Off shore health benefits

Weekly Update

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List are Important Issues to Consider and Questions to Ask – Oct 2020

Reinsurance – make sure the proposed international insurance products are underwritten by a strong re-insurer, this is very important. Reinsurers 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.  Just because a company is Reinsured through Lloyd’s of London does not mean much these days. A great example is the PA Group filing for bankruptcy in Oct of 2020. They continued to collect premiums through Sept of 2020 knowing the end was coming while turning down so many claims. Is there an easy Lloyd’s team jumping in to help? I think not. The Cayman Islands have not jumped into help either, very disturbing situation.

Annual Renewals – make sure the international insurance plan that you are considering guarantees an annual renewal each year.  Vivid 19 has changed everything and can be used against an applicant. Make sure that you are not penalized too harshly for poor claim experience.  A strong insurance company pools it’s members by using an “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. (This is our requirement)

Claims Reimbursement – make sure that a reimbursement check or deposit can be cut and mailed out  or deposited within 4-8 weeks after a claim filing, and that a member is not penalized with miscalculated exchange rates. DHL or UPS are the preferred carriers for international mailing. On most  occasions, monies can be wired to a foreign bank account or directly to a hospital.We encourage all of our members to try and only pay the deductible (and co-pay if one applies) to any provider (hospital or doctor). The Insurance Company who is insuring can you negotiate the remaining balance.

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 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. It is so important to deal with organizations who will talk over the telephone or in person, as opposed to relying on faxes or emails 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.

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.  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 16 years, adding hundreds of new clients each year. Also, we pride ourselves with a high annual client retention rate. Experience in international benefit planning is everything, especially in a time of crises, like Covid 19. Approximately, 60% of our business comes from client referrals.

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.  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 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 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 crisis situation correctly and in a timely manner can mean the difference between life and death in some serious situations.

Broker / Agent Communication – make sure your international broker or consultant can be reached either by telephone or email.  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. Many brokers take days to respond, and some cases, unfortunately, simply do not respond after a sale has been made. This is unacceptable. Our team uses Whatsapp and Skype for instant communication and texting is popular. 

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 a carrier offers a  preferred provider internet search option. 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. Which providers and hospitals are listed as “out of area” or non PPO? You may be penalized for going out of network in the States. Which Top Cancer Centers are available to you?

Check to see if your current domestic doctor or hospital is in the network prior to joining.  Many international insurance companies allow a member to “opt out of coverage in the States” and save up to 100% off annual premiums; this is a good situation for expatriates who have national coverage in their home country or Medicare in the USA or who just do not require coverage in the States. Not every member 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” out of coverage in the USA.

Annual Deductible and Copayments – make sure that the international carrier is not imposing a much higher deductible or high coinsurance charge  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 subpar networks. This is not the industry standard. 

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 a 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.

Coverage & Benefits – 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.

Lifetime Coverage Limits – make sure that you review plans that at least offer $500,000 of major medical coverage per lifetime (for long term 12 month renewable plans).  The standard is $500,000 – $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.

My team only works with expatriates & third country nationals  (country by country).  We work directly with our clients and do not work through middlemen brokers. You do not need to pay “override” fees or commissions to a “middle-man” broker or consultant.  Counting on a domestic plan to cover you, your family, or business group abroad is not a smart approach. Coverage outside the USA or other countries can be  expensive and domestic insurance 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. 

Most cases, domestic coverage abroad is limited to only vacations, etc. (no more than 30-60 days, check your policy writing and do not rely solely on what a domestic agent tells you, they do 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 while jeopardizing your health. Many domestic plans only cover for “life threatening emergencies” when abroad as defined by corporate lawyers.

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 (US TEL)

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


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