How to choose the best health insurance for expats

How to choose the best health insurance for expats

Health insurance might be the last thing you think about when you move abroad as an expat. 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.

Types of expat insurance

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

• Local health insurance
  Expats who live permanently in another country sometimes purchase domestic health insurance policies. Whilst this is fine for some expats, it can be restrictive. For example, you may only be entitled to treatment in low-quality hospitals and won’t necessarily have medical cover for trips abroad.
• Travel insurance
  This sometimes includes cover for accident and emergency treatment, but usually, it covers you only for temporary trips abroad.
• International health insuranceInternational or expat health insurance is a good solution for expats who want access to the best hospitals and doctors where they live, and who want full coverage when they travel or make trips home.

An international policy seems like the obvious choice. The downside? International health insurance is more expensive than both travel 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 have very different public healthcare systems as many expats from European countries enjoy at home.

Depending on the characteristics of your country of relocation, you will certainly not opt for the same type of expat insurance. 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. Country of residence – The country where you’ll be living & working, or spending most of your time
2. Country of nationality – The country that issues your passport
3. Health plan – We help you access private healthcare around the world: the health plan you choose sets out the limits & restrictions on the treatment you can receive
4. Member – When you purchase a health plan, you become a member of William Russell
5. Period of cover– The duration of your health plan (usually one year)
6. Benefit – A specific medical treatment or medical service that is recognised by a health plan & covered up to a specified limit
7. In-patient – Someone who’s been formally admitted to a 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 the 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. Waiting period – The length of time you must be covered by your plan before you can claim for a particular benefit

Step 1 – Find a plan that covers your destination

At William Russell, we provide health insurance to expats in over 140 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. They are:

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. Expats 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.

In countries that rely on private healthcare, you will definitely need health insurance. 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 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 provider that covers your destination is essential to avoid wasting time.

All William Russell expat health insurance plans come with a choice of six different ‘zones’ of international cover.

Step 2 – Pick the right plan

Our research shows that when would-be expats start thinking about their health and well-being abroad, it’s usually considered in very general terms. Most people simply want to ensure they have access to private care. But while most health insurance gives you access to private healthcare, the health plan you choose defines the rules and limitations of that access. That’s why it’s so important to pick the right plan.

Many providers have will provide standard and optional benefits. As standard, all our health plans 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 plan: value plans, and comprehensive plans.

Value plans

Private healthcare and health insurance are expensive, so we’ve 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

We live in an age of consumer choice and personalisation. While most people usually think of consumer choice with respect to lifestyle matters, personalisation is extremely topical in healthcare. For example, our health plans cover tests to sequence the genes of cancer cells, which can help oncologists give you a treatment plan personalised to your condition.

We think it’s only right that you can personalise your health insurance plan to suit your circumstances too. So, once you’ve picked your health plan, you can personalise it with a range of optional benefits and add-ons. Not everyone needs cover for expensive benefits like dental treatment, so we’ve made those benefits optional.

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

• Well-being: Increase your well-being benefit on the Silver and Gold plans
• Emergency medical evacuation: Increase your cover for emergency medical evacuations
• 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 plan
• Complex dental care: Add cover for complex dental care on the Gold plan
• Routine & complex dental care: Add cover for routine and complex dental care on the Silver plan
• Personal Accident cover: Add cover for personal accident
• Direct billing: Add direct billing for everyday medical care such as doctor visits and specialist consultations*

*Only available in certain countries.

Step 4 – Pick 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 member choose an excess somewhere between US$50 and US$10,000 per claim. There 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 doctor visits. That’s why members with these plans typically choose a low or nil excess.

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.

Insurance is designed to cover the unexpected, and so policies don’t typically cover pre-existing conditions unless this is specifically agreed. 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:

• whether you smoke
• your age
• any medical conditions you’ve had in the past or currently have – these are called ‘pre-existing conditions’
• your height and weight
• 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.