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Choosing Online International Health and Medical Insurance

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For many years, the overseas expatriate was an employee of a domestic company. Overseas postings were considered part of ongoing executive training and consequently, accommodation, vehicles and health care were all considered part of any remuneration package.

Since the globalisation of telecommunications, inexpensive air travel and corporate downsizing, the professional expatriate is now often on his/her own as a contractor. Overseas health care insurance, travel and living accommodation are now matters left to the expatriate to organise and finance.

Introduction

Many expatriates are not aware when they go overseas for the first time that national health policies from country to country can be quite different from health care services back home. They often exclude foreigners and non-residents. In addition, today's expatriates are frequently be hired on a contract basis for employment abroad, thus losing out on any employment rights or benefits from their home country. Therefore, healthcare and adequate insurance converage should be of concern to any expatriate.

The newly arrived expatriate is exposed to considerable risk until he/she places both their financial and health care insurance affairs in order, if their companies do not offer such services to them. International medical insurance is something you never wish to use, but should have when an emergency or sudden illness arises during an international work assignment.

So what is private international medical insurance?

Private medical insurance is designed to cover a majority of the costs of private medical treatment for curable short-term illness or injury (commonly known as acute conditions). Most people overseas buy such coverage as they are in difficult or inaccessible locations, do not know the quality of existing local national health facilities, or are unaware of what health services are available to foreigners. They want speedy access to international helpline facilities and, if necessary, to be flown home or elsewhere for treatment and recuperation. Others, such as information technology contractors in Europe, cannot take part in local national health schemes as their are constantly traveling; they become customers well-suited for private international medical insurance.

The advantages are speed of service, quality and location of treatment. As an international private patient you can often choose when treatment will take place, which specialist treats you, and the location of care. You will usually have the privacy of an en-suite room with many of the comforts of home available. For an expatriate undergoing treatment, it may be important to be at home with family members. Your insurer may fly you home for treatment.

Some illnesses or treatments may not be covered under your plan and the associated exclusions should therefore be carefully read and digested. International medical insurance coverage is usually offered throughout three zones of the world:

  • Area 1: Western Europe as Area 1
  • Area 2: World-wide (excluding the USA/Canada)
  • Area 3: Full global coverage

Options are also commonly offered for routine dental, maternity, travel and personal accident coverage.

Common exclusions from international medical insurance

War or civil war risks, drug abuse, self-inflicted injuries, HIV/AIDS, infertility, normal pregnancy (unless opted-in), cosmetic surgery, sex change or gender reassignment surgery, preventative treatment, kidney dialysis, mobility aids, experimental treatment, experimental drugs, organ transplant (unless opted-in), injuries from dangerous hobbies (often called hazardous pursuits). ALWAYS read the exclusions section carefully on any new plan.

How do I buy international medical insurance and where do I find the right coverage?

You may buy such coverage directly form a specialist expatriate insurer, or alternatively seek advice from an independent intermediary or broker. It costs you no more to use an intermediary/broker as they are remunerated by commissions from the insurer when placing your business. A "cooling off" period is usually offered by insurers of between 14-30 days where you may cancel enrollment and get your money back without penalty. The important things to look for with an insurer are a good range of full coverage benefits, clear exclusions, value for premiums paid, a history of excellent customer service, major underwriting to ensure long term security and clear claims procedures that are supported by 24 hour multilingual helplines (preferably free of charge). The only time you want to be assured of good medical insurance is the moment you wish to use it.

Category definitions of coverage

When looking for coverage, one may easily be confused by literature mentioning standard, comprehensive or fully comprehensive coverage. Important category definitions of coverage are given below:

In-patient: Entering a hospital for private treatment or procedures that require an overnight or longer stay.

Day-patient: Sometimes referred to as day-care or day-case, entering a hospital for private treatment or procedures that do not require an overnight stay, but may require a hospital bed.

Out-patient: Treatment, procedures or consultations which DO NOT require any type of stay in a hospital.

There are a variety of plans available, ranging from low-cost plans offering limited coverage (and voluntary excesses on claims) to those offering wide-ranging coverage and benefits. The majority offer in-patient and day-patient coverage, but not always out-patient coverage.

What am I covered for and what is NOT included?

Please note that medical insurance is designed to cover only treatment for curable, short-term illness or injury (commonly know as acute conditions). Some illnesses and treatments are never covered, and that is common with many insurers. (see exclusions above).

A standard or basic international scheme will usually cover in-patient or day-case/day care treatment, hospital cash benefit, post-hospital treatment, nursing at home, emergency evacuation, repatriation or burial of mortal remains, emergency dental and complications of pregnancy. It will NOT cover such as
out-patient, routine maternity, or dental costs.

A comprehensive international scheme will cover all of the above as well as out-patient care and specialists, complementary care, organ transplants, routine maternity, routine dental (sometimes), and generally has higher budget limits than a standard plan. It is not usual for any plans to include pre-existing conditions which may go back 2-5 years or even longer with some insurers (exceptions do apply for company schemes).

What affects premiums

Whatever plan you take, it is likely that your premiums will rise above the average rate of inflation. Medical inflation in the United Kingdom, for example, is running at some 10% with economic inflation at 4%. Also, each year, more and more people submit claims on their medical insurance, raising premiums for everyone. A straightforward hip replacement today can cost 6,000 sterling, or almost US$10,000 dollars. The sophistication of both treatment and testing procedures are also increasing - for example, magnetic resonance imaging (MRI) scans cost around US$1,000 each. As plan holders get older, they are more likely to need treatment and thus premiums also rise with age bands, usually 4-5 year periods.

What details of my health must I provide to insurers?

As mentioned earlier, there are a number of medical conditions which you may not be able to have covered under insurance plans. Apart from some company plans and large group plans, you normally will not be able to secure coverage for a current or recent illness (otherwise known as pre-existing conditions).

Insurance companies may accept your application in one of two ways:

A. Medical history declaration coverage

You will be asked to fill out a form to provide details of your medical history. Previous medical reports may be required. It is essential that you provide all information requested or as much as possible to avoid future complications or rejection of future claims. If you have a medical condition that is likely to reoccur, you may receive coverage that exclude that particular condition and any related complications, with possible review for inclusion in the future.

B. Moratorium coverage

You are asked to complete a form with no medical history requested. Instead, the insurance company will automatically NOT cover any preexisting conditions. Such conditions may automatically become eligible for coverage only when you do not exhibit symptoms, or receive treatment, medication, tests or advice from your general practitioner or specialist for that condition for a continuous period of (usually) two years after your policy has been made effective.

How do I make a claim?

Most international insurance providers will send a client pack, with insurance certificate(s), claims forms and a helpline card with international contact numbers. Many international insurers now pre-authorise any in-patient treatment, meaning that you typically must contact a helpline before seeking
treatment and incurring costs. Out-patient costs are usually dealt with through routine claim forms (i.e. you pay first). If in doubt, always call the helplines before seeking treatment and committing to costs.

Checklist

Before purchasing an international medical insurance plan, you need to understand the following:

A) You agree to provide all the information requested by your insurer. If you do not comply or provide inaccurate details, your insurance company may refuse claims or cancel coverage altogether.

B) You agree to pay monthly, quarterly or annual premiums as long as you require coverage. If you do not pay your premiums, coverage will stop. Your insurer will only pay for legitimate costs you have paid, or agreed to pay, up to the last date covered by your premiums.

C) The cost of your premiums is likely to rise once a year, typically during a review of your coverage. Medical inflation is approximately 10% annually and if you change age bands, your premium costs for the same plan could rise. Only by taking voluntary excesses or downsizing one's plan can you keep premiums constant or keep the annual increases small. For example, switching from a fully comprehensive plan to a standard plan as one gets older.

D) If the insurer's plans change during the year, you will be informed in advance. They will not prevent you continuing coverage even if you have made claims;

E) If you switch from one insurer to another, you may not necessarily be covered for conditions or treatment that your existing plan covers now.

Medical insurance control and complaints procedures

All international insurers of repute have proper client liaison teams and complaints procedures, properly documented in their client packs. Your application form is a vital document as it forms the basis of your contract with the insurer. Always complete these forms accurately and fully, signed and dated. If you do not, your insurer may refuse to pay certain claims in the future.

By law, in the United Kingdom all insurance companies have to treat personal information, especially medical information, with absolute confidentiality. Only occasional anonymous statistical information may sometimes be used. The vast majority of international insurers are well developed with client service procedures and claims handling. Both they and their underwriters will always pay legitimate and properly covered claims. However, if fraudulent claims are made, they will not pay and may cancel the policy. A lot of international cover is thus based on "trust" and common sense frequently prevails.

Developments in the Indonesian medical industry

Recent years have shown a lot of development in the medical industry in Indonesia. Domestic and foreign investors alike have built new hospitals and clinics with an eye towards providing better quality medical services to higher-end consumers in Indonesia.

We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.

This article was contributed by Medibroker International.

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