Expat healthcare: Local versus global coverage

Expat healthcare: Local versus global coverage

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Some important questions are answered to help expats choose which healthcare insurance offers the necessary coverage for a transient expat lifestyle.

At what point do you need to consider international health insurance?

There are numerous factors to consider when looking to live and work abroad, not least those relating to your health and wellbeing. Finding the appropriate level of health coverage is essential for anyone moving abroad, but with so many different options available it can sometimes prove tricky to find the package best suited to you. Should you choose a local insurance cover or opt for international health insurance?

Many countries have well-developed health systems in place and some offer public healthcare insurance to expats which gives access to free or subsidised local healthcare. These types of insurance and healthcare systems, as well as local private packages, can often provide expats with an adequate basic level of healthcare cover. However, if you find yourself frequently travelling between countries then global health insurance may be required to fill the gaps that local healthcare cannot cover.

Local versus international health insurance: What's the difference?

Local coverage is primarily designed to offer you medical insurance in your designated country and comes in the forms of:

  • free state health cover, common in countries such as the UK and Spain;
  • through state health insurance providers, such as in Belgium, France or the Netherlands;
  • through a private health insurance provider, which offers access to local private facilities and shorter waiting times for treatment.

Many expats opt for local coverage, particularly in nations which have reputable and well-established healthcare networks, as the costs are generally lower than those associated with international health insurance packages.

An international insurance plan, however, provides you with coverage wherever you go; in your country of residence, your home country and abroad. It may also offer additional services in the country you live in, such as a wider choice of hospitals, access to English-speaking doctors, and extra treatments such as dental and maternity care that may not be included in certain local packages.

However, it is important to note that for some features, for example if you want private maternity coverage, you will need to have been covered for a minimum amount of time, such as 6–12 months, while state health cover will sometimes cover you once you are registered.

Will local health insurance cover me when travelling abroad?

Some local private plans might cover you while travelling abroad up until a set amount of time, for example, up to three months. However, in general, local plans provide coverage while you are in that country of residence, so if you find yourself in a situation that requires you to frequently travel, move between countries or spend extended periods abroad, a local plan is often not adequate.

In essence, international health insurance covers you wherever you go, meaning you won't have to worry about purchasing cover every time you travel to a new country. A comprehensive international health insurance package can cover you for a range of eventualities, including sudden illness, treatment of injuries and expatriation in case of emergency.

It should be noted, however, that if you are an EU, EEA or Swiss national based in Europe, then the European Health Insurance Card (EHIC) entitles you to receive medical treatment in all European Economic Area (EEA) countries as well as Switzerland. This does not, however, entitle you to free treatment – rather you will receive state healthcare at the same price as a national of that country would. 

How do I go about switching policies when moving country?

If you are moving country, either for a short period of time or permanently, it is first of all important to ensure that your current health insurance package remains valid until the day you depart.

In many cases, insurance companies will request that you cancel your policy in writing, either by post or online. There may be some cost involved in the cancellation, particularly if you have any outstanding payments or cancel before the allowed time. Some policies may have restricted cancellation dates, such as three months before your package expires or on 31 December of each year.

If you receive state health care cover then the cancellation process will vary according to the country you are in. For example, in the Netherlands where state healthcare is mandatory for all long-term expats, your insurance will automatically end once you cease to be employed in the country. The next step is to then arrange for health cover in the country you are moving to. This may involve either state or private cover, or you may wish to opt for international health insurance coverage.

However, in some cases, this can cause a gap in your coverage; it may take time before you can cut through the red tape to access local health insurance abroad, or there may be restrictions on how long you need to be paying social security before you are eligible for certain free medical treatments.

For these reasons and more, some expats opt to take out international health insurance while still in their home country to avoid this lapse, as well as avoid the need to arrange insurance as soon as they arrive. Regardless of what you choose, make sure you thoroughly research your options before making your final decision.

Will global health insurance cover me in every country?

Most international insurance providers allow you to narrow your cover down to specific regions, which tends to consist of either Europe-only or worldwide coverage that either includes or excludes the US. This is primarily due to the high cost of medical care in the US, prompting insurance companies to offer you global cover without the US in order to reduce the cost of the premium. You can of course opt to include the US in your package, albeit at a higher price.

Even if the majority of your travel is within Europe, you may want to consider worldwide cover in the event you have to travel farther afield.

International health insurance premiums are typically calculated based on factors such as:

  • your age;
  • medical history;
  • area of coverage required.

What else is covered by international health insurance packages?

Generally, the core package offered by international insurance cover will include more or less the same treatments you'd receive from local coverage, such as:

  • Hospital care
  • Surgery
  • Emergency dental treatment
  • General consultation fees
  • Cancer treatment.

You can, however, personalise your package with a number of extra features to help ensure all your needs are covered. This can include everything from physiotherapy and psychiatric treatment to the cost of prescription medicine, vaccinations and eye tests. Women can also opt for maternity cover, which is generally included in premimum or 'gold' international health insurance packages.

Travelling to regions where local health services are less developed can often be a cause for concern, particularly for those with pre-existing medical conditions which may require treatment at short notice. In such cases, you may wish to seek out cover which includes medical evacuation, which enables you to be transferred to a more advanced medical facility in the event that the local health service is unable to adequately treat you.

Take your time and consider your specific needs

It's important that you take your time to properly assess the additional services on offer. Physiotherapy or psychiatric treatment may not be on your list of top priorities, but those are the type of treatments which can prove costly if you find yourself in urgent need of them while abroad. Supplement insurances are particularly useful if you travel frequently or spend several months at a time away from home, so consider what treatments you may potentially require.

It's easy to focus on keeping the price of your premium as low as possible, but it's equally important to ensure all your health needs are covered so your insurance is useful to you. Another large price influencer is the deduction level; the higher the amount you are willing to pay towards your healthcare greatly reduces your insurance payments (for example, paying the first EUR 275 per year of all your claims).

Make sure you consider all aspects of your lifestyle. For example, if you intend to participate in sporting activities then it's important you have a detailed overview of which activities your policy covers. In the event you sustain an injury from an extreme sporting activity or sports such as skiing or motorbiking, and if they aren't specifically listed in your insurance contract, you may well find yourself liable for all treatment costs.


Contributed by Bupa Global / Expatica

Bupa Global offers a variety of health insurance packages to expats around the world.

Updated 2016.

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