Andrew Wilson

Andrew Wilson is the CEO of APRIL Medibroker, an independent specialist broker advising expatriates on their choice of international medical or healthcare insurance.

Click here to submit a question for Andrew to answer publicly next month (please note that Andrew is only able to answer a selection of questions received but all questions are read and considered.) Alternatively, click here if you would prefer to discuss your individual needs privately or are looking for a specific quote.

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25/08/09 - Elisabeth in Spain asks:

"I don't understand why I would need an "expat" health insurance plan when I move abroad - why can't I just get the same coverage as the locals?"

Andrew's reply:

Many expats move to another country under the assumption that comprehensive healthcare is available to them when they get there - whether a free system such as the UK's NHS or by simply slotting in to a state system. Even if such systems exist, or local health insurance plans are readily available there are a number of very important factors that need to be taken into account to ensure that you and your family are adequately provided for should the need for medical treatment arise. In many areas of the world (and not just those countries without a developed healthcare infrastructure) international medical insurance is not a luxury but a necessity. Some of the most important of these factors are shown below:

Availability of healthcare:- In many countries expats are ineligible for local health insurance, at least for a period of time (such as the USA and, in many circumstances, France). This leaves the option of an international insurance plan or paying for treatment yourself. Whilst the latter option can appeal to many on a "it'll never happen to me" basis, the reality is that paying for treatment yourself can be a VERY expensive risk to take.

Choice of hospitals and doctors:- International health insurance plans generally give a free choice of which doctors and hospitals can be used by the policyholders to ensure that the best care is available. Many "local" insurance plans can either restrict cover to include only certain hospitals/doctors, and in some countries only those providers in a certain area (such as county, province or state etc). A local plan may not give cover over an entire country, whereas an international plan will not only cover all of that country but also other countries too.

Quality of Treatment:- By giving coverage across a greater geographic area (not just a single location), international plans allow far greater flexibility and choice should you need treatment. This is especially important should the unthinkable happen and you suffer from a major medical condition. An expat insurance plan will allow you to choose when and where to have the relevant procedures - this even extends to the scenario of "elective" treatment, allowing you to travel abroad to centres of excellence (although in most cases you would have to bear the cost of the actual travel expenses).

Strength and Longevity:- All of the insurers and plan providers that we at April Medibroker use have an enormous level of experience in dealing with all medical situations that have affected expats the world over. They are all underwritten by companies with strong ratings by the likes of Standard and Poors, and customers need not be concerned that they are likely to disappear any time in the future.

Mobility and Portability:- There is an ever increasing global trend of "international citizens" who are geographically mobile whether it be through their employment or just their chosen way of life. International medical insurance plans are portable between the vast majority of countries, whereas local/domestic plans in most countries are highly unlikely to be. One of the great benefits of this portability is that cover can be continuous - if claims are made for a medical condition, cover and future treatment can be continued. If you move between different insurers and plans there is always an inherent risk that conditions that have been claimed upon on one plan are unlikely to be covered under a new policy as "pre-existing conditions".

Additional Benefits:- In conjunction with a global experience of healthcare, international insurance providers also offer a wider spread of benefits (and with higher financial limits) than most country specific insurers. Multi-lingual assistance services, available 24 hours a day, seven days a week are an integral feature of most policies. Medical evacuation and repatriation are key features of international plans, ensuring that the best and most appropriate treatment is available to policyholders at internationally renowned centres of medical excellence. Benefits such as this are of even greater importance for expats in countries with less developed or lower quality healthcare systems.

I would strongly recommend that anyone considering a new life abroad takes fully independent advice from a broker in order to find the most appropriate solution to their health insurance needs. At April Medibroker we only advise on plans that have a proven track record of quality and integrity. If local health insurance is the best way for you, we will let you know - in fact we can provide this as well in certain countries.

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22/07/09 - Steve M. in London asks:

"I will be moving abroad soon and need medical insurance that covers me in different countries. My main concern is making claims on this new insurance - please could you advise how this process works?"

Andrew's reply:

Please note that this information is provided as generic advice only. All insurers/providers have their own separate claims procedures and their Policy Wordings must be consulted for exact claims advice. Although each international health insurance provider has their own claims procedures, as a “rule of thumb” there are a number of similar themes that run through most, if not all, plans. It is important to make sure that policyholders are familiar with their insurers own claims process - if they are not followed correctly claims could be delayed or even refused.

If an international medical insurance policy has an excess or deductible this will be taken into account when the claim is settled (ie the insured person may still have a liability to a portion of the claim as agreed when applying for cover). Similarly, some plans and benefits have a system of “co-insurance” or “co-payment” whereby the insured is prepared to pay a set percentage of the costs, rather than a set monetary amount applicable either per year or per claim.

Inpatient/Daypatient Claims

This type of claim can be defined as those where there is a requirement for treatment in hospital:

Inpatient Treatment - treatment at a hospital where an insured person is admitted and occupies a bed for one or more nights.

Daypatient Treatment - treatment at a hospital where an insured person is admitted and occupies a bed, but does not remain overnight.

It is a condition of international medical insurance plans that inpatient/daypatient claims are pre-authorised. This means that the insurer/provider should be contacted in advance of treatment and advised as to what treatment is required and at what hospital it will take place. The insurer will then contact the hospital and arrange for any bills to be paid directly by them, thus saving clients from having to pay potentially large treatment costs and then reclaim the money from the insurer.

Worth noting is the fact that some insurers will impose penalties on clients for inpatient/daypatient claims that are not pre-authorised. Whilst the claim may still be settled, it may only be at a percentage of the overall cost (generally this is at about 80%).

There are, of course, circumstances where pre-authorisation is not practically possible - principally in the event of accident and emergency. We at APRIL Medibroker always recommend to our clients that they keep a copy of their insurance documents or membership card with them and also make sure that friends, family or colleagues also have access to them should the client be unable to contact the insurer.

Outpatient Claims

This type of claim is defined as:

Outpatient Treatment - treatment at a hospital, consulting room, or out-patient clinic where an insured person does not occupy a bed.

Under international health insurance plans, this type of treatment does not generally need to be pre-authorised but needs to be paid for by the policyholder and then claimed back from the insurance company.

It is, however, always a good idea to contact the insurance company in advance to check that the required treatment is covered under the terms of the policy.

In order to do this, original itemised invoices and receipts must be obtained from the doctor, therapist etc at the point of treatment/payment. In addition to these documents a claim form needs to be completed by both the insured person and the treating medical practitioner (note that many insurers will not reimburse any charges made by the medical practitioner for completing a claim form). These claims forms are available either from the insurer or can be obtained from the downloads page on this site.

The completed claims form, along with the appropriate original receipts and invoices should then be sent to the claims department of the insurance company as soon as possible (many companies will only accept claims submitted within a certain time from treatment being received - generally six months).

Upon receipt, the claims department will assess your claim and refund eligible payments either by cheque or bank transfer. They may however require further medical reports or information before they will make the payment. Should treatment be required on an ongoing basis, new claim forms aren’t necessarily required for each set of bills and receipts as long as the insurer is advised that they relate to an existing claim. It is however possible that if the treatment continues longer than six months the insurer may require either a new claim form or an up to date medical report (which they may not be willing to pay for).

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Click here to submit a question for Andrew to answer publicly next month (please note that Andrew is only able to answer a selection of questions received but all questions are read and considered.) Alternatively, click here if you would prefer to discuss your individual needs privately or are looking for a specific quote.

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