst leaves the expatriate exposed to the risk of finding they are without healthcare cover when they need it most. GLOBAL HEALTHCARE MANAGEMENT For employers, the pitfalls of mis-handling expatriate healthcare include falling foul of the law, reduced profitability, and loss of repute. For the individual and their family on assignment, the risks are more personal with issues of personal safety and wellbeing, career progression and financial inconvenience all coming into play. A truly global healthcare management service should provide employees with seamless access to a package of information, such as an online database of international doctors and healthcare facilities, screened by international doctors. Providers should include primary care 7 specialists, general practitioners, dentists and healthcare facilities known for providing quality care in their area. It s also important to provide peace of mind for employees and their families living in an unfamiliar environment, where the healthcare system may be very different to the one they are used to. International healthcare plans which offer access to a secure website, where expatriates can find doctors (CIGNA International s own website provides this information for around 200 countries), where they can speak to a doctor and ask advice, before seeking medical treatment, and where they can obtain telephone referrals to qualified local doctors, safe in the knowledge that they meet recognised quality standards will all contribute to this. It s also worth noting that many clients, even large employers, have small expatriate populations relative to their total global workforce. As a result, they have little experience on which to base their questions to a potential international healthcare provider. Here are ten key questions their intermediary should be asking an insurer: 1. Can members speak to a physician, in any language, 24/7? Immediate access to a knowledgeable medical professional is key to assessing a condition quickly. It provides an expatriate with confidence and the reassurance that they aren t facing a serious situation alone. International PMI CIGNA International The Guide to International Private Medical Insurance 2004 HealthInsurance

6 8 International PMI CIGNA International Physicians are also more inclined to offer self-treatment advice, and to find it easier to have a peer to peer conversation with the member s local or referral doctor. 2. Which assistance company do you use and how experienced are they? Probe the vendor s true capability and experience on issues such as the percentage (and number) of its cases occur outside of North America (or is most of its international case activity in one area?), the size, location and background of medical staff and whether expatriate medical assistance is their long term, core business or a recent diversification. It takes significant medical case activity to build a worldwide resource and knowledge base. 3. How is your assistance company integrated into your service, provider network and healthcare processes? The more integrated, the better. This avoids cases being handled in isolation, being mis-routed, requests for help being overlooked and eliminates opportunities for error. 4. What medical assistance services are included in your basic service? Some carriers bundle certain medical assistance services into their core offering, while others make this a fee for service option. Indemnified evacuation and repatriation services are often an option. 5. Who are the staff delivering international medical monitoring and care management? What is their international clinical experience? Beware of a US-centric set up. The value of US nurses is clearly understood in North CASE STUDY As employers keenly count the cost of benefits administration, expatriate healthcare needs to earn its keep in every part of the business and every corner of the globe America and many European countries, but a US based nurse may not have the professional stature required to get the cooperation of a treating doctor in the rest of the world. The most effective care managers don t simply receive information. Ask whether those staff have practiced medicine abroad? Do they understand the nuances of medicine, in all of the locations where you have staff? 6. Do you employ a full time international medical director? What is his/her international clinical experience? Few health insurers have a full time international medical director with international clinical experience. Their presence indicates a commitment to quality medical care. 7. What sort of providers are in your international provider network? If the health insurer provides a directory of international network providers to its members do they provide guidelines on how members can use the network appropriately? A member is best served by a real time medical assessment of their current A CIGNA International member was recently receiving complex cardiac care in the Middle East. Normally, the care required would have involved the patient travelling to Europe or the US, to receive the necessary surgery. However, CIGNA researched local options in detail, identifying a suitable provider, with appropriate training, capabilities and experience in the required procedures. We consulted with the patient, their family members and the client company s medical director to weigh up the options. When the consensus supported the local option, CIGNA arranged the admission, monitoring and payment of services. The outcome was a patient who was very pleased with their experience, who was able to return to work faster by eliminating air travel, and whose treatment cost significantly less than repatriation and treatment in the US or Europe. * Source: Helping expatriates achieve assignment success Expatriate Survey. CIGNA International Expatriate Benefits, symptoms, to determine the most appropriate provider/specialist. But there are cost savings to having access to an international provider network. In the US, CIGNA International uses its non-mandatory Preferred Provider Organisation (PPO), which delivers services at negotiated discounts. Recent negotiated savings on surgery cases include : savings of $41,025on one claim, where the charge amount was $82,100 savings - $4,564 on a second claim, where the charge amount was $18, What is the selection criteria for inclusion on your international provider directory? There is no international qualification, accreditation standard or process applied by health insurers. The optimum approach is a quality assurance process based on objective criteria: establishing the provider s training, experience, and documented history with the carrier or their assistance company. Onsite evaluations by medical professionals represent the gold standard. 9. Do all of the providers with whom you have contracts or formal arrangements meet your provider selection criteria? This will demonstrate how seriously the carrier takes their own selection criteria. 10.Do members have access to a prescription pharmacy network? Being able to collect prescription drugs from a network of approved pharmacies, and only have to pay the excess or co-insurance, as opposed to the full price of the drugs, reduces claims administration, the need for expatriates to use their own money, and adds to their peace of mind. QUESTIONS WORTH ASKING They re questions worth asking. As employers keenly count the cost of benefits administration, expatriate healthcare needs to earn its keep in every part of the business and every corner of the globe. That s when it will pay to have the answers. CONTACT DETAILS CIGNA International Expatriate Benefits is part of CIGNA International, the world s largest global health insurer. For more information about expatriate healthcare issues, or a free copy of CIGNA s expatriate surveys, contact Mark Coleman on +44 (0) , or HealthInsurance The Guide to International Private Medical Insurance 2004

7 Ron Buchan, Allianz Worldwide Care s CEO offers intermediaries 10 reasons why they should enter the international PMI market 9 10 reasons why No matter what the business, providers of professional services sensibly look not only to obtain new clients but also to widen the scope of services provided to existing clients. The same philosophy of course, applies to insurance intermediaries. Many traditional advice areas, such as mortgage endowments, with profits contracts, personal pensions and investment products, have become less attractive markets. It could therefore be argued that the insurance intermediary, more than any other professional, needs to be sure that they are providing advice in every area where they are competent. The background to international PMI is very simply that more and more people are choosing to travel and work throughout the world. Large corporate entities become larger by acquiring overseas operations or themselves being acquired by overseas operations. Either way, the globalisation of business is a clear and rapidly increasing trend, particularly over the last 10 or 15 years. PLATFORM FOR MOBILITY Labour is becoming more mobile. For example, the continued development of the European Union creates virtually free movement of workers across a Union which is arguably the world s largest economy. Furthermore, the gradual adoption of English as the world language of business creates a further platform for increasing easier mobility of labour. Therefore, the 10 reasons why intermediaries should be involved in the international PMI market are as follows: 1 DEMAND This is a market where demand creation is not an issue. Unlike domestic private medical insurance where demand needs to be created in an environment where there is a huge free competitor, in the international environment there is no debate about the need to effect private medical insurance. The choice facing expatriates is simple, be insured or pay yourselves. State involvement in healthcare provision is more or less unknown outside of the European Union and even in the Arabian Gulf where previously medical services were provided free, expatriates now need to provide their own solutions. 2 SERVICE There are many factors that potential clients, both corporate and individual, need to judge when making a choice of international insurance provider. There are not only the usual questions of scope of cover, terms and conditions, exclusions or the cost, but also, and perhaps more importantly, there is the question of expatriate service. Unlike domestic health insurance, international health insurance is much more to do with service provision than it is simply with the payment of hospital bills. The extent of an insurer s provider network; the quality of local healthcare delivery knowledge possessed by the insurer or the quality and robustness of the insurer s assistance packages, all need to be evaluated by the intermediary. Added to that, the need to assure the dependability of the service provider, assistance provider and the reinsurer, (and sometimes these are different people) all creates a complex situation where advice is absolutely necessary. 3 OPPORTUNITY This is easy business. Intermediaries with domestic health insurance clients also have immediate opportunities for international business. Intermediaries with corporate clients with which they may have either general insurance risks or employee benefit risks, also have an opportunity to talk about PMI and in particular international PMI. Most intermediaries have clients for whom they provide a range of services and yet these same clients will have international PMI services arranged elsewhere. Remember, in this particular niche mar- International PMI Allianz Worldwide Care The Guide to International Private Medical Insurance 2004 HealthInsurance

8 10 International PMI Allianz Worldwide Care ket, all clients with a need will have the product. The question to ask, is whether this product is from you. 4 CONTACTS There is an underlying economic and political imperative which is stimulating the globalisation of business. This increases the number of corporate clients with overseas operations and it increases the number of individuals taking up employment abroad. Link this phenomena with the more or less total penetration of some kind of insurance provision among the target market and you have an ideal opportunity for intermediaries to step outside their existing client base and identify individuals and corporations who are likely to either have or be interested in international health insurance facilities. An easy entrance into a new client provides the opportunity for an even broader advice relationship with that client in the future. Remember, in the corporate market, 35-40% of business is held directly by the insurer and therefore you will not need to dislodge an existing intermediary. Also, around 75% of individual business is direct. 5 VICE VERSA The inverse of reason 4. If you do not do unto others as proposed in reason 4, others will do it unto you. 6 GLOBALIASTION Increasingly, the distinction between domestic health insurance and international health insurance will blur. There are already multinational clients who wish to provide a uniform or related benefit package to different categories of employees in different locations and of different nationalities around the world and to do so with one pooled risk. This situation exists. Is it domestic business or international? Who knows? But it is the way of the future. there is no debate about the need to effect private medical insurance. The choice facing expatriates is simple, be insured or pay yourselves 7 TIMESPAN Travel insurance plans offer only emergency treatment and are suitable only to cover short trips. As well as the full time expatriate, the number of individuals, either employees or, more likely in this category, self-employed contractors, spending periods of months in overseas locations, is increasing. This creates the need for shorter term full international health insurance and this is an easy and growing market. 8 DELIVERY Healthcare delivery is constantly developing. The demands on clinicians for increasingly advanced and specialist skills, and the demands on providers in terms of increasingly expensive and sophisticated equipment, is leading to an international regionalisation of healthcare. At one time, a medical centre of excellence might have been the big hospital in the big town up the road. Now, this could be the pioneering heart surgery facility in the US, a conjoined twins specialist unit in Singapore or an oncology specialist unit in a London Teaching Hospital. Health insurance will increasingly need to be sans frontieres or without borders. 9 WEALTH International health insurance not only appeals to expatriates, it also appeals to the very wealthy. Imagine life either on a yacht or flitting from home to home. (There are more people doing this than one might think, although few are involved in the insurance business!) Very high net worth individuals represent a lucrative area for financial advice across the full spectrum of services. International health insurance is becoming an increasingly important element of this service. 10 COMMISSION The money isn t bad. International health insurance premiums can be higher than domestic plans, reflecting inclusion of outpatient cover and, for the better plans, the inclusion of chronic condition coverage. Commission can therefore be adequate to justify an intermediary s time in both studying and entering the market and of course in providing the necessary advice to interested clients. HealthInsurance The Guide to International Private Medical Insurance 2004

9 BUPA International s commercial director, Anthony Cabrelli gives intermediaries the top 10 tips on the relocation process 13 Top 10 tips on relocation The relocation process can often be very stressful for people, particularly when it involves moving to a country with a different language and customs entry requirements, such as a visa, banking and healthcare systems. Many people will often seek advice from intermediaries about the relocation process. BUPA International has developed a comprehensive guide called On the Move designed to provide useful information and advice to people intending to take up a post abroad. The key to any successful move abroad is to be well prepared and organised. BUPA International wants to help make the relocation process as smooth as possible for everyone involved so below the company answers some of the questions often put to intermediaries by people moving to another country. 1. WHAT DOCUMENTATION WILL I NEED? Anyone travelling abroad should ensure that their passport is valid for the duration of their trip. Some countries have an immigration requirement for passports to be valid for a minimum period beyond their date of entry to the country. Anyone planning to move outside the EU may require a visa. Details of visa and work permit requirements can be obtained from the relevant country s embassy. It is advisable to allow plenty of time to organise visas as they can often take weeks or months. It is also useful to take copies of other important documents such as birth and marriage certificates. The Foreign & Commonwealth Office is a useful source of up to date information on travelling to any destination or telephone WHAT ABOUT MONEY MATTERS WHEN I RELOCATE? Different rules and procedures apply when managing finances overseas. When relocating, it is advisable for people to find out from their bank about branches or affiliates in the host country. A local bank account is often needed so people can pay for local utilities and gain credit a reference from a UK bank is sometimes required for this. Tax rules also vary from country to country and some people may need to declare worldwide income, depending on timing and length of expatriation. Information about tax regulations overseas can be found on 3. WHAT DO I DO ABOUT HEALTHCARE? It is essential for people to ensure that they have access to high quality healthcare in their new country. The wide range of benefits offered by international health insurance can provide total peace of mind, 24 hours a day, 365 days a year. When choosing an international health insurer, there are some key considerations: Make sure that the insurer provides global insurance, offering help whenever and wherever it is needed. Ensure the scheme offers immediate emergency care, referral to a specialist or hospital if necessary, therapist treatment, dental treatment, hospital and inpatient care. A good insurer will have a multilingual 24- hour helpline to provide expert advice and support. Look at the online services that each insurer offers as they can cut administration time. Other health considerations include vaccinations which are often required for extended trips or moves abroad. Sometimes a medical examination will also be required and proof of immunisations before International PMI BUPA International The Guide to International Private Medical Insurance 2004 HealthInsurance

10 14 International PMI BUPA International entry to a country is granted. Detailed lists of inoculations required for each country are available from the Department of Health at When taking prescription drugs abroad it is important to find out any restrictions to bringing them into the host country. Contact the relevant embassy for details. can ensure British nationals living abroad can organise a long term supply of any medication they need. It can be helpful to take a first aid kit and medical reference book to help recognise common ailments and take multiple copies of medical records as these will be required by many organisations such as schools. It is worth considering wearing a medical bracelet to identify any specific allergies or drug reactions. 4. ARE THERE SPECIALISTS TO HELP WITH THE RELOCATION PROCESS? Relocation consultants are available and can do a huge amount of groundwork for you and will help with everything from removals, insurance and language training to finding schools. A list of relocation agents is available at 5. DO YOU HAVE ANY TIPS TO HELP FIND A NEW HOME? The decision to rent or buy a property depends on a number of factors including the nature of the host country s housing market, the type of property required, price and restrictions on ownership on real estate. Some of these factors can make it difficult for expatriates to purchase local property. It often makes sense to rent providing flexibility to the expatriate. It is often also possible to rent furniture and home furnishings. 6. DO I NEED INSURANCE? Unfortunately, items do occasionally get lost or damaged in the moving process. People should assess their needs thoroughly when organising insurance protection for their move. Many removal companies are able to recommend or organise suitable insurance. Things to check when researching schools include: Are there limited places or waiting lists? Remember to take copies of relevant qualifications and certificates in order to make formal applications. Check when the school year starts. Many countries offer a choice between local or international schools. Some of the benefits of local schools include language development and opportunities for wider friendships with host country children and an appreciation of a different culture. International schools are often viewed as the safer choice taking into account social integration and formal qualifications. 8. CAN I TAKE MY PETS? The primary consideration should be what is best for the animal, taking into account its age, condition and climate of the host country. Some rental agreements may not permit pets so it is worth checking this. There could be very strict documentation, immunisation and quarantine requirements in some countries. Many countries require some form of health certificate to accompany incoming pets. The consulate of the host destination will be able to provide full details of transportation and entry requirements. 9. WHAT IF I DON T SPEAK THE LANGUAGE? Learning the language of a new country is not essential but it can help to provide a sense of belonging and achievement. There are many ways to learn a new language including traditional classes, video and audio cassettes, books and the internet. 10. ARE THERE EASY WAYS TO MEET FELLOW EXPATS? Expat clubs are designed to help those relocating and provide a ready made network of support. The clubs can provide a wealth of practical advice as well as tips on how to meet new friends and they can be a great source of insider information about the social scene. The local embassy will have details of local clubs on their website. Detailed country by country health advice can be found on BUPA International s website: 7. HOW DO I FIND A SCHOOL? Maintaining a quality education for children is always a priority when relocating. In addition to researching the options available, it is always a good idea to visit the schools as well to talk personally to the teachers. These visits are often combined with a visit looking for housing because schooling may be a factor in deciding on a location. HealthInsurance The Guide to International Private Medical Insurance 2004

11 Norwich Union Healthcare s head of international, Shah Rouf says that wherever they are in the world, employees need the reassurance that they are protected as well as, if not better than, they are at home Global challenge Predictions of the global village have been made for the past decade and in recent years we have started to see them come true. With improved technology the flow of information across national boundaries is becoming faster and greater in quantity, the reduction of trade barriers has seen the marketplace open up, and relative global stability has made companies feel confident to enter new markets abroad. This globalisation has in turn lead to an increased number of expatriates working abroad, with the offer of a new challenge, the opportunity to experience a different culture, the promise of warmer climates and tax concessions often making the opportunity too good to refuse. It s a similar story for the self employed and retired, with cheap flights and the internet meaning that it is now far easier for them to live their dream in sunnier climates whilst still maintaining a foothold in the UK. A prime example of this is the thousands of British who emigrate to Spain and France every year, keen to escape the rat race and take advantage of the lower cost of living and slower pace of life. With a growing number of companies either globalising for the first time or expanding an existing small international presence, employers are increasingly facing the challenges of managing an internationally mobile workforce. CHOOSING THE RIGHT BENEFITS Being relocated thousands of miles away from home can be a very daunting process and if the employer isn t careful, it can leave their employee feeling isolated and under valued. Therefore, ensuring the best benefit structure is in place is paramount to the successful relocation of the employee. However, different legislation, cultural issues and custom and tax rules mean relocating an employee abroad with the same employee benefits as at home isn t always a simple process. An employer can take a number of steps to help formulate the most appropriate benefits package for their expatriate employees. These include: Obtaining country information which clarifies the local conditions including tax, social security legislation, healthcare provision and employee expectations Tailoring employee benefits to suit different local conditions Deciding whether benefits are paid as a cash allowance or provided by the company (this will depend very much on tax) Obtaining help and assistance from someone familiar with the locality. Putting international private medical insurance on top of the list One of the first benefits an employer should consider including in their employee benefits package is international private medical insurance (PMI). Whilst some employers do not see the need for private medical insurance, instead expecting their employees to return home for treatment, new rules being introduced by the government to cut down on so called health tourists - foreign nationals who come to the UK purely to obtain free treatmentmay mean they will no longer be entitled to their usual NHS benefits. For example, if a UK national has lived and worked outside the UK for five years, they are no longer automatically entitled to free hospital treatment under the new legislation. Similarly, pension holders who live abroad for six months or more a year will not normally be entitled to free GP services once the new rulings are introduced. International healthcare provision is a diverse and complex topic. Every country has a different healthcare system in place offering different levels of expertise and access. In Poland and soon in Saudi Arabia for example, employees need to have PMI in place before they can work. In France however, if residency is obtained the employee can transfer to the French healthcare system - the Couverture Maladie Universelle. Yet, an employer has to be mindful that this still only usually entitles their employee to around 70% of healthcare charges, meaning a top-up insurance may still be required. Whether the employee is being relocated to a country that has limited primary care facilities or the most high tech hospitals in the world, the need for international PMI is clear to see. 15 International PMI Norwich Union The Guide to International Private Medical Insurance 2004 HealthInsurance

12 16 International PMI Norwich Union Wherever they are in the world, employees need, and indeed expect, the reassurance that they are protected as well as, if not better than, they are at home. They need to know they have access to quality medical treatment whenever and wherever they need it. And, where the treatment isn t available in the country they are living, they need to know that where necessary, they will be evacuated to the nearest country where treatment is available. Employers should look beyond the standard policy benefits and look at the added value benefits a provider can offer their employees. Typical examples of questions they should ask include: Is the routine maintenance of chronic conditions covered? A chronic condition such as diabetes can easily be managed at home via their GP but if they were in a country with limited primary care facilities it could be a completely different story. Do employees have access to round-theclock support and advice from a multi-lingual medical advice line 24 hours a day, 365 days a year, irrespective of their time zone? Are employees restricted to a defined hospital list? Can the insurer settle bills directly with the hospital or does the employee have to pay the bill themselves and claim the money back? Can the insurer settle bills in the local currency where necessary? And, what kind of evacuation facility is available in the event of them falling ill where treatment isn t available? ADDING VALUE THROUGH INTERNATIONAL MEDICAL INSURANCE However globally minded a company is, with such a diverse range of healthcare provision, tax rules and legislation across the world, an employer could be forgiven for finding the relocation process somewhat daunting. That is why international PMI is no longer just about supporting the employee through paying for medical treatment. Recognising the minefield facing employers, insurers are continually looking to add value through their private medical insurance scheme - by providing benefits that offer advice and assistance to the employer as well as the employee. These include: Providing access to country profiles, giving HR managers an effective document offering practical information for employees considering taking an international assignment, and for their use throughout the assignment. Offering access to a library of articles giving practical and expert insight into managing international assignments Providing a dedicated HR helpline to answer any questions relating to the above information Giving access to practical assistance and advice in the administration of international assignments Offering added value through tailored policy support material and online tools providing practical tips and advice to help the employer help their employee relocate successfully. Norwich Union Healthcare for example, is in the process of enhancing its Corporate Global Care policy with a Global HR Assistance service for employers. The unique service will be provided by ECA International - one of the world s largest membership organisations for international human resources, serving a global network of over 4000 HR professionals in 35 countries. ECA s expertise offers employers a wide range of information and support to help them manage international assignments with maximum efficiency. Global HR Assistance from Norwich Union Healthcare will be designed to provide: Access to in-depth solutions for inexperienced or small international HR teams Quick access to key information for more experienced or larger international HR teams General information on international HR dynamics for the HR community and supporting intermediary. The Global HR Assistance service, accessed through a new online portal available later this year, is designed to help make the relocation process as easy and stress free as possible. Not every international PMI provider offers these added value benefits. However, being part of one of the world largest insurers, Norwich Union Healthcare recognise the importance of providing a policy that is not just an employee benefit but is also an employer benefit. Further details of standard cover and exclusions under Norwich Union Healthcare s Global Care policy can be obtained from your usual healthcare sales consultant. HealthInsurance The Guide to International Private Medical Insurance 2004

13 The healthcare systems may vary across Europe but, writes Sarah Marfleet Axa PPP healthcare s senior marketing controller, the expat needs quality care 19 Expanding market With the expansion of the EU, relaxation of border controls and increased interdependency and trade between member states, Europe could be viewed in many ways as a single entity, as British nationals continue to move throughout Europe to live and work. At the same time, however, it is evident that a huge amount of diversity still exists across Europe that makes it far from uniform. A rich melting pot of diversity of language, culture, currency and economy ensures that far from being a single entity, Europe remains a diverse, complex and rapidly changing region. The healthcare systems across Europe vary enormously in quality and cost. Whilst the European expat workforce may face little exposure to the types of tropical diseases and health issues faced in other global destinations, nevertheless the need for quality healthcare provision remains apparent. THE EURO EXPAT Intermediaries who want to be successful in the European market are faced with a wealth of opportunities to sell private medical insurance (PMI) and it is critical that they understand the varying types of expats and their healthcare needs. A significant number of British retirees leave the rain and bustle of Britain each year, to seek a life of relaxation in sunny southern Spain. Research by AXA PPP healthcare estimates that up to 400,000 UK citizens have retired to Spain and over 10,000 to Portugal. The retiree hotspots of Southern Europe present a wealth of business opportunities, where a thriving expat community lives. The demands for health insurance vary enormously. For some retirees, who consider Spain as their second home, their product preferences will vary greatly from the super-rich in Marbella. On the other hand, to the working expat, who may be travelling throughout Europe and making frequent trips back to the UK, a comprehensive PMI package should ensure that they are covered for medical treatment across Europe, as well as back in the UK. Again, research estimates that over 400,000 working British expats are living in the EU. Where the expat is part of a corporate health scheme, product requirements may vary significantly from the self-employed expat who is paying the cost of their PMI plan themselves, and where extended periods of ill health need to be avoided, to keep their business running. LEGISLATION In many parts of Europe, where quality healthcare does exist and the state system provides reputable medical facilities, there is an increasing amount of legislation which impacts both the extent to which the expat is eligible to receive state healthcare and the corresponding cost. Intermediaries can guide companies through the minefield of healthcare legislation that appears to be increasing across Europe, making eligibility for state healthcare far from uniform. Increasingly, different countries are tightening their healthcare regulations for foreign nationals. In Switzerland, for example, expatriates must produce a certificate of insurance, signed by their PMI provider, confirming that they have adequate health insurance. In France, the introduction of couverture maladie universelle (CMU) in 2000 requires all residents to register with the French state system. Similar systems apply in Germany and Spain. Intermediaries who are well read on these varying legislations are a valuable tool for any individual or employer who is considering international PMI. OPPORTUNITIES ABOUND Within the changing face of Europe, intermediaries and medical insurers can work together to provide a range of products to suit varying circumstances and budgets. With the diversity in the quality, cost and accessibility of healthcare systems throughout Europe, intermediaries who are knowledgeable in this market are well placed to provide genuine added value to their expat clients who need the right advice to ensure they get the best product to meet their needs in a complex yet compelling market. For further information about international medical insurance from AXA PPP healthcare, call our intermediary helpline on or For corporate scheme enquiries, call our International Corporate Sales Team on or International PMI World AXA PPP healthcare The Guide to International Private Medical Insurance 2004 HealthInsurance

14 20 Medical inflation, the rising cost of prescription drugs, and rampant litigation are all combining to drive change in the US healthcare system. Gregory Cain of CIGNA International Expatriate Benefits explains just what s happening across the pond International PMI World CIGNA International Counting the cost In the US, several market forces will increase the complexity and cost of healthcare, and will demand significant changes if the current system is to survive. And it s likely that both the forces and the changes they drive, such as the cost of and access to care for expatriates in the US will have direct implications for European insurers and underwriters. In recent years, medical inflation has averaged from the low to mid-teens for US insurers, and shows little prospect of slowing. Nationally, health expenditure for 2003 hit US$1.6 trillion, and is likely to increase to US$2.6 trillion by CONTROLLING PRESCRIPTION DRUGS COSTS One of the largest individual contributors to this trend increase is the cost of prescription drugs, which is projected to continue growing at an annual rate of 20-30% for the next few years. For intermediaries seeking cover for clients with a US-based expatriate population, managing costs will, to a large extent, be dependent upon the insurer s strategy for purchasing prescription drugs, and they need to be taking an innovative approach, such as being able to collect prescription drugs from a network of approved pharmacies, and only have to pay the excess or co-insurance, as opposed to the full price of the drugs. This not only reduces claims administration, it removes the need for expatriates to use their own money, and adds to their peace of mind. Other forces at work within the US system include: Changing face of managed care After years of evolution towards stronger forms of managed care, including small, tightly controlled networks of providers and specialist referral procedures, there is now a shift back towards less restriction, accompanied by payor intervention. The two main causes for this shift are: dissatisfaction among purchasers with the hassles of the strongest forms of managed care (e.g. Health Maintenance Organisations, Point of Service Plans, etc.), and the increasingly stronger bargaining position of healthcare providers when it comes to insurers and Managed Care Organisations. Not surprising occurrences, considering the maturity of the managed care industry in the US. Cost of a litigious society Reform of the law of negligence with respect to medical malpractice at both state and federal levels has enjoyed limited success, but while states with unlimited non-economic damages had increases of between 36%-113% in 2002, states with limits did not experience the same peak. Limiting jury awards for pain and suffering is a contentious political issue, but large awards by juries have left many doctors (surgeons, A&E doctors, obstetricians, etc.) unable to afford medical malpractice cover, and the trend is for them to either leave their practices, or move to less expensive specialisms. Direct government involvement in healthcare purchasing In spite of the obvious limitations of single payor systems (e.g. nationalised healthcare) in controlling healthcare costs, it s a concept that may be adopted as a central policy position for several Democratic presidential hopefuls in the forthcoming elections. The Bush administration is also expected to introduce less draconian reforms to counter the Democrats. Federal and state initiatives already account for 46% of national healthcare expenditure, while reimbursement rates for Medicare and Medicaid (healthcare programs for the elderly and poor, respectively) continue to decline as these programs struggle with their own funding crises. The trade-off between universal access to insurance benefits and the necessary rationing of care, in order to afford such a plan, would take a considerable reorientation of most Americans idea of unfettered access to high tech medicine. GOVERNMENT REGULATION Regardless of future changes to the federal government s role in financing healthcare in the US, significant new regulations already contribute to administrative costs. The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains two important rules that are taking effect in 2003: Privacy Rule: a comprehensive body of requirements around patients rights to access, accounting and protection of their individually identifiable health information. The rule, which became enforceable on April 14, affects both healthcare providers and US-affiliated insurers. Administrative Simplification Rule: this rule expands and standardises electronic transaction code sets used by healthcare providers, insurers and policyholders. This required substantial systems modification by all parties to meet the final 15 October 2003 enforcement date. The costs related to preparing for compliance with HIPAA are substantial and will ultimately be borne by patients and policyholders. We predict there will have to be changes if the current US healthcare system to survive. The options include: consumers funding a greater share of their healthcare services directly from their own pocket; greater government involvement in attempting to regulate prices and rationing care; or tort reform to reduce the increasing cost of professional liability insurance. In the words of Mae West, Fasten your safety belts, we re in for a bumpy ride. And if the past experience is anything to go by, the UK should watch out for the turbulence! HealthInsurance The Guide to International Private Medical Insurance 2004

15 An oil rich region like the middle east attracts many expats which can put pressure on its health service, write Ron Buchan, Allianz Worldwide Care s CEO 21 Anyone for Gulf? The key market segment of interest to the providers of international healthcare within the Middle East are the six oil rich Gulf states comprising the Gulf cooperation Council (GCC). These countries are Bahrain, Kuwait, Qatar, Saudi Arabia, Oman and the United Arab Emirates (UAE), which includes Abu Dhabi and Dubai. Following the discovery of oil within this region in the early 1970s, and the resulting rapid and substantial increase in state revenues, all GCC states embarked on a programme of rapid and substantial infrastructural development. UNIQUE DEMAND This process created a unique demand for expatriate workers, predominantly from Asia and the Indian subcontinent but also from Europe and, to an extent, the US. Among western countries providing expatriates to the Middle East, the UK is currently the largest. According to Foreign and Commonwealth Office statistics, the split of British residents by GCC country is as follows: Qatar 4,500 UAE 48,000 Bahrain 7,000 Kuwait 4,000 Oman 6,000 Due to the turbulence in the country resulting from the recent terrorist attacks, the current number of UK expatriates in Saudi Arabia is not so clear, but is a reducing number. Our current estimate would be 35,000. Until comparatively recently, all residents of the GCC states, whether national or expatriate, were entitled to free healthcare services. There are a number of excellent medical facilities within the region and the attractive tax free packages available have also encouraged suitably qualified clinicians to spend at least some time practising in the Gulf. RAPID GROWTH However, not withstanding the resilience in the price of oil (and note the current record high price levels for crude oil) all of the GCC states are now feeling some financial pressure. In the main this is caused by the rapidly growing local population. More than 50% of the national population of the GCC states is under 20 years. This means a continuing substantial increase in the adult population creating a significant strain on services such as education and health as well as on government resources to provide job opportunities. (In the GCC, most nationals are employed by the state in some capacity, except in Bahrain and governments have to fund this.) FREE HEALTH ERODING Therefore, free healthcare is gradually being withdrawn from expatriates across the region. In the UAE it is necessary, prior to the granting of a work permit, to either purchase a state sponsored health card or to show acceptable evidence of the existence of health insurance. In Saudi Arabia whilst legislation has not yet been enacted, free treatment for expatriates is now no longer available at most state hospitals. Equally, in Kuwait, Oman and Bahrain, expatriates are increasingly being excluded from free healthcare delivery. Indeed, in some states, in particular Kuwait, there are clear plans to introduce charging for healthcare for local nationals also. STRONG MARKET We therefore have a small and compact region, populated with many British expatriates, all of whom will need health insurance. There is therefore clearly a strong market for international health insurance. Furthermore, the concentration of expatriates in one small geographic area, which is a different model to that which faced by expatriate insurers elsewhere, means that additional services can be provided. In particular, direct settlement arrangements for outpatient treatment as well as inpatient treatment are increasingly being put in place. This means that many multinational companies with employees in the Gulf will purchase separate local direct settlement plans for their Gulf-based employees. This provides opportunities for UK based intermediaries in that many of these companies are overseas subsidiaries of British companies and the individual members are include numbers of UK nationals. LOCALS Establishing connections with local companies or creating web-based marketing initiatives to attract locally based individuals are clear opportunities for UK intermediaries. It must be noted, however, that UK expatriate insurers are interested in Gulf domiciled expatriates but they treat the rapidly growing insurance market for local nationals with more caution. The dynamics for the development of international healthcare business within the Gulf are clear and obvious, and although there are some locally based intermediaries, modern technology opens this market also to intermediaries. International PMI World Allianz Worldwide Care The Guide to International Private Medical Insurance 2004 HealthInsurance

16 22 BUPA International s commercial director Anthony Cabrelli explains that Africa s vastness means an expat would need emergency evacuation cover International PMI World BUPA International Out of Africa Amajor concern for people living or phone access to a multilingual team of dedicated health professionals who can offer expert from season to season with the highest rates The rates of malaria and typhoid claims vary working in Africa is what happens if they become ill or if their spouse or advice and support. A third and final option occurring between January and April. child needs medical treatment. It is available is repatriation cover which allows customers Many claims are for gastroenteritis/travellers important for them to know they will have immediate access to appropriate healthcare services and that their entire healthcare needs will be met by highly qualified professionals, delivering a high standard of care. Medical facilities in Africa can often be very different from those to which many people are accustomed. Private medical insurance (PMI) enables members to either use the best facilities available in the host country, move to another country to receive treatment or with the appropriate level of cover, return to their home country. In a continent as vast as Africa, many customers may find themselves living or working in areas where their nearest medical facility is hundreds of miles away. In the event of serious illness or injury, a delay in accessing medical treatment could be lifethreatening. Therefore, emergency evacuation cover is essential for anyone choosing an international PMI policy in Africa. Customers will want to be reassured that the insurer can organise their evacuation quickly and efficiently should they become seriously ill or injured. Delayed access to appropriate medical treatment may result in more serious medical problems developing which can be costly both financially and in terms of health. BUPA International can offer some extra reassurance in the form of assistance cover. This includes evacuation cover straight to the nearest medical centre of excellence. This option is invaluable for those who might worry about local healthcare arrangements: a 24- hour, 365 days a year Healthline service is available providing members with instant teletomers to be treated in their home country. Cus- want to be assured that their insurer will be there for them whatever time of day it is and wherever they are in the world. It is still important to consider the health risks when moving to an exotic destination. Many of these can be minimised by making the necessary preparations before travelling, taking sensible measures while they are away and watching out for any problems throughout their time in the country. For those making the move to Africa, it is important to seek up to date advice before leaving. Most family doctors run travel clinics or can refer people onto one. It is important to seek this advice well in advance of any planned departure (eight weeks is recommended) as it can take as long as a month for some immunisation courses to be completed and therefore effective. Typical immunisation courses for Africa will include a booster for polio and tetanus, and immunisation against hepatitis A and typhoid. However, as new disease outbreaks occur, the requirements for immunisations can change and these vary from country to country (and even between regions in large countries). Always allow some time to seek advice prior to travel. BUPA International has compiled a brief outline of its claims experience in the continent: BUPA International provides medical insurance to over 40,000 people in Africa. Most customers requiring emergency evacuation are transferred to specialist medical facilities in Johannesburg. Most claims are made by customers living in Nairobi and Mombasa in Kenya. A large number of claims relate to skin conditions and eye conditions. diarrhoea, which can be caused by consuming contaminated food or water. Hospitals in South Africa commission outside providers to perform diagnostic tests such as X-rays and pathology tests. BUPA International occasionally receives claims for unusual injuries such as stab wounds, gunshot wounds and animal attacks. BUPA International offers the following general health advice to people visiting Africa: Infection from contaminated food and water is a major cause of illness in travellers, in particular travellers diarrhoea. Stick to boiled or bottled water and avoid ice in drinks. Alternatively, water can be sterilised with iodine drops/tablets or with a quality filter. Dishes and cutlery should ideally be washed with sterilised water. Hot tea, coffee, beer and wine are usually safe. Ensure that milk has been pasteurised and that cheese, cream and ice cream are made from milk that has been pasteurised. Peel all fruit, eat only cooked vegetables and avoid salads. Ensure that seafood, fish and meat are thoroughly cooked and eaten hot whenever possible. Avoid leftovers. Wash hands before eating or handling food and always after using the toilet. How to protect yourself against mosquito, other insect and animal bites These can be minimised through wearing suitable clothing, having insect screens in living accommodation, using repellents and a mosquito net. Do not approach stray dogs as they are frequently not as friendly as at home. HealthInsurance The Guide to International Private Medical Insurance 2004

17 Amber Chable, Norwich Union Healthcare s trade marketing manager says SARS has highlighted the importance of PMI for expats 23 Asian opportunities East Asia has always been a popular location for expatriates with an estimated 950,000 currently working in the Far East alone. However, last year saw an epidemic that some fear may have affected the Asian economy as much as the Asian financial crisis of The outbreak of Severe Acute Respiratory Syndrome (SARS), a severe respiratory virus, not only posed a major threat to society, but also the Asian economy. Believed to have originated in China s southern Guangdong province in November 2002, SARS saw its first recorded death in a Hong Kong hospital in March In the months to follow the virus killed nearly 800 people worldwide. The World Health Organization announced that the outbreak had been contained in July 2003, but experts predict that SARS will continue to be a threat and warn that health authorities need to be ever vigilant for its return. One of the main causes of panic when the SARS outbreak occurred was a lack of understanding about the virus. People stopped travelling and we saw daily reports showing individuals wearing face masks to protect themselves against viral particles. As the number of recorded cases of SARS fell, people slowly started to SARS - the facts remove their masks and get back to normality. WORLD HEALTH SYSTEMS PUT TO THE TEST SARS helped demonstrate how many of the world s health systems are not prepared for such an outbreak. Whilst enormous efforts were made to contain the virus at source, in China they constructed a 1,000 bed isolation camp for SARS patients in just days. Further afield, the world was ignorant to the deadly threat. In Canada for example, doctors were not warned that they might see cases of an unusual and contagious pneumonia. As a result the SARS virus managed to spread before the medical authorities began to isolate patients and protect medical staff. Richard Tedder, professor of virology at University College London said that SARS was a wake up call to public health doctors worldwide. Hopefully one of the beneficial effects of the outbreak might be to divert much needed funding to make sure that countries are better prepared in future. SARS IMPACT As Asia slowly comes to terms with living with SARS, the Asian insurance industry is assessing the economic impact of the virus. The World Health Organization believe that SARS is a new mutated strain of the Corona virus - a family of viruses well known as a cause for the common cold It is likely that infection takes place through droplets of body fluid - produced by sneezing or coughing Experts believe that after infection, the incubation period can be up to 10 days Known symptoms are similar to those of flu, including high fever, headache, sore throat, and cough The Department of Health say there are no current SARS-related travel restrictions although patients who have recently returned from a country where SARS is prevalent, or who believe that they may have come into contact with an infected person, should consult their GP if they develop these symptoms The SARS outbreak saw the sales of travel insurance policies fall by almost 80% in Hong Kong*, due to the drop in business and leisure travel. Life insurance policies have also experienced a decline. Whilst one would expect to see an increase in the demand for life policies going forward, at the time of the outbreak intermediaries found it very difficult to arrange face to face meetings with potential clients. Those who were willing to meet were often reluctant to go to hospitals and clinics for the medical checks necessary under the terms and conditions of the policy. Governments around the region have taken steps to help the insurance industry cope with the situation. China, for example, was the country hardest hit by SARS and the China Insurance Regulatory Commission (CIRC) has urged insurers to honour SARS related claims and has banned any promotion around the SARS virus to help prevent potential cases of misselling. DEMAND FOR MEDICAL INSURANCE Following the outbreak, intermediaries in Asia have seen a rise in demand for medical insurance with sales seeing an increase of 15%* as a result of greater awareness for the importance of critical illness cover. Outbreaks such as SARS serve to highlight the importance of expatriates having access to relevant information and protection when living abroad, especially to areas where access to primary healthcare is limited. * Source: Asia Insurance Review Magazine June 2003 Edition - SARS Round-Up Gauging The Impact of SARS on Asia Insurers. International PMI World Norwich Unioin The Guide to International Private Medical Insurance 2004 HealthInsurance

18 25 Allianz Worldwide Care does business with global partners Global nature Allianz Worldwide Care is the Dublin-based specialist international healthcare subsidiary of the worldwide Allianz Group, the Europe s largest insurer. Allianz Worldwide Care has located its central service operation in Dublin, the Republic of Ireland. From this base, members worldwide are serviced by a specialist management and staff, supported by a cutting edge administration system which was specifically designed by the Allianz Group for the very particular needs of Allianz Worldwide Care. The company has physical representation in the UK, Germany, France and Italy and in addition, via collaboration with other Allianz Group operating companies, Allianz Worldwide Care transacts business in Latin American, Asia Pacific, Eastern Europe and the Middle East. It is the global nature of the Allianz Group which makes Allianz Worldwide Care stand out from other providers of similar services. GEOGRAPHICAL SPREAD A key ingredient in the company s service proposition is not only the extent and geographic spread of its provider network but also its detailed knowledge of both the providers in the network and of the local healthcare dynamics in countries around the world. Via cooperation with local Allianz companies which offer domestic health insurance in various parts of the world and also via cooperation with Mondial Assistance, the Allianz Group s assistance company, Allianz Worldwide Care has been able to create a broad international provider network. This mechanism has also allowed the company to gather detailed knowledge about the healthcare delivery mechanisms in the various countries around the world where the company covers insured members. This truly international healthcare delivery expertise is frequently used to connect members in need with the most appropriate clinicians and medical institutions. Allianz Worldwide Care has also invested significantly in its medical capabilities allowing the company to oversee the appropriateness of proposed medical interventions and to monitor their outcomes. It also enables the company to oversee the appropriateness of available clinicians or facilities and to take appropriate remedial steps when considered appropriate. This can be a vital service in many parts of the world. PRESTIGIOUS In the UK, Allianz Worldwide Care operates via intermediaries and positions itself as a high quality, blue chip service provider. The company numbers many of the world s most prestigious and substantial corporations as clients and the company enjoys a virtually perfect client retention record. As well as a full range of book rated plans, the company also provides fully tailored solutions for larger corporate clients and also offers companies a range of premium and funding options generally considered to be the most innovative in the market. The company also offers cover to individuals and has a range of benefit tables and premium options to suit most needs. Allianz Worldwide Care supports intermediaries and is pleased to work with those intermediaries interested in either developing or broadening their international health insurance client base. CONTACT DETAILS Web: Tel: Kevin Melton, UK regional manger. International PMI Profile Allianz Worldwide Care The Guide to International Private Medical Insurance 2004 HealthInsurance

19 International PMI Profile AXA PPP healthcare 26 Forging links AXA PPP healthcare is one of the UK s leading healthcare companies, founded in the UK in 1940, before the establishment of the National Health Service. Today, we form the UK healthcare arm of AXA (one of the world s leading insurance and asset management companies) and serve around 2m customers through our medical insurance policies for companies and individuals at home and abroad. We have over 30 years experience in the international medical insurance market and today, we have a team of over 80 people dedicated to looking after the healthcare needs of people living, working or travelling abroad. As well as operating from our company headquarters in Tunbridge Wells, AXA PPP healthcare has relationships with associate companies in Malta, Cyprus, Saudi Arabia, Bahrain and the UAE in order to increase distribution of expatriate plans. CARING FOR CUSTOMERS We are also continuing to build stronger links with hospitals around the world and are continuing to build arrangements so that we settle customers bills directly with them. Our strategy is to forge long term links with hospitals to ensure our customers have access to safe, quality care at the right price. We now have direct settlement arrangements with over 500 hospitals around the world - saving customers the trouble of having to pre-pay and recover their medical expenses from us after they have been treated. In addition, our customers are able to make use of around 11,000 medical providers (hospitals, clinics and specialists) through our relationships with third party associates, providing our members with access to an even wider range of hospital networks around the world. OUR PRODUCTS Expatriates have different healthcare requirements. Which is why AXA PPP healthcare has developed a range of policies with varying levels of cover. We ve developed these policies after extensive market research, taking into account what our customers actually say they need and what health support they value the most. This, coupled with the experience we have gained through providing medical cover for over 60 years has given us a firm foundation upon which to provide health plans that really meet the needs of the 21st century expatriate. Our International Health Plan is used by individuals as well as groups of all sizes, from companies with three employees to the world s leading multinational corporations. We have three levels of cover available: Prestige, Comprehensive and Standard. The Comprehensive Option provides comprehensive cover, not just for inpatient and daycare treatment, but also for outpatient treatment. This is our most popular plan, chosen by a significant proportion of our customer base. The Standard Option has been designed for those people who do not require outpatient benefits. The inpatient and daycare benefits are very similar to the Comprehensive option, although benefit levels may vary in some cases. The Prestige Option provides all the benefits of the Comprehensive plan and includes routine pregnancy cover, disability compensation cover, annual travel insurance and a stress counselling helpline. Most recently we have added the following benefits to our individual and small corporate product ranges: Increased overall limits Travel and childhood vaccinations Eyesight tests AXA PPP healthcare has links with hospital networks around the world Optical cover Annual health screen Chronic cover is now included on our small corporate product range A PHONE CALL AWAY An invaluable part of all our plans is our exclusive and award winning health information service, Health At Hand. Staffed by registered nurses, midwives, health visitors, pharmacists and qualified counsellors and supported by one of the largest electronics medical libraries in Europe, we re always there to answer any health-related queries at any time night or day, 365 days a year. We can also provide our members with regularly updated fact sheets on over 150 ailments and treatments post, fax, or via our website In addition to our 24 hour Health at Hand service, we provide a 24-hour doctor, dental and optical helpline. When our members need to seek medical advice abroad, it can be very reassuring to know where to find Englishspeaking practitioners. Through this service, we offer details of local English-speaking doctors, dentists and opticians around the world. Furthermore, we recently launched a telephone-based interpretation service in over 100 languages to help customers talk with their doctors especially in cases where the doctor speaks little or no English. CONTACT DETAILS For further information about international medical insurance from AXA PPP healthcare: For corporate business call Naoimh King on or For individual business call our intermediary helpline on or HealthInsurance The Guide to International Private Medical Insurance 2004

20 Customer feedback plays an important part in pricing 27 A personal approach BUPA International is the largest international expatriate health insurer in the world covering 115 nationalities in over 190 countries. It is part of the BUPA Group, which covers seven million members worldwide. BUPA International has been operating around the world for over 30 years and is the fastest growing business sector within BUPA. BUPA International is a truly global company with nearly 100 employed advisers all over the world, giving support on a local scale. It operates a multilingual helpline, which acts as a central point of contact for our members. It is open 24-hours a day, 365 days a year giving members reassurance and peace of mind wherever they are in the world. BUPA International pays claims directly to its network of 5,000 hospitals and clinics worldwide to save its members time, money and inconvenience. BUPA International provides a wide range of flexible high quality global health insurance options for groups and individuals living and working abroad for six months or more. Depending on the member s requirements, BUPA International s schemes can offer primary care, maternity cover, home nursing, routine and emergency dentistry, as well as hospital treatment and accommodation, health checks, cover for chronic conditions, emergency road ambulance and cover for sports injuries. Recently BUPA International has developed International a new method of calculating an individual customer s price for cover. From 1 April 2004 a customer s price is based on the country where they reside. Insurance cover will however, continue to be worldwide and customers will be able to purchase USA cover as an add on if they wish. A further change is also being made to individual (Lifeline) products where a customer s price will be based on their precise age and not, as previously, a five year age band. This is a significant change from the previous pricing model where individual (Lifeline) products were calculated on a worldwide basis and company products on a regional basis. The new approach to pricing is in response to customer feedback asking for products and prices that were more tailored to their circumstances. In a bid to ensure the more personal approach to pricing is as simple as possible, BUPA International has looked at countries individually and then classified them into one of seven zones. Each zone will group together countries with a similar claims experience. The zone in which the country falls will determine the cost of subscriptions. New pricing highlights: Customers will be priced according to country of residence. Single year age bands will be introduced to individual products, (Lifeline). Countries will be individually priced and placed in zones depending on their claims experience. Risk is priced appropriately. Customers pay a price according to experience. Countries will not be cross-subsidising each other. The BUPA International Lifeline (for individuals) and company schemes offer choice and flexibility. There are three Lifeline and four company levels of cover to choose from, each one appropriate for different circumstances. Whichever level customers choose, they can be sure that BUPA International will care for them and their families wherever they are. BUPA International has invested significantly in enhancing and developing its Internet capabilities. Intermediaryworld is a dedicated website specifically for intermediaries which allows them to carry out their day to day business over the Internet. It is a user-friendly site to navigate with fast downloads, launched as a direct response to feedback provided by intermediaries and BUPA International advisers. The site is broken down into six key areas: quotes, brochures, administration, commission, news and global information. During 2004, the latest world health information will be added to the site to help intermediaries inform their customers. BUPA International was the first international insurance company to allow members to track claims and buy online. Designed exclusively for BUPA International members is Membersworld, a fully secure site that enables them to check their claims status online. Other features include online claim forms, full access to membership details, instant quotes and information on local embassies, hospital networks and an electronic version of BUPA International member s handbook. Assistance Cover, one of BUPA International s latest initiatives, is a range of enhanced benefit options that can be added to an existing BUPA International policy. There are three options to choose from Healthline, Evacuation and Repatriation. All three options have been designed to help the member receive the best healthcare to suit his or her individual needs. They may simply require medical advice or need to book an appointment over the phone from time to time. They may live in a remote part of the world and need the reassurance that they will be transported to the nearest medical centre of excellence in an emergency. If they prefer, they can travel back to their country of origin to be around their friends and family while receiving their medical care. BUPA International is the winner of eight prestigious awards including the Queen s Award for Export 1999, Best International PMI Provider two years in a row at the International Financial Adviser Awards for Excellence and Best International PMI Provider for five years running at the Health Insurance Awards. CONTACT DETAILS For further details of all of BUPA International s products and services please visit: or call our intermediary sales team on: or via at: International PMI Profile BUPA International The Guide to International Private Medical Insurance 2004 HealthInsurance

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