If
a Group medical insurance scheme is operational
within an organisation, the members of the scheme
are actively encouraged to contact the insurer
(24 hour medical assistance telephone numbers are
provided), to answer their questions, respond to
their requests or address their concerns.
Where to take treatment in a particular country is
a common question and the insurers can provide this
information on a global basis. Companies usually
supply a hospital list to each member who joins the
scheme, listing the hospitals with which they have
arranged direct settlement agreements. The employee
is not restricted by these lists and may use any
hospital of his/her choice within the terms of the
coverage that has been provided by their company.
If a hospital is not featured, he/she should contact
the insurer before starting treatment and ask that
the bill be paid by the insurer directly to the hospital.
In most cases, the insurer will guarantee payment.
Other insurers
will work on a pre-authorisation basis, not providing
a list of hospitals, but insisting that the member
contacts them before receiving treatment. In doing
so, the insurer can confirm that the planned treatment
is eligible for cover and can arrange direct settlement
with the hospital or provider. If the member fails
to contact the insurer, his/her claim could subsequently
be denied.
Managing the
cost of medical claims is important to the insurers:
ultimately this has an impact on the premiums that
they charge their customers and therefore the retention
of those customers. This is achieved by obtaining
discounts from hospitals and providers on a global
basis, guaranteeing a good volume of patients through
those hospitals' doors. Where this is not possible,
the international insurer will arrange to link
with a local insurer, to take advantage of their
own local agreements with medical providers. A
good example of this is BUPA International and
PPP International's alliances with Old Mutual in
South Africa, where BUPA members are provided with
a local helpline and assistance through Old Mutual.
The main benefits of these alliances are the eradication
of time zone differences and the ability to submit
out-patient claims locally, therefore speeding
up the reimbursement process.
In North and
South America, most international insurers have
local partners who provide a local service to US
and Canadian based expatriates. These partners
will arrange direct settlement of bills, process
claims and advise members of nearby clinics for
out-patient consultations, as well as the PPOs
(Preferred Provider Options) that they use. Likewise
in Germany, PPP International use the services
of the Asklepios Clinics, giving their members
access to a fast expanding network of healthcare
services, including amenities for acute care and
rehabilitation.
If an organisation
has not purchased international medical insurance,
it is strongly recommended that it considers doing
so, if only to utilise the expertise of the insurer,
and to transfer the key responsibilities for health
provision. The alternatives are for the expatriate
to adopt the local medical insurance scheme or
rely on the State provision (if available). The
local insurer should be able to offer directional
advice on which hospitals, clinics and consultants
to use and where they are located. If State provision
is adopted, the expatriate will be restricted to
State run hospitals.
These alternatives
can differ in quality and cover per country and
ultimately might not be the most cost effective
way to provide health benefits for the expatriate
on a global basis. Furthermore, where an organisation
has a mobile expatriate workforce, it could mean
re-inventing the wheel every time the expatriate
relocates.
David Heppard
IHC (Independent Healthcare Consultancy)
Independent advice on international medical insurance
Tel: +44 (0)20 7353 4099
Fax: +44 (0)20 7353 4089
E-mail: dheppard.international@ihc.co.uk
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