International private medical insurance provider MediCare International explains Greece’s healthcare system and how expatriates moving there to work or retire can access it.

As Greece is a member of the European Community, many moving there to work or retire might think that their medical expenses would be covered under the European Health Insurance Card (EHIC). However, an EHIC is not intended to replace private medical insurance, as the protection it offers is temporary and the range of treatments covered is limited.

• The EHIC will cover any medical treatment that becomes necessary during a trip – because of illness or an accident, for example
• The card gives access to reduced-cost or free medical treatment from state healthcare providers
• It includes treatment of a chronic or pre-existing medical condition that becomes necessary during your visit
• It includes routine maternity care (not only because of illness or accident), as long as you are not going abroad to give birth. However, where the birth happens unexpectedly, the card will cover the cost of all medical treatment for mother and baby that is linked to the birth
• The card also covers routine medical care for people with pre-existing conditions that need monitoring

Getting ill when you’re away from home is something most of us have experienced. From having to explain your condition using your charades skills to taking medicines that are as foreign as the destination you’ve chosen, it’s not usually a situation you want to repeat. But what happens when your illness is much more serious than the sniffles or a sore throat? Kevin Melton, sales director at international private medical insurance provider AXA PPP International, explains the ins and outs of medical evacuation, why no self-respecting expat should ignore the danger, and how to make sure you're covered for all eventualities.

Medical evacuation

There are a variety of ways to medically evacuate people. It all depends on where the evacuation is taking place and the condition of the patient.

Most evacuations are carried out via commercial flights. This is only appropriate for medically stable and conscious patients who are able to breathe on their own. If the patient is evacuated in this way, it usually involves buying either an upper-class seat or a couple of extra coach seats.

Other types of evacuation are for patients who are medically unstable. The Lufthansa airline has intensive care units (ICU) aboard some regularly scheduled flights. This option is good if the patient is at a destination that Lufthansa serves.

The ICU units have state-of-the-art equipment, and the costs are controlled, because the flight is part of Lufthansa’s regular activity. However, it does mean the patient has to be at the right place at the right time, and the aircraft must be able to accommodate him or her, because the ICU takes up an area of coach seats.

 

Moving can be a stressful time – even if you’re just going down the road. But what if you’re moving halfway across the world? Along with sorting out your home, taxes, the kids' schooling and all of the other items on your to-do list, don’t forget about your health. Kevin Melton, sales and marketing director at AXA PPP International, talks about health tips and what you can do before you go to ensure a smooth sailing into your new life.

 

Vaccinations

Depending on where you’re going, you may need to get vaccinated. For the latest information, you can check out the World Health Organisation website, or, if you have international health insurance, your provider should be able to help you, via either a medical helpline or an online personalised service.

Relocating overseas with your family? Kevin Melton, sales director at AXA PPP International, has some advice on how to ensure the children stay healthy

Choosing to move to another country with your children can be a challenge for many reasons. Not only might you have to ‘sell’ the idea to your children, you also have to make sure the move is as safe and secure for them as possible.

Most importantly, you wouldn’t take any chances on your children’s health at home, so why would you when you go abroad?

Depending on where you’re going, your children may be exposed to a whole new set of germs, viruses and bacteria, so you may want to prepare for them becoming sick with minor ailments more frequently than might be normal. Coughs, colds, tummy bugs, rashes, allergies and viral illnesses are all possibilities. You can be prepared by taking basic medicines from home that you know your children are familiar with and respond well to.

Countries around the world have very different regulations on drugs. Prescription and over-the-counter medicines that are available legally in the UK are among the items that could get you into a lot of trouble in your destination country, as international healthcare insurance provider MediCare International explains.

The term ‘illegal drug trafficking’ usually refers to drugs such as heroin, cocaine and marijuana. However, the truth is that ‘drugs’ can also encompass pharmaceutical drugs, together with herbal medicines and locally made preparations.

With global travel becoming easier, and an increasingly transient workforce, assumptions regarding what may, or may not, be illegal have tended to slip off the radar for many.

Rules regarding the legality of drugs differ from country to country, so travellers should be aware of the local statutory position. Rather than just checking the weather forecast before they set off, they should ensure their prescription medicine isn’t actually banned – it could cause more than a headache otherwise.

Alison Massey, of specialist health insurance provider Now Health International, looks at recent developments in health and considers the importance of transparency from insurers in such a volatile landscape.

For those looking to further their careers, experience new cultures or gain a fresh perspective on the world, the expat lifestyle has many appeals. However, the benefits of being abroad go beyond emotional wellbeing, as was shown recently by the British medical establishment’s apparent acceptance that it has been pushing anti-sun exposure too far.

Britons have now been told by a range of medical organisations, including Cancer Research UK and the National Heart Forum, that ‘little and frequent’ sun exposure is good for them. Sunlight is, of course, the best source of vitamin D, which is thought to slow cell growth and spread. Around the Mediterranean, cases of prostate, colon and breast cancer are less common than in northern European countries.

But there is, of course, a great deal more to consider than the effects of the sun when it comes to expat health. When arranging your move abroad, extensive planning of the medical insurance needed is essential. What’s covered by the policy, and what isn’t?

One important point to keep in mind is the volatility of life away from home. Personal plans regarding location often change, and the medical landscape is anything but predictable. You need to be confident that the insurance covers the things you didn’t see coming.

By way of a recent example, the deadly cholera outbreak in Haiti marks what medical director at Bupa International Dr Sneh Khemka calls “a new era in modern medicine – the war on re-emerging diseases”. With the growth of cities, globalisation of world commerce and increase in air travel, he says, “Health professionals are fighting a constant battle to keep the spread of big killers at bay.” Particularly in developing economies, diseases such as tuberculosis, cholera, polio and dengue fever are “back and on the rise.”

The advice from Dr Khemka is that, as well as ensuring they’ve had the necessary vaccinations before moving to another country and giving their children the right childhood immunisations at the right ages, expatriates should familiarise themselves with the local healthcare system. How do they access care in an emergency? Are they insured by an organisation with good local knowledge?

Evacuation cover, a possibly dubious expense in developed countries with decent medical services, is critical in underdeveloped, high-risk places, particularly when disaster strikes, as in Haiti. Even if expats can afford the bills for a medical evacuation – which can exceed £50,000 before treatment even begins – they certainly won’t know how to negotiate their way to instant treatment at the right hospital. As medical journalist Peter Pallot puts it, “The ability to call in medical assistance specialists, contracted to insurers, saves lives. Swift intervention, that is not available locally, avoids or minimises long-term damage to health.”

It’s also important to find out exactly what constitutes an emergency to the insurer, and what evacuation would mean for the expat’s dependants. Portability – cover that can be continued in another country without re-underwriting – requires similar consideration. Will cover endure if the expat moves?

In such a complex, transient world, it’s absolutely imperative, when planning to move abroad, that you choose a health insurance company which is completely transparent about what is and isn’t covered, and at what cost. You shouldn’t have to sift through reams of small print to find out where you stand. The insurer should also demonstrate local knowledge and an understanding of the ever-shifting sphere. From that comes peace of mind, which means you can focus on the benefits of the expat life, relax a little, and perhaps soak up a few rays. As we now know, sunlight, like most things, is great in moderation.

Now Health International is strategically placed to serve the main expat hubs and global emerging markets, having offices in Hong Kong, Dubai and the UK.

For more information, see www.now-health.com

April Medibroker’s business development manager, Paul Bolam, explains how growing medical costs affect international health insurance premiums.

We have all heard of inflation; basically, it is the increase in the cost of goods and services this year compared with last year.

Many governments issue a monthly inflation index, which tells us how much the cost of living has increased over the last 12 months. Healthcare also suffers from inflation, commonly known as medical inflation.

What is medical inflation? Why is it different from standard inflation, and what causes it?

We are getting older, and need more medical treatment the older we become. We are also living longer, so the medical treatment we need has to continue longer. Medicine has made huge advances in the last few years; we are not dying from conditions as we used to, so we need medical care to treat them. For example, more people survive a heart attack than ever before, and cancer is now being treated, unlike ten to 15 years ago, when a diagnosis of cancer might have been a death sentence.

The advancement of medical research must be paid for: drug companies and medical supply companies spend a fortune in developing new drugs and medical equipment. They do not pay for this development – funding comes from government grants, insurance company funding, and the charge when selling the drugs and equipment.

Throughout the world, new hospitals are being built. The cost of accommodation and nursing also is reflected in the charges made by hospitals; they are, after all, businesses, and want to make a profit at year end.

Doctors, however, control the cost of treatment; they decide what treatment to recommend, and they want to be thorough. Tests can include blood tests, X rays, CT and MRI scans, ECGs, echo scans – the list is endless. Surgical procedures are also more complex, or, in some cases, less complex (for example, keyhole surgery) but the equipment used costs more to manufacture. Less-invasive techniques, such as colonoscopy or gastroscopy, assist in the diagnosis of conditions which, previously, would have involved surgery but still involve using expensive equipment.

Who pays for all these costs?

Mostly, we do, if we pay for treatment ourselves, or if we have expat medical insurance.

International medical insurance companies usually do not specify the hospital or doctor you may use. There are so many across the world that it is not possible to dictate a specific hospital or doctor in a particular country. In the USA, insurers use networks which have specified hospitals and doctors who have agreed to charge set fees. It is not like this in the rest of the world.

An international health insurance company will contact a hospital when a patient requires inpatient treatment, and arranges for bills to be sent directly to them. When a bill arrives, the international medical insurance provider will assess the costs and may query the charges. International health insurance companies know how much a procedure costs and what a hospital will charge. They will challenge bills that they consider to be too high, but, at the end of the day, the invoice has to be paid.

All these increased costs are assessed by international medical insurance companies when they review their premiums, which usually end up being higher than last year.

How do you know what is best for you?

First of all, speak to a specialist international medical insurance broker, who knows which of the plans they have available will suit you. International health insurance providers have different ways of developing and charging premiums – it is a complex issue. Each insurer publishes premiums rates, and, as I said earlier, the premiums reflect our age.

The older we are, the higher the premiums. The younger we are, usually, the lower the premium. Once 50–55 is reached, things start to change. Some international medical insurance companies start to increase premiums at this age, so, by the time you retire, international health insurance may be the highest monthly or annual cost you pay.

Once you are insured and you have claimed for treatment (after all, that is what international medical insurance is for), you may have little choice but to stay with the same insurance company, otherwise your condition may not be covered by a new international medical insurance company, so you will want to ensure that your future premiums are manageable.

Some international health insurance companies, such as InterGlobal, offer a no-claims discount, so if you have not claimed on your plan in the previous policy year, they will give you a discount of, usually, 10% of your renewal premium. Taking this into account along with any excess you have chosen, you need to assess whether a small claim is financially necessary. You may find that a small claim will cost you more than the value of the treatment.

IMG Europe will give 15% no-claims discount on your renewal premium, but it is not automatic. You have to claim it, and the premiums offered at renewal are not the same as in the first year. They are usually higher, so the no-claims discount can be very important when your renewal offer is made. This will also need to be considered when making a small claim.

IHI Bupa does not increase premiums for your age once you reach 60, but they will still increase premiums for medical inflation. If you apply for a new plan over the age of 60, they will apply a premium loading. We have found that this is still competitive compared with other insurers in the long term.

Nordic Healthcare does not increase premiums as you get older, and they have historically only increased premiums by 5% per year to cover increasing medical costs. The premiums may be higher in the first few years, but, overall, there may be significant savings compared with other plans.

Moving to live in a new country is about enriching your life and fulfilling your potential. However, the single biggest cost you could face abroad is healthcare – whether the incidental doctors’ visits and the medication they prescribe or the unexpected events that can result in a long hospital stay and a huge bill.

At April Medibroker, we have many years’ experience of providing international private insurance solutions to expatriates from our extensive database of the international providers/insurers, enabling customers to make an informed selection of medical insurers to suit their needs.

For a free, no-obligation expatriate health insurance quotation, click here.

While the majority of expats have found wealth and happiness since moving abroad, it seems the grass isn’t always greener for health. Almost half (44%) of expatriates believe the standard of healthcare is worse in their new country, according to a survey by expatriate health insurer Bupa International. In fact, one in five – equivalent to around 38 million expats worldwide – believe that that their health has deteriorated since moving abroad.

The research also shows that one in five expats say they would rather be treated outside their country of origin or current residence if they fell seriously ill. The countries topping the table of where people would most like to be treated given the choice are Singapore (23%), followed by the USA (15%) South Africa (10%) and the UK (10%).

Dr Sneh Khemka, medical director for Bupa International, said, “These findings are very interesting – while Singapore is seen to have the best healthcare by nearly a quarter of expats, the truth is that, while there are many excellent hospitals in Singapore, the quality of healthcare available there varies, as it does in every country around the world. Therefore, it’s very important to have access to expert medical advice when living abroad, to be sure that you are going to be directed to the most appropriate facilities, whichever country you’re in.

“For example, we recently helped a customer who was involved in a severe accident in the Bahamas, evacuating him by air ambulance to the nearest centre of medical excellence in Miami for emergency treatment.”

For more information about Bupa International, visit www.bupa-intl.com

Lebanon is now an important centre for international workers, but post-conflict international health cover can be hard to arrange, and good hospital facilities can only be accessed with the right cover. International health insurance provider MediCare International explores the issues.

Lebanon is, in many ways, a big draw for expats. With beautiful scenery, a Mediterranean climate and vibrant nightlife, the country is often viewed as an exciting prospect for those looking for something different. However, as was recently demonstrated, the country is still embroiled in conflict from time to time, making everyday life occasionally unpredictable and sometimes dangerous. It is essential that expats living in Lebanon, and particularly Beirut, have adequate medical cover, not only for everyday health concerns, but just in case they are caught in the fallout of conflict.

The country currently has around 6,000 UK expatriates, according to data released by the Institute for Public Policy Research, which works across a range of sectors, from commerce through to charitable work. Lebanon is still home to many who work in post-conflict and reconstruction activities.

Health insurance policies which include limited cover against terrorist attacks are available, but, with conflicts not solely confined to war zones nowadays, effective cover which reflects this new global reality is now even more important.

International health insurance provider MediCare International explains the workings of Switzerland's healthcare system.

Switzerland is known throughout Europe for its quality medical and paramedical services, with healthcare always high on the political agenda. The country spends about 10% of its GDP on health, placing it near the top of OECD countries for medical expenditure. This considerable investment means that Switzerland possesses a wealth of medical facilities employing the latest technology, as well as one of the world's lowest patient-to-doctor ratios.

However, the high level of healthcare in Switzerland comes at a cost: everyone living in the country is required to have basic health insurance. Expats must obtain health insurance within the first three months of their arrival in Switzerland, and babies must be insured within three months of birth. The only people exempt are international civil servants, members of permanent missions, and their family members. Individuals are responsible for contacting insurance providers, since employers do not necessarily arrange coverage.