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Stake a Claim - International Private Medical Insurance
Why buy IPMI?
International private medical insurance, like domestic PMI provides insurance to cover the costs of private healthcare. The plans have been designed to meet the needs of expatriates, frequent travellers and business people working overseas and offer a number of benefits specific to the needs of these customers. For example:
• Portability – international plans often provide cover in large geographical areas, or worldwide, so you can keep the same plan if you move around a lot.
• Airfare costs for you to visit a critically ill family member.
• Emergency evacuation by air ambulance when there is no medical treatment available in your location.
• Cover for primary consultations with a GP.
• Bringing home your body if you die abroad.
• Cover for treatment needed as a result of terrorism – an increasing threat for everyone.
But the real reasons for buying IPMI in the first place, as well as the reasons for claiming, may not be due to these unique factors.
General reasons range from the obvious: covering the costs of medical treatment and other medical expenses to save money in the long run; to the more abstract: peace of mind and protection when you are in an alien environment away from home. Or you may want to cover more specific things, such as GP visits maternity treatment or wellness (preventative) tests.
In some places the law requires you to have private medical insurance in place before you can enter a country. This is the case in Saudi Arabia and Abu Dhabi.
However, whatever your reason for buying a plan in the first place, the claims still tend to follow the same pattern.
A “typical” claim?
Most claims are for out-patient treatment for minor ailments such as upper respiratory tract disorders (for example the common cold, sore throat, sinusitis and laryngitis), ear infections, abdominal and muscoskelatal (muscle/joint) pain and slight injuries. You will probably claim for an initial visit to your doctor (if their plan covers primary consultations), medication and follow up treatment, which may be with a specialist, physiotherapist, alternative therapist or your GP.
If you have dental or optical treatment included in your plan you are likely to make a claim for it.
Similarly, if a plan includes cover for maintenance of a chronic condition (one that cannot be cured), such as diabetes, hypertension or arthritis, claims are common. Most plans require that the condition manifested itself after the cover began. However, once a condition is diagnosed as chronic it will almost always need ongoing treatment, hence the high level of claims.
In fact, any benefit for guaranteed treatment, such as wellness (preventative) or maternity treatment, will come up regularly on a claim form.
What’s not so common?
The pattern of claims follows the pattern of illness in general. So, there are more claims for minor ailments and fewer claims for more serious illnesses or accidents.
Emergency evacuation, although a key part of an IPMI plan, is not such a common subject of a claim. However, when it is needed, it is a life-saver.
One InterGlobal member, a 56 year old man living in Nigeria, was found to have an enlarged aorta (the largest blood vessel in the body, that extends from the heart into the abdomen) when he went for a CT scan. Follow up tests showed that he had an aortic root aneurysm (a blood filled sac that had formed in the weakened part of a blood vessel in his heart). This meant that he could potentially die at any time: life-saving surgery was needed. The patient was evacuated from Nigeria to South Africa to have major heart surgery.
In all, the patient stayed in South Africa for a month, including seven days in hospital while he underwent surgery, a week for pre-operation tests and two weeks for post-hospitalisation treatment. The costs, which totalled 322,000 South African Rand (over £20,000) and included his evacuation by air ambulance, were covered by his IPMI plan.
Getting what you want
No IPMI plan will cover every single medical eventuality. So, to make sure that you can claim for the things that you want or need to, you need to find out:
• Whether there are legislations or regulations specifying what level of cover you must have. For example, legislation in Abu Dhabi in the United Arab Emirates requires women expatriates’ PMI plans to cover them for pre-existing medical conditions and maternity treatment (for women).
• Whether there are things that you will need to, or would be sensible to cover because of your location. For example, in some remote locations in Asia or Africa, as the case study above illustrates, adequate emergency treatment may not be available locally so benefit for emergency evacuation is a must.
• Whether there are any things that you are expecting or assuming will be covered. For example, you might assume that you will be covered for treatment for pre-existing conditions or that your plan will cover primary consultations. However, not all plans cover these so you will need to investigate only those that do.
• Whether there are any things that you specifically want covered. For example, dental treatment, wellness tests, psychiatric treatment or extras like a visit to a critically ill relative or legal expenses.
Above all, make sure you read the table of benefits and plan rules and, if in, doubt, check with the provider. By understanding your cover from the outset, you can avoid any issues that may arise when you make a claim. If you are in any doubt as to whether a plan will suit your needs, seek independent advice from a broker or financial adviser.
Andrew Sandilands
Compliance Officer
InterGlobal
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