How to choose the best health insurance for expats

How to choose the best health insurance for expats

Health insurance might be low priority when you move abroad as an expatriate. However, there is a massive risk of getting ill abroad – which is why it pays to be prepared. With this guide, you can learn the basics of health insurance and choose the best health insurance plan for you and your family.

Key takeaways:

• Know the different types of healthcare systems worldwide and which type exists in your country of residence before you decide on health insurance for expats.
• Most of the best health insurance for expats will give you access to local private healthcare. 
• It’s important to choose your insurance policy based on your specific healthcare needs as an expat – your plan will define the countries covered and your level of private medical coverage.
• Make sure you find a health insurance provider that can cover your country of residence and any destinations within your travel plans to avoid low-quality care and high costs if you have sudden, serious health issues.

Know the types of expat insurance

If you want access to private healthcare as an expat, there are typically three types of insurance policies you can consider:

• Local health insurance
  Expatriates who live permanently in another country sometimes purchase domestic health insurance policies. Whilst this is fine for some expats or for short-term arrangements, it can also be restrictive. For example, you may only have coverage for treatment in low-quality hospitals and won’t necessarily have medical cover for trips abroad.
• Travel insurance
  Trip insurance can sometimes include health coverage for accidents and medical emergencies,  but usually it covers you only for temporary trips abroad.
• Global health insurance
  Global health insurance is a good solution for expatriates who want access to the best hospitals and doctors where they live, and who want full medical coverage when they travel or make trips to their home country.

An international policy seems like the obvious choice. The downside? International health insurance is more expensive than both travel medical insurance and local health insurance. However, many expats find access to high-quality hospitals and English-speaking doctors priceless. Especially in places like Southeast Asia and Africa, which both have very different public healthcare systems than those found in Europe or North America.

The choice of your health insurance will depend on the characteristics of your country of relocation. Be sure to find out about:

• The quality of the health system and the medical care provided
• The cost of medical care in your host country

Understanding health insurance for expats

Before we begin, here’s an explanation of some of the terms we use in this guide.

1. Benefit – A specific medical treatment or medical service that is recognised by a health plan & covered up to a specified limit
2. Country of residence – The country where you’ll be living & working, or spending most of your time
3. Country of nationality – The home country that issues your passport
4. Health plan – The insurance coverage that defines the limits & restrictions on the treatment you can receive in local medical facilities
5. Member – When you purchase a health plan, you become a member of William Russell
6. Period of cover– The duration of your health plan (usually one year)
7. In-patient – Someone who’s been formally admitted to hospital for medical treatment, staying in a hospital bed for at least one night
8. Day-patient – Someone who’s been formally admitted to a hospital for medical treatment, but doesn’t stay overnight
9. Out-patient – Someone who visits a doctor, specialist, or receives minor treatment, but who is not formally admitted to hospital or clinic
10. Post-hospital – The period after your discharge from hospital, during which you might attend consultations or receive follow-up treatment as an out-patient
11. Pre-existing conditions – Any medical conditions you’ve had in the past or currently have
12. Medical evacuation – Also known as medevac, this is emergency transportation to the closest medical facility with the best treatment for your health condition
13. Repatriation – Transportation back to your country of nationality when you need ongoing, critical medical treatments not provided in or near your country of residence
14. Waiting period – The length of time you must be covered by your plan before you can claim for a particular benefit

Be aware of the types of healthcare systems

At William Russell, we provide private health insurance to expats in over 150 countries. The rules for each country are different, so it’s always best to check the official advice from your country’s government or health service before moving there. You should be aware of which type of healthcare system your new country uses. There are four main healthcare systems worldwide:

1. Single-payer healthcare system, where healthcare is nationalised and paid for by the taxpayer. Healthcare is provided free to all citizens and may also be free for temporary residents. This is the system in place in the UK, UAE, Spain and Hong Kong.
2. Government-subsidised private healthcare, where citizens pay into a privatised, but government-regulated national health insurance system. Expatriates and non-citizens very often need private insurance in these systems. This is the system in Japan and China.
3. A sickness fund system is when the healthcare system is largely privatised and relies on personal health insurance, but this is often provided by employers with payments taken from payroll deductions. This is the system in place in France, Germany, Korea and the Czech Republic.
4. Out-of-pocket healthcare is when the responsibility for paying for healthcare costs fall on the individual. In these countries, personal health insurance is absolutely essential, as without it a person may be liable for extremely high healthcare costs. This is the system used by the United States. Find out more about health insurance costs in the USA.

Step 1 – Find a plan that covers your destination

Now that you know the different types of healthcare systems around the world, you can begin to understand when you need private health insurance for expats and what kind of coverage is best for you. 

For example, in countries that rely on private healthcare, you will definitely need health insurance. However, don’t fall into the trap of believing that countries with nationalised or socialised healthcare systems won’t require insurance. As a non-citizen of these countries, you may be placed on a long waiting list or charged some costs.

Some countries with national health systems may still deny healthcare to non-citizens. Many also demand that non-citizens show proof of health insurance as a requirement for remaining in the country. This is especially true for British citizens living in countries such as Spain after Brexit.

Once you know you want or need an international policy the first thing you need to do (if you haven’t already) is to work out where you’ll need cover. Finding a health insurance provider that covers your destination is essential to avoid wasting time.

All William Russell expatriate health insurance plans come with a choice of six different ‘zones’ of international cover. This way you can choose the right area of coverage based on your living and travel plans and avoid paying for generic worldwide coverage when you don’t need it.

Step 2 – Pick the right plan

With over 30 years of experience helping expats with international insurance, we know soon-to-be expats often take a casual approach to their health and well-being abroad. Most people simply want to ensure they have access to private care. But what most new expats don’t realise is that, while most global medical insurance gives you access to private healthcare, the health plan you choose defines the limits of your access. That’s why it’s so important to pick the right plan.

Many providers will give you standard and optional benefits. As standard, all our health plans at William Russell include cover for:

• Hospital treatment
• Cancer treatment
• Visits to the doctor*
• And emergency medical evacuation.

Beyond these standard benefits, we differentiate our health plans by their additional benefits (e.g., mental health treatment, maternity care) and their levels of cover (i.e., how much the plan benefits cover you for).

We have two types of plans: value plans and comprehensive plans.

Value plans

Private healthcare and health insurance are expensive, so we designed our value plans to keep your costs down by focusing on cover for serious medical conditions.

Comprehensive plans

The comprehensive plans give you a wider range of cover for health conditions and treatments, and the benefits generally come with higher annual limits.

Find out more about the different health plans and what they cover.
*If you choose the Bronze plan, we only cover your visits to the doctor following your discharge from the hospital.

Step 3 – Personalise your policy

Though often overlooked, personalisation is extremely important in global healthcare. A personalised insurance policy can complement certain lifestyles and make the difference in the quality of treatments if serious health conditions occur. 

Once you’ve picked your health plan at William Russell, you can personalise it with a range of optional benefits and add-ons. For example, not everyone needs cover for expensive care like complex dental treatments, so we’ve made those benefits optional.

If you need them, there are several optional cover choices available with each plan for:

• Well-being: Increase your well-being benefit on the Silver and Gold plans
• Enhanced emergency medical evacuation: Increase your cover for emergency medical evacuations on all plans
• Private hospital accommodation: Choose private accommodation during hospitals stays on the Bronze and SilverLite plans
• Routine dental care: Add cover for routine dental care on the SilverLite and Silver plans
• Complex dental care: Add cover for complex dental care on the Silver and Gold plans
• Routine & complex dental care: Add cover for routine and complex dental care on the Silver plan
• Personal accident cover: Add cover for personal accidents
• Direct billing: Add direct billing for everyday medical care such as doctor visits and specialist consultations*

*Only available in certain countries.

Step 4 – Choose the right excess

When you first started thinking about health insurance, you were probably just looking for a policy to pay for your private healthcare. So, why bother with an excess? After all, an excess means you pay towards your medical bills before the insurance company starts paying.

Nil excesses

Counter-intuitively, not having an excess (known as ‘nil excess’) is unpopular with our members. Why? Having a nil excess means more expensive premiums: sometimes, health plans with nil excess can be 20% more expensive than a plan with the smallest excess available.

Excess examples

Whilst the right excess amount depends on your circumstances, most of our members choose an excess somewhere between US$50 and US$10,000 per claim. Here are a couple of excess strategies that are popular with our members:

1/ Bronze plan with a high excess

If you’re only concerned about cover for serious medical conditions – such as cancer care and hospitalisations following an accident or illness – then chances are you’re considering a Bronze plan. With a Bronze plan, choosing a higher excess might be a good option to save money on your premium. True, you won’t have cover for medical expenses that fall under those amounts. But if you’re mainly concerned with serious medical conditions like cancer, your total medical expenses are going to dwarf you’re excess.

2/ Silver or Gold plan with a low excess

If you’re considering a Silver or Gold plan, then you’re likely interested in cover for everyday medical care such as doctor visits and pharmacy prescriptions. The cost of a doctor visit or physiotherapy session depends on where you live, but they’re unlikely to cost more than a couple of hundred dollars. Now, if you chose a high excess such as US$800 per claim or US$500 per annum with your Silver or Gold plan, you wouldn’t have much cover for your routine healthcare provider visits. That’s why members with these plans typically choose a low or nil excess.

Be familiar with underwriting for expats

When you apply for an insurance plan with us, we assess your medical history, including any medical conditions or injuries you have suffered in the past. It helps us decide the terms on which we can offer you cover.

Since insurance is designed to cover the unexpected, its policies don’t typically cover pre-existing conditions unless specifically agreed beforehand. Medical underwriting helps ascertain what, if any, pre-existing medical conditions will be covered and at what cost. If you’re applying for a policy that includes medical underwriting, you’ll be asked to complete a health questionnaire. It will ask you about aspects of your health and lifestyle, such as:

• If you smoke
• Your age, weight, and height
• If you have any pre-existing conditions
• Your general health

The insurer might also ask for information from your doctor, and in some cases, you may need to have a medical examination. See more on medical underwriting explained here.