How to choose an expat medical insurance policy, for a non-US citizen?

Question

Expat medical insurance (global medical insurance) is long-term medical cover for those living outside their home country. It's available from a wide variety of providers (Bupa, Aetna, Cigna, IMG, Aviva, AIG, and dozens of others). It normally covers "worldwide" or "worldwide excluding USA (and sometimes Canada)" regions, rather than a single country of residence.

I'm specifically looking at plans for a non-US person resident outside the US (the US is a special case when it comes to health insurance).

Many of the smaller providers (and even some of the large ones) are nominally run from tax havens with minimal regulation (although the admin is often in the US or UK).

Given the lack of regulation, and the wide variety of countries they operate from, are there any organizations or trade associations that rate them for reliability, or compare plans? There are many specialist brokers that represent a few plans, but it's hard to get an overview of what's possible from them.

When comparing plans, I realise these are some of the things to check for:

• how financially stable is the insurer? Is it even a real insurer, or just a sales front for another plan? Is there some independent way to find out?
• how are claims handled? 24x7? Where?
• are renewals guaranteed? If not (or even if they supposedly are), what factors can cause loss of insurance?
• how are increases calculated? Most of the US-orientated companies seem to use a "group" system, where customers of a similar age are grouped together, which means the risk is spread among a small number of similar people (rather than young new customers), which can cause steep rises. What other increase methods are used?
• does the policy have fixed limits for each item, or is there an overall limit?
• are deductibles (excess) per illness, per visit, per insurance year...

What have I missed from this list? I've intentionally left off cost, as in general you get what you pay for, if it's cheap there's normally a reason (such as being a loss leader for sharp increases in future years).

What I'm looking for (and probably many others are) is to establish a policy with a company that'll be there, and still offering guaranteed renewals to an acceptable policy at an acceptable price, in 5 - 10 years time. Is that an impossible objective?

Just to clarify after the first off-target answer, this question isn't about whether I should get such a policy. It is something I (and many expats) need (I live in multiple countries). I have a policy already, that I'm not super-happy with, and I'm looking for a better one.

With a domestic health insurance policy in one country plus travel insurance, you have time limits for journeys, and are sent home to be treated for anything major. With global medical policies, you are treated in the country you are currently in (or evacuated to somewhere better), for as long as you're there.

In summary: what methods and checklist should I use to select a long-term expat health insurance policy? And what should I avoid?

Answer 1

From my experience, you would be better off buying private insurance in the country you're going to, if you're going there for a prolong period of time. If you keep traveling around and never staying at one place for more than a month or two - go to an insurance company at the country of your citizenship and get a travel insurance.

I you're moving somewhere for 5-10 years, you would probably be better off with the same coverage as locals have.

Buying insurance from a company registered elsewhere when you're in a country causes several difficulties:

1. As you mentioned - lack of regulation and oversight may leave you with a "policy" which is a worthless piece of paper.

2. Most local insurers have streamlined procedures with the local providers. You may be paying slightly more in premiums, but you know exactly what benefits you're getting and who you're getting them from, and you don't need to wait months for reimbursements that may not come.

3. If a local insurer goes under you will get a replacement policy through the regulator. Or not. But you'll know exactly what is going to happen and can plan accordingly. Insurance companies rarely go under unexpectedly without a regulator taking care of a replacement provider. Unless there's no regulator, see point 1.

I cannot understand how US citizenship/person-hood is related to your question in any way.

Answer 2

I think you have done a great job doing your research and summarizing your thoughts. You now should contact a couple of the plans that look best suited to your needs, get quotes, and experience how they operate.

There are brokers, I work for one, that can help answer all of these questions and can offer objective advice on the history, service levels, stability of each of the above plans. It might be worth talking with a broker - they don't cost you anything and you can get a different perspective based on your specific needs.

One more consideration - not all of the plans listed are available to cover everyone in every country. Aetna is not available to expats residing in the USA. BUPA is not available to US citizens living abroad, etc. Dubai and other countries do require you to buy a locally compliant plan if you are getting a work visa there. So think about where you will be living and get a plan that will cover you in all of them.