Expat Focus International Healthcare Update 26 July 2016

US expats need to comply with ACA

America’s Affordable Care Act (ACA) has some elements that US residents who are living and working overseas need to abide by.

Among them is a need to meet the minimum essential coverage and the Individual Shared Responsibility Payment; failure to meet some of the criteria could lead to financial penalties.That’s because all US citizens, regardless of whether they live in the United States or overseas, are subject to the act’s ‘minimum essential coverage’ requirement unless they qualify for exemption. Many expats working overseas do not have this minimum coverage.

They can get it by signing up with employer-provided coverage or joining a government-sponsored program such as Medicare Advantage.

Expats can also meet their obligations by purchasing health insurance directly from an insurance company.

The financial penalty for not meeting the individual shared responsibility payment is based on a percentage of the family’s income or on a per person basis – whichever is greater.

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There are also new rules – announced in June 2016 – which give more details on how ACA affects expats.

Any US expats confused about their obligations under ACA should consult with an expert who can give more information.

Legislation on tax related healthcare

Meanwhile, the house of representatives has passed legislation on tax related healthcare which will see the expansion of health savings accounts (HSAs).

The move will see the current caps on repayments of advanced premium tax credits being raised.

HSAs are generally used to pay for out of pocket medical expenses which are not covered by health insurance plans and include unexpected health events. Contributions made under an HSA are tax-deductible and employers also make contributions.

Expats can use all Dubai's hospitals

From next year, expats with health insurance cards will be able to use all hospitals in Dubai.

Currently, government run hospitals are reserved for Emiratis and expats can only use them if they are willing to pay for treatment up front or are an emergency case.

Now insurance cards are being accepted by all Ministry of Health hospitals from 2017.

The new system’s implementation has already begun at 15 health facilities as a trial.

Indeed, more than 500 hospital workers are to be trained in how health insurance and its billing mechanism works so they can accept an expat’s health insurance card when it is presented.

The move has been welcomed as good news for expat patients, particularly for those who live in remote areas including the Northern Emirates.

The government says it’s willing to accept expats as patients if they are covered by an insurance company, so long as the hospital receives a guarantee that the medical costs will be met by the insurers.

US healthcare costs reach new peak

The cost of healthcare in America has reached a new peak and now stands at $10,345 per person.

This is the first time that the figure has passed $10,000 and the Department of Health and Human Services says that health care spending in the country will now grow at a faster rate than the country’s economy for the next 10 years.

The boom in costs will hit expats, citizens, and employers as well as federal and state governments.

Indeed, average growth projected to be 5.8% every year until 2025 means the nation’s health expenditure bill will reach $3.35 trillion this year – and all levels of government will account for around 47% of all health care spending.

Among the reason for the growth is an ageing population, rising medical prices and a stronger economy with Medicaid and Medicare expected to grow more quickly than the private insurance.

British expats and travellers need health insurance cover

Health insurance experts say that British expats and travellers have taken the European Health Insurance Card (EHIC) for granted for too long to enjoy access to free or cheap healthcare when travelling in the European Economic Area and in Switzerland.

With the future of the EHIC now up for debate after the Brexit vote, many expats and travellers from the UK may be without proper health coverage.

However, experts in healthcare have said that many Brits have not realised that they still required medical health insurance since the EHIC did not always provide full cover.

The managing director of the European division of International Medical Group, Philip Wright, said: “This is a government issued card and it clearly says, ‘Make sure you have valid travel insurance’. That’s because the EHIC may not cover the full cost of treatment.”

One issue for expats is that after leaving the UK they were not entitled to health treatment under the National Health Service and nor are they entitled to receive treatment using the EHIC, so many expats have to fund International health cover for themselves.

Mr Wright added: “People have become used to travelling with some comfort about the level of medical cover they had with the EHIC. They do not often consider other forms of health cover since the card is government-funded and free. I am worried that without the EHIC people may have large medical bills they will struggle to pay unless another provision is made by the UK.”

British expats told to 'rest easy' on healthcare fears

British expats living in Valencia, Spain, have been told to relax over fears of healthcare provision by the regional president.

There are 100,000 British expats living in the region and President Ximo Puig said they should ‘rest easy’ over their healthcare fear since all citizens are guaranteed access to health provision.

Only 20% understand protection benefits

A survey by insurance firm Zurich has revealed that just one in five people with income protection cover understand the benefits.

The cover will provide the person with an income should they become too disabled or ill to work and around 42% of those questioned said they had experienced a loss of income during their working lives when seriously ill.

Zurich says there is still a general feeling of ‘it won’t happen to me’ attitude among many people when it comes to being unable to work.

Just 19% of those questioned said they had a good knowledge of what income protection was, which suggests more needs to be done to raise the benefits of these products.

When asked how much they would be willing to spend, 25% of respondents said they would offer 5% of their income for the protection though actual cover can be bought for less.

However, 56% said the government should cover them for loss of income when ill and 37% said their employer should provide the cover.

China's healthcare costs rocket

Expats living and working in China need to ensure they have the correct level of healthcare insurance with news that the cost of treatments there are rocketing.

The country offers state insurance which will cover the basic types of treatment but for severe illnesses including cancer and diabetes, there is no financial support. Many families struggle to meet their medical bills.

The public health insurance scheme covers nearly half of China’s population of 1.4 billion but it only offers the basic level of coverage and with costs rising, families are struggling.

The Boston consulting group estimates that by 2025, the personal health care bill for Chinese people will quadruple to 12.7 trillion yuan ($1.9bn or £1.4bn).

Northern Emirates may get mandatory healthcare

People living in the Northern Emirates of the UAE are demanding access to health benefits that workers elsewhere enjoy.

The government in Abu Dhabi introduced mandatory healthcare this year for workers and Dubai initiated a similar scheme this year. But there is no universal health cover in the Northern Emirates.

One reason for the call is that low paid expat workers, particularly labourers, cannot afford to be sick since they cannot afford to lose income. Most expats working there have medical health insurance cover.

A mandatory health cover scheme will help provide those who struggle to pay for medicines with the cover they need.

Meanwhile, Abu Dhabi’s move to mandatory healthcare provision has led to calls from expats on low incomes to claim the extra health insurance policy costs are too high.

Many of those expats concerned say they are wary of the extra charges that will be imposed by employers or sponsors.

In addition, under the Health Authority Abu Dhabi (Haad) scheme, expats aged over 40 will now have to pay up to 50% under the Basic Plan for their insurance premium.

The insurance premiums are provided by the national health insurance company which has announced how much health cover is provided for expats and Emiratis, including inpatient and outpatient treatment.

Healthcare costs in Oman to rise

Expats living and working in Oman will need mandatory health insurance and face higher healthcare costs with news that the country’s healthcare provision will rise by nearly 13% every year until 2020.

This means the country’s bill for healthcare provision will rise from $2.3 billion in 2015 to $4.3 billion, according to the GCC Healthcare Industry Report.

The sultanate is reviewing a five-year plan for its provision of healthcare and has acknowledged that more hospitals and beds will need to be added. Health chiefs are considering the construction of a medical city.

Among the reasons for the growth in healthcare expenditure is a predicted 3.1% rise in the population by 2020.

To help pay for the healthcare, Oman has announced a plan to bring in mandatory health insurance for expats. This policy will be phased in over the next five years.

The result of this, the government says, is that the number of patients who visit private hospitals will rise.

HIG launches expat programme

The Health Insurance Group (HIG) has launched an employee assistance programme aimed at expats around the world to provide support and help.

The firm has teamed up with health and productivity provider Morneau Shepell to offer a variety of programmes to help employees acclimatise when sent overseas for work assignments.

A spokeswoman for the firm said: “Employers have obligations to provide support and care to their employees who operate internationally. A move overseas can be helped by providing support to address personal or operational problems.”

The service aims to help expats with a round-the-clock counselling service to help expats struggling with personal life issues and work problems. The service is confidential.

In other expat healthcare news…

A report has revealed that expats make up 91% of Saudi Arabia’s healthcare professional roles in private hospitals. In state run hospitals, expats account for 41% of professional roles.

The government in Oman is to relaunch its organ donation scheme after just five people signed up to it since its launch in March. Expats are among those being targeted for donations.

A new health insurance plan for expats living in Hong Kong has been launched by Italian insurer Generali Global Health. Employers can ‘mix and match’ elements of the product to deliver what they need for their employees.

A new webpage aimed at British expats and travellers has been launched by the UK government with information on a range of post-Brexit, issues including healthcare and the European Health Insurance Card (EHIC).

A new trend for accessing healthcare and health information is emerging in China, with rocketing numbers of people utilising web-based medical care, a survey has revealed. Apparently 80% of Chinese people with internet access have registered with healthcare services and they say they receive a better service with many accessing an ‘online doctor’ rather than attending a hospital.

An American survey has revealed that 28% of workers say their job is good for their health – while 16% said it was ‘bad’. More than half of respondents said their employer had a wellness programme that was beneficial to their health.

Expats living and working in Morocco who don’t have healthcare cover will be pleased to hear that the government has announced that the prices for 139 medicines used for chronic diseases have been reduced. The Ministry of Health says the move will reduce the cost of healthcare for its citizens and expats who suffer with issues including asthma and high cholesterol.


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