What to bear in mind when choosing an international PMI plan for expat employees

The number of British citizens moving abroad each year averages 60,000 and a significant proportion of these are on expat contracts from UK employers. This means HR directors need to ensure that their expat benefits are right if they are to attract and retain the best employees. Health insurance is top of most expat employees' lists - but the range of benefits from international private medical insurance (PMI) plans is wide and most group schemes can be tailored to fit specific employers' requirements. What are the key features that HR directors should consider when arranging their international PMI benefits structures?

Every employee taking an expatriate posting, or moving overseas to live, needs effective international PMI which will provide cover in the event of a medical emergency and provide day to day medical care. While access to high-quality private healthcare is readily available in most western countries, the cost of treatment can be prohibitive without insurance. Expat postings may also be to countries and regions where healthcare is more limited and therefore access to emergency medical evacuation is essential. Without effective international PMI, staff may require more time off work, or take longer to recover, reducing productivity.

Most providers offer a choice of group or individual plans, ranging from plain vanilla, which provide basic emergency cover – to high-value plans which offer additional cover for outpatient care, dental treatment and other benefits. The majority of employers with expatriate staff buy their international PMI on a group basis, which offers greater flexibility in negotiating competitive rates and customised plans to suit the company’s specific needs.

There are a number of different ways international PMI is underwritten. Originally nearly all plans were underwritten on a full medical underwriting basis – where an employee’s full medical history was taken into account, involving long, complicated forms. This approach became less common as plans offering moratorium underwriting increased in popularity. For moratorium plans expats’ pre-existing medical conditions are excluded for a period or permanently, which greatly simplifies the application process, but can penalise expats with existing medical conditions. Many group schemes are now underwritten on a medical history disregarded basis – where all members of staff of a group are covered without reference to their previous medical history. HR directors should choose a provider that can tailor its underwriting approach to the employer’s exact needs.

There are a number of options available to manage the cost and level of cover. Resist the urge to save money by relying on reciprocal arrangements, such as the European Health Insurance Card (EHIC), or by buying domestic rather than international PMI cover. Neither provides comprehensive cover, nor provides emergency medical repatriation in the event of an emergency. In addition domestic plans are not portable between countries which can cause chaos when an expatriate employee moves to a new posting – especially if he or she has developed a medical condition which may be excluded in the new location.

The geographic area of cover can have a significant impact on cost. Due to the high cost of treatment in the US, worldwide policies are expensive and there is no need to provide this cover to employees who never travel to the US. Plans can always be tailored to offer cover to executives who travel occasionally outside their normal region for a limited number of days each year.  Within group schemes it is generally possible to tailor geographic cover to suit different workers’ postings, so the level of cover received matches the countries individuals will visit.

Costs can also be managed through voluntary excesses and by excluding benefits that are not needed – for example, many plans automatically include maternity benefits, which will clearly not be necessary in all cases. 

Take time to drill down into the details of the benefits. For example, all quality international PMI plans offer emergency evacuation by air ambulance or scheduled airline to the nearest high quality medical centre, but not all will allow the patient to be accompanied by all their family members.

Also consider carefully the insurer’s approach to treatment of chronic conditions. Some lower cost schemes exclude cover for chronic conditions which could leave the company facing large treatment bills if a member of staff develops a long-term illness during their expat posting. Other plans, particularly premium-quality products offer more generous cover for chronic conditions.

There are a number of additional benefits that may be valuable to expat staff. For example, some international PMI plans are now available which respond to security emergencies as a result of political and civil unrest or catastrophic weather incidents. If your employees are likely to be based in less stable jurisdictions they will be grateful for the cover provided by emergency security service specialists.

Finally, spend time choosing an insurer that specialises in international PMI as a core service and offers effective international emergency assistance services and a local presence around the world.

Stephen Hartigan is chief executive, InterGlobal