Offshore Health Benefits, LTD
Shopping for International Medical Insurance and Air Ambulance?
Important Issues to Consider and Questions to Ask - June 2012
Reinsurance - make sure the proposed international insurance products are underwritten by a strong re-insurer, this is very important ( Lloyd’s of London, Sirus, ACE, etc). Re-Insurers often audit corresponding companies who sell their products. Also, a strong re-insurer should have strict guidelines in place related to Underwriting, Claim Reimbursement, Customer Service, Annual Renewals,
Pre-existing Conditions and Product Design.
Annual Renewals - make sure the international insurance plan that you are considering guarantees an annual renewal each year. Also, make sure that you are not penalized too harshly for poor claim experience. A strong insurance company pools its members by using “age-banded†rating and does not base the annual renewal rate solely on one’s claim experience for the year. This is one of the most important issues related to annual renewals. Many international carriers weigh in a member’s annual claims experience over many other factors. Also, make sure that the international carrier’s international pool of members does not include people who live in the USA for more than 6 months out of any year (may vary). This drives up the rates big time.
Claims Reimbursement - make sure that a reimbursement check can be cut and mailed out within 2-6 weeks after a claim filing, and that the member is not penalized with miscalculated exchange rates. DHL or UPS are the preferred carriers for international mailing. On many occasions, monies can be wired to a foreign bank account or directly to a hospital.
Direct Payment & Wire Transfers - make sure that the international carrier can pay via “direct wire†or “guarantee of payment†for costly or expensive procedures. Many carriers require the member to pay for large medical expenses upfront; this is not good, especially for care in the USA. A quality international broker and carrier can get on the phone and make things happen and help you with a direct pay to a hospital or provider. You need to deal organizations who will talk over the telephone or in person, as opposed to relying on faxes or e-mails with no or limited follow up. Please note that there are hospitals, clinics and providers abroad which simply do not accept insurance and will require payment ahead of time by a patient. It is good to have a credit card when you travel in case of an emergency.
5. Brokers - make sure your international broker or consultant has an insurance license. Many brokers outside of the USA do not have licenses and many international carriers do not require it. Also, make sure that your broker or consultant has experience in international benefits. International insurance companies often market to domestic brokers who mainly sell in the USA, and dabble in international, as prospects pop-up on their radar screens. My company, Offshore Health Benefits LTD, has been thriving for 10 years, adding new clients each year. Also, we pride ourselves with a very high annual client retention rate. Experience in international benefit planning is everything, especially in a time of crises. Approximately, 60% of our business comes from client referrals.
Brokers Fees - make sure your broker or agent is not embedding extra commissions into your rates or charging processing fees. Some brokers add hidden fees and do not mention this to prospective customers. The international carriers pay out commission percentages based on the carrier’s advertised book and annual renewal rates and volume. You should never pay more than the published book rate during your first year of coverage. Many book rates are available on the internet. Beware of “application†fees, it is not necessary to pay these.
Medical Air Evacuation and Assistance - make sure that your prospective international carrier has a strong relationship with their Medical Air Evacuation and Assistance partner. Many carriers contract this service out and do not have a solid communication system in place, this is very important. Handling a crises situation correctly and in a timely manner can mean the difference between life and death in some serious situations.
Broker Communication - make sure your international broker or consultant can be reached 365 days a year. All of our clients have our company cellular telephone number and we welcome calls 24-7, and 365 days a year. I personally have dealt with many life threatening emergencies in since 2002. Many brokers take days to respond, and some cases, unfortunately, simply do not respond after a sale has been made. This is unacceptable.
Coverage in the USA - make sure that the international carrier’s PPO (preferred provider organization) partner in the USA honors the member’s insurance card at the time of admission or appointment, and has a direct billing relationship. Also, make sure that carrier has provider internet search capabilities that are updated monthly for the members. Members should be free to go to any “western trained†provider of your liking outside of the USA. Many PPO networks offered by international insurance companies in the USA are limited, very limited. Check to see if your current domestic doctor or hospital is in the network prior to joining. If your USA provider is not in the network, ask to see what it would take to have the provider or hospital added. You may consider going out of network, if this is the case, check to see what percentage of the medical visit would be covered. You may also consider changing your provider in the USA. A few international carriers allow the members to “opt out of coverage†and save 20-50% off annual visits; this is good situation for expatriates who have national coverage in their home country or Medicare in the USA. Not every member needs access to medical care in the USA. Don’t waist your annual premium on unnecessary benefits. If you are not from the USA, you may want to “opt†of coverage in the USA.
Annual Deductible and Co-payments - make sure that the international carrier is not imposing a higher deductible for care in the USA. Many international insurance companies out of Latin America and Europe increase deductibles for care in the USA and offer sub par networks. This is not the industry standard. Your overall benefit may be lower in the USA (standard), but your deductible should not change once you return the USA or your home country.
Plan Limitations - always read the plan Exclusions & Limitation Section and ask questions. Please understand that each international carrier has various limitations, especially for pregnancy, organ transplant, mental health, pre-existing conditions, preventive care, RX, air ambulance, and the first 180 days of coverage. There is no such thing as a 100% perfect plan.
Internet Purchase - do not purchase an international insurance plan off the internet without speaking to knowledgeable representative first. You may not be buying what you think you are! Some countries are off limits to certain insurers.
Coverage & Benefits - review the various plan offered by each carrier, many plans do not reimburse on a “Reasonable & Customary†model. Be aware of this. Also, Outpatient RX Reimbursement, Preventive Care, Organ Transplants, and Pregnancy coverage may not be included with all plans.
Lifetime Coverage Limits - make sure that you review plans that at least offer $1,000,000 of coverage per lifetime (for long term 12- month renewable plans). The standard is $1,000,000 - $5,000,000 per policy, per lifetime.
Choosing Annual Deductibles - check to see if there are limits with annual deductible options. Many carriers do not allow the members to lower their annual deductibles at time of annual renewal or during the contracted year. You may increase it in most cases.
Our consulting team would be glad to assist you, your family, or your business group. Remember, domestic health insurance and international health insurance is very different. Many “domestic brokers†or “domestic agents†and so called “international brokers†offering international plans, simply do not have the international experience that is required to handle emergencies, assist with claim management and wire transfers, translate with foreign providers, negotiate renewals, evaluate plans, and assist with air and ground evacuations.
My team only works with expatriates, third country nationals, and foreign locals. We work directly with our clients and not through brokers. You do not need to pay “override†fees or commissions to a “middle-man†broker or consultant. Coverage in the USA can be very expensive and usually only covers a member living or traveling outside of their home country in case of an emergency or “life threatening emergency†if you are lucky. Many expatriates often move out of their home countries and maintain their home country health insurance plan for an extended period of time or simply try to “beat the system.†This could result in a denial of claims and could cost you hundreds, if not thousands of dollars while jeopardizing your health.
Thank you for taking the time to read these tips.
We look forward to your questions and thoughts. Safe travels to you!
Robert Tillotson
Offshore Health Benefits, LTD
cell: 512.296.4976
http://www.tilloglobe.com
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