Important Issues to Consider and Questions to Ask – April 2019 Robert Tillotson – Offshore Health Benefits, Ltd.

Who Actually is Insuring Me Abroad?

Make sure the proposed international insurance products are underwritten by a strong re-insurer, this is very important. Re-insurers like Lloyd’s of London and other large Financial Companies often audit the 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. Lloyd’s of London and it’s corresponding companies have been offering some of the highest renewals in 2019.

Annual Renewals, What’s Acceptable?

Double Check the international insurance plan which you are considering and verify that is guarantees a renewal each year.  Also, make sure that you are not penalized too harshly for poor claim experience. In 2018 & 2019 we are seeing huge increases by international by companies like Cigna International, Aetna International, and others. 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. Non USA Addresses should be required.

Should I Pay The Entire Medical Bill While Abroad?

We encourage of our members to pay the deductible (and co-pay if applies) to any provider. The Insurance Company who is insuring can negotiate the remaining balance. You may have to pay a deposit. Let’s chat about this one.

Direct Payment & Wire Transfers

Make sure that the international carrier can pay via “direct wire” or “guarantee of payment” for costly or expensive procedures.  A few carriers require the member to pay for large medical expenses upfront; this is not good, especially for care in the USA. A knowledgeable 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 should only deal with organizations who will talk over the telephone or in person, as opposed to relying on faxes or e-mails or even chat boxes. 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.

Brokers / Agents

Make sure your international broker or consultant has an insurance license and is bonded for at least $1 million per claim.  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 and hospital claim negotiation.  International insurance companies often market to domestic brokers who mainly sell in the USA and Latin America, and only dabble in international, as prospects pop-up on their radar screens. Offshore Health Benefits LTD,  has been thriving for 17 years, adding hundreds of new clients each year. Also, we pride ourselves with our a high annual client retention rate. We only work with Expatriates living around the world.

Brokers / Agents 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. You should never pay more than a 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 partner Medical Air Evacuation & Assistance partner (varies).  Most carriers contract this service out and may not have a solid communication system in place, this is very important. Handling a crisis situation correctly and in a timely manner can mean the difference between life and death in some serious situations.

Broker / Agent Communication

Check to see if your international broker or consultant can be reached either by telephone or email directly.  All of our clients have our company cellular telephone number and we welcome calls 365 days a year. Our company Skype name is “Offshore Health Benefits” and we welcome calls most days of the week. We offer a Whatsapp number as well. 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, How Does This Work?

Verify that your prospective international carrier’s PPO (preferred provider organization) partner in the USA or Indemnity program 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, so check online lists. These network are often referred to as “rental networks.” Check the city or general area where you may spend your time (States) and research whic hospitals are open.

Do I Need Medical Coverage in the USA?

Not every Expatriate needs access to medical care in the USA.  Don’t waste your annual premium on unnecessary benefits. If you are not from the USA, you may want to “opt” of coverage in the USA and simply purchase a low cost travel plan for those trips back to the States or Canada.

Annual Deductible and Co-payments

Check that the international carrier is not imposing a higher deductible for care in the USA. (Coinsurance levels are usually higher 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.
Double check and review the limits associated with the 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, let’s chat about this one.

Global 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.

Should I purchase From the Net?

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 and many agents are eager to sell. Many plans do not offer a guarantee renewal and you could be stuck after year one (pre-existing condition).

Coverage & Benefits While Abroad

Review the various plan offered by each carrier, a few  plans out there 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. Remember, if the rate is too low, you may not be covered for basic major medical procedures. There are waiting times for many benefits (ie. 12-24 months for pregnancy).

Lifetime Coverage Limits

Check the Conditions of Coverage Section and review plans that offer at least offer $500,000 of major medical coverage per year. .  The standard is $500,000 – $5,000,000 per policy, per year.

Domestic Coverage Limitation

In most cases, domestic coverage abroad is limited to only vacations and short trips (no more than 30-60 days, check your policy exclusion writing and do not rely solely on what a domestic agent tells you, keep in mind, that they may not want to lose commissions). Many expatriates often move out of their home countries and maintain their home country health insurance plan (with a US address of a relative, etc) 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.

Thank you for taking the time to read these tips. While every tip may be tough to meet, we strive to pass on only International Insurance Plans which come close at a reasonable annual rate. There are so many companies which do not pay claims or put up a fight, contact our team for a list. Don’t Get Taken.

We look forward to your questions and thoughts. Safe travels to you!

Robert Tillotson – Global Consulting, OffshoreHealthBenefits.com

*this information is solely the property is Offshore Health Benefits, LTD , the reproduction, editing, copying, or redistribution is strictly prohibited without the expressed and written approval of Offshore Health Benefits, LTD.