What Every Expat Needs To Know About Health Insurance

Monday, 5 November, 2018

as an expat reliable health
insurance is essential

what's on your mind?

Moving overseas brings lots of new experiences and uncertainty. One key area that can cause you some sleepless nights is healthcare.

What can you expect in your new home and how does it compare to the healthcare you’ve been getting?

The quality of care can even have an impact on whether you make the move or not and where you end up going. If there’s more than one option available to you then it could be the deciding factor between them.

We thought about writing a review for each region.

We could highlight the health care star performers in each and the ones that lagged well behind.

We could also look at any quirks in legislation that may impact healthcare for an expat.

We decided against this as it would be far too long winded and could be out of date as soon as we finished it. Plus there are people on the ground who do a far better job of providing this information than we could.

So instead we decided to write about the overall issues expats face with healthcare.

Needless to say if you are moving make sure that you research the country you’re heading to. Don’t take anything for granted about the healthcare system in the place you intend moving to.

It’s more than likely that your company will provide you with some form of medical insurance. So let’s start there and if they don’t we’ll deal with you later.

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company scheme

The number of expats who have no idea what their company health insurance covers is shocking.
 
You can make some big assumptions about who and what gets covered. 
 
Unfortunately, by the time you find out there’s an issue it’s too late. You’re stuck with a big medical bill and/or some difficult choices to make.
 
Most likely both!

who it's for?

The first thing you need to do is check that your company scheme covers your family.

This may sound a bit crazy, it’s a given that they would get cover.

Though, you know what it isn’t!

We’ve come across many people who have thought that their family were covered and it turned out they weren’t.

Also it is worthwhile making sure that they get the same level of cover that you do.

Again it’s not uncommon for an employee to get a higher level of cover than their dependents.

If the coverage is on a lower level, then establish whether it’s going to be enough.Make sure that your family is getting the cover that you want them to.

where does it end?

The next thing that you want to find out is where you’re all covered.
 
Does your company’s scheme extend cover beyond your current country of residence?
 
If not then when you travel on business or go on holiday to another country do you have health insurance?
 
What about when you visit back home?
 
Again you can’t assume that you do only to find out that you’re not, with disastrous consequences.
 
Also if you only have cover in the country where you’re living , how good is the healthcare there?
 
We knew someone in Malaysia who’s 4 year old daughter was diagnosed with having a rare brain tumour. Whilst Malaysia has some amazing medical facilities and excellent doctors they encountered a big issue. Their daughter would need specialist paediatric nurses as part of her recovery. Unfortunately, they weren’t available in Malaysia. The best option available to them was to get her treated in Singapore.
 
Fortunately, they could do this because they had an international policy.
 
Would this option be available to you?

what are you getting?

So you know who gets cover and where they get it. Now you want to know what you get cover for?
 
More to the point we want to know what your company scheme doesn’t cover. Again it’s best not to assume anything even if you work for a big multinational.
 
We once met someone who worked for an international cosmetics company in Singapore. We asked him about his health insurance and whether he’d like us to take a look. He told us with absolute confidence that his company scheme was more than adequate. That was until he needed angioplasty and a stent. It wasn’t covered on his company scheme as it was considered an outpatient procedure. He had to pay US$7,000 out of his own pocket for the procedure. He then asked us to help him with his health insurance so he had something more comprehensive. It was now too late he had a pre-existing condition. This would lead to an exclusion of the cardiovascular system on any future policy. That’s a pretty big exclusion.
 
If you’re not covered for outpatient procedures check what this includes. What does your company’s insurer consider to be an inpatient procedure?
 
More and more procedures that we would once have gone into hospital for are now in and out in a day.
 
The insurance company will push to put them in the outpatient category. 
 
If they do you’ll end up paying for them.

history matters

Some company schemes can ignore the pre-existing conditions of its members.
 
It comes at a cost to the employer though it is available on policies with a big enough number of members.
 
Corporate schemes get better terms as insurers can capture more members all in one go.
 
Not all employers are happy to pay for this and don’t always make it available.
 
If you’ve had health issues or undergone procedures in the past having your medical history ignored is a big win.
 
So, it’s worthwhile knowing whether this option applies to you.
 
If your company doesn’t provide it in their scheme then there can be wider implications. Your past could lead to exclusions on other related conditions.
 
This could be the case even if you’ve never suffered from them. The previous example is a good illustration of this.
 
A narrowing of the arteries lead to an exclusion of the whole cardiovascular system. This was applicable even if it wasn’t a direct related condition.
 
It’s important to find this out because the likelihood is that you won’t get told. Check on whether any exclusions apply and what they relate to exactly.
 
Try and appeal the insurers decision if the scope of the exclusion is broad. You’ve got nothing to lose and it could work out in your favour.

maternity

You may be planning on starting or extending your family whilst you’re an expat.
 
If you are then that’s wonderful, though here’s a word to the wise.
 
It’s rare for an employer to include maternity benefits on their scheme. So, you can be pretty certain that you’ll be footing the bill yourself.
 
The last baby that we had came with a bill a touch over $11,000. This was in Malaysia a country known for having reasonable medical costs and it was back in 2013.
 
Also this was for a routine pregnancy, C section and a healthy baby. No doubt today it would be far more expensive and if you’re somewhere else it could cost much more.
 
So don’t presume that your company includes this in their plan, check while you still have time to act.
 
If your company plan doesn’t provide for maternity costs then you should look at getting cover. It’s also worth noting that even when you have cover there’ll be a waiting period of between 10-12 months.
 
Before you decide on a policy  it’s important to check the policy definitions.
 
In particular you should look at the ones for complications of pregnancy. We’ll cover this in more detail later in the article when we highlight “What to look for when buying a policy”.
 
You should also consider what happens after your baby arrives. You may have a period where your baby has cover without a need to register him or her on the policy.
 
This may not include everything so make sure you know what your policy pays for.

international or domestic

Is the company scheme that you are member of an international policy or is it a local one?
 
We’re not going to disparage local policies it’s not that they’re bad it’s that they’re not made for expats.
 
You may want treatment closer to friends and family. A local policy will give you treatment in the country where you are right now and nowhere else.
 
In our previous example of the little girl who needed specialist care. A domestic policy would have fallen short in that situation. The family had options. They even considered getting treatment back in their home country where they had a wider support network.
 
They came to the conclusion that Singapore was the best treatment option for their daughter. This was because they had access to a paediatric oncology ward and specialist nursing.
 
We also had a friend who was living in Vietnam. He developed an ulcer on one of his eyes. It was a major threat to his eyesight. He got the condition checked at a local hospital. The treatment options they gave made him uncomfortable. So he sought a second opinion from another facility in Vietnam. This didn’t fill him with confidence either. So he looked at which hospital was the best for his condition within the region. He found a clinic in Hong Kong that had state of the art facilities and excellent medical staff. He had international medical insurance so he was able to take this treatment option.

have you got continuity

Does your company run a single medical plan for all expat staff around the world? Or does it have separate regional or country health plans.
 
This difference may not seem so important, especially if you’re starting out as an expat.
 
Though it is very important because as an expat the likelihood is that you won’t stay in the same place forever.
 
If your company runs an international plan you’ll have continuity in your cover. If your company has local country or regional plans then you won’t have this continuity.
 
Each time you move you’ll join a new health insurance scheme. If you or your family have received any treatment, you could find yourself with an exclusion for a pre-existing condition.
 
This could mean you end up footing some medical bills yourself.

when you retire

If you’re retiring abroad you may still need international health insurance. When you’re heading into your 60’s it can start to get pretty pricey.
 
In your mid 60’s your options get narrower because many insurers don’t take new applicants over 64.
 
If you or your partner have a pre-existing condition, cover will have exclusions. So, it’s worthwhile asking your company if you can stay on their health insurance plan. You don’t always have to be a current employee to be on their scheme.
 
You’re going to have to pay for the cover yourself though it’ll be about 25% cheaper than you can get on your own.
 
It’s pretty much down to their discretion to allow it. If they say yes you’ll have continuity of cover and cheaper premiums.
 
If this isn’t an option for you another alternative is to form your own group scheme.
 
You need at least four individuals to get this going. You’ll get cheaper premiums with the more people that you have the discounts will get bigger.
 
If you get it big enough then you may even be able to get the inclusion of pre-existing conditions.
 
Such a scheme may already exist through a club or residents society, so it’s worth finding out.
 
You can find out more about setting up your own group scheme here.

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so you need some health insurance

So you don’t have access to a company plan or you’ve found out your company scheme has some gaps.
 
So what do you do now?
 
Well that depends on where you live and how long you intend being there.
 
If you’re in Australia and intend to stay there for good, a local insurance policy is fine.
 
Though if that’s the case you’re not an expat in the strictest sense of the word.

expat health insurance

If you’re in South East Asia, travel frequently and intend moving somewhere else in the future, an international policy is the one for you.
 
Whilst a local policy could seem like a cheap option there are good reasons to avoid them.
 
For one when you move you will have to set up a new policy, which could lead you to the dreaded pre-existing condition.
 
It all comes back to continuity of cover that you get from an international policy over a local one.
 
As we mentioned earlier you may not always get the best treatment options where you live. An international health insurance gives you the option of looking further afield.
 
So you can ensure that you and your family get the best healthcare possible.

how to apply

When you apply for a health insurance policy there are two ways you can do it.
 
These are either on an underwritten or on a moratorium basis. In both cases you will have to provide a complete medical history as part of the application process.
 
On an underwritten policy the insurer may want more background on your medical history.
 
If there are any issues which may lead to an exclusion they will inform you before the policy is set up. If you accept the exclusion it will always remain on the policy. This gives you the option to query, accept or decline the policy exclusion terms.
 
The main point here is that you’ll know in advance of the policy going live.
 
If there are no questions, or exclusions all valid claims will be paid.
 
On a moratorium basis the policy will just go live. All pre-existing conditions get exclusions. Depending on what the condition is, if there’s no reoccurrence over the next two years the insurer could lift the exclusion.
 
The insurer won’t tell you that there are exclusions on the policy upfront. You’ll only find out when you come to make a claim.
 
Having an insurer decline a claim can lead some policy holders to feel resentment.
 
For others it presents an opportunity to have exclusions lifted.
 
We prefer the underwritten basis because you are fully aware of what your policy covers you for. No nasty surprises when you come to make a claim.
 
Plus exclusions on any serious conditions won’t ever be lifted.

more on maternity

We took at look at maternity cover in an earlier section. If looking to buy international health insurance for maternity expenses then consider this.
 
For Starters we’ve already told you that there’s always a waiting period before you can make a claim. This is usually between 10-12 months that the policy needs to have been active.
 
As we all know a pregnancy lasts nine months. Which means get pregnant too soon and you’ll end up footing the bill yourself. You’ll have also been paying insurance premiums to make matters worse.
 
I know people who had a policy and wanted to save some money so they didn’t add the maternity cover from outset. They then decided that they wanted to have a baby adding the maternity option to their policy. They understood that they had a waiting period of 12 months. Two months on they were pregnant, pissed off and paying maternity fees. Don’t make the same mistake!
 
Another thing that we touched on in the last section was the policy definitions. In particular those relating to complications of pregnancy.
 
Not all policies are equal when it comes to how they deal with complications of pregnancy.
 
The difference is important for all mums to be.
 
So here’s the thing that you need to look out for because the differences between policies mean a great deal for your and your family.
 
Some insurance companies don’t pay for treatment to save the unborn baby when complications arise. They will only pay for a D&C procedure.
 
Whilst other companies will pay towards saving the unborn baby should complications occur.
 
The two definitions are extremely different and most families would prefer the latter. 
 
Again you should be aware of what a policy covers your baby for once he or she is born. One thing that I didn’t mention was that most insurance companies don’t cover congenital conditions.
 
This also applies to company schemes as well. If a condition has other complications linked to it, such as down syndrome insurers decline cover completely.
 
There are a few insurance companies that will cover congenital conditions.. Though certain criteria must be met if cover is going to be extended to the newborn.
 
Parents need to submit an application for the child within a certain timeframe after the birth. At the time of birth parents must have been covered by the insurer.
 
If you fall into a high risk category then it is worthwhile seeking one of these companies out.

vive la francais

On a final point if you’re French then we’ve got some very good news for you.
 
As an expat you can continue to pay into the French state system and they’ll extend cover for you overseas.
 
The cover that you get will be comprehensive and will cover your family. It will also cover maternity costs and will provide cover for any congenital conditions.
 
You’re very lucky!

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