When you move abroad, one of the most important parts of your financial security is your international health insurance plan. While expats may become part of the local government health plan if they satisfy certain residency and immigration requirements, such government plans, especially in second and third world countries, often cover only basic medical needs. In addition, you cannot take this  LOCAL coverage with you to another country or back home.

What Is Covered, What Is Not
Several multinational insurance companies offer international health insurance plans to meet the needs of expatriates. Basic plans provide for in-patient or in-hospital care, covering hospital accommodation, surgeons’, physicians’ and anesthetists' charges. Included too, are specialists in radiology, pathology, oncology and radiotherapy. Local road ambulance is usually covered as well.

More enhanced plans may also include outpatient visits as primary consultations and primary care, also some therapies such as acupuncture, osteopathy, physiotherapy, homeopathy, primary consultations and primary care as well as some prescribed drugs. At-home nursing care and emergency dentistry are sometimes options.

For those who want more extensive coverage, there are comprehensive plans with higher premiums. Comprehensive plans may cover psychiatry, organ transplants, rehabilitation, home nursing, childbirth, home delivery, general practitioners consultations, eye and ear specialists and other specialists such as dietitians, psychotherapists, chiropractors and osteopaths. Diagnostic tests such as lab work, x-rays, scans, etc., may also be covered, along with prescription drugs.

Almost all international health plans offer the option of adding emergency travel medical and evacuation coverage for an extra fee  while others include it in the basic premium. Such plans provide for immediate transportation from anywhere in the world to the nearest center of medical excellence for in-patient treatment of emergency conditions, and usually also reasonable return fare to your country of residence after recovery.

All health plans have some restrictions and exclusions. If you engage in hazardous sport or occupation, some plans will not cover you. Pre-existing conditions known or unknown before being insured are typically not covered  - but some insurers can underwrite and cover many pre-existing medical conditions with an extra premium depending on the condition. Other exclusions are cosmetic treatment and care for sexually transmitted diseases, alcohol abuse and self-inflicted injuries. Treatment as a result of war or riot is not covered either, but some plans allow  cover for acts of passive war and terrorism, meaning that you’d be covered if injured while you were an innocent bystander.

Most  international health plans plans exclude treatment related to menopause, pregnancy and childbirth. However, a few plans cover a normal or complicated delivery after a 12-month waiting period once the policy is in force. Some cover maternity if the insured becomes pregnant after becoming insured.

What Will it Cost Me?
Comprehensive plans usually cost just over double that of a basic in-hospital plan. With most plans, you may choose to have 100% of approved charges covered, or you lower your premium costs by paying 20% of the charges yourself. You also save by electing to pay a deductible amount.

International health insurance is generally less expensive than comparable domestic U.S. coverage because the insurer knows that most regular claims will be paid outside of the U.S. Because of high medical costs in the U.S. and Canada (while not insured under a government plan), coverage that includes these countries can be as much as two to three times the cost of coverage without it. This coverage is recommended for expatriates who travel to U.S. and/or Canada for extended periods that would not be covered in the optional medical evacuation plan.  Most us or Canadian expats will want a medical plan that covers treatment in the USA or Canada. 

A major factor in determining a premium is the your age. Some plans also take gender into account.

A 35-year old man who wants international health insurance covering him for treatment in the U.S. would pay $1,267 per year for a basic plan with a $500 deductible. For a 35-year old woman, the basic plan would cost $2,215 per year with $500 deductible. For a man or a woman aged 35, the cost for a comprehensive plan from another carrier would be $4,143 per year with $400 deductible. This plan provides much more out-patient care and would cover some pre-existing conditions. Both plans would cover your children age nine or under at no extra charge.

For persons 59 years old, the basic plan would be $2,684 annually for a man and $2,460 for a woman with $500 deductible while a comprehensive plan would cost $5,301 per year with $400 deductible for either gender.  SOME comprehensive plan’s premiums  FOR A PERSON WHO IS AGE 60  would not increase with age but would be subject to the same inflationary increases for all persons insured. However, the cost of the basic plan would increase with age plus inflationary increases.

Both plans would cover you for life. U.S. citizens retiring abroad should note that Medicare does not cover  medical care outside the U.S. What if you return home to stay? Well, if home is anywhere but the U.S., you’ll be fine. The basic plan sited above would cease coverage six months if you permanently return to the U.S., while the comprehensive plan would continue coverage even in the U.S. Both plans are not HIPPA or COBRA compliant.   

In addition to the basic and comprehensive plans described here, a variety of plans are available with different types of coverage. Whatever you needs or circumstances, researching your health insurance options is an important part of planning your life in a new country. Be sure to look at plans offered by various reputable insurance companies, read the find print and ask questions if there are items you don’t understand. A wise choice can protect your health – and your assets.

David G. Tompkins can be reached at tompkins@expatfinancial.com or www.expatfinancial.com, and at 800-232-9415 or 604-351-5278.