Already compulsory for expats working in Saudi Arabia and the Emirates, medical insurance is becoming a must-have in one more important country. No, not some other popular working expat location. Somewhere a little closer to home: the UK.
Yes, it’s true, sensible expats are taking out medical insurance to cover not only their working destination, but also the UK.
Why is this? Well, in the last two years it has become ever more likely that the expat who returns to the UK will find that NHS trusts will refuse to offer him free treatment. That is because he may be treated as a non-resident, and non-residents of the UK are not now eligible for free NHS treatment. Of course, emergency cases will be treated, but non-residents will probably find a large bill for any treatment beyond patching up in the Accident & Emergency room.
Treatment in the UK
You may recall the case of Expat Network member Michael Johnson, which we featured in Nexus last year.
Johnson had had a bit of an accident in the Philippines, had developed a lower-back hernia, and needed an operation. But he could not afford it and he didn't have medical insurance. Could he come back to the UK and get treatment, he asked, free of charge?
The answer was not that simple, ranging from 'strictly speaking, no' through 'maybe' to 'with a bit of luck, yes'. The reason for the range of answers is that we are not entirely sure how government regulations are actually being applied in individual GP surgeries and NHS hospitals.
The government issued strict new guidelines on eligibility for free NHS treatment. They were introduced in an attempt to cure 'health tourism', where non-residents come to the UK just for free medical treatment. But doctors tend not to follow restrictive regulations when faced with a patient in pain whom they can cure.
So there was no definitive answer for Mr Johnson, until and unless he comes back to the UK and tries for himself, but we can provide a few tips.
Most UK nationals who are resident in another country are not entitled to free UK health service treatment, and are not advised to visit the UK for the purpose of obtaining NHS treatment, as they would normally be charged.
However, people of any nationality coming to live in the UK are entitled to the same NHS services as any other citizen, as long as they are coming to make this their permanent home. This entitlement begins as soon as the person arrives in the UK.
So, if Mr Johnson came back to the UK 'permanently' (and, of course, his plans could change) then he should be able to receive treatment free of charge. But declaring himself a permanent resident of the UK again could cause him tax problems.
If his name is still on the books of a UK medical practice, the GP - who may not know he is non-resident - could refer him for free treatment.
Accident and emergency department help is free for anyone, but if you are found to be non-resident when referred for further treatment, then you will be charged for it.
And Mr Johnson certainly cannot now take out medical expenses insurance cover and hope that would take care of the fees - his hernia is clearly a 'pre-existing condition' which would be excluded from his cover.
According to Carl Carter, managing director of medical insurer IMG Europe, “The fact that some international medical insurance policies stop cover as soon as you return home, coupled with the refusal of some NHS trusts to provide free treatment, has caused problems for many part-time as well as full-time expats.” The solution, says Carter, is look for a policy that provides seamless cover when the expat is home or away.
Covering the Globe
Elsewhere in the world, private medical cover is becoming more and more necessary, as the cost of treatment rises faster than inflation, and governments realise they cannot afford to treat everyone free of charge.
In Australia, medical insurance take-up is officially encouraged through a premium rebate system. In France, patients have to pay 20% of the cost of any treatment they receive from the state and so ‘top-up’ insurance is popular to cover this. In Spain, long waiting lists are encouraging a greater take-up of medical cover.
If you are going west, cost becomes a major factor. The US, Canada and the Caribbean are often excluded from policies because of the relative expense of treatment in those locations. If you are going to be travelling or working in these areas then your policy premiums will face heavy loading.
If you are heading for an area of the world where medical care is basic or even non-existent, and where disease is common, then you are taking serious risks with your health if you do not have cover that will allow you to be evacuated to a hospital with western standards of care.
Calculating the Odds
To buy or not to buy? That is the question. Medical insurance is problematic: it’s expensive and you may never need it. You pay hundreds – maybe thousands – of pounds to cover yourself against everything from coughs to coronaries and then the only thing you need is a throat lozenge. All that money for ten minutes with the doctor and some pills.
And yet, if you do not have medical cover you may well spend a lot of time worrying about it; or worse, thinking ‘it’ll never happen to me’. If you take this approach, make sure you have plenty of readily accessible money stashed away, ready to pay the doctor or hospital direct if the worst should happen.
Better still, get your employer to arrange cover for you (and your dependants). But beware that this employer-sponsored scheme does actually cover you when you are not at the workplace.
Cost of Cover
The real argument for medical cover is that it’s the better mistake to make. If you have it and you don’t need it, that’s £500, or £1,000 or more, wasted. Whatever the number, it’s exact and known.
But if you don’t have it and it turns out that you do need it, the potential loss is seriously open-ended. Private hospitals are expensive and generally unimpressed by the argument that you need the treatment even though you can’t pay for it.
The cost of comprehensive international medical insurance plans can vary from around £500 a year to over £13,000, depending on your age, the size of your family, the countries you will travelling to and just how ‘comprehensive’ you want the plan to be. Almost all plans exclude pre-existing conditions - which must be declared - and alcohol, drug or HIV-related illnesses, and injuries resulting from war or terrorism.
But pre-existing conditions can sometimes be accommodated. IMG Europe’s plan, for instance, gives cover for declared and accepted pre-existing medical conditions after two years’ membership. Most other plans work on a two-year moratorium basis, where a period of two years without symptoms, medication or treatment is needed before cover is given.
And your job may be dangerous. If your expat assignment takes you to some of the world’s hotspots you will not under most policies be covered against the consequences of a terrorist attack. Most medical insurers have a full war-risk exclusion, but one – Medicare International – provides ‘passive war’ cover including terrorist attack.
This type of cover may be of interest if you are working in the Gulf area, such as in Iraq, Lebanon or Kuwait; or in some parts of Africa. Policyholders can call on the full policy cover, including hospital benefits and evacuation, in the event of injury by terrorists or as part of a broader war conflict.
As Medicare International’s David Pryor says, “In an age where localised conflicts seem to be ever-present, reconstruction and rebuilding is of vital importance. Attracting the specialists necessary can be helped if they know they can at least have full medical cover.”
Read the Small Print
Before committing yourself to a medical insurance plan, get the detailed terms and conditions and make sure you understand them. Ask practical questions about how your cover will work. You can’t predict the precise circumstances in which you will (or might) need to make a claim, but it would be useful to know, for example, how you would prove to the receptionist at a private hospital that you were covered for the treatment you needed.
You should also find out the procedure for paying bills. Do you put them on your credit card and settle later with your insurer? Or does the hospital deal directly with the insurer. Who pays in that short – but potentially crucial – period between your arrival at the hospital and your insurer’s formal acceptance of liability?
Who decides that you need to be airlifted to a better hospital in another country? Do you decide? Or does the hospital admit you would be better off elsewhere? Or is there a qualified third party who can make the decision for you?
You often know you have picked the right policy when your insurer handles a minor claim efficiently. If the insurer messes up something minor, take your business elsewhere before they have a chance to bungle something major.
If you are cost-conscious, then there is one simple way to reduce the price of a medical insurer’s premiums. This is to accept a larger ‘excess’ than is usual, meaning that, in return for lower premiums, you agree to settle the first part of any claim you make out of your own funds. If you set aside £1,000 or some other sum for this purpose, then insurers will generally lower their premiums proportionately.
You can find out the premiums and policy details of many of the international medical insurance plans at www.medibroker.com
European Health Card
The E111 European medical certificate has ceased to be valid, and you will now need a European Health Insurance Card (EHIC) for medical treatment during a visit to the EU states plus Iceland, Liechtenstein, Norway and Switzerland.
You can obtain a card on-line at the Department of Health website at www.dh.gov.uk
Remember that the card does not cover the cost of repatriation after an accident or injury, so you are still advised to take out full travel and medical insurance. The card is also only supposed to be used by travellers, not those who are taking up employment in these countries.
International travel is undertaken by large, and ever increasing, numbers of people for professional, social, recreational and humanitarian purposes. More people travel greater distances and at greater speed than ever before, and this upward trend looks set to continue.
Travellers are thus exposed to a variety of health risks in unfamiliar environments. Most such risks, however, can be minimised by suitable precautions taken before, during and after travel, and so the World Health Organisation has produced a guide to measures which can prevent or reduce any adverse consequences for travellers’ health.
The guide advises on the full range of significant health issues associated with travel. The roles of the medical profession, the travel industry and travellers themselves in avoiding health problems are recognised. The recommendations address the health risks associated with different types of travel and travellers.
Chapters of the guide cover: health risks and precautions, health considerations of travel by air, environmental health risks, accidents and injury, infectious diseases, vaccine-preventable diseases, malaria and blood transfusion. There is also a destination list, showing the vaccination requirements and malaria situation.
To view the whole guide online, click here