Whether they are on long or short-term assignments, expatriates want a wider range of health care options as well as peace of mind. Natasha Gunn reports.

The expatriate, who tends to be a sophisticated individual, is likely to be aware of developments in medical science and of the diversity of treatments and medications available.

Therefore, balancing their health care needs and expectations with the company's policy and budget can be tricky.

"The expatriate community network is a very powerful machine – expatriates compare their company benefits amongst themselves," says Andrew Apps, European business manager for Goodhealth Worldwide, a UK-based insurance company that deals with individuals and small- to medium-sized companies

"The demand also comes from the companies, who want to ensure that their expatriate workers, in whom they have heavily invested, are as productive as possible and that, should they fall ill, things can be sorted out quickly and efficiently."

Flexible policies to fit the expat

To satisfy demanding expatriates, companies need to be willing to offer a range of health care options.

"Health policies need to be flexible to reflect the increase in medical treatment options," says Marc Posthuma, sales director Benelux for CIGNA International, which specialises in corporate contracts.

According to Apps, the international medical insurance market has responded to changing ideas about treatment and demands for broader coverage. Policies today can often include extras alongside the base product.

Sarah Marfleet, senior marketing controller International Development AXA PPP healthcare, confirms this assessment.

“Though some companies may only wish to provide a generic healthcare package, increasingly companies are expecting a broader range of cover for their expatriate employees, with benefits such as cover for chronic conditions, HIV and war risks," she explains.

Goodhealth, for example, includes coverage for alternative treatments. "We include traditional Chinese medicine for those living and working in the Far East because it is licensed there,” says Apps.

"The important thing with any insurance company is to make sure that people are only receiving treatment from experts who are licensed through a regulative body," he adds.

Assuring peace of mind

Along with culture and language training and career assistance for trailing spouses, health care is an important part of an expatriate's overall package. But quality health coverage probably has more impact on an expatriate's peace of mind than other aspects of the package.

A checklist for selecting a policy to suit your needs According to Andrew Apps of Goodhealth Worldwide, you should look for the following: Transparency: Make sure you know what you are getting. You may buy a cheap one and find exclusions all over place. Ease: Is the coverage valid no matter where the employee might be? History: Does the company have specialist knowledge of international healthcare?

As Posthuma explains, "The most important need of the employee and family is that they are assured of direct access to medical care. They need to have the feeling that any medical problem will be solved right away."

In addition, expatriates want to know they can go home for treatment if necessary. Marfleet says, "Private medical insurance (PMI) becomes more critical in reassuring expatriates that, should a medical emergency arise, they have the means by which to get the treatment they need quickly and can be evacuated or repatriated if necessary.”

Most insurance companies offer a 24-hour medical emergency service such as SOS International. Goodhealth also has policy and claim centers in each of the world’s four major time-zones. Says Apps, “Not only can clients reach us at any time of the day but they can benefit from the regional offices’ good understanding of the local culture and healthcare services.”

The cost of providing peace of mind

Yet quality health care that gives expatriate employees peace of mind — important in making sure the assignment is successful — can be expensive.

CIGNA International offers employees, regardless of status, two types of packages for medical costs, both of which cover all pre-existing conditions.

Says Posthuma, "CIGNA prides itself on providing international health care plans, which, because they are value for extensive coverage and service, free the employee from having to worry about whether a claim will be reimbursed or not. Due to our experience and our extensive network of medical providers worldwide, we are able to manage costs from the outset and achieve cost savings. In this way we can offer very competitive premiums."

Flexibility for frequent travelers

Expatriates now move more than ever, whether for long or short-term assignments, and are also more likely to travel through or live in greater variety of countries. Travel has been made even easier by low-cost airlines. Says Apps, "All Goodhealth policies provide the ability for the individual to go from one country to another without having to reregister or change their policy.”

CIGNA puts employees on assignment for a few weeks to a couple of months on a global contract. “However,” says Posthuma, “When a company consists entirely of a commuting population, we have a special programme rather like a travel insurance, which covers the medical and service costs. We can also put short-term and frequent travelers on the international corporate Healthcare plan from a flexibility point of view and if wanted by the employer.”

AXA PPP healthcare’s International Health Plan is designed for expatriates who are living and working outside of their home country for more than six months a year.

Marfleet reports, “For the expatriate commuter, for example, a British expatriate who lives in Paris, but who travels extensively around Europe on business, our international health p lan would provide continuous cover within Europe.”

For the short-term overseas travelers, who may only be traveling outside of the UK for a few weeks each year, AXA PPP Healthcare’s UK products would still offer a certain amount of cover for their trip overseas. Marfleet says, “Our travel insurance products provide a good complement to our medical insurance cover.”

State systems versus private health coverage

There is always the option of using the host country’s state social system though in certain countries this may be closed to foreigners or even compulsory.

However, state provisions, which have been designed for domestic needs, give limited cover, longer waiting times for treatment and provide a level of service below what an internationally mobile employee might need.

International plans, though costly, replace all other plans or state systems, give clients the freedom to choose a medical provider and are transportable.

France is a good example of a country that demands that everyone registered as working there join the social system, but it has a cost limit.

Apps says, “Goodhealth is unique in the market in that we provide Premier, a ‘top up’ product for people working in France, which works in conjunction with the state’s social system."

March 2003

Natasha Gunn is the editor of Expatica HR.