Healthcare What to expect as an Expat

Healthcare What to expect as an Expat

What’s on your mind

Looking to move overseas brings with it a great deal of uncertainty and one key area where this can mean sleepless nights is healthcare. What can you expect in your new home and how does it compare to your old one are important questions that are very important for your family and yourself. It may even have an impact on where you move if there is more than one option on the table.

We did think about writing a review of each region highlighting good and bad countries in each and regional quirks in legislation. We decided against this as it would be far too long winded and we wouldn’t really do it justice. If you are moving make sure that you research the countries that you are heading to and don’t take anything for granted. Instead we decided to write something that highlights general issues that expatriates can face in relation to healthcare.

We did think that we would start off with a summary of each region and the quality of healthcare JUST KIDDING!

The likelihood is that you will be moving overseas and your company will provide you with medical insurance that covers your family as well. If this isn’t you then don’t worry we will deal with you later so keep reading.

Company Plan

The amount of expatriates living overseas who have no idea what they are covered for by their company schemes and assume that everything will be taken care of is frankly ridiculous. Unfortunately the time when they become aware of any issues is when it is too late and they find themselves stuck with a walking great medical bill.

So before you do anything else check that your family are covered under the company policy (we have encountered situations in the past where only employees are covered and dependents are not) and they are covered at the same level as you the employee. If the answer is no then you need to do something about it and get them coverage (keep reading).

So the family are covered at the same level as you, good start, the next thing to establish is what exactly are you covered for and more importantly what does the plan not cover. Again just because you work for a large multinational don’t assume anything.

I once met someone who worked for an international cosmetics company in Singapore and assumed that everything was covered until he need angioplasty and a stent. Unfortunately because he wasn’t admitted his company scheme didn’t cover it as it was classed as an outpatient procedure and he was only covered for inpatient procedures which meant he had a $7,000 (US) medical bill to pay. why didn’t he just get admitted I here you ask? Well that would be insurance fraud and hospitals generally don’t like to play along. He came to me and asked if I could set him up a more comprehensive policy in case he needed any other procedures, unfortunately by this time it was too late as he had a pre-existing condition which meant that the whole cardiovascular system was excluded.

If you have had health issues in the past or procedures performed it is important to establish whether or not your company scheme allows or excludes pre-existing conditions. Corporate schemes tend to get better terms as insurance companies can capture a number of members all in one go, this means that for a relatively small cost pre-existing conditions for members can be excluded. Not all schemes will exercise this option and if you have had a procedure in the past it may mean that other conditions that could be deemed to be related are excluded. Check on whether the option has been exercised and if not get clarification on exactly what you are excluded for as it maybe that you can appeal and get any exclusion reduced.

You may be planning on starting a family or expanding it further whilst you are an expatriate well congratulations. A word to the wise though the last baby that we had overseas in Malaysia came with a medical bill of just over $11,000. That was for a routine pregnancy, no complications in a country that has very reasonable medical costs (we were covered) so it could have been more expensive. If kids or more kids are a part of your plans whilst living and working overseas then check that you are covered under the company plan as this is not always the case. If your company plan doesn’t provide for maternity costs then you need to get covered, we’ll deal with this later. Even if you are covered you will need to check the policy definitions and in particular focus on the complications of pregnancy. Again we will touch on this later when we deal with what to look out for when buying a policy.

Following on from our previous point about pregnancy what happens after the baby is born? There will be a period of time when the baby is covered for treatment without being registered own the scheme. Again know what your baby is covered for and what it isn’t before you head into hospital.

 

Is the company scheme that you are member of an international policy or is it a local one. Whilst we don’t want to disparage any local policies we would suggest that you are better off with an international policy as it means that you can get treatment elsewhere should you need to, sadly this isn’t an option with the local plan. An example of this was a friend who’s little girl was diagnosed with a brain tumour a devastating diagnosis, that would require a complex surgery, chemo & radiation therapy, specialist paediatric oncology aftercare and rehabilitation. They looked at a number of options, treatment where they were living at the time (whilst they were happy with the surgeon they did not feel that the specialist nursing that they needed was available), heading back to the UK so that they could have the support of their family around them (their daughter would have ended up on a general paediatric ward exposed to infections with no immune system or going for treatment in another country that had specialist nurses and a designated paediatric oncology ward. Obviously they chose the latter and were able to as they were a member of an international plan a local one would not have allowed them to explore all of these options.

Does your company run a single medical plan for all of their expat staff around the world or does it have separate regional or even local country health insurance plans. This may not seem important right now especially if you are becoming an expatriate for the first time., though you should be aware as expats tend to move from one assignment to another. If your company runs an international plan for all expats then that isn’t really an issue if you move with them somewhere else as you will have continuity of coverage. If they run regional or local schemes and you move from one to another then this can be an issue especially if you or one of your family have received treatment it may mean that you or they could be subject to coverage exclusions on your new company plan. If you try and get a private policy the result will be the same an excluded pre-existing condition.

If you are retiring or you have a pre-existing condition and you are leaving your company there may be an option to continue with your existing policy and pay the premiums yourself (or get a future employer to contribute) if your company has selected the option. It is worthwhile checking at some point.

Those are the main areas that you need to be aware of in relation to your company or future company health plan when moving overseas, if we have missed anything please let us know.

So you need a plan

So you don’t have access to a company plan for one reason or another and you need to get you and or your family covered with some health insurance, so what do you go for?

Well some of this depends on where you live and how long you intend to be there. If for example you have emigrated to say Australia and intend to stay there for the good then local insurance will be perfectly fine though in this case you’re not really an expat are you. If you are moving to somewhere in South East Asia, will be traveling frequently and intend to move somewhere else in a few years then you really need an international policy and avoid taking a local one. Our reason for saying this is that you will have continuity of coverage with an international policy if you have health issues you will still have coverage even after you move where with a local plan you will have to get a new policy which would mean that you have pre-existing conditions excluded.

 

As we mentioned earlier you may not always get the best treatment in the place that you live, so having the option to get treatment somewhere else that can give you the best care is pretty important and an international plan will give you this.

When you apply for a health insurance policies there are two ways in which the application can be made which is either underwritten or on a moratorium basis. In both cases you will complete the application and be required to give details of your medical.

With the underwritten policy you will be asked to provide more information if required and you will be informed of any exclusions on the policy and accept these before the policy becomes active. Otherwise the policy will be set up and when you make a claim it will be paid.

If the policy has been set up on a moratorium basis then all pre-existing conditions that have occurred (or possibly in the past 5 years) are excluded, if there are no further reoccurrences over the next two years then the condition may be included after that depending on the severity.

We prefer the underwritten basis as you are fully aware of what is covered and the moratorium basis can lead to confusion and disappointment with the policy.

We also mentioned maternity cover in the last section and if you are buying health insurance that covers these costs then there are several things that you need to take into account.

Firstly there is always, always, always a waiting period of at least 10 months between cover starting and claims being eligible. I know people who had a policy and wanted to save some money so they didn’t add the maternity cover from outset. They then decided that they wanted to have a baby. and added the maternity cover and understood that they had a waiting period of 12 months before they were eligible to make claims. Two months on they were pregnant, pissed off and paying maternity fees. Don’t make the same mistake.

Another thing that we touched on in the last section was the policy definitions in particular those relating to complications of pregnancy and here is where I deal with this in more detail. Not all policies are equal when it comes to how they deal with complications of pregnancy and this will be extremely important to most mums to be. So here is what you need to know, some insurance companies will not pay for treatments to save the unborn baby and class complications of pregnancy as a D&C procedure. Other companies will pay towards saving the unborn baby should complications occur. The two definitions are extremely different and can have significant impact on your family to be.

We mentioned earlier about that you should be aware of any what your baby is covered for when they are born and the same applies here. One thing that I didn’t mention and also applies in our last section is that most insurance companies will not cover any congenital condition that a child is born with. In some cases where the condition can lead to further health complications for example Down syndrome they won’t provide cover at all. There are some exceptions to this and as long as a parent has cover with them and the application is made within a certain timeframe after the birth they will provide full cover for all children, though these are few and far between. If you fall into a high risk category then it is worthwhile seeking one of these companies out.

On a final point you are French then we would recommend that you pay into the state system which will provide you and your family with excellent international medical coverage that covers all children with congenital conditions and maternity costs. If I only our own countries extended such a service to their citizens well all I can say is “vive la France!”.

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