Expatriate health insurance : An overview

International health insurance (expatriate health insurance) is a huge subject area. Hundreds of insurers and specialist providers operate in this expanding sector. Attempting to comment on and analyse every possible market you may find on a web search would be impossible.

There are specialist products and providers for truly international/ multi-nationality individuals (film stars, racing drivers, the rich) and specialist products for citizens of particular countries outside their own country, and international products for citizens who have not left their own country, and specialist products for those visiting the UK; These are not the concern of Private Healthcare UK; Our focus is on expatriate health insurance products for UK citizens who are about to move or have moved overseas for work, study or retirement.

There are some perfectly respectable non-UK based providers of cover, but in general, we limit our coverage of international health insurance to those companies with a UK office or UK connection.

Why do you need international health insurance?

An increasing number of UK citizens leave the UK on a permanent, temporary or semi- permanent basis:

  • They may be working overseas as an employee or contractor.
  • They may be retired or semi- retired.
  • They may run a business from a foreign country.

They are increasingly caught in a pincer movement between the NHS, which no longer sees itself as a bolt hole for expatriates, and the host country, which sees no need to offer free health, cover to non-citizens.

In the UK, you can be fairly confident that, whatever your nationality, the local Accident and Emergency will treat you when urgent help is needed. In some European countries, as long as you have the right paperwork, you can get free emergency treatment.

In many countries around the world, you have no such right. Tales about paramedics making two checks on victims, are they alive?, do they have a credit card to pay the bills? are true. Some hospitals will not admit you unless you promise to pay all bills.

The standards of health care in some overseas countries can be better than in the UK. In other countries, you may have to fly across borders to get decent or lifesaving care. Even if you get free emergency treatment, all other non-emergency treatment is not free. As a non- citizen, you may not even be allowed to be treated in a state hospital.

A small number of countries in the Middle East and Europe have or are bringing in laws that all expatriates must have International Insurance.

You speak the language as a native, but if you are not conscious, the language barrier can stop you getting the best treatment.

What's the solution?

There are many international health insurance policies to choose from when you are seeking expatriate health insurance. Most offer a take it or leave it package. A few offer a core level of cover with a range of options.  International health policies are designed for people who are living or working outside the UK for at least six months of the year.

Medical treatment can be provided in the country concerned, a nearby country, or in the UK. Cover is provided for private individuals, employees and the self-employed.

What does international health insurance cover?

International health insurance is designed to cover only treatment for curable, short-term illness or injury. Some illnesses and treatments, such as cancer, are never included.

A basic policy will usually cover in-patient and day-patient treatment, post hospital treatment, nursing at home, emergency dental and complications of pregnancy. It will not cover outpatient, routine maternity or dental costs. A wider policy will cover all the above plus out-patient care and specialists, routine dental treatment, normal pregnancy and complementary care.

Most international health insurance plans include the costs of land and air private ambulances, and the costs of repatriation/ evacuation. A multilingual 24-hour help line is often provided. An increasing number seek to include normal health care costs too, such as optical and dental care.

Family and children

Even if you have an employer who provides international health insurance, this may not cover your partner and children travelling with you. For most international cover there is a facility to include partners/ children. Some independent schools offer international health insurance plans to pupils.

For students studying overseas, the situation is very complex and varies hugely by country. If your child is going to study overseas check out with the Embassy and University what is required and what is recommended.

Travel Insurance

"I do not need an international health insurance plan, as I have annual travel insurance. It has a medical expenses section."

A dangerous misconception. Most travel policies only cover medical expenses after you have paid the hospital. And they tend to cover accidents and illnesses, rather than longer term medical problems and needs.

Travel insurance is not a replacement for international medical insurance, as among many drawbacks it only covers emergency treatment, not routine medical treatment.

Several international health insurance policies now offer travel insurance as an option. This may not be the cheapest cover, but avoids arguments when you need help, not disputes. A simple insurance rule applies; a specific policy takes precedence over a more general one. If you have travel cover with one company, and international health cover with another, if it is not clear cut, they are not going to fight over who pays your claim, except in a reverse way; i.e. both will argue it is up to the other one.

Does it cover treatment in the UK?

Some expatriate health insurance policies allow treatment in the UK, others do not, while some only allow it if you have to be repatriated for major treatment.

Does it cover returning expats?

If you move back to the UK permanently, or even temporarily between homes, your cover will almost certainly not apply. Tell insurers before you return and they may be able to help with temporary cover or offering a replacement PMI  policy for UK residents. When it comes to the UK there are often additional exclusions, exemptions and restrictions placed on policies - even by the same provider who has been giving a returning expat insurance abroad.

Can UK insurers offer expatriate cover regardless of where you are going to live?

An increasing number of  countries have regulatory requirements that prohibit an overseas insurer who has not been licensed as an insurance company in that country from writing policies, irrespective of the status of the person seeking cover. For example, in Abu Dhabi, you have to have health insurance in order to get a visa but the only insurance products recognised are those authorised in Abu Dhabi. Our country list gives information where it is known there are restrictions, but there are other small countries where insurance rules are vague and effectively made up by whoever is ruling at the time.

Why not just buy cover locally?

Local cover (cover offered by insurers in the country you live in) is increasingly available to UK citizens. Some of these policies are good, others are very limited, once you study the small print. Insurers may offer local cover but will not pay for transportation to the UK or other country with suitable facilities for treatment or recuperation, emergency evacuation or repatriation for you or relatives.

Local cover is often just that, restricting the hospitals which can be used to a few miles radius of where you live. If your idea of retirement heaven is a daily process of home to beach to shops to pub, then local cover may be all you need. But if you intend to travel around Europe, or wherever else you are based, a local policy can be poor value.

Top up insurance

Many UK expatriates, particularly once they have settled down, are quite happy to be regarded as full time residents of the country they live in. So they accept the local state care and cover. Now, in some countries, you do not even get a choice. UK expert or not, you have to buy cover like any local national.

A standard system across Europe is for the state to provide free or charged for health care. This can be rather basic. So you may get operated on, but the hospital only gets £500 from the state, you are expected to pay the balance. Top up policies cover the difference between the tariff price paid for by the state, and the real cost. They also offer private rooms, outpatient treatment, pharmacy and dental costs.

In many countries, the first port of call is the local GP, who is a lot more expensive to visit than the British equivalent.

Will the NHS protect me?

If you live in the UK you are entitled to free NHS care. If you live abroad for some or part of the time, the rules have changed.

If you live in the EU, you are not eligible for NHS treatment if you spend 6 months or more overseas in a year.

If you live outside the EU, you are not eligible for NHS treatment if you spend 3 months or more overseas in a year.



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