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International and expatriate health insurance : Requirements by country
It is impractical to provide comprehensive detail on the requirements for international and expatriate health insurance in every country. In addition, rules and requirements often differ by nationality too. Private Healthcare UK only covers the requirements for UK citizens.
Countries may have rules on allowing you in as a long stay visitor, depending on whether you are working temporarily, have moved there permanently, are a student, or retired there.
In some countries, rules apply to "workers" so the position of retirees is unclear.
Some countries will now only allow you a visa if you can prove you have health insurance.
Theory and practice, particularly in non-EU countries can differ. Corruption is not unknown; in some countries you are expected to "pay" certain officials, while in other countries you will be thrown in jail if you try to.
In some countries you have to buy local insurance.
In some countries you can buy international health insurance, but only if the insurer is authorised in that country.
The basic rule in most countries is that a UK citizen resident in that country is subject to the same laws and rules as all other residents. There is no excuse for not doing your research on what health provision there is for foreign citizens, rules on what health insurance you must have, or require, before you go abroad.
Most expatriate / international health insurance policies will cover the countries mentioned below. Links to company and policy information are ONLY included when there are country-specific policies.
Health insurance for Europe
Cyprus has become one of the most popular choices with expats from the UK in recent years.
Because Cyprus is in the EU and has very high standards of medical care, expats are entitled to free health care.
All residents need to be protected by the French Healthcare System which means expatriates must register with a local GP/Family Doctor. Many people buy top-up insurance to protect them against the substantial difference in what the state pays, and what the health system charges individuals.
Any expatriate living in France who is not working and/or is below the French retirement age is no longer eligible for free healthcare from the state.
The French state system only pays for 70% of healthcare costs, the individual is responsible for the balance.
To become a permanent resident in France and to obtain a residence permit (carte de sejour) the individual must prove that they have health insurance that either provides partial or total reimbursement of their medical expenses.
Britons who are retired and under pensionable age are not covered by the national French system.
Any Britons over the UK's state retirement age, 65 for men and 60 for women, are covered by getting a form E121, which means their fees are paid by the UK government under a reciprocal agreement.
Expats can also get cover for the first two years they are living in France by obtaining a form E106 from the Department of Health before leaving the UK, and anyone who has lived in the country for at least five years is entitled to care as a resident of France.
For those who are healthy, it is possible to get an international plan to cover the three years between the expiry of your E106 and the five-year residency qualification period.
International plans are generally more expensive than UK plans but they will also cover you wherever you travel in Europe as well as in France.
The first rule is not to give up a healthcare plan in the UK if you have one until you have checked out exactly where you stand. Cancelling a policy over here would be a disastrous mistake because many insurers will let you change from a UK plan to an international plan that covers Europe, while keeping you on the same underwriting terms.
If you want to relocate to France and know you are going to need some treatment in the future, the current situation is that you will have to pay for your own care once your two years E106 benefit runs out.
In Germany, health insurance is mandatory.
If you are planning to spend more than six months in Germany, or move there in a job-related capacity, health insurance is mandatory.
Everyone living in Germany must be insured for at least hospital and out-patient medical treatment.
The options available to you for health insurance while living in Germany are; the government-regulated public health insurance system, private health insurance from a German or international insurance company, or a combination of the two.
Most German residents are members of the government health system GKV. If your gross annual salary is below 48,150 Euros per year or 4,013 Euros per month, membership in the GKV is mandatory. The total cost of government health insurance is currently approximately 15% of your gross salary up to a maximum monthly income of 3,600 Euros. If you earn more than this amount your insurance premium remains constant. Your employer will normally pay slightly less than half of the monthly premium.
GKV benefits include in-patient (hospital) care in a ward at your nearest hospital, out-patient care with registered doctors and basic dental care. Your non-working dependents resident at your address in Germany are included in your insurance at no additional cost.
Members of the GKV join one of the 250 ‘Krankenkassen’ in Germany (non-profit associations administrating the government health scheme). The health insurance funds adhere to established government regulations on what they offer.
You and your dependents are automatically enrolled in the government long-term nursing care scheme. This presently costs 1.95% of your gross salary (a maximum of about 80 Euros per month) of which your employer pays half.
For those seeking to upgrade their medical coverage, for instance the right to consult a private doctor, to homeopathic remedies, a private room in hospital and higher dental reimbursements, supplemental insurance coverage is available which can top up the government system benefits.
You may opt for private health insurance PKV instead of joining the government health plan if you can show that your gross annual salary is more than 48,150 Euros and has been more than 47,700 Euros per year for each of the past three years. If you cannot or do not, you will automatically be registered as a voluntary member of the government system and will not be able to change to a private insurance plan until you have been a member of the government system for up to 3 years. It is important to take this decision at the outset, when or before arriving in Germany, to avoid being forced into the government system by default.
Generally, private health plans cover a wide choice of medical and dental treatment and provide broad geographical coverage. Private patients generate higher earnings for medical professionals and will usually be treated by senior doctors. A private patient can also request, and will often get, doctors who speak their native language.
The cost of full medical insurance is based on the benefits chosen, as well as on the age, gender and any pre-existing conditions of the insured. You can reduce the monthly cost of your private insurance by agreeing to a deductible.
By purchasing a private medical insurance plan from a German health insurance company that provides a certificate recognized by the German government you take advantage of the same employer subsidies as a government plan member.
Everyone, whether state or privately insured, must pay into the government long-term nursing care scheme.
An alternative to private care is to buy an expatriate health insurance policy from a UK insurer as a top-up to the national scheme - but most products offered are still ‘full’ schemes where you will be duplicating cover, as few insurers offer top-up policies to comply with the changes made to the German health system in 2007.
In theory, all EU citizens are treated equally. But in practice, the drastic cuts in health services mean that any expat who does not buy international insurance is taking a huge risk.
It is not compulsory to have private health insurance in Ireland, but as private health insurance is very common, it is a good idea.
Health insurance is used to pay for private care in hospitals or from various health professionals in hospitals or in their practices.
If you are a UK expat in Ireland, there are two schools of thought on international health insurance, and until the question is tested in this country where legal arguments between insurers and the state has become a way of life, no one is sure which is correct.
Version one says that you can buy and use an international health insurance plan.
Version two says that as the state heavily regulates health insurance and licences insurers under strict rules, it is a technical illegality for any insurer in any country to compete with the four authorised insurers.
There are only 4 major healthcare insurers in Ireland:
- Vhi healthcare - state owned
- Laya Healthcare
- Aviva Health
Ireland has a reputation of being expensive for healthcare - but Any EU national or a person "ordinarily resident" in Ireland is entitled to the following for free:
a) All in-patient public hospital services in public wards, including consultant services, subject to certain charges. There is a daily charge of €60 for public hospital accommodation, up to a maximum limit of €450 in any consecutive 12 months.
b) All other outpatient hospital services, including consultants. Accident and Emergency department treatment. If your doctor refers you, there is no charge. Otherwise it costs €60 per visit.
c) Maternity and Infant care services including the services of a GP during pregnancy and for up to six weeks after the birth. FREE.
A visit to a GP will cost you around 30 to 45 euro - and some insurance schemes will refund some of this fee - you would have to be pretty sick to make enough visits to a GP to make it worthwhile taking out insurance for all the family.
Health care insurance is compulsory in The Netherlands for residents and expatriates.
Having international health insurance does not exempt you from the laws or the compulsory system.
You are free to choose one of any number of health insurers who all offer a basic coverage package, as well as an array of extras, such as supplementary coverage for: dental, after-pregnancy care and extra physiotherapy.
Insurers are not permitted to refuse anyone the basic package regardless of age, employment status or general health, but may refuse anyone for supplementary insurance.
If you are from the UK, unless you have a residence permit based on study, you are legally required to have the minimum, basic insurance. Your residence may be at risk if you do not get insured within 4 months of officially residing in the Netherlands.
You may wish to take out supplementary insurance to cover elective treatments, as well as dentistry and physiotherapy and other treatments the government considers to relate to be the individual's 'own responsibility'. This is also where the real differences in policies show up - from no frills and basic to private hospitals.
No one who qualifies for the basic insurance package may be refused for that package, however, insurers are allowed to impose conditions and determine the pricing for supplementary insurance, and may refuse anyone supplementary insurance coverage. You can choose to switch your basic coverage to another provider once a year.
A third of hospitals in Spain are independent. The state system has some of the longest waits in Europe for treatment. Many people buy private health insurance.
Newly arrived UK expats have to report within three months with their passport to a "Foreigners' Office" (Oficina de Extranjeros) in their province of residence or a designated police station. They will get a certificate stating name, address and nationality, identity number and date of registration. Those under UK pensionable age (65 for men and 60 for women) have no automatic right of access to free extended healthcare.
UK expats who are retired, employed or registered self-employed in Spain can expect the same treatment as a Spanish citizen. If you have not reached UK pensionable age, are not getting a disability pension, and are not working, you are only entitled to emergency treatment.
Economic problems mean that health services are being cut and there is an 'anti-foreigner getting healthcare' paranoia developing in some places. So even if you are legally entitled to free treatment, actually getting it may not be easy. It make sense to take out either a local or full international cover.
As Switzerland is part of Europe, many people mistakenly believe that they will be covered automatically under the European Health Insurance Card scheme, even at a basic level for healthcare.
As the country refuses to join the EU, this is not true. It is compulsory for non-citizens of the country to ensure they are covered independently within three months of relocating to the country, as they will be not be eligible to receive free healthcare.
Although in theory the national laws say that expatriates with adequate private medical insurance do not need to buy the compulsory local cover, every single case is decided on a one-off basis. Insurance is run by local cantons so only they decide what they will and will not accept. So arbitrary is the process that several international health insurers will not cover expats in Switzerland. There is an argument to buy top-up or international cover in addition to the local cover.
As Turkey has risen in appeal amongst those seeking an affordable retirement haven in the sun, so has the number of those expat retirees finding themselves in financial difficulties as a result of health care costs.
In Turkey, there is no national health system. For expats who move to Turkey and who don’t speak Turkish and who have never contributed to the Turkish tax or social system, there really is only one way to get medical care – and that’s to go privately. Whilst the cost of living in Turkey is far lower than in the UK and therefore health care costs are a lot more affordable there too, health care anywhere in the world can be costly in relative terms.
Any UK expatriate, whether employed or self employed, working or planning to work in the UEA, needs to take steps to ensure they comply with the law. No insurance = no visa.
Employees and their dependents, including their spouse and up to three children under the age of 18 years, must be provided with private health insurance by their employer.
The Abu Dhabi government aims to provide its citizens with the highest standard of living, including the provision of world-class healthcare services for residents and nationals alike.
All companies must ensure their staff are covered by health insurance and will be personally liable to cover costs of staff who lack an authorised health insurance policy as approved by the relevant UEA insurance authority.
The Health Insurance Policy replaces the existing health card and will have to be obtained prior to renewal of visas.
The laws are being applied to all people, including the self-employed.
If expats do not have an approved medical policy, they cannot get a visa or work permit, open a bank account, rent a house, or register children at the local school.
Anyone working in this country is wise to have insurance.
The new rules mean that the insurer and any broker the cover it is bought from, must both be specifically registered in the country for the insurance to be accepted. Valid insurance bought from a broker or insurer not locally registered, will mean that a visa will be refused - this has already happened. Not all UK insurers or brokers selling expat cover will know this. It takes years to get authorised in the country, so only international insurers and brokers will be authorised.
Insurance is not compulsory but it is advisable.
As a UK national living and working in Australia, you are liable to pay one percent of your total earnings towards the Australian Health service (Medicare) if you earn in excess of:
- AUS $50,000 as a single person
- AUS $100,000 as a couple
Insurance can be arranged to avoid paying this levy.
If you are working in the country you have cover under the state medicare system and access free treatment in public hospitals and free or subsidised treatment for out-patient care. If you are a retiree you don't qualify for state support and need to either pay for it or take out private medical insurance.
Bahrain is introducing compulsory private health insurance for all expatriates. 2009 saw compulsory insurance for expats working at large companies with over 500 employees. The following years will see this extended to those with over 50 employees, then over 10 employees, then all expats except domestic helpers, and finally, all domestic helpers. By 2013 all expats will have to have cover.
Meanwhile, even small businesses will have to pay increased fees and levies to the state, for every expatriate worker. Individuals and companies will be expected to buy international health insurance from the insurance market.
Whether these rules are theory or practice is unclear and with the current turbulent state of the country, few insurers will offer cover there.
Medical insurance premiums in Canada are supplementary (top-up) plans, as there is no official acknowledgement of the existence of a private health insurance. Recent Court rulings are changing this, but only in some states. The state system is struggling, with many Canadians seeking treatment in the USA.
The language barrier and cultural differences, makes it hard for expatriates to obtain medical services and insurance coverage in China. Expatriates often choose to travel to Hong Kong for surgery or crucial medical advice. Medical costs in China and Hong Kong are the highest in the world after the USA.
All healthcare policies are underwritten by a registered insurer in China. As medical policies currently issued by insurers in China do not cover treatment outside the Mainland, virtually no expatriates staying in China take up a local medical plan.
After a delay of several years, 2014 will see compulsory health insurance in Dubai for residents and expatriates.
The mandatory health insurance is also linked to the visa, and every expatriate’s residence or work visa renewal would require him or her to be covered by health insurance. This includes domestic workers such as maids and drivers. Individual expatriate employees who sponsor their spouses and children will have to bear the cost of their health insurance.
Emiratis will receive insurance cards to replace the existing DHA health cards that provide for health care services and preventive care.
Health insurance packages will be made available for all employers in Dubai. The basic health insurance package will cost Dh600 per year and will provide basic health services and surgeries. It will not cover preventive care.
The DHA will provide insurance companies with Health Insurance Permits and the move is aimed to ensure that every insurance company follows high standards as well as rules and regulations.
For UAE nationals: Every national’s Benefit Package will include the provision of preventive and curative health services, based on DHA’s policies.
For residents: A benefit package that includes the health insurance coverage to be offered by the employer or the sponsor, which should not be less than the essential benefits package. The employer and the sponsor can provide additional coverage to employees and their dependents.
The government will be responsible for UAE nationals, based on the health funding policy and regulations issued by the DHA.
Employers will be responsible for their employees, based on their current health insurance policy; and the benefits shall not be less than those of the essential benefit package.
The sponsors will be responsible for their sponsored individuals (spouse, children, etc), who do not work for an employer; and the benefits shall not be less than those of the essential benefit package.
Employers are responsible for:
Enrolling their employees in the mandatory health insurance scheme based on their current health insurance policy, and in accordance with this law and its regulations.
Bearing the cost, which must not be deducted from the beneficiaries.
Ensuring the validity of the health insurance coverage throughout the period of their employment.
Bearing the full cost of the health care services provided and the emergency services for any of their employees, in the absence of a valid health insurance cover.
Providing health insurance cards to their employees.
Submitting evidence of health insurance coverage when requesting a new residency visa or for renewal of a residency visa for their employees.
This law is to apply to the entire emirate of Dubai, including the private development areas, free zones, including Dubai International Financial Centre.
From April 2010, expatriates living in Japan must provide proof of current or future enrolment in the country's national health insurance system to renew or apply for a visa with validity longer than one year.
Foreign nationals can buy insurance provided by international private health insurance companies. This supplements, instead of being a replacement for the coverage offered by the national health insurance system - which has a lot of problems.
Kuwait's government has made health insurance a mandatory requirement for expatriates.
Expats must arrange for private health insurance prior to arrival.
Cover is a requirement for a work visa.
While many employers provide expats with insurance for the duration of their stay in Malaysia, independent contractors, subcontractors and non-profit workers are often required to purchase policies themselves. These should cover both emergency care and doctor's visits, as well as dental care.
Expats whose families will be joining them in Malaysia should make sure cover extends to their spouses and children.
New Zealand is consistently in the top 4 destinations that emigrating Britons choose for their new life abroad. Some 215,000 Brits reside there permanently.
Private health insurance is essential.
Plans to bring in laws to make health insurance compulsory for expatriates.
Plans to bring in laws to make health insurance compulsory for expatriates.
The Kingdom of Saudi Arabia has made health insurance compulsory for expatriate workers in KSA. The law aims to ease the financial burden on the government, which offers free medical services to some 22 million people, including about 6 million foreigners.
An international health insurance policy from an approved cooperative health insurer will be a requirement in the granting of Iqamas and work permit renewals.
Insurance must be sold by a locally-registered company, although foreign companies have been allowed to open a branch in the country.
If you are going to live or work in Saudi Arabia, buying an international health insurance now is recommended.
United Arab Emirates/UAE
The United Arab Emirates (UAE) is a federation of seven states.
Although each state - Abu Dhabi, Dubai, Ajman, Fujairah, Ras al Khaimah, Sharjah and Umm al Qaiwain - maintains a large degree of independence, the UAE is governed by a Supreme Council of Rulers made up of the seven emirs, who appoint the prime minister and the cabinet.
Most people expect the other five states to follow and make international health insurance compulsory for expatriates, bought via locally authorised companies.
The costs of medical treatment in the USA are very high and increasing every year. If you go to work or live in the USA without buying health insurance, you are taking an enormous financial gamble.