Expat Focus International Healthcare Update 19 July 2016
Brexit fallout will impact on expats and their healthcare
The fallout from the Brexit vote continues, with many British expats living and working in Europe worried about whether they will have access to healthcare once the country’s withdrawal from the European Union is completed.
Currently, UK citizens who live in EU member states are entitled to free healthcare with the European Health Insurance Card (EHIC).However, the Prime Minister of Spain, Mariano Rajoy, says that once the UK leaves the EU, his country will not be obliged to offer the perk to British expats – until then, the expats are protected under the current agreement.
A Department of Health spokesman confirmed that access to the EHIC by British expats in the European Union is ‘an issue to resolve’ during withdrawal negotiations.
Mercer warns of increased expat healthcare costs
Meanwhile, relocation firm Mercer says the healthcare costs for expat workers could increase because of the Brexit vote.
The firm is now warning companies to consider what the impact of the EU’s healthcare reciprocation system will be for foreign nationals who live and work in the European Union.
The main concern should be for expat employees who would not have access to primary and secondary care in the country where they are working; this will affect the affordability of moving expats between certain countries.
A spokesman for Mercer’s Healthcare arm, Simon Griffiths, said: “There may also be an increase in bureaucracy for expat workers and there may need to be compulsory company healthcare provision. There also needs to be clarity over how personal data is going to be managed and stored by multinational companies when separation occurs.”
He added that the situation will not only affect British expats working in Europe but also EU nationals working in the UK, which means employers should begin reviewing their workforce plans.
Employers do not have Brexit healthcare plans in place
A survey has also revealed that most employers do not have post-Brexit healthcare plans in place, according to Jelf Employee Benefits.
Before the referendum vote took place, they asked HR and finance staff what plans they had in place should the UK vote to leave the EU and 83% said they have no formalised plan at all, while 17% did not know if there was a plan.
The firm’s managing director of international services, Doug Wright, said employers need to look at how healthcare provision for expats will be affected by the Brexit decision.
He added: “Our recommendation is to seek professional advice for the impact on pan-European benefits including well-being and health cover.”
Expats don't understand health insurance jargon
A survey by an American university has revealed that only 14% of expats can answer four basic questions about their health insurance cover.
For those who do not know, one news site has explained what most of the terms of an expat’s healthcare cover will be. These include:
Allowable charge: This is the amount an insurance provider thinks is the normal amount that an expat should be paying for a health service. For example, if a doctor determines they can carry out a health check for $150 but the insurance company says the allowable charge is $120, then the doctor must accept this. If not, the expat may have to pay the difference.
Benefits: These are the healthcare plan benefits which are listed in detail as well as the service providers that the expat can use.
Claim: This is when an expat asks their health insurance provider to meet their medical costs.
Co-payment: also known as ‘co-insurance’. Some health insurance providers will ask that the expat pays a fee when using a service. For example, when visiting a doctor, they may be charged a $10 amount which will be known as a ‘co-payment’; when it is described as a percentage, it is ‘co-insurance’.
In-network provider: Used to describe a health service that is part of the insurance firm’s network – those not in it are described as an ‘out-of-network provider’.
Employers warned over expat healthcare costs
Firms who employ large numbers of expats are being warned that their healthcare costs will continue to rise, according to a report from PwC.
The accountancy firm says that one big surprise is that the biggest increase in spending is being driven by lower cost basic healthcare.
The report points out that the driver price rises last year was the high cost of speciality drugs, but this year it is the utilisation of urgent care medical centres.
The report, Medical Cost Trends, highlights the growing numbers of people are heading to medical centres seeking treatment for routine ailments including colds and ear infections while expats visiting doctors has fallen by 17% over the past 10 years. Spending on outpatient clinics, however, has risen by 19%.
PwC says part of this drive is the convenience of visiting a health centre but points out that convenience ‘comes at a cost’ and there’s also a growth in demand for mental health services.
Wellness programmes could reduce healthcare costs
The growing popularity of wellness programmes for employees in Europe and America, including for expats, shows no sign of abating. These are becoming a staple for workplace health benefits, according to the Society for Human Resource Management (SHRM).
They found that 90% of workers questioned said they would increase their investment in a wellness programme if they saw a reduction in their healthcare costs as a result.
Indeed, two out of three of those who responded said they had seen their healthcare costs drop in 2014 because of the wellness programmes provided by their employer.
Most of those who undertook the programme had to take part in wellness screenings and regular consultations with programme coordinators to ensure they were exercising more, eating healthier and getting rid of bad habits, particularly smoking.
Many employers have introduced wellness programmes as a way to reduce their healthcare insurance premiums and boost the health of their employees and, as such, some firms have also introduced mandatory health screenings.
US begins consultation on expat health coverage
Employers with expats working in the US have an opportunity to reply to proposed changes to expat health coverage, particularly the Expatriates Health Coverage Clarification Act of 2014.
The aim is to determine the minimum level of health coverage that is provided by an expat’s health plan in the US and whether these plans are covered by the Affordable Car Act (ACA) and its so-called ‘market reforms’.
Under the proposals, expat healthcare insurance will need to cover the need for inpatient and outpatient hospital services, physician services as well as emergency services.
In addition, the expat’s dependent children will also be eligible for coverage until they are 26. The plan sponsor must also believe that the coverage provides ‘minimum value’.
The new regulations will also define who is a ‘qualified expatriate’ to receive health plan cover and it also covers US citizens who work outside of the country for at least 180 consecutive days as well as expats moving to the US to take up an employer’s assignment.
The consultation, which was launched by the Departments of Health, Treasury and Labor in June, will end on 9 August and the finalised regulations will come into effect from 1 January 2017.
Dubai health insurance fees increase
The cost of healthcare insurance in Dubai for expats will increase after the country’s health authority unveiled a new structure for medical service costs.
The Dubai Health Authority (DHA) is looking at what medicines and healthcare provision should cost as they are losing large sums providing health services to the public.
They point out that their services currently cost much less than their international counterparts and the body is looking at setting prices for treatments, procedures and services that will conform to an international benchmark.
However, the DHA also says that the exercise will also lead to health care providers working in the private sector being forced to reconsider their pricing structures as well which could see treatment prices falling.
One reason for this is that their charges will not be met by healthcare insurance firms since they will be considered to be ‘exorbitant’.
One hospital has already implemented the changes and is awaiting government approval for the move.
All expats and nationals will be affected by the Sadaa Health Insurance changes and those who currently have no health insurance cover will be covered by a government health care system.
Other changes include forcing expats who are older than 40 to pay 50% more for their Abu Dhabi Basic Insurance Plan and also pay extra for dependents, including their spouse and children under the age of 18.
Other dependents, including a fourth child and parents, will not be covered by healthcare insurance and any treatment costs will need to be met by the expat.
Emiratis will also now have to pay 20% of their treatment cost at a private hospital but they still receive free treatment and government run hospitals. The changes were announced on 30 June and began on 1 July.
US expats have healthcare details hacked
US expats around the world need to be aware that hackers are selling their personal details after hacking a healthcare database, according to researchers.
There is apparently a huge trove of patient data available for sale after several large-scale cyber-attacks on healthcare providers.
The latest breach affects a healthcare firm in Missouri with nearly 48,000 patient records, many in plain text format, being stolen and now up for sale.
The latest hack joins other databases which are currently on sale to other hackers, including one containing 210,000 patient records from a healthcare database in the Midwest.
Hackers have regularly targeted the healthcare insurance industry; one major breach in May last year affected 10 million customers of Blue Cross Blue Shield Association.
The Department of Justice has announced its aim to crack down on cyber criminals targeting healthcare databases with a range of initiatives.
Why expats’ healthcare insurance is vital
A survey by the Occupational Safety and Health Administration in America has revealed that businesses are paying out $170 billion every year dealing with workplace illnesses and injuries.
Around 3 million employees, including expats, working in the private sector are injured every year with most illnesses and injuries being seen among small and medium-sized firms.
The most common cause for workplace injury, according to healthcare insurance firm Travelers, is handling materials, for 32% of employees, followed by slips and falls by 16%. Being hit by an object accounted for 10% of injuries.
For those employees and expat workers the cost of the injury may come as a surprise, with a fractured bone costing $42,000 while a dislocation costs $97,000, a sprain or strain costs $17,000 and an electric shock $55,000.
In other Expat Focus healthcare insurance news…
Expats in Singapore are being warned that their healthcare insurance premiums will rise over the coming years to help meet the growing costs the city-state faces in caring for its rapidly ageing population. Singapore will be spending $44 billion on healthcare by 2030 and account for 7.3% of its GDP, compared with 4.6% in 2013. Private healthcare is also growing in popularity and now accounts for 64% of total health expenditure.
Expats living and working in China can now buy earthquake insurance cover with a potential maximum pay-out of $150,000 to cover damage and loss to their property and pay for healthcare costs.
Growing problems with the Czech Republic’s healthcare system will be worrying expats with healthcare insurance cover, since there is a shortage of doctors and nurses. A recent protest from doctors highlighted the problem that many hospitals can no longer ‘guarantee safe healthcare’.
Expats with healthcare insurance provisions should begin expecting virtual consultations from a doctor, say industry experts. There is a growing trend for people seeking a consultation to use their smartphone rather than attending a surgery – the online doctor can also prescribe medicines. One leader is HealthTap which has signed-up 100,000 doctors to serve its customer base in 100 countries.
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