When travelling or living for periods overseas, it is surprising how many countries exist where medical treatment of a reasonable standard is just not available, or is available but expensive. Many case histories sadly can testify to the crippling experience both mentally, physically and financially, falling ill overseas can become. It is a generally undisputed fact that over half of all expatriates abroad have no medical insurance at all making them vulnerable to the consequences of any crisis of health.
Private Medical Insurance is like having a parachute when flying, you may not need it but it had better be there, as you and your family may not survive without it, i.e. such as being medically evacuated from the Gobi desert.

The Cost/Cover Trade Off

Too often clients only look to price or premium comparisons which can be a big mistake. Always check out benefits of cover, level of cover and any exclusions to such cover. Some Plans are cheap for a reason. Often they take out large voluntary excesses on any claims or severely limit or cap the benefits you may receive under the Plan. Cover limits can vary considerably from �50,000 to �5,000,000 in some cases. A serious accident or transplant operation in the USA can soon eat up a low cover plan limit. Exclusions should always also be read carefully.

Vital Questions to ask the Insurance Provider

1. Does the Plan allow for cooling off periods, cancellation and repayment in full?
2. Does the Insurer offer a 24 hour International Help line contact, available globally?
3. Does the Plan require a medical before joining or a moratorium?
4. How long are pre-existing conditions excluded from cover when joining the Plan?
5. Are all nationalities accepted or are there restrictions?
6. Does the Plan allow you to continue cover through your life time?
7. Does the Plan allow you a non-cancellable undertaking to provide you renewal terms on an annual basis for as long as you decide to continue with cover, irrespective of any claims you may have made? Is there any age cut-off?
8. Does the Insurer allow you and your Doctor freedom of choice concerning hospitals and clinics where you may be treated?
9. Does the Provider allow for direct settlement of bills to hospitals in full settlement of any in patient treatment claims, regardless of location?
10. What is the procedure for outpatient claims? Does the Insurer pre-authorise claims or do you have to pay first and hope that your claim is paid later? Pre-authorised claims cannot be rejected and if such treatment is covered by the Plan, payment is then guaranteed

Emergencies Evacuation and Repatriation

1. Does the Plan include evacuation and repatriation as standard?
2. Does such cover include both emergency evacuation and repatriation costs? Some Plans only cover travel, not accommodation, some Plans have evacuation as an option and not built into the Plan, some policies only give you cover one way
3. Does the Plan cover both your outward journey and pay for you to return to where you started?
4. Does the Plan only cater for one person or can a business colleague or family member also accompany the Plan holder undergoing treatment elsewhere? Emergency medical treatment abroad is very stressful and difficult at the best of times, all the above points should be standard within a good plan.
5. Does your intended Plan include or exclude pre-existing conditions? If medical questions are not required you can be sure that any pre-existing conditions are excluded for a period of time. Check how far back the Insurer goes to exclude pre-existing conditions, one year? two years? five years? more? Often Plans will allow for pre- existing conditions to come under the Plan in later years if you have been treatment free for a period of time and not consulted a doctor regarding the previous illness. Check carefully.
6. Can you easily change from one insurer to the next on �no worse terms�. If you are on a moratorium, can you transfer that time spent already running down the moratorium period? Some will help with this, some will not.

GP Costs and Out Patient Charges

This is a big area where it is likely if you have a comprehensive Plan that most claims will arise. You need to confirm that General Practitioners� charges are fully reimbursed.

1. Check wording carefully concerning outpatient costs cover and GP charges. Some Insurers offer full cover some offer a limit on budget for this. Outpatient costs usually contain fees of specialists visited. Note any restrictions here.
2. Check to see if any drugs, medicines or financial limits are set for Out-patient treatments to ensure �full cover�. I prefer to see as many items of cover as possible simply stated as �Full Cover�. The more detailed explanations in brochures allow something to be excluded in this area. Full cover cannot be misinterpreted or misrepresented easily.

Outpatient Cover, Complementary Medicine,Dental and Routine Maternity

If you can afford the premiums, Out-patient cover makes sense as often specialist care comes into this category. In-patient or day-care only really means a catastrophic cover where you literally are covered in hospital, not if you are walking. Many Plans limit the outpatient cover to a budget limit, some Plans do not.

Dental cover can also be a minefield as Plans treat dental pain differently from routine dental cover. Emergency dental may be covered if you break a tooth but the Insurer may not pay for a routine filling. If you suffer an abcess that may be covered but not a crown. Check the Plan carefully regarding �elective� or emergency/pain dental cover.

Complementary Care

More Insurers are taking an enlightened approach to holistic or alternative approaches to healthcare, allowing Plans which include such as chiropractic, osteopaths, homeopaths and acupuncturists, subject to a budget limit per annum.

Routine Maternity Care

This can obviously be a valuable part of family planning yet many couples and pregnant women often only contact an Insurer when already pregnant. Almost all Insurers we know will treat this as a pre-existing condition and routine maternity cover will not be offered for such ongoing pregnancies, but emergency will be. If a couple are in a Plan for a year, then routine maternity cover is usually available on a co-insurance basis (you pay a portion) Talk it over with/email your Broker.

Other cost potential cover inclusions

1. Does the Plan include compassionate return home leave costs, for example in the event of a close family member�s death?
2. Does your Plan include home country cover? For example, you may be covered in Asia but not back home in the USA. Some Insurers will give 90 days home cover or a travel option to give you reduced medical cover out of area.
3. Do you have the right geographical area of cover? If you do not need cover in the USA or Canada or Caribbean, then Plans may be much cheaper. Europe cover only is often cheaper than worldwide cover, even after excluding the USA.
4. If you have an accident involving third parties, are any legal costs covered? Some Plans now offer this as included.

Complaints

All Plans should offer clear complaints procedures and show how to contact the right adjudicators in the company There are also independent regulatory authorities in most western countries who can assist in a dispute. If you have bought your Plan through a Broker or Advisor, they will usually assist, particularly if you are right and have a legitimate claim under a Plan recommended by them.

Overview

Generally, as with most services, you get what you pay for . If you pay more for a comprehensive Plan with a reputable Insurer, you are usually not disappointed, but if you buy a cheap cut rate Plan, beware when trying to claim from it. It is important to determine one�s geographical area and routine travel plans as well as possible voluntary excesses which can reduce premiums. In the final analysis, medical insurance is best to have with you so as � to sleep at night� rather than think of ways to claim from it. Insurance Companies like to keep their clients for the long term if both parties fully understand the contract, its obligations, exclusions and limitations.

It is always best to compare at least three product providers� Plans or have a review of your medical insurance needs done by an independent Broker. The Insurer�s brochure pack and benefits/exclusions need careful reading. Understand what you are committing to, what the contract actually states and what its limitations and geographical area encompass.

You may not read this document again until the very moment you really need to use it. Brand name alone does not indicate good quality and service.

Many of the lesser known expatriate specialist Insurers have excellent premiums, wide benefits, good claims records and efficient support teams in emergencies. Your Helpline card is the key to medical help when overseas, make sure you have it and know when to use it. All professional international Insurers have 24 hour Helpline numbers with access to Doctors via their assistance teams. Most will allow clients to either reverse charges or simply call toll free.

Mr J Leslie Smith, B Sc Econ (Hons)

Managing Director - Medibroker Limited

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