Navigating your way through the sea of private health insurance products for expats on the market can be a long and tiring journey in itself.

For many expats the choice is made simple. The employer decides the healthcare options as part of a total relocation package.

"For us, it totally depends on employers. They come to us and we present them with the options from about five health insurance providers we work with. The client decides what options to make available to the expat employee," says Jacqueline Biersma of RMS Relocation Management Services in the Netherlands.

Fortunately or unfortunately, depending how you look at it, many other expats going to work in Europe have to do the leg work themselves. OK, if you go looking for yourself, you will find there are a lot of health insurance providers focusing on the expat market.

Making the decision

There does not seem to be much difference between the options of the various providers so how do you make the final choice?

"A lot of our clients are totally confused by the time they come to us for advice," says Leslie Smith, founder and managing director of Medibroker, an independent specialist broker advising expatriates on international medical or healthcare insurance.

"Having read through a mountain of brochures they are none the wiser on the right product for them. We go back to basics. It is not about products or brands. We find out what the client needs," says Smith.

Expats should seek the advice of an independent broker, who is not tied to one provider, before signing up to any plan.

Choosing the right area cover is the first task. This decision can also influence whether the expat should consider (depending on their financial means) whether they should opt for a standard plan or a plan that provides coverage that is more comprehensive. If the expat is going to relocate for example to Italy, basic hospital cover may be fine. But work regularly takes the expat further afield, a fuller package may be advisable.

Smith then discusses with the expat about the add-ons required including dentistry cover, cover for partner and children and maternity cover (if the expat is starting a family) etc. All benefits can potentially add to the costs, so it is important to balance needs with the expat's wallet. But it would not be wise to penny pinch now in the hope that you will not need to use your health insurance.

Generally, health insurance will pay to have the expat treated in the nearest "centre of medical excellence". But what if a US citizen wants to return to the US for elective procedures or an expat wants to be repatriated to their home country to be treated there? Some options provide for this but you have to read the fine print.

Fine. A broker can help you tailor the options to your needs. But it is important to have faith in your health insurance provider.

So, is a major player still the best bet?

Not always, says Smith.

Sometimes, in Smith's experience, large companies can be slower in their administration, which can affect how long it takes to pay claims.

Smith says that there are a number of top-class niche providers in the field of expat private health insurance, including the William Russell Group, InterGlobal Insurance Services, GoodHealth, ALC (à la carte healthcare) and ExpaCare.

Smith audits each provider he works with every year to check efficiency. "Basically, once a year, I visit the complaints department of each provider to find out how many complaints they receive in relation to how fast and effectively they deal with and pay up claims."

Generally, claims should be settled within 14 days and InterGlobal will pay USD 15 a day for each day after that period that the claim remains outstanding.

"Clients are demanding more transparency and choice and some of the big corporations are lagging behind while several on-line brokers are meeting the challenge."

Cormac Mac Ruairi worked for eight years as a journalist for the Irish media before moving to Amsterdam in 1998. He now freelances for media in the Netherlands.

Subject: Private health insurance