Expatmedicare Guide to International Health and Medical Insurance

Expatmedicare GuideChoosing the most suitable and affordable policy for you and your loved ones can be an extremely challenging exercise. There are over 100 insurers in the market, a plethora of medical policies and options, with different limitations and definitions. At Expatmedicare, we believe in total transparency and in educating our clients so that they can make informed decisions. Here, we try our best to provide you with all the information you may need. Should you require more information or answers to any of your questions, we will be most happy to assist you with your research. Feel free to contact us.

Before you make your decision, it is important to understand some basics:

 

What is International Health and Medical insurance and what does it do for you

Whether its called International health and medical insurance or Expat medical insurance, it all refers to the same thing and serves the same purpose which is to provide expatriates with access to more choices and high level of medical advice, treatment and facility wherever and whenever they need.

The main objective of an international medical insurance is to pay for the cost of active treatment, which is treatment for acute conditions (an illness, disease or injury that is short-term) and for other costs such as hospital accommodation, nursing, emergency dental treatment, etc. Depending on the type of insurance, it can include cover for other treatments such as out-patient, dental, optical or maternity.

Understand what is covered in your insurance

Generally, there are 2 categories of coverage: Standard and comprehensive. Premium for comprehensive cover is higher compared to standard cover.

Standard Plan

Under the standard plan, most insurers will provide coverage for the following:

  • in-patient: an insured person who stays in a hospital bed and is admitted for one or more nights solely to receive treatment
  • day-patient: an insured person who is admitted to a hospital bed but does not need to stay overnight
  • emergency treatments including accidental damage to teeth
  • medical evacuation: evacuation of an insured person to the nearest medical facility for treatment in the case of emergency and when it is not readily available at the place of accident. Cover is extended to the insured person’s escort.
  • home nursing by a qualified nurse immediately after discharge from hospital and on recommendation by a medical specialist
  • cancer: Oncology which is treatment for cancer, including diagnosis, therapy (radiotherapy, chemotherapy, surgery, etc)
  • reconstructive surgery administered immediately after an accident or disease, e.g. breast reconstruction after mastectomy and sometimes lumpectomy which may take place simultaneously during cancer-removing surgery, or months to years later

Comprehensive Plan

The comprehensive plan covers additional out-patient (an insured person who receives treatment at a recognized medical facility, but is not admitted to a hospital bed as an in-patient or day-patient) treatment.

Many insurers provide different modules, which you can add on, such as medical evacuation and repatriation, dental, optical and maternity coverage. Premium increases with more add-ons.

Understand what is not covered in your insurance

Most insurers will exclude chronic illness and pre-existing condition. Having said that, most will cover cost for treatments required to stabilize the health condition of the insured. Some insurers may accept to cover pre-existing conditions depending on how your policy is underwritten. The list of exclusions changes from time to time as new technologies surface which in turn affect medical cost. Below is a list of exclusions found in most international health and medical insurances:

  • Addictive and mental conditions and disorders (some insurers might cover treatment on discretionary basis)
  • Allergies and allergic disorders
  • Artificial life maintenance
  • Birth control (contraception, assisted reproduction, sterilization, abortion, etc)
  • Conflict and disaster (treatment as a result of nuclear or chemical contamination, war, disaster, etc)
  • Cosmetic and plastic surgery (unless it is administered immediately after an accident or disease, e.g. breast reconstruction after mastectomy and sometimes lumpectomy which can take place simultaneously during cancer-removing surgery, or months to years later)
  • Obesity
  • Congenital conditions

How is premium priced

Underwriting is the process by which the insurer uses to evaluate the risk and exposure of potential clients and assess their eligibility to receive coverage. In this process, they will determine how much coverage to provide, what is excluded if any, and thus the premium to be paid by the client. Each insurer has its own set of underwriting guidelines to protect the financial status of the company. There are 3 types of underwriting: Full Medical Underwriting, Continuing Personal Medical Exclusion (CPME) and Moratorium Underwriting.

Full Medical Underwriting (FMU)

Under FMU, applicants are required to submit a full declaration of their medical records to the insurer who will then verify with the applicant’s GP. Insurer will then make a decision to cover or exclude any pre-existing condition or name other conditions to exclude due to the potential of arising because of current condition. If applicant fails to disclose details of any past or present illness, should the illness arise in the future, insurer has the right to deny any claims.

Thus it is extremely important to be very thorough in your medical declaration. Some insurers may agree to cover pre-existing conditions at a loading, meaning, higher premium. This is dependent on various factors such as your state of health at application, the condition of your illness, when your illness appear, how long you have had it, etc.

With FMU, applicant will have to wait a period of time to know whether they will be covered or not.

Continuing Personal Medical Exclusions (CPME)

If you want to switch insurer, maybe due to bad customer service, but you are suffering from a pre-existing condition that your current insurer is covering, your next chosen insurer will most probably use CPME to underwrite your policy. With CPME, applicant’s benefits and exclusions, if any, in the new policy will be similar to their old policy. In this instance, applicant will go through full medical underwriting. This process ensures continuous medical coverage.

Moratorium Underwriting also known as Point-of-Claim Underwriting

Provided that you are healthy and with no past illnesses, the most common and cost-effective way to get international health and medical insurance coverage is by moratorium underwriting. With moratorium, applicant need not make any declaration of his/her medical history. Illness is assessed at the point of making a claim. Usually, pre-existing conditions that occurred 5 years before your policy starts will be excluded. If no claim has been made on the pre-existing condition or related condition for a continuous period of 2 years, it will then be included in the cover. If a claim has been made during this two-year period, the two-year qualifying period starts all over again.

With moratorium underwriting, coverage starts straight away.

What affects the price of the premium

There are 5 basic determinants of premium pricing

1. Risk Profile of Applicant

Premium is priced to reflect the risk under taken by the insurer. The main risk here being the age. As one ages, the chances of health deteriorating is higher and thus, likelihood of more claims. For that reason, premium is age-related. Other factors that some insurers consider are gender, occupation, lifestyle habits, BMI (Body Mass Index), etc. Different insurers have different levels of premium based on 1-year, 5-year, or 10-year period. It is important to analyze how your premium will affect you as you grow older. Table below shows an example of how premium increases with age (5-year period).

Age BandStandard Plan (In-patient) US$% increase
30 - 34$1,549 
35 - 39$1,70410.01
40 - 44$1,95814.91
45 - 49$1,19912.31
50 - 54$2,79727.19
55 - 60$3,60628.92
60 - 64$4,94437.10
65 - 69$7,60353.78
70 - 74*$8,66413.96
75 - 79*$9,97715.15
80+*$11,27212.98
Note: Goodhealth 2010 rate, Major Medical, Nil excess, Area 4 (China, Singapore, Japan, Australia, New Zealand, the Caribbean, Russia and the rest of the world, excluding USA) * Applicable to renewals only

Most insurers will place an age ceiling for new applicants, varying from 60 to 80. This is due to the difficulty in determining the risk factor which ultimately determines the premium. Should the applicant be accepted despite being over the age ceiling, most insurers would have offered the policy on special terms and with a significant loading.

2. Level of Coverage

Generally, there are 2 categories of coverage: Standard and comprehensive. Premium for comprehensive cover is higher compared to standard cover.

Standard Plan The standard plan satisfies the main objective of an expat medical insurance and that is to cover in-patient (an insured person who stays in a hospital bed and is admitted for one or more nights solely to receive treatment), day-patient (an insured person who is admitted to a hospital bed but does not need to stay overnight) and emergency treatments. To read more about what is covered under standard plan, please click here.

Comprehensive Plan

The comprehensive plan covers additional out-patient (an insured person who receives treatment at a recognized medical facility, but is not admitted to a hospital bed as an in-patient or day-patient) treatment.

Many insurers provide different modules, which you can add on, such as medical evacuation and repatriation, dental, optical and maternity coverage. Premium increases with the number of add ons.

Graph below shows how premium increases with age between standard and comprehensive plans.

Graph

Note: Goodhealth 2010 rate (US$), Major Medical vs Foundation, Nil excess, Area 4 (China, Singapore, Japan, Australia, New Zealand, the Caribbean, Russia and the rest of the world, excluding USA) * Applicable to renewals only

 

3. Options

An option allows you to have more control over your premium by selecting your level of benefit, these options may include:

  • the option to co-pay
  • annual deductibles
  • grade of hospital accommodation
  • choice of network of hospitals
  • option of medical evacuation
  • choice of area of coverage

4. Loading charge

A loading charge covers an insurer’s administration costs and profit. An insurer will negotiate directly with its medical provider regarding rates and payment terms. Usually, an insurer with large number of subscribers will have better leverage in negotiating better rates and payment terms with their medical providers and in turn, less loading charge.

5. Medical Inflation

In most cases, your insurance will automatically be renewed at the end of the contract period. At renewal, you will notice that your premium is adjusted, and normally with an increase that is more than the rate of general inflation. Most insurers have to adjust their premium annually to remain profitable due to medical inflation which is largely caused by claims increase and rising medical cost especially in the area of cancer. New drugs being developed, new technologies, new methods of diagnosis, etc.

Find out how to reduce premium

Increase the annual deductible

If you are happy to pay for the occasional visits to your doctor or prescription, increasing your annual deductible can sometimes reduce your premium significantly. Sometimes by even 70%, it differs from product to product. Deductibles can be per policy or per medical claim. And it can range from US$50 to US$10,000. Table below shows an example of how premium changes with different levels of deductibles

Age BandPlan without deductiblePlan with US$400 deductiblePlan with US$1,600 deductiblePlan with US$5,000 deductiblePlan with US$10,000 deductible
10-25$3,196$2,192$1,586$1,255$942
26-44$5,011$3,959$2,874$2,278$1,707
45-59$6,019$4,928$3,659$2,909$2,182
60+**$6,327$5,321$3,948$3,019$2,264
Note: IHI BUPA 2010 rate (US$), Annual premium per person, Hospital Plan ** Applicable to renewals only

Pay for only what you need

Know what you need to be covered and pay only for that. Many companies lump extras that may seem as at no cost but in fact you are paying for it some way or another. One of these extras comes in the form of being covered for chronic conditions. You have to first decide if you are under high or low risk category. Are you obese? Do you smoke or drink heavily? Do you have a family history of any of the chronic diseases? If you determine that you are in the low risk category, you can use your own judgment to delete this cover. Having said that, there are also rare cases where a perfectly healthy young individual develops a chronic illness.

No Claims Discount

An international health and medical insurance is usually more expensive compared to a local plan. This is due to various reasons such as wider geographical area of coverage, higher level of coverage, etc. As the market develops, insurers often come out with more innovative products and competitive rates to fight for new businesses and keep their customers. Some insurers offer a No Claims Discount, sometimes up to 15%, upon renewal. Once a claim is made, a substantial increase in premium may result. If your policy offers No Claims Discount, it could be better to go for individual policy verses one policy for the entire family as one claim may affect the premium of the whole group. So it pays to have a long-term plan and do your due diligence to shop around for the best products and insurers.

Define your area of coverage

Most insurers have 2 categories: Worldwide and worldwide excluding USA. Some insurers have more specific geographical breakdown. Premium increases with wider area of coverage. With better definition, in some cases, it could reduce your premium by 60%.

Pay premium annually

Most insurers will give you the freedom to pay monthly, quarterly, half-yearly or annually. The rate decrease with the decrease in payment frequency. In some cases, paying your premium annually can save up to 7.5%.

Full declaration of medical history

With Full Medical Underwriting, sometimes premium can be reduced by 3%.

Tailor different levels of cover for different members of the family

Different persons require different levels of coverage. Generally, younger healthier individuals require lesser coverage with lower benefits compared to older individuals. Examine the different requirements and where you can save cost

Lower level of benefits

Understanding the kind of medical facility available in your country of residence, the standard and the cost of medical treatments are important. This will help you understand how much benefit you need and in which area. You can limit out-patient cover, state a specific category of room, or restrict your choice of hospital.

Questions to ask when choosing the most suitable insurance

With over hundreds of insurers and thousands of products available, how do I ensure that I have researched thoroughly and made the right decision for me and my loved ones? A decision that will give us the peace of mind and relief us of any financial burden in case of unforeseen illness or accident.

First, if you are employed, find out if your employer has included medical insurance as part of your staff welfare benefits. If not, and if you decide to cover yourself, you have to understand your needs and what is available in the market.

It is important to keep in mind that you should go for value verses cost. Choose the insurance that best suits your needs at the most affordable price and not choose an insurance with the cheapest premium despite its low coverage.

Please see the link Determine your needs and requirements.

What to look out for before making your purchase

What is not covered ?

Most insurers have a list of conditions and treatments that are not covered and it differs from one to another. The most common exclusion is pre-existing conditions. In such case, even if some insurers cover, there will be a loading to the premium. Listed below are some of the most general exclusions:

  • Addictive and mental conditions and disorders (some insurers might cover treatment on discretionary basis)
  • Allergies and allergic disorders
  • Artificial life maintenance
  • Birth control (contraception, assisted reproduction, sterilization, abortion, etc)
  • Conflict and disaster (treatment as a result of nuclear or chemical contamination, war, disaster, etc)
  • Cosmetic and plastic surgery (unless it is administered immediately after an accident or disease, e.g. breast reconstruction after mastectomy and sometimes lumpectomy which can take place simultaneously during cancer-removing surgery, or months to years later)
  • Obesity
  • Congenital conditions

It is important that you understand what needs to be covered and what your policy actually covers you. Our consultants will be able to help you review your current policy, guide you through your research and decision making process. Feel free to email us, or visit our FAQ page.

Annual Deductible

An annual deductible is the total amount you have agreed to pay each policy year before receiving any reimbursements from your insurer. E.g., if your annual deductible is US$500, and the total amount you have paid for one or various eligible treatments is US$2,500, your insurer will pay out US$2,000 to you and the cost of all other eligible treatments thereafter within each membership year. Deductibles can be per policy or per medical claim. And it can range from US$50 to US$10,000. One of the ways to make your medical insurance more affordable is to increase your annual deductible. In some cases, your premium may be reduced by up to 70%. Feel free to contact us to discuss how we can help you reduce your premium.

Waiting Period

Waiting period is the length of time you have to wait before making any claim for that particular treatment or for the policy to be in force. In the event of an acute (short-term), serious illness or injury most insurers will cover immediately or when the insurer accepts a transfer.

Waiting periods are imposed to prevent any abuse of the system. Generally, waiting periods are applied to the following:

  1. Dental – 6 to 9 months depending on procedures carried out

  2. Orthodontics – 6 to 24 months

  3. Maternity – 8 to 12 months

  4. Wellness (mammogram, PAP smear, prostate cancer screening, etc) – 12 months

  5. Pre-existing conditions – 24 months

When buying as a group, some waiting periods may be waived. It is important to understand your personal circumstances, plans and needs in order to select the most appropriate product. If you need further assistance, do feel free to email us, or visit our FAQ page.

Claims

The main reason to purchase an international medical insurance is to ensure that you receive cover whenever you need. Thus, it is important that you have a clear understanding of the claim procedure. At all time, ensure that you have your policy details and all the relevant information for access to your insurer’s medical helpline, which should be available to you 24 hours a day, 7 days a week, in multilanguage.

To make a claim

  1. you can either pay first and claim later. This is the case for most out-patient treatments. Most insurers will require that your doctor complete the claim form. So do ensure that you have them when you receive treatment.

  2. your insurer will pay directly to your clinic or hospital due to the direct payment network already established or payment guarantee issued prior to treatment or admission

  3. in cases where you need to be hospitalized immediately, most insurers will pay out directly provided they are informed within the time period set out in your policy agreement, usually within 48 hours of admission. Failure to do so will mean that you may only be eligible for reimbursement of a proportion of the cost incurred.

Most insurers will require a doctor’s or specialist’s referral when you claim for the following:

  1. Physiotherapy

  2. Chiropractic treatment

  3. Acupuncture treatment

  4. Osteopathic treatment

  5. Homeopathic treatment

  6. Podiatric treatment

Problems with claims

Before going for any treatment, if time allows, do check with your insurer to find out if it is covered under your policy. To avoid any delay or rejection to your claim, do ensure that information required is fully completed and that your insurer receives the claim within the time period set out by your insurer, usually within 3 months of receiving the treatment. If all claim procedures are adhered to, normally you should receive your claim within 2 weeks. Should you face any problems with your claims and require any advice or assistance, we will be happy to provide our service at no extra charge. Do feel free to email us, or visit our FAQ page.

Overall Annual Maximum

This is the total amount that your insurer will pay out per member per policy year. Meaning, if your Overall Annual Maximum is US$1,000,000, it means that you can claim up to US$1,000,000. Do take note of the benefit limit which applies for each condition as well. For e.g., if your benefit limit for maternity is US$7,000, your bill comes up to a total of US$8,000, your insurer will only pay US$7,000 and only US$7,000 will be added to your Overall Annual Maximum. For international health and medical insurance, the Overall Annual Maximum is usually between US$1,000,000 to US$2,000,000 or no limit at all.

Maternity

Most international health insurers provide maternity benefits. Do take note that the waiting period is between 8 to 12 months depending on the insurer. Benefit limit can go up to US$14,000 depending on the insurers’ definition, whether its normal delivery, medically prescribed caesarean or delivery following fertility treatment (some insurers exclude pre and post-natal treatment for delivery as a result of fertility treatment).


Maternity benefits usually covers:
  1. pre and post-natal care & treatment

  2. delivery cost (home, normal, medically prescribed caesarean or following fertility treatment)

  3. complications of pregnancy

  4. routine new born care (usually for up to 7 days following birth)

If you are planning for a baby, feel free to contact us to discuss the most suitable plan for you.

Guaranteed Lifetime Renewal

Being covered at all times is of utmost importance and is your responsibility to your loved ones. Not all products are created equal. Some policies insure up till age 65 and some goes beyond age 80. Some policies guarantee renewal no matter how your health condition has changed during the policy year. Some will adjust benefits without these being reflected in the premium. Some will reject renewal leaving you with no cover at all. In buying an international health and medical insurance, it is important to plan long term and protect yourself from unnecessary future expenses. It is therefore important that you work with a professional to help you determine your needs and requirements and identify the most suitable product(s) within your budget. Do feel free to email us, or visit our FAQ page.

 

Medical Evacuation and repatriation

What is the level of medical facilities in your country of residence? Unless you are based in a developed country with excellent level of medical facilities, medical evacuation is usually an essential part of an expat medical insurance package.

A medical evacuation is only executed when the medical treatment required is not readily available locally or at the place of accident and is medically necessary. Insurers will pay for the cost of moving you to the nearest medical facility to receive treatment. Cover will usually also include the cost of one other persons traveling with you.

A medical repatriation is executed under the same condition as a medical evacuation, but it provides you the option of getting treatment in your home country, in a familiar environment, near your friends and family.

Some insurers provide the flexibility to delete or add on either medical evacuation or medical repatriation in your cover.

Area of Coverage

Most insurers have 2 categories: Worldwide and worldwide excluding USA. Some insurers have more specific geographical breakdown. Premium increases with wider area of coverage. One of the ways to reduce your premium is to define your area of coverage. In some cases, with better definition, it could reduce your premium by 60%. Do feel free to email us, or visit our FAQ page.

Moratorium

Usually, pre-existing conditions that occurred 5 years before your policy starts will be excluded. If no claim has been made on the pre-existing condition or related condition for a continuous period of 2 years, it will then be included in the cover. If a claim has been made during this two-year period, the two-year qualifying period starts all over again.

It is important to point out that there are many pre-existing conditions that will never be covered by a moratorium policy, such as:

  • Diabetes

  • Hypertension (raised blood pressure)

  • Hyperlipideamia (raised cholesterol level)

  • Ischemic heart disease

  • Cancer

  • Thyroid disease

  • Auto-immune disorders

  • Arthritis

Chronic conditions

Chronic condition is defined as a disease, illness or injury that possesses at least one of the following characteristics:

1. ongoing and has no known cure 2. likely to re-occur 3. permanent 4. requires long-term treatment

This includes heart disease, stroke, cancer, chronic respiratory diseases, arthritis and diabetes. Visual impairment and blindness, hearing impairment and deafness, oral disease and genetic disorders are other chronic conditions. These diseases are often preventable, and frequently manageable through early detection, improved diet, exercise, and treatment therapy.

According to World Health Organization (WHO), 60% of all deaths globally are due to chronic diseases. Of the 60%, 20% occur in high-income countries and the remaining in low and middle-income countries. In the European region, 86% of deaths are caused by chronic diseases. In the U.S, 7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.1 In Asia (particularly in China and India), chronic diseases are increasing. Each year, 8 million deaths from chronic disease that occur are among those 30–69 years of age.2 One of the common misunderstandings of chronic diseases is that it only happens to old people. Research has shown that 50% of chronic disease deaths happen to people under 70 and 25% to people under 60. Common causes of chronic diseases are unhealthy diet, inactivity, smoking and excessive drinking. Policies that cover chronic conditions are naturally more expensive. Most insurers will set limitations to the kind and cost of treatment, such as setting a lifetime or annual limit to claims pertaining to chronic conditions. Some will not cover at all. If you determine that you are in the low risk category, you can use your own judgment to delete this cover. However, having said that, there are also rare cases where a perfectly healthy young individual develops a chronic illness. And should that happens, it will be seen as a pre-existing condition which many insurers may not be willing to cover or it will be covered at a very high cost.

1 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports 2008;56(10). 2 Source: A.D. Lopez et al., Global Burden of Disease and Risk Factors (GBD, 6).

Pre-existing conditions

Even though various insurers may have different definitions of a pre-existing condition, it is generally defined as a medical condition that existed prior to obtaining your medical insurance. This can be as simple as a hay fever, or a previous diagnosis of a cancer.

Prior to an insurer approving your application, you will be asked to complete a medical questionnaire. It is very important that you provide all the information required as accurately as you can. If in doubt as to what to disclose, it is better to err on the safe side and do so.

With these information, insurer will then decide the status of your application. What to cover or not to cover and how much to cover. Should an insurer decide to cover your pre-existing condition, it will be accepted based on certain terms and conditions and at a higher premium. How much more will depend on the type of pre-existing condition and the insurer. An insurer may decide to exclude your pre-existing condition in your policy or in some extreme cases, reject your application.

Insurers will usually impose a waiting period, meaning that treatments or claims pertaining to your pre-existing condition or related condition will only be covered after the waiting period, which differs from six to twenty-four months, depending on the type of pre-existing condition and also on the insurer.

In excluding the pre-existing condition in your policy, the insurer will not cover for any treatment pertaining to the particular condition or any related condition. Thus, it is important that your doctor reports the correct diagnosis in your claim