Expat Focus International Healthcare Update February 2019

British expats warned to get health insurance

British expats who are living in the European Union have been warned that they should consider buying health insurance coverage should a no-deal Brexit occur.

The warning comes from Ministers who are part of a special Brexit committee; they say that the NHS will not be able to fund health treatments under a no-deal scenario and that expats will need private health insurance instead. That’s because should the expat fall ill after Brexit then they will have to pay for any health treatment or medicines they receive.The details have been unveiled in the latest of the government’s ‘no deal notices’ that have been published recently.

However, the Health Secretary Matt Hancock is rushing to make deals with France and Spain in time to avoid this happening.

European Health Insurance Card will become invalid

A no-deal Brexit may mean that the European Health Insurance Card (EHIC) will become invalid after 29 March. However, should the Prime Minister Theresa May’s Brexit deal be agreed by MPs, then the EHIC system will automatically roll over, so nothing will change until 1 January 2021 at the earliest.

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Expats have also been warned that they will be unable to fly back to the UK for treatment on the NHS if they’ve been resident in another country.

The NHS now prevents British expats who live overseas from using NHS hospitals for free – a move that was introduced in 2015. The Daily Telegraph has also revealed that the European Commission is preventing any member states from negotiating directly with the UK for expats living in their countries to access healthcare for free in the event of a no-deal Brexit.

250,000 British expats to 'return home' for health care

Up to 250,000 British expats could return to the UK if there is a no-deal Brexit as they face losing free healthcare in the country where they live.

The movement of so many people has been termed ‘Brexodus’ and could increase the burden on the NHS, as well as social care services, since most of the returnees will be expat pensioners. The government has already said that it’s cheaper for them to pay France and Spain to look after Britons in their countries, rather than have them return home, as pensioners can have their treatment reimbursed by the NHS under reciprocal health agreements.

Media outlets reported that under government plans, there is a worst-case scenario under a no-deal Brexit that would see 150,000 expats returning in the first 12 months after March 29. The government says another 100,000 expats may return the year after.

There are currently 1.3 million British expats living in EU member states and the government says that this ‘worst case scenario’ is not only ‘misleading’ but also out of date.

British expats in France get healthcare offer

A new healthcare insurance policy that has been designed to meet the needs of British expats living in France has been unveiled by April International.

The firm has launched MyHealth France which expats can use to cover top-up expenses that are not generally covered by the country’s social system, such as dental and optical services and also hospital private room costs.

The plan has five levels of cover that enable expats to pick a level of protection; there are no pre-existing condition restrictions and no age limits applicable.

The firm’s managing director, Joe Thomas, said:

"The new policy will give reassurance and comfort to British and other nationals who are living in France while the Brexit negotiations continue. Healthcare costs and health insurance in general have emerged as a concern for all expats living in France, particularly British nationals, so the solution should provide a way forward."

There are currently 1.3 million expats who live in France with the British community accounting for 150,000 people, which is France’s largest single foreign nationality. The expat population is expected to rise to 1.5 million over the next two years.

The best six countries for healthcare

An annual global retirement index published by International Living has revealed the best countries for delivering healthcare.

One of the big issues for expats who are heading overseas to retire is the cost of healthcare and accessing world-class care for a fraction of the cost they pay at home.

The index looked at 25 countries and took into account access, cost and the quality of care, as well as the cost of medicines and insurance premiums.

In first place this year is Malaysia, where most doctors speak fluent English and there’s an up-to-date infrastructure delivering health care. In second place is France, which is also highly rated by the World Health Organisation for having an affordable and accessible health care system with subsidised prescription medicines. In third place is Thailand, followed by Ecuador, while Costa Rica and Mexico tie for fifth place.

Destinations for American expat retirees

Meanwhile, an analysis of where the Social Security Administration (SSA) sends social security checks to US expats overseas has revealed some surprising retirement destinations.

The work was carried out by an expat resource service who looked at healthcare and living costs for retirees and they found that currently, the SSA is sending checks to nearly 700,000 Americans living overseas and many of them have decided to start a fresh life in another country – with cheap healthcare at the top of the list for determining their destination choices.

However, along with being exposed to a new culture, many US expats are paying much less for their health care costs in retirement than they would in the US. The analysis of social security payments highlights that the average check for a married couple is just under $1,300 per month – that’s around half of their income in retirement, the SSA says.

In first place for where US expats can enjoy retirement with a good level of health provision on that sort of income is Buenos Aires in Argentina. The expat service says the US social security check also goes further than in many US cities if expats heads to Georgetown in Malaysia and Puerto Vallarta in Mexico.

UAE struggling with expat health insurance

The health sector in the United Arab Emirates is still struggling with delivering medical insurance for expats and citizens alike, it has been revealed.

One issue is that insurance firms are looking to raise premiums as they are faced with ever-growing bills. There’s also a problem with patients having to wait for longer in clinics and hospitals while their insurer to give preapproval for medications and diagnoses. Also, many employers are also reducing their employees’ health cover when it comes to renewing premiums, leaving expats with higher out-of-pocket expenses.

The government will now look at ways of improving healthcare delivery.

Globally mobile employees benefit from tie-up

Globally mobile employees could benefit from a new venture being formed by security consultants Drum Cussac and global travel provider Collinson.

The new 24/7 offering is aimed at providing welfare support for employees when travelling overseas and helping employers fulfil their duty of care responsibilities. The offer delivers a single point of contact to support a business traveller at every stage of a journey, from preplanning to their debriefing after returning.

There’s also emergency evacuation, crisis management and global medical assistance provision as part of the package.

The global head of assistance at Collinson, Scott Sunderman, said:

"We are combining our medical assistance expertise and global traveller expertise with Drum Cussac to revolutionise business travel risk management."

Extra expat health fees cancelled

Kuwait has revealed plans to cancel the extra health insurance fees for expats’ dependents.

Media there say that since 2017, when expats were given the right to sponsor parents, in-laws and siblings, they have needed medical insurance cover of up to KWD 3,000 (£7,645/$9,872). Expats also had to pay between 160 and 250 dinars every year when renewing residence permits for their relatives.

Now health insurance will cost KD 50, which means that the insurance cover for private health of 3,000 dinars is no longer required. The Ministry of Health in Kuwait has unveiled plans to enable expats to pay their health insurance fees online.

The idea is that this will remove the long queues expats encounter when paying their health fees. The ministry says that the system will be similar to the one already in place for employers who pay their health insurance fees online, and expats will be able to register relevant data there too.

In other expat healthcare news…

Security risk services firm International SOS has teamed up with the Forum for Expatriate Management (FEM) to be their exclusive risk management partner. The partnership will see both organisations combining expertise to create a ‘transformational agenda to help protect the mobile workforce’.

Research from Canada Life Group insurance reveals that 34% of employees in the UK say their employers are not doing enough to communicate their workplace benefits to staff, including health and well-being provisions.

Expats in China can access a new AXA health offering aimed at users of the country’s WeChat social media platform. The firm will be among several partners offering health and travel-related insurance solutions to potential customers.

A Nottingham-based insurance broker has created a new healthcare division offering solutions that are tailormade for business owners and employees. The firm, Russell Scanlan, says that the service will build on a company’s current healthcare provision with health and well-being support plans, among other benefits.

Canadian expats heading overseas for work can access a new Zurich Canada offering to cover travel and medical cover. The new product is aimed at closing the coverage gap Canadians experience in healthcare since their current insurance will not transfer when they are out of the country.

Bahrain’s National Assembly says employers must now prioritise hiring Bahraini medics before employing expats under a new Bahrainisation drive. Expats can only be employed if there are no qualified Bahrainis available, politicians say.

International health services provider Aon has teamed up with Claim Central, an insurance tech firm, to help boost their customer service offering with real-time chat, video streaming and digital payments. Aon’s claim management service will now be streamlined and digitised.

The number of expats and Australians with private health insurance has reached an 11-year low in the face of rising premiums. The organisation Private Healthcare Australia says that 44.6% of the population has healthcare in place, but this could fall by 2023 to 30% if nothing is done to address growing healthcare costs. News outlets are reporting that growing numbers of Australians and expats are heading overseas for treatment that is cheaper and they avoid the increasing health insurance premiums.

The growing popularity of digital GPs being offered by a growing number of international health service providers has been underlined with news that nearly half of young workers prefer them. The findings from Willis Towers Watson discovered that 41% of those aged between 18 and 24 would rather see an online doctor. For those who are aged 55 and over, the figure is 16%.

Following cuts to public healthcare, health insurers in Spain say they have attracted 1 million more customers over the last five years. The figures reveal that one in every five households now has private health insurance, which costs around €1,186 (£1,040/$1,339).

Oman’s Ministry of Health has revealed plans to replace 200 expat nurses with Omanis as part of the country’s Omanisation programme.

International health provider Cigna and South African firm Hollard have teamed up with Nigeria’s NSIA Insurance to offer citizens and expats there an international insurance offering. The aim is to provide employers an opportunity of offering staff and expat employees access to high quality healthcare and elsewhere in Africa and around the world.

Kuwait’s Health Ministry says expats there have paid KD 176.6 million (£450 mn/$581 mn) in health insurance fees between 2015 and 2017. The ministry has also revealed that KD 25,000 is spent on financing health awareness and enhancement programmes aimed at boosting expat health levels in the country.


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