Critical Considerations When Designing International Private Medical Health Insurance Plans

iPMIM©

CRITICAL CONSIDERATIONS WHEN DESIGNING iNDIVIDUAL iPMI PLANSEXCLUSIVE INTERNATIONAL HEALTH INSURANCE C-SUITE EXECUTIVE COMMENTARY FROM ALC HEALTH, GEOBLUE, GLOBALITY HEALTH AND CIGNA GLOBAL.

ROUND TABLE SESSIONS | AUGUST 2014

iPMI

Seeking out new life and new civilisations. No matter how undiscovered and

alien your new country may feel, DKV Globality provides you with outstanding healthcare wherever you go.

With Globality CoGenio® and Globality YouGenio® we offer internationally operating companies and their

expatriate staff as well as individuals and their families flexible underwriting solutions, high-level products

with comprehensive outpatient, inpatient and dental insurance cover and market leading services around the

globe. Plus the advantage of covering pre-existing diseases in the insurance policy. Trust in our expertise.

Outstanding care for outstanding people. DKV Globality is the international

health insurer with a special focus on expatriates. As a member of Munich Health with more than 5,000

experts at 26 locations worldwide we offer innovative healthcare solutions for clients and partners all over

the world. As an integral part of the Munich Re Group, we give you the financial strength and security of

one of the world’s leading insurers and reinsurers.

Call our consultants at +352 270 444 2201 or

visit www.dkv-globality.com to find out more.

Globality Health means …… feeling at home wherever you are.

www.globality-health.com

Global coverage, reliablity and service.

Globality Health is the international health insurer with a special focus on expatriates. As part of Munich Health, we give you the strength and security of a leading global primary insurer and reinsurer. Under the Munich Health brand, Munich Re pools its primary insurance and reinsurance operations, as well as related services in international healthcare business. Munich Re as a group stands for exceptional solution-based expertise, consistent risk management, financial stability and client proximity. Some 40 million clients in over 30 countries place their trust in the services and security Munich Re provides.

With Globality CoGenio® and Globality YouGenio® we offer international companies and their expatriate staff and individuals and their families, flexible underwriting solutions, high-level products with comprehensive outpatient, inpatient and dental cover and market leading services around the globe.

Call our experienced consultants at +352 270 444 2201 or visit www.globality-health.com to find out more.

http://www.globality-health.com/en/?r=ipmi





















With access to over one million hospitals, doctors and care specialists globally, Cigna Global customers are never far from the treatment they need, regardless of where they are in the world.

A 24/7 specialist claims centre and direct claims settlement in most cases takes the worry out of health care whilst living abroad.

We have worked hard on becoming the carrier of choice for brokers. With a new Broker Quote Tool providing three side-by-side quotes in seconds, a suite of three products designed to be flexible enough to handle even the most complex of customer requirements, and a multilingual sales support team just a call away, Cigna is the easy choice.

http://www.cignaglobal.com/intermediaries





Sometimes it’s goodto have a lot on your plate.With a wide range of international health plans providing coverage for expats, travelers, students, missionaries and more; GeoBlue keeps your plate full of options.

Our network of elite physicians in over 180 countries extends an all-access pass to an exclusive level of care worldwide. And because each GeoBlue policy is U.S. licensed and offers the most complete set of benefits and services in the industry, you can feel confident that your clients expectations will be exceeded.

©2014 GeoBlue. All Rights Reserved. GeoBlue is a trade name of Worldwide Insurance Services, LLC, an independent licensee of the Blue Cross and Blue Shield Association.

For more information:

Visit: www.geobluetravelinsurance.comCall: 1 (855) 481-6647 or 1 (610) 254-5850Email: [email protected]

FEATURED CONTENT

9 | Featured Content

13 | RT Questions

17 | RT Delegates

22 | 56.8 Million Expatriates By 2017

26 | RT: Critical Considerations When Designing Individual iPMI Plans

44 | 460 Million International Tourist Arrivals Expected In Current Peak Season 2014

49 | The Benefits Of International Private Medical Insurance

| 9Roundtable

iPMIM©

FRONT COVERAll around the world tourists, expatriates, students and corporate business travellers are seeking the right medical insurance coverage. In our most recent round table discussion iPMIM speaks with business leaders from the world of iPMI about individual iPMI plan design.

LEGAL © 2009 - 2014 All rights reserved. All editorial content and graphics in iPMI Magazine are protected by copyright, international treaties and other applicable copyright laws and may not be copied without the express written permission of iPMI Magazine.

NEXT ROUND TABLE International Private Medical Insurance Magazine (iPMIM) is excited to announce the next exclusive C-suite executive round table business forum: International Private Medical Insurance VS Local Health Insurance. Only 3 round table positions remain, and this is your opportunity to have your say. Example questions: What are the major differences between International Private Medical Insurance plans and local health insurance plans? Is there a difference between an offshore insurance company and an international insurance company? Will insurers start operating their own local TPA services in member hot spots to localise service-offerings? Contact us for more details about this exclusive forum.

iPMIM©

CRITICAL CONSIDERATIONS WHEN DESIGNING iNDIVIDUAL iPMI PLANSEXCLUSIVE INTERNATIONAL HEALTH INSURANCE C-SUITE EXECUTIVE COMMENTARY FROM ALC HEALTH, GEOBLUE, GLOBALITY HEALTH AND CIGNA GLOBAL.

ROUND TABLE SESSIONS | AUGUST 2014

iPMI

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CRITICAL CONSIDERATIONS WHEN DESIGNING INTERNATIONAL PRIVATE MEDICAL INSURANCE PLANS FOR INDIVIDUALS

Roundtable

Q1

26 |

TALK US THROUGH YOUR UNDER-WRITING CAPABILITIES AND IDE-AS. WHAT BENEFITS DOES FULL MEDICAL UNDERWRITING BRING?

Q2

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HOW DO YOUR PRIVATE MEDICAL INSURANCE PLANS COVER PRE-EXISTING CONDITIONS?

Q3

31 |

WHAT IS THE KEY TO SUCCESS WHEN DESIGNING HEALTH IN-SURANCE PLANS FOR INDIVIDUAL EXPATS?

Q4

32 |

CAN YOU TALK US THROUGH YOUR DISTRIBUTION CHANNELS AND ANY NEW TRENDS YOU HAVE IDENTIFIED?

Q5

34 |

WHAT FACTORS MUST ONE CON-SIDER WHEN DESIGNING HEALTH AND MEDICAL INSURANCE PLANS FOR INDIVIDUAL EXPATRIATES?

QUESTIONSWHAT’S ONFEATURE

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QUESTIONS

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HOW IMPORTANT IS THE PORTABILITY OF AN INDIVIDUAL EXPATRIATE INSURANCE PLAN?

Q7

39 |

HOW CAN INSURERS ADD VALUE TO EXPATRIATE HEALTH INSURANCE PLANS?

Q8

41 |

CURRENTLY, WHAT IS YOUR MOST POPULAR AND APPROPRIATE PLAN FOR AN INDIVIDUAL EXPAT WORKING ON A SHORT-TERM ASSIGNMENT?

Q9

42 |

WHAT NEW PLAN FEATURES AND BENEFITS CAN WE EXPECT TO SEE IN THE NEXT 5 YEARS?

Q10

44 |

HOW DOES DESIGNING A GOOD EXPAT HEALTH INSURANCE PRODUCT EQUAL QUALITY DRIVEN HEALTHCARE ANYWHERE, AT ANY TIME?

Q6

37 |

WHAT’S ONFEATURE

Andrew is a Director of ALC Health. With over 30 years senior sales and marketing

experience across the medical insurance industry, Andrew has held a range of management roles with a number of industry leading players. Including BUPA, Mutual of Omaha, Wand AG and Aetna (Goodhealth). Andrew joined ALC Health in December 2009.

As a seasoned traveller and former expatriate having worked extensively in Russia, Georgia and Germany, Andrew

understands what it is like to be living overseas in an unfamiliar country, but also the importance of being able to access high quality medical care both at home and abroad.

A respected, well-known health insurance industry figure, Andrew is a regular speaker at health insurance and IPMI conferences around the world, and brings unique insight into the international health and iPMI industry, backed up by a wealth of market experience. l

| 17Roundtable

ANDREW APPS DIRECTOR

IPMIMAGAZINE.COM | INTERNATIONAL HEALTH AND MEDICAL INSURANCE | EXPATRIATE HEALTHCARE

https://ipmimagazine.com

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As Head of Cigna’s Global Individual Private Medical Insurance division based

in Glasgow, Scotland, Phil is developing the company’s individual consumer strategy on an international scale and creating a world-class international individual business.

He is responsible for building the business segment and driving profitable growth, targeting high net worth and globally mobile individuals through various channels including internet, bancassurance and broker in key global markets.

Phil brings over twenty years’ of experience in global sales, marketing, product strategy and general management to the Cigna Global Individual Private Medical Insurance team. Phil first joined Cigna International in 2002 as Partnership Director for the UK business. He went on to hold several positions within the organisation, including Health, Life & Accident (HL&A) Europe Sales & Marketing Director and Interim CEO for HL&A Europe, before moving to lead the international individual business in 2011. l

PHIL AUSTIN HEAD OF GLOBAL iPMI


BRENDAN SHARKEY DIRECTOR INDIVIDUAL PRODUCTS

| 19RoundtableRoundtable

Brendan Sharkey is the Director of Individual Products for GeoBlue.

From the nuts and bolts of international health insurance to the crucial themes of global health and safety, Brendan is frequently called upon to discuss the global insurance landscape. Press contributions include CNBC “Squawk Box”, WGN AM Talk Radio, Forbes, The Wall Street Journal, NY Times, USA Today, among others. A citizen of the world, Brendan has lived in Scotland, Canada, Australia and the United States.

GeoBlue is the trade name for the international health insurance programs of Worldwide Insurance Services, an independent licensee of the Blue Cross Blue Shield Association. GeoBlue combines the latest mobile technology and worldwide healthcare expertise to deliver health benefits that put the health, safety and convenience of world travellers first. GeoBlue’s approach opens the door to an elite community of thousands of contracted doctors and hospitals all around the world. l



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Philip is the Chief Commercial Officer for Globality Health, part of Munich Health,

the health segment of Munich Re. With 20 years of experience, Philip started

a career in health insurance with BUPA as part of the team that managed all large corporate accounts.

Following BUPA Philip joined Standard Life Healthcare (SLH) and spent 8 years on the board running sales and then operational divisions. During this period SLH moved from being heavily criticised for service to winning

7 awards in one year including Best Health Insurer. Philip also managed the project to merge SLH with FirstAssist following that acquisition.

After SLH joined Munich Health to head up the health reinsurance team for UK and Ireland working with a wide range of insurers and MGAs to develop their insurance offerings.

Moving within the group to Globality Health, Philip first set up the UK branch and after a year was made responsible for global sales and marketing as CCO. l

PHILIP WRIGHT CHIEF COMMERCIAL OFFICER


iPMIM

MLC 2006 C-LEVEL EXECUTIVE ROUND TABLEBUSINESS FORUMEXCLUSIVE C-SUITE EXECUTIVE COMMENTARY FROM THE MARITIME AND COAST GUARD AGENCY , GLOBALITY HEALTH, INTEGRA GLOBAL, ALLIANZ WORLDWIDE CARE AND IMG

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http://issuu.com/ipmimagazine/docs/mlc2006

22 | CRITICAL CONSIDERATIONS WHEN DESIGNING INTERNATIONAL PRIVATE MEDICAL INSURANCE PLANS FOR INDIVIDUALS

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INTRODUCING A BUSINESS INTO NEW EMERGING MARKETS IS THE RESPONSE FROM WORLDWIDE BUSINESS OWNERS TO THE PRE-EMINENT MEGA TREND THAT IS GLOBALISATION. ESTABLISHING A GLOBAL FOOTPRINT MAY BE OF PIVOTAL IMPORTANCE TO A WIDE RANGE OF INDUSTRY, AND ACCORDING TO PWC, CROSS-BORDER ASSIGNMENTS ARE SHOWING NO SIGNS OF A SLOWDOWN.

In fact, 59% of CEOs plan to send more staff on international

assignments with predictions that global corporate travel and international assignments will increase 50% by 2020.

But it isn’t just business crossing borders.

Leading research firm Finaccord forecasts that students will constitute the most rapidly growing category of expatriates worldwide between 2013 and 2017, increasing at a compound annual rate of 3.6%, followed by individual workers (3.2%), retired expatriates (2.9%), corporate transferees (2.8%) and other expatriates (2.3%).

Total number of expatriates worldwide in 2013 amounted

to around 50.5 million, with Saudi Arabia hosting the highest number and India exporting the most. This figure has grown at a compound annual rate of 2.4% since 2009. By 2017, Finaccord forecasts that the number will reach around 56.8 million.

“Global mobility has increased significantly over the past decade and expatriates constitute a large and diverse market” comments Tobias Schneider, a Consultant at Finaccord.

“According to this analysis, the majority of expatriates in 2013 were classifiable as individual workers (73.6%) followed by students (8.8%), retired expatriates (3.7%) and

corporate transferees (1.0%), with the balance of other expatriates (defined as non-employed spouses and children) making up the residual 12.8%.”

Whatever the motivation to move, the health and safety of an individual’s life must be of critical importance.

Assignments may include areas of the world where social inf rastruc ture, communication, and utilities are primitive, or even nonexistent. This can have a dramatic effect on the overall welfare of an individual, as they struggle to come to terms with foreign surroundings and unknown cultures. It isn’t easy living as an expat and a mix C

Roundtable

56.8M EXPATRIATES BY 2017



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TOTAL NUMBER OF TOURISTARRIVALS 2013

1087 MILLIONMORE TOURIST ARRIVALS IN 2013 THAN 2012

52 MILLION

TOTAL NUMBER OF EXPATRIATES WORLDWIDE IN 2013

50.5 MILLIONTOTAL NUMBER OF EXPATRIATES WORLDWIDE IN 2009

46 MILLION


8Recent Thoughtsof social, economic and personal circumstances can lead to failure and return. This is one of the big hidden costs of expatriation. The expat quits and wants to return to their country of residence. On return, they may also leave the company, forcing downtime, expense and an empty international appointment to fill.

In the most recent exclusive iPMI Magazine Medical Insurance Round Table, we spoke with leading C-Level Executives at ALC Health, Cigna Global Individual Private Medical Insurance, GeoBlue and Globality Health, about the importance of individual iPMI and how to best approach plan design. iPMI can play a major role in the ongoing management of an individual’s wellbeing.

In turn this may increase productivity and performance and decrease the risk of failure and return. A happy, healthy, stress-free employee will always out-perform an unhappy, unmotivated one. The right iPMI plan can provide the vital safety net and comfort blanket, in what can be a highly challenging and stressful lifestyle. l

Roundtable

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8Medical insurance is a reasonable expenditure considering the overall expense of relocation and travel.

8Comprehensive medical insurance should be looked at as not only a necessity, but as a perk.

8Assistance programs and counselling services may ease cultural integration pains.

8Product portability remains a key feature that individuals may look for when selecting an iPMI plan.

8 As numbers of expatriates and business travellers increase, so does the demand for comprehensive, yet flexible iPMI.

“The majority of expatriates in 2013 were classifiable as individual workers (73.6%) followed by students (8.8%), retired expatriates (3.7%) and corporate transferees (1.0%).”



ANDREW APPS: The internet has allowed consumers to become a great deal more informed about what cover is available to match they individual requirements.

No longer are consumers prepared to accept a ‘one size fits all’ solution, so the importance of taking a flexible approach to medical insurance plan design has never been more important.

Plans need to take into account local medical amenities and in turn allow policyholders to elect where they wish to be treated and by whom.

Plans also need to offer the flexibility which allows consumers to add in / take out those benefits which quite simply they cannot use. It is madness that a single man should be forced to pay for routine maternity cover, a benefit that clearly they cannot use simply because they want to buy a top of the range plan. It sounds obvious but many international plans still insist on including routine maternity care as an integral core element of their plan design.

Furthermore, for many expatriates and particularly those living and working in Europe, they simply do not need global cover as they are living and working in a capital city and not travelling on business (with or without elective USA cover) Giving people a choice is key.

Of course one of the over-riding issues will always be the cost of iPMI and to the consumer this is particularly important given that in most instances, the responsibility for paying the premium rests squarely on their shoulders, so offering both a choice of payment and excess options will make any plan that much more attractive.

But we mustn’t forget that for the average

expatriate, we are their lifeline when they get injured or taken ill and the first people they turn to when they need help at 3.00am in the morning.

Efficient customer support day or night and a true 24/7 help line is imperative, as is a compassionate approach to customer service in general. Bedside manner is all important.

At the end of the day, we cannot simply treat customers as ‘numbers’ and expect them to put up with sub-standard service.

At ALC Health we take customer service extremely seriously and are proud of how we deliver a level of support that ensures our members can justifiably rely on us day or night no matter where in the world that they find themselves.PHIL AUSTIN: In an ever more competitive marketplace, plan design and innovation is crucially important to retain an edge in the market and bring new services to our customers. Customers want the flexibility of being able to build a plan which fits their exact needs, they need to know that their insurer has the global capabilities to be able to provide the treatment they need when they need it, and ever more importantly they want online services and apps to make their lives easier. Flexibility

When it comes to designing a plan, we know that customers and brokers alike need flexibility. A modular plan design means the customer does not need to purchase services they will not use, after all if the customer does not need cover for Vision and Dental care, then why should they pay for it? Expats are looking for flexibility to build a plan which suits their needs as well as their budget. C

WHAT FACTORS MUST ONE CONSIDER WHEN DESIGNING HEALTH AND MEDICAL INSURANCE PLANS FOR INDIVIDUAL EXPATRIATES?

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Q1


By offering a completely modular plan design, along with a wide range of deductibles and cost share amounts, we can help customers to build a customized plan which fits their needs as well as their budget.Service Capabilities

Service is also very important. Cigna has a reputation in the market as a provider of first-rate customer service, and our individual expatriate product is no different.

With a 24/7 customer service line which is answered by a real person, customers can get access to treatment wherever they are in the world. If it’s an evacuation from a remote area of Borneo at 3 o’clock in the morning, we’re there.Technology

Expats are usually tech savvy, and demand online services which they can use to access their health care plan on the move. Following the completely online sales and underwriting process, customers get access to the Cigna Global Customer Area which provides online claims submission, checking on progress of claims, access to all important documents and health & wellbeing services.

From later this year, customers on our Gold and Platinum plans will benefit from Safe Travel by Cigna, a new app for Apple and Android devices which provides up to the minute global travel advice, country information and an SOS tracking feature which when activated will alert a predetermined emergency contact of an impending danger. BRENDAN SHARKEY: It is most important to always bear in mind that expats are typically learning to function in a new culture and sometimes face major challenges when conducting what would be routine business at home.

That’s why expat health insurance plans should place a premium on personal, concierge-level service and robust, seamless coverage. Their health insurance carrier should strive to be a true partner in helping them meet

their goals for their time abroad. Many expats prefer to return to their home

area when dealing with a complex major healthcare episode. As such, the plan should provide an option to be covered at home and the benefits should mirror coverage in the host country.

If pre-existing conditions are covered abroad, they should also be covered at home.PHILIP WRIGHT: Ultimately, the generic healthcare needs of individual policyholders are similar whether at home or living overseas.

We need to look past these and consider the specific demands of expats, country-by country. These are influenced by the quality and breadth of cover available in the country of residence allied to cost and of course, the acceptability of local treatment.

The demands an expatriate resident in Scotland makes on their iPMI policy are very different to those made in Indonesia for instance. The breadth of benefits and services available must be appropriate to each location.

Increasingly we see demand for local knowledge and claims service provision, particularly as the traditional expatriate market diversifies away from its European ‘outbound’ roots.

As well as enhancing service, this also enables closer control of claims expenditure and a hands-on approach to cost containment, which is a crucial tool of course.

Munich Health has a presence in many markets, through local primary insurance businesses, reinsurance arrangements and service providers which helps us to understand both meta trends and the real behaviour in local markets. l

Roundtable

| 27IPMIMAGAZINE.COM | INTERNATIONAL HEALTH AND MEDICAL INSURANCE | EXPATRIATE HEALTHCARE


ANDREW APPS: Moratorium (MORI)We ask for only basic information about

the applicant and any members of their family that they wish to include under their cover. We will not ask anyone to give details of their medical history, but instead we rely on the applicant(s) to understand that we will not cover treatment of any medical condition which was in existence at any time during the five years immediately before their policy commences with us or treatment of a specified related condition to a pre-existing condition.

After a two year period has elapsed as a policyholder, if the member requires treatment for a medical condition which was not covered in the first two years then they will be able to claim; but only if they have not had any symptoms, medical treatment or any medical advice, or taken any drugs or medicine, or followed any special diets in respect of those pre-existing medical conditions for the period of two consecutive years immediately before the need for treatment starts.

There are of course some medical conditions none the less – those which continue or keep recurring – for which a member will never be able to make a claim. This is because they will always need to have medical advice or take medication and therefore will never be able to go for the period of two consecutive years without advice or medication. Full Medical Underwriting (FMU)If an applicant prefers, they can tell us about their medical history and we will use that to decide whether or not we can offer cover for any past diagnosis or medical condition. The applicant is then in a position to decide whether or not to continue to purchase the policy with these specific conditions.

After two consecutive years of membership where the member has not had any trouble from the medical condition involved, they can ask us for the exclusion to be reviewed and included as part of their cover. Continuation of Personal Medical Exclusions (CPME)

As more people look to more specialist iPMI providers such as ALC Health in preference to the more traditional big brand companies for their health insurance cover, the importance of being able to offer ‘switch’ or ‘transfer’ terms becomes key.

More commonly known as ‘Continuation of Personal Medical Exclusions’ or ‘CPME’, this option is usually available when transferring from a fully underwritten or moratorium policy held with another insurer. Whilst we will transfer any medical underwriting terms applied to the existing plan, it is important to remember that this relates only to the specific underwriting terms and the new ALC Health policy will be subject to our general terms including the exclusions and benefit limitations. What benefits does full medical underwriting bring? The most obvious advantage is that the member knows from the outset what pre-existing medical conditions will or will not be covered under the new plan. However, the application process is longer and more involved than that applied to a Moratorium application and requires the applicant to complete a more extensive health declaration, listing all medical symptoms and treatment.

Only when this has been provided and reviewed by us (and which may involve a request for additional information from either the applicant or their doctor) will we be able to offer cover terms. C

TALK US THROUGH YOUR UNDERWRITING CAPABILITIES AND IDEAS. WHAT BENEFITS DOES FULL MEDICAL UNDERWRITING BRING?

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This makes buying (or selling) FMU policies very difficult online because of the need for intervention and likelihood of additional information being required to complete the process.PHIL AUSTIN: The vast majority of the policies we underwrite are fully medically underwritten (FMU). This gives the customer two benefits: first they get complete clarity over what is covered and what isn’t, so they aren’t going to find out after having undergone treatment that we are not covering their claim.

The customer fills out an 18 question medical questionnaire at the point of sale, and our underwriting team confirm any pre-existing conditions which will be excluded from the policy up front. These exclusions can be reviewed on an annual basis and removed if there is sufficient evidence that the condition is nonrecurring.

The second big benefit for the customer is that they always get the best price as the insurer is able to mitigate some of their risk. We find that customers more often than not prefer to go down the FMU route.Continuation (Medical History Disregard)

For members leaving a Cigna group plan provided through their employer, we can offer a continuation solution which allows the member to move to one of our individual expatriate plans without undergoing underwriting. This means that any pre-existing conditions covered under the group plan will continue to be covered under the individual plan, of course with an appropriate loading on the policy premium.Switch (Continued Previous Medical Exclusions)

Customers who already have an individual expatriate plan with another insurer may be able to apply to transfer to a Cigna Global plan without undergoing further underwriting. In these cases, we will continue any exclusions applied by the other insurer, but will not apply any new exclusions.

BRENDAN SHARKEY: We offer multiple expatriate plans across a spectrum of audiences from professionals to students to missionaries. In most instances we employ full medical underwriting up front. If the applicant is offered coverage, we do not place personal medical exclusions on the policy.

Full medical underwriting allows carriers to price their products fairly over the long term. Thorough up front risk-assessment means fewer surprises when expenses are incurred and thus helps to moderate premium increases year to year. Members can buy a plan with confidence in being adequately covered.PHILIP WRIGHT: A flexible approach to underwriting is essential and mitigates the uncertainties of moratorium business.

Our FMU philosophy is to provide full cover wherever possible by offering premium loadings on acceptable pre-existing conditions, thus those clients who opt for FMU always have a full understanding of the scope of their cover.

Our in-house medical team supports this approach and works closely with our underwriting staff in each and every case where loadings are required.

Moratorium cover has always been offered as an option and offers a rapid and simple application process. Given that it effectively defers underwriting to the point of claim, there is always a danger that policyholders cover expectations will not be met and thus there is a great responsibility incumbent on insurers and brokers to ensure full understanding of moratorium terms at the point-of-sale.

CPME as a marketing tool is attractive; however we believe that the potential risks are too great to maintain a fair pricing model for our pooled individual FMU and moratorium clients. l

| 29Roundtable



HOW DO YOUR PRIVATE MEDICAL INSURANCE PLANS COVER PRE-EXISTING CONDITIONS?

ANDREW APPS: This is very much dependent upon the nature of the medical condition that we are being asked to cover. If it is a fairly minor issue then the chances are that we will simply make a monetary charge (if any) to enable the condition to be covered, but for something more complicated or long term, we would need to investigate the matter further before coming to any decision or conclusion about the scope of cover that might be offered.PHIL AUSTIN: Up until now, if a customer does not already have an international plan, be this provided by the individual or their employer, they have only had one option: FMU with exclusions applied. We’ve recognised though that sometimes customers want to pay a little bit extra to have their condition covered. Later this year, we will offer customers with some common pre-existing conditions the chance to apply a loading to their policy which will mean that treatment associated with this condition will be covered. This will integrate with the online

underwriting process, and provide the customer with two options: exclude or load. It’s this sort of flexibility which helps Cigna stand out from our competitors and put the control squarely in the hands of the customer.BRENDAN SHARKEY: If an application is accepted and you have prior credible health insurance coverage, the policy covers pre-existing conditions without a waiting period. Prior credible health insurance is a US admitted health insurance policy or a foreign private medical insurance policy offering comprehensive coverage inclusive of inpatient and outpatient benefits.PHILIP WRIGHT: As mentioned earlier, we have a very flexible approach to underwriting many pre-existing conditions. Once again, our position within Munich Health helps greatly by giving us access to the NORMRISK underwriting tool, which enables us to rapidly assess individual health insurance risks. This often means that we can grant cover for conditions routinely excluded by most insurers. l

Q3

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WHAT IS THE KEY TO SUCCESS WHEN DESIGNING HEALTH INSURANCE PLANS FOR INDIVIDUAL EXPATS?

ANDREW APPS: Customer needs need to be met and product design needs to be sufficiently flexible to meet the needs of differing locations; where necessary by offering country specific options

Consumers have become a great deal more informed about what is available to them across the iPMI market and have a much better understanding of what they want. The key is to provide a choice of flexible options that are both simple to understand, easy to buy and of course offer value for money.

We all know how important Health Insurance is and the increasingly high cost of medical treatment worldwide, but we sometimes forget that it is no longer just about a list of benefits but a complete package of cover, service, support and flexibilityPHIL AUSTIN: There are a few key questions which expatriates are likely to ask of themselves when choosing an expatriate health care plan. Does the product meet my needs? Is it affordable? What other benefits do I get

with the plan? And can I get treatment when I need it?

Building the right product is clearly very important. Customers can now choose between three distinct cover levels: Silver; Gold or Platinum, meaning we are able to provide plans suitable for customers in each segment of the market. We talked before about modularity, and I feel this is really important. After the customer has selected their level of cover, they choose which additional benefits they need. Don’t need medical evacuation cover? You don’t need to take it. Don’t need cover inside the United States? You don’t need to take it. It’s all about the customer knowing they got value from their premium and bought a plan which fits their needs.

Innovation is also key. We’ve spent time speaking to expatriates and assessing what other needs they have outside their core health insurance. A big one was the unknown of moving to a new country, so later this year we will launch C

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Safe Travel by Cigna, a new app for Android and Apple devices exclusive to Cigna Global Gold and Platinum customers.

The app provides the customer with personalised travel alerts based on the countries they’re travelling to.

It also provides up to date information on specific issues affecting each country of travel, and an online document portal meaning the customer can keep copies of important documents like their passport securely at their fingertips.

Ease of getting treatment is another key consideration for an expatriate. Will I be able to receive quality treatment for my trip to Zimbabwe?

In short, Cigna has one of the biggest treatment networks with over one million hospitals, physicians and clinicians worldwide, meaning the customer is never far from the treatment they need regardless of where in the world they find themselves.

With a global 24 hour assistance service, they are never far from being guided to the nearest centre of medical excellence and getting the reassurance that their treatment is covered under their plan.BRENDAN SHARKEY: Ensuring that benefits are robust—high limits, few inside limits, no

exclusions or penalties for common conditions—so that expats are not placed in a financial bind.

As an illustration, GeoBlue plans offer an unlimited medical maximum on an annual and lifetime basis. Preventive care is covered without a waiting period or inside limit.

Similarly, the program should offer the broadest and deepest assistance services possible, including convenient access to top quality care.

Variability in plan selection is important so that members can choose to trim back coverage such as prescription drugs or select a higher deductible so that the plan fits within their budget.

Finally, carrier payment directly to physicians and facilities should be fast, accurate and transparent to all concerned. Helping members avoid upfront payment is a key ingredient. PHILIP WRIGHT: In a market with so many variables, knowledge is the key. To design products appropriate to a mobile expatriate market of many nationalities, spread all over the globe, the starting point has to be a deep understanding of the range of needs of each category of expatriate client coupled with the factors specific to their nationality and country of ‘expatriation’. l

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CAN YOU TALK US THROUGH YOUR DISTRIBUTION CHANNELS AND ANY NEW TRENDS YOU HAVE IDENTIFIED?

ANDREW APPS: At ALC Health we understand the unique and important role that brokers and IFA’s have in advising clients about their international health insurance which is why perhaps more than most we place great value on this key distribution channel.

Indeed some 95% of our business is generated through our global network of brokers and IFA’s which enables us to offer a offer a range of exceptional product solutions that not only match the demands of their clients whilst combining a level of service and support that is difficult to find elsewhere but understand the importance of this unique relationship.

Technology is taking a key role in the way iPMi products are distributed and we have seen an increasing number of price comparison web sites being launched, particularly from South East Asia.

For many of these sites the process is primarily price driven (cheapest first) however the very nature of iPMI products demands ‘human intervention’ and so many of these,

at least for the time being, are used simply as part of the sales journey rather than a complete end-to-end cycle.

It will be interesting to see which direction this form of distribution will take in the coming years.

‘Star’ service ratings against each provider are beginning to emerge so as to give users a more rounded view. PHIL AUSTIN: Undoubtedly, brokers have a huge role to play in this market.

Our research has confirmed that a high proportion of expatriates in the market for this type of insurance would prefer to approach a broker. It presents a huge opportunity for brokers to help customers navigate through the market and ultimately add value.

It’s for that reason that we’ve spent a lot of time speaking to brokers and building our whole proposition around how brokers want to work with us. We’ve just launched a new Broker Quote Tool for example, which allows the broker to instantly create C

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three side-by-side quotes along with a slick PDF pack which they can mail to their customer from the tool, it’s simple, but it’s that efficiency which brokers really value.

Another key trend is brokers using their web presence to manage lead activity, and moving away from the traditional structure of the broker sitting across the desk from the client.

A key driver with this has been AppLink, our quote tracking service.

The broker displays their unique AppLink URL on their site for their customers to click through and build quotes for themselves.

Brokers are then paid commission on the sale.

We’ve just made some further improvements to this, it’s now completely co-branded with the broker’s logo and contact details for example, and the broker can now retrieve and manage their own leads being generated through the tool.

It’s a new distribution channel which has potentially enormous potential for brokers.

BRENDAN SHARKEY: GeoBlue distributes through retail brokers, consultants, general agents, domestic health insurance carriers and its own e-commerce website.

Looking ahead, it may soon be possible to mine “big data” to proactively identify customers who are likely to serve as expats or planning an episode of international living.PHILIP WRIGHT: As the IPMI centre of excellence for Munich health, Globality operates a complex multi-channel distribution strategy.

Our individual plans are distributed via partners within the group in several countries (DKV Seguros in Spain, Ergo in Germany, Simply Health in the UK and DKV Belgium for instance).

Elsewhere our diverse broker channel provides world-wide coverage and ranges from large iPMI brokers taking an ‘online aggregator’ approach through to smaller brokers servicing their local expatriate communities. l

Roundtable

| 35IPMIMAGAZINE.COM | INTERNATIONAL HEALTH AND MEDICAL INSURANCE | EXPATRIATE HEALTHCARE


http://ipmimagazine.com/medical-health-insurance/index.php/en/healthcare-international-medical-health-travel-expatriate-insurance

HOW DOES DESIGNING A GOOD EXPATRIATE HEALTH INSURANCE PRODUCT EQUAL QUALITY DRIVEN HEALTHCARE ANYWHERE, AT ANY TIME?

ANDREW APPS: Any healthcare product to be successful needs to combine benefit offering, service proposition and value for money. But it should also reflect what the consumer actually wants rather than the insurer attempting to second guess what the market wants.

To that end, it needs to work with the medical profession to really understand what is needed not just globally but also locally. After all, what may be popular – or even available - in one country might not be the case in another.

The questions that need to be asked are what are the c o s t s o f treatment in a given location and do the benefits of the plan match these costs?

Will the plan have longevity – it is all too easy to come up with an attractive plan in order to enter a new market and grab market share?

Are the premiums being proposed sustainable or will drastic action have to be taken in a couple of years when the all too attractive proposition prove to be too good to be true?PHIL AUSTIN: Global expatriate plans are undoubtedly driving up quality which builds value for the expatriate. Customers expect the same level of care whether they are at home in Europe or the US, or travelling in sub-Saharan Africa.

One of the key benefits of an international individual plan is the consistency of quality, and Cigna can point the customer in the direction of a provider we’ve had experience of working with before wherever they are in the world. This gives the customer the advantage of experience in the market and ensures delivery of a quality experience.

Customer centricity is at the core of everything we do at Cigna, and this philosophy is reflected in everything from plan design

to customer service. We spend a lot of time listening to customer feedback and building market led products and customer propositions, rather than trying to second guess th e

market or the customer. BRENDAN SHARKEY: Unless a health insurance program makes it convenient for expats to identify, access and pay for top quality healthcare anywhere in the world, why would you buy it? When members gain access to top tier services abroad, it leads to the most favourable medical outcomes.PHILIP WRIGHT: Any good product will be designed to deliver sufficient benefits wherever needed, to ensure the most appropriate healthcare is provided - quickly and efficiently.

Access to an effective international network is essential to be “anywhere, at any time”. l

| 37Roundtable

Q6



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HOW IMPORTANT IS THE PORTABILITY OF AN INDIVIDUAL EXPATRIATE INSURANCE PLAN?

ANDREW APPS: This has become a key issue as greater numbers than ever migrate from one country to another, so it is important that any plan offers the ability for a member to take their cover with them.

The last thing an expatriate who is working abroad for business reasons and who may be moved to another during the course of their career wants to hear is that their policy will be re-underwritten simply because

they will be living in a different country and all that might entail if they have made a recent claim.PHIL AUSTIN: Very important. Expatriates do not want to have to be re-underwritten every time they move country, and fully expect that their plan will be portable.

Cigna Global plans offer complete flexibility, allowing an expatriate to move around and take their health cover with them.

We also offer up to 90 days’ cover for trips back home to the country of which the customer is a national. That’s included as part of every policy. BRENDAN SHARKEY: Because expats are among the most mobile people on the planet, it is extremely important for their insurance plan to function seamlessly when they cross borders.

Plans should provide benefits in the expats

host country as well as other countries. PHILIP WRIGHT: The expatriate population is constantly growing and becoming more mobile – also the general pattern of expatriate ‘assignment’ is moving away from the traditional model with many more expats choosing to remain overseas long-term. Thus portability between expat locations and the return to the home country is essential.

No one wants to face new underwriting

requirements with the risk of pre-existing conditions exclusions or special terms each time they move.

We already have agreements with several insurers which enable continuation of cover by converting into a ‘local’ plan on a client’s return home. This gives the client the opportunity to switch to a potentially more suitable (and compliant) scheme.

We are also establishing reciprocal OMA (one medical assessment) agreements with local insurance partners worldwide to ease ‘expatriation’ as well as the return home.

One of the first, and most successful of these has been with DKV Belgium, whose policyholders can transfer to Globality if they become expatriates. l

| 39Roundtable

Q7

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More than medical care and ambulance services:• 3000 patients returned home every year

• Cost-effective double and multiple transport facilities

• Worldwide operations - experts in long-haul flights

• Shuttles with shared capacities on a weekly basis

• Online tracking of free capacities at www.taa.at

• Own fleet of seven aircraft

Platinum Safety of Flight Award 2013 | ERA member | EBAA member | EHAC member | EURAMI certified

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Take me home.

HOW CAN INSURERS ADD VALUE TO EXPATRIATE HEALTH INSURANCE PLANS?

ANDREW APPS: As the core design of iPMI plans become more similar – as more and more benefits are becoming structured on a full refund basis - the need to be different and stand out amongst the pack becomes all the more important. iPMI is no longer purely about the financial aspect of medical treatment but the very wellbeing of the policyholder.

At ALC Health we have approached this issue head on by introducing free membership of the Blood Care Foundation thus ensuring sufficient clean blood supplies which are screened against transmissible infections including HIV and other infectious agents. The blood is sourced and delivered worldwide in the event of an emergency blood transfusion being needed.

Other membership services include ALC World, providing an extensive on-line resource of relevant medical information along with access to the very best medical facilities across the globe including carefully selected doctors and medical facilities near to where our clients live and work.PHIL AUSTIN: Undoubtedly, customers expect more now from their health insurer than ever before.

Creating value for this customer segment is particularly important, especially when premiums for expatriate individual plans can run into the thousands.

It’s therefore up to the insurer to not just provide a high-quality product, but to ask what other services and value enhancements they can bring to the customer.

Online services are particularly important. Expatriates demand online claims submission and being able to view the status of their claim payments at the click of a button. Every

Cigna Global customer gets access to an online customer portal, which gives them all the claims functionality, and also a wealth of information about their plan and how to get the best from it.

Later this year, we will also launch Safe Travel by Cigna, a new app which has been specifically developed as a free add-on for our Gold and Platinum customers.

This will provide country information, up to the minute travel alerts for the specific countries the expat is travelling in, and secure online document storage.BRENDAN SHARKEY: Added value can come in many forms: robust insurance benefits, fast, convenient payment of provider bills and claims, ready access to top doctors and hospitals, translation databases to facilitate understanding of symptoms, diagnoses and treatment plans, wellness services as well as convenient online and mobile tools and databases to name a few.PHILIP WRIGHT: With many providers offering similar covers and the market struggling to innovate on the benefit side, service is the key value-add.

With globalisation comes a need for localisation and we are moving away from the era of IPMI providers being able to service a global clientele from a single European base.

Distributed policyholder services, in particular claims and assistance centres; settlement networks and access to digital services stand out as areas that can add value.

Our in-house Globalites network of worldwide healthcare service offices leverage our membership of Munich Health and enable us to draw on the great depth of local knowledge available within the group. l

| 41Roundtable

Q8

More than medical care and ambulance services:• 3000 patients returned home every year

• Cost-effective double and multiple transport facilities

• Worldwide operations - experts in long-haul flights

• Shuttles with shared capacities on a weekly basis

• Online tracking of free capacities at www.taa.at

• Own fleet of seven aircraft

Platinum Safety of Flight Award 2013 | ERA member | EBAA member | EHAC member | EURAMI certified

24-HOur EmErgEnCy SErviCE+43 512 22422-100

[email protected]

www.taa.at

Take me home. IPMIMAGAZINE.COM | INTERNATIONAL HEALTH AND MEDICAL INSURANCE | EXPATRIATE HEALTHCARE


CURRENTLY, WHAT IS YOUR MOST POPULAR AND APPROPRIATE PLAN FOR AN INDIVIDUAL EXPAT WORKING ON A SHORT-TERM ASSIGNMENT?

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depended on the individual and their personal requirements, but we are currently see an upsurge for our more comprehensive cover plans such as ALC Health’s Prima Premier and Prima Platinum plans with each offering an extensive range of usable benefits.

Including full refund out-patient GP services, full refund prescription medicines, annual health checks, eye tests, vaccinations and most importantly, full cancer cover. PHIL AUSTIN: Given that our plans are so customizable, we take each case and recommend the best solution for each customer.

That said, customers often come to Cigna when they want the very best, and we have seen an uptick in sales of our Platinum top-end plan which offers comprehensive cover with no benefit limits in most cases.

Expatriates want the best they can afford, particularly when moving their family abroad, and they know they can get the level of cover

they need from Cigna. BRENDAN SHARKEY: Our most popular plan is the GeoBlue Xplorer plan. Members can choose to purchase worldwide benefits including or excluding the USA.

When members remove the US coverage area, they save 50 to 60% on their expat health insurance premium. PHILIP WRIGHT: All of our plans are designed for expatriates intending to reside overseas for a minimum of 3 months.

Of course, those with the very shortest assignments tend to choose more basic cover, such as our Classic plan which offers both in and outpatient benefits.

As the duration of an assignment becomes longer the likelihood increases that a spouse/family will be accompanying the policyholder and thus our more comprehensive plans, Plus and Top, come in to play; alongside the need to replace the full range of benefits afforded in the home country. l


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WHAT NEW PLAN FEATURES AND BENEFITS CAN WE EXPECT TO SEE IN THE NEXT 5 YEARS?Q10

ANDREW APPS: Clearly the iPMI market is growing quickly and over the next few years there will be a greater emphasis on developing more ‘regional’ products – by country – that will still enable the member to seek medical treatment both at home and abroad.

The industry will become more dependent upon technology through sophisticated back office systems, greater use of social media and a move to fully paperless experience - the infamous plastic membership card is already starting to see a decline in popularity and will be replaced by mobile apps that work seamlessly with smart phones that can be read by medical facilities worldwide and which will be able to pre-authorise treatment, arrange cashless settlements and monitor personal wellness.

Products and services that are complimentary to iPMI will start to emerge as ‘standard’ rather than being an ‘add on’ proposition as providers start to push the boundaries in what can and cannot be offered.

The industry will become less reliant upon

the traditional expatriate moving the emphasis to the growing market of the global citizen. PHIL AUSTIN: The global individual expatriate market has come a long way in the last five years, and I expect the next five years will be no different.

Undoubtedly, we will see more emphasis being put on flexibility on the length of cover, i.e. a move away from the rigid structure of 12 month policies which often don’t correlate with the length of the individual’s work assignment abroad.

There will also be more of a focus on the development of online and mobile services, such as an app which provides directions to the nearest hospital or clinician, and I fully believe that will become the expectation from customers. The growth of medical tourism is a key trend affecting the industry, and I would predict there will be a greater prevalence of healthcare solutions specifically targeted towards this segment.BRENDAN SHARKEY: We should expect to see advances in mobile technology that


http://ipmimagazine.com/medical-health-insurance/index.php/en/daily-insurance-industry-news

| 45Roundtable

enables expats to seek, find and pay for healthcare services from the palm of their hand.

There will also likely be innovation in how benefits are packaged and priced so that they can be closely tailored to each expat family’s needs. PHILIP WRIGHT: Increasing localisation of product and service on one hand, while premium control measures giving policyholders greater freedom to adapt cover to meet their budget. Wellness benefits will increase in importance and providers will become more involved with the management of policyholders’ health.

Also, having pioneered formless claims reimbursement, at Globality we will continue to simplify the client experience via the roll out of a broad range of digital services.

We predict that global clients will become increasingly demanding of service delivered by insurers who have a deep local understanding and presence; coupled with the ability to access information in real time to support

their needs, wherever they may be. As markets develop and regulators become more aware of iPMI, the requirement to offer compliant products with seamless benefit and service delivery across many countries will grow – here our experience in the Middle East with our UAE partner Daman is particularly relevant. l

Get involved in the next iPMI Magazine Round Table: Local Health Insurance VS iPMI. Contact us for further information

and example questions. Write [email protected]



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460M INTERNATIONAL TOURIST ARRIVALS EXPECTED IN CURRENT PEAK SEASONDemand for international tourism remained strong in the first four months of 2014. International tourist arrivals worldwide grew by 5%, the same rate as during the full year 2013. C

“Risks are changing and traveller numbers increasing. With this comes a big need for consumers to start understanding the difference between travel and medical insurance.”


Roundtable

| 47

Prospects for the current peak tourism season remain very positive with over 460 million tourists expected to travel abroad in the May-August 2014 period.

Destinations worldwide received some 317 million international tourists (overnight visitors) between January and April 2014, 14 million more than in the same period of 2013.

This 5% growth consolidates the already strong increase registered in 2013 (+5%) and is well above the long-term trend projected by UNWTO for the period 2010-2020 (+3.8%).

Growth has been widely spread with nearly all subregions recording increases in international arrivals of 4% or higher.

By region, the strongest growth was registered in Asia and the Pacific and the Americas (both +6%), followed closely by Europe and Africa (both at +5%).

By subregion, Northern Europe, Southern and Mediterranean Europe, North Africa and South Asia, (all +8%) were the star performers.

“The encouraging start to 2014 and the overall positive sentiment in the sector raise high expectations for the current peak tourism season, benefiting destinations from both advanced and emerging economies,” said UNWTO Secretary-General, Taleb Rifai. “The 5% growth in the number of international tourists crossing borders in the first months of 2014 further reflects the impact of the increase in public support to the sector as well as the immense capacity of tourism companies to adapt to changing markets.”

Most destinations share in growth Asia and the Pacific (+6%) consolidated its growth of recent years, with South Asia (+8%) and North-East Asia (+7%) in the lead.

Growth picked up in the Americas (+6%), with all four subregions showing

significant improvement compared to 2013.Europe, the most visited region in the

world, maintained the strength it showed in 2013 with international tourist arrivals growing by 5% through April. Northern Europe and Southern Mediterranean Europe (+8% each) led growth. Africa’s international tourist numbers grew by 5% as the recovery was consolidated further in North Africa (+8%).

International tourist arrivals in the Middle East are estimated to be down by 4%, though this figure should be taken with caution as it is based on limited available data for the region.

With regard to source markets, international tourism expenditure data for the first part of 2014 indicates that the growth in demand continues to be strong out of emerging markets, in particular from China, the Russian Federation, Saudi Arabia and India. Moreover, demand from advanced markets is strengthening as the economic situation improves gradually, with encouraging growth registered in expenditure from Italy, Australia, the Republic of Korea, the Netherlands, Norway and Sweden.

Various indicators point to a strong Northern Hemisphere’s summer peak season. Over 460 million tourists are expected to travel abroad during the four months from May to August, which account on average for 41% of all international tourist arrivals registered in one year.

According to the UNWTO Confidence Index, prospects remain very positive for the period May-August 2014. Confidence has picked up, particularly among the private sector further in Europe, the Americas, Asia and the Pacific and the Middle East.

Data on international air travel reservations from business intelligence tool ForwardKeys support this outlook with bookings for May-August up by 8%. l



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Unfortunately many medical facilities overseas do not provide the same standard of healthcare as you may be used to at home. Language barriers may exist, with long waiting periods in unfamiliar, below-par uncomfortable surroundings. You may not understand the communication between caregivers and

specialists, and due to cultural differences, medicine may be practised based on local guidelines, standards and quality.

BENEFITS OF iNTERNATIONAL

PRIVATE MEDICAL INSURANCE

| 49Roundtable

If in any doubt, please contact your insurer or broker for a full explanation of the medical insurance cover you require. One size does not fit all in 2014.



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ACCESS TO HEALTHCARE AT HOME FOR EXPATS

8 Expatriates like to head home for major health care treatment. Does your expat insurance plan support global portability?

MEDICAL EVACUATION OPTIONS

8 In case of civil unrest or demonstrations, will your insurance policy cover for medical and non-medical emergency evacuation?

PORTABILITY AND ONGOING USABILITY OF PRODUCT

8Will your expat insurance policy offer coverage in your home country when your assignment ends? The best laid plans can go wrong,CULTURAL DIFFERENCES

TRAINING AND SUPPORT

8Working in a different country comes with challenges. Understanding local custom and culture is key to living abroad. Superficial symbols like a handshake, food, languages and basic etiquette are important to master when living abroad.

EMPLOYEE ASSISTANCE PROGRAMS AND WELLNESS SUPPORT 8 Living away from home can be stressful, especially during times of ill health. EAPs are intended to help employees deal with personal problems that might adversely impact their work performance, health, and well-being.


Access the highest quality hospitals and healthcare specialists overseas, giving you peace-of-mind and an always-on travel companion.

| 51Roundtable

As risks are changing traditional travel insurance policies may not cover travellers for evacuation or repatriation. The right iPMI plan can.

The most seasoned traveller may forget things. The right iPMI plan may help you utilise local pharmacies, where ever in the world you may be.

Receive 24/7 365 day-a-year, counselling and assistance services, to better manage cultural integration pains, and day-to-day tasks.

Mobile technology and various apps can add-value and improve the customer experience, however personal-service still remains number 1.

Product portability means some iPMI plans may cover you for healthcare at home. Also, if you are moving on a regular basis, product portability should mean no-need to have the policy re-underwritten.

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