As seasoned expats know, the need for medical care may arise unexpectedly when traveling abroad. Even professional travel guide Rick Steves says, “Every year, I end up in a European clinic for one reason or another.” By planning carefully and obtaining an international health plan, expats can enjoy their times abroad with confidence instead of stressing about what might happen. With numerous international health insurance companies to choose from, expats are inundated with the task of choosing the right health insurance plan that fits their needs. Fortunately, selecting an expat health insurance plan can be a simple and easy process by following these tips.
1. Get Vaccinated
Some international health insurance policies require expats to receive vaccinations before obtaining coverage. While individual policies will differ, this is usually for the following reasons:
- Some countries require expats to obtain vaccinations before obtaining a visa
- Vaccinated expats are less likely to experience preventable health problems during their travels abroad, saving the insurance provider the expense of preventable health care
The CDC has a comprehensive list of global destinations and recommended vaccinations for each. The United States Department of State site also includes detailed vaccination recommendations by country. Expats should research their destinations in order to know which vaccinations they need.
For example, those entering the United States will need to obtain several different vaccinations before obtaining a visa. The U.S. Department of State has a list of all required vaccinations for United States visa applicants. Other countries, such as Peru, have recommended but not required vaccinations. In Peru, yellow fever vaccination is recommended for all travelers.
2. Learn Visa Requirements
Visa requirements are critical in determining expat health insurance needs. For example, when traveling to Schengen Countries (Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, and Switzerland) expats must provide a one-page proof of travel, health, and accident insurance showing coverage of 30.000 Euro or more.
3. Find out Eligibility for the National Healthcare System
It is also important to consider the length of time one will be spending abroad. Some countries (such as Romania) require expats to be privately insured for five years before they qualify for the national healthcare system. Expats should obtain private health insurance to ensure coverage until they are eligible for national healthcare options.
The type of coverage will change depending on the country. In the UK’s National Health System, everything from prescription medication to eye exams to emergency care are covered. In the French medical system, individuals are reimbursed for their care at rates which are dependent on the importance and cost of the care. Medicines recognized as irreplaceable and expensive are reimbursed at a rate of 100%, although small medical service drugs are only reimbursed at a rate of 15%. Full reimbursement information can be found on the L’Assurance Maladie website.
Additionally, those traveling from countries that participate in the European Health Insurance Card program may qualify for discounted or free care in their destination countries.
Since there is a high variance in medical coverage from country to country, expats need to research the destination country’s specific healthcare system and requirements.
4. Check Expat Health Notices and Advisory Warnings
Expats may need to buy additional types of supplemental medical coverage such as medical evacuation and war and terrorism depending on where they are moving.
In preparation to moving abroad and purchasing an international health plan that provides additional coverage in high-risk areas, expats should check the following websites for health and travel warnings:
- The U.S. Department of State Website
- CDC Travel Health Notices
- Gov.UK Foreign Travel Advice
- Australian Government Department of Foreign Affairs and Trade
5. Know if Pre-Existing Conditions Limitations Apply & Be Aware of All Exclusions in a Plan
When filling out the insurance application, be sure to include all pre-existing conditions. Any claim related to undeclared pre-existing condition will be rejected, even abroad.
- Exclusions are quite standard in insurance policies. Careful attention should be paid to the exclusion list in order to ensure that expats do not pay for coverage of a medical condition they don’t have (or for any medical service they do not need).
- Sometimes exclusions have an expiration date. For example, some plans only offer maternity care after 18 months of coverage. Other plans may offer maternity care after 10 months, while some plans exclude maternity care entirely.
- All international health insurance plans will have a list of exclusions for risks they cannot specifically insure. These generally include acts of war and terrorism (even in countries where war has not been declared), and nuclear explosions. Recreational activities are often not covered by insurance.
- If individuals are traveling to areas where high-risk exclusions may apply, they may obtain war and terrorism, and medical evacuation extensions to their policies. Typically, short-term travel medical plans will likely have more exclusions than long-term plans.
6. Compare Plans
The following should be considered when examining possible healthcare plans:
- Company Reputation – Choosing healthcare providers with great customer service reputations is always important. Since a company with poor customer service can lead to serious claims problems while abroad, research the company’s customer service reputation before signing an insurance policy. Check testimonials from other expats, policyholders, and insurance review websites.
- Domestic Coverage vs International – Compare the rates and coverage of health insurance companies domestically to the rates from a niche international health provider, who may provide rates at a premium but offer more comprehensive coverage as well as borderless coverage. While the domestic provider may have potentially lower rates, many domestic insurance providers offer less coverage. For example, an expat who purchased domestic health insurance in Thailand may be able to receive healthcare while in the country; however, a doctor’s visit while on a trip back in the home country might not be covered through a domestic insurer, but would be covered through an international health insurance provider.
- English Support – Finding a company with 24/7 healthcare support in English is easily overlooked but essential. Additionally, expats should ensure they will have access to English speaking doctors, hospitals, and claims support.
- Availability of Medical Providers – Having a wide-range of in-network medical care providers is important. Expats should find out how much their plan covers in-network and out-of-network treatment and how it affects premiums.
- Health comparison websites – Aggregator websites are a good way to compare rates with several different providers overseas. This is a great starting point when researching plans, although it is recommended to buy directly from the health insurance provider’s website to avoid problems filing claims or obtaining treatment.
7. Decide Between Long-term and Short-term Health Insurance Plans
The length of the time abroad is an important factor when selecting an international health insurance plan.
- Short-term international health insurance plans are for travelers visiting the destination country a limited amount of time. Some insurance companies define short-term travel as lasting between 1-180 days. Normally, these plans cover only emergency expenses and do not provide comprehensive health insurance. Short-term plans are also often not renewable and do not cover pre-existing conditions, maternity care, or mental health. Typically, short-term travel medical plans will likely have more exclusions than long-term plans.
- Long-term international health insurance plans are designed for expats living overseas for 6 months (180 days) or longer. These plans tend to be more inclusive in their coverage options because there is a greater likelihood some kind of medical care will need to be obtained. Unlike short-term international health plans, pre-existing conditions can be covered (generally with a waiting period or with medical underwriting). Additionally, maternity coverage and mental health coverage are often part of long-term international health plans.
8. Consider Your Individual and Family Needs
Family needs, such as prescriptions, should also be considered when choosing an international health plan. A tip that may help some expats is to explore different coverage arrangements. For example, sometimes it may cost less to cover children under one spouse’s plan and have the other spouse on a separate plan. Speaking with the insurance provider will allow expats to explore different family coverage options and the best arrangement to save money on an insurance plan.
9. Know Deductibles and Coinsurance Options
Expats should know what out-of-pocket expenses they can afford to pay, or are prepared to pay, should a claim arise. Always research these costs and all fine print when coinsurance is discussed. Expats should research the following about potential insurance plans:
- What will the out of pocket expense be on all health care plans?
- Will the insurance company be billed directly, or will policyholders be responsible for paying upfront and filing a claim for a refund?
Like other types of insurance, a higher premium usually means a lower deductible if care is required.
Regarding coinsurance, plans with a higher monthly premium often offer better coinsurance options. For example, a plan with a $400 monthly premium might require a smaller copay (or no copay at all) when compared to a plan with a $125 monthly premium. Expats who anticipate the need for regular prescription medications, doctors’ visits, and other circumstances where a copayment would be required should carefully research the coinsurance portion of a potential healthcare plan.
10. Understand the Continuation of Coverage
Some insurance plans will deny a policyholder’s ability to continue coverage if that person becomes too much a liability. There are two things to be aware of in terms of coverage continuation:
- Expats should pick a plan that offers a guaranteed renewal in order to ensure coverage is not suddenly excluded due to a new medical condition (such as a cancer diagnosis)
- Expats should also check to see if borderless coverage is provided when they relocate to another foreign country or back to their home countriy
It is important to note that even though a plan offers guaranteed renewals, that does not mean the plan will be renewed at the same rate. Some expats have been shocked to see price hikes at the time of renewal. Other situations where rates may increase include job changes, moving to a different region or country, and health conditions. On the other hand, sometimes insurance providers offer lower premiums for customers who show loyalty when it’s time to renew a policy. Expats should regularly review their insurance options when a policy is coming close to its expiration date and make sure they are getting the best coverage that fits their needs.
When choosing a health insurance plan, expats should carefully set a budget, find out required vaccines, check out health and travel advisory warnings, look for exclusions and pre-existing conditions, and compare health insurance plans that best meet their individual and family needs.
Since 1947, Clements Worldwide has been a leading provider of international health insurance for expatriates and international organizations. Clements Worldwide exclusively offers GlobalCare® health insurance plan that provides coverage across borders and is valid in over 180 countries. To learn more about international health insurance and obtain a quote, visit Clements Worldwide.