Almost all the expatriate plan providers offer cover in Area (1) Europe, Area (2) Rest of World and Area (3) World-wide cover, inc USA/Canada. However, few of these companies wish to consider cover for permanent residents of the USA, which has the most expensive healthcare systems in the World. There are often domestic legal restrictions against permanent residents, without overseas addresses outside of their present country of residence, e.g.: France, Switzerland or the USA, taking up international healthcare or medical insurance plans. This does not apply to expatriates in most cases, who by definition are "roving residents" located in one country, for perhaps two or three years, before returning to their country of passport and origin. An expat, almost by definition, is on the move, outside the taxpayer net of his/her host country. Their substantial place of residence is considered to be elsewhere.

In other words, many Providers of international medical insurance will be happy to offer insurance cover to a couple from the UK, with a London home, who spend six months a year in Florida too, at a second home. By definition, these lives are covered under foreign jurisdiction, not USA Federal or State Law, as they are temporary residents in the USA only, with their main homes and addresses (of contract) in such as the UK or elsewhere. Dispute or claim would be based in the UK under UK law, with clients using a UK address too, in the majority of cases.

These are grey areas of jurisdiction for domestic Regulators and also for Insurance Underwriters.Exposure and risk of insurers to large USA losses or medical claims, is often a deciding factor in limiting the amount of elective or emergency or holiday medical cover a Plan Provider will offer. The French Government too, as are many other European Governments are fairly protective of their domestic medical insurers and will insist that permanent foreign residents take out domestic cover and pay domestic health payments and taxes.

Notwithstanding this point, it is our view as Independent Healthcare Insurance Advisors, that no offshore or foreign insurance contract can be declared illegal by any domestic national government regulator if the client holds a foreign passport and is also domiciled in another country or has another substantial home in their country of origin. i.e.: Bone Fide International Health Insurance contracts, cannot be deemed illegal by a domestic regulator, such as that of France or Switzerland or other EU countries either.

However, the situation for expatriates in the USA is a little more complex as many insurers are wary of exposing themselves to potentially huge medical costs for their client expats, who intend to reside in the USA permanently. There are clear distinctions between individuals intending to live or work in the USA for a period of time or part of each year, and those intending to become permanent residents, (green card holders) or becoming citizens of the US. We understand that domestic USA legislation insists that permanent foreign passport holding residents, with a green card, must take out USA based insurance plans, not international plans, (with exceptions for those with multiple domiciles or homes in other countries, where they may also reside for part of the year).

National Governments want "the new breed of high net worth patients" to come to their countries for medical treatment, but also want to protect their domestic insurance market. They cannot have it both ways if they discriminate against the expatriate community, by legislation which forces the expat to limit their location of cover to domestic only. Expats want good international healthcare plans, without boundaries, valid world-wide.

The situation in France is similar to this, but complicated by new European Union legislation under consideration and new case law concerning healthcare across the community for all EU citizens. For example, many UK citizens may soon have the right to take their elective care for a hip replacement in another EU country then send the bill quite legitimately to their local Healthcare Trust in England. Matrix (B) shows the wide variation available from our many Providers concerning premium frequency and also currency of payments available. In any event it is always better for expatriates intending to relocate, on any basis, to first contact an independent specialist brokerage or consultant in this field for advice before traveling.

Matrix B - Frequency and currency of payments by provider
Company	GB Pounds	US Dollars	Euros		Yearly	Semi Annual	Quarterly	Monthly
Interglobal
William Russell
Morgan Price
Bupa
Goodhealth						*
IHI Danmark
Expacare
MNUI
Integra Global
PPP
Medicare
* Global Health Only

Issues such as "pre existing medical conditions", emergency evacuation, terrorist cover, travel cover out of area, changing from one insurer to another, benefit costs of catastrophic cover or Inpatient cover only against comprehensive, ages, sex, smokers or not, maternity considerations, nationality of passport and occupation, can all affect the choice of plan to be taken. The cheapest is not always the best and the most expensive or biggest "brand name" not always best value. Review at least three choices of plan from separate companies first, from your Advisor, before deciding on a plan.