I have a business client in need of international private medical insurance. He is a software designer looking to take up a government contract in Chad. He is only 32 but is 287lb and has type two diabetes. Apart from an obvious loading, what else should I be considering in this iPMI case?
Guy Jones, managing director, Berwick Devoil Healthcare
The client must consider many issues: first, both the UK and US governments are not recommending travel to Chad at this time due in part to the risk of terrorism. Most medical insurers have exclusions or restrictions relating to terrorism. Insurers could even void the cover if he travelled against government advice.
The length of the contract would depend on whether he would be better off taking comprehensive travel insurance or a full-blown iPMI scheme.
The next issue is the underwriting on the policy, some medical insurers might load the premiums for his weight, but the exclusion of the diabetes would be the biggest concern. Diabetes comes with many underling issues, that coupled with his weight, could mean that heart conditions could also be excluded.
Although many international medical insurers have a chronic condition benefit, given it is pre-existing, this would be excluded by most, including travel insurance and iPMI. Some insurers may ask for a GP's approval to the travel.
If we could find a policy that would not exclude the client's pre-existing medical conditions, the poor medical facilities in Chad will still need to be considered. He must have evacuation and repatriation cover.
Malaria and water-borne diseases are common. Poliomyelitis, measles, cholera, and Aids/HIV are prevalent in Chad, all of which can lead to hospitalisation. Ensuring adequate cover for these conditions is essential. There are a few insurers who are proactive in African countries, so that is where we would recommend starting.
Nic Brown, European sales director, Aetna
Given the remote location of your client's contract and their chronic condition, two things are key: comprehensive cover incorporating evacuation and individual healthcare support.
In this instance, our recommended approach would be to cover the client under a plan that specifically suits globally mobile individuals. The client is located in an area where medical facilities may well be limited, so they will need to be assured that the costs of travelling to an alternative facility for treatment will be covered.
The adviser should also consider that the client may also need in- and out-patient cover, specialist consultations and vaccinations. They may find the option of being evacuated to an alternative medical facility of their choice, following an illness or accident, appealing.
Because of the client's diagnosed diabetes, they would need to be medically underwritten on an individual basis to ensure they are covered in the best way possible to manage the condition.
Perhaps look for insurer options not limited to exceptional case-by-case underwriting in the case of this client. Diabetes is a chronic condition and control is critical to limit the development of complications for the client.
A package that offers additional support services can help with such considerations, including: a health risk assessment with individual recommendations; and support in helping the client manage their own care and individual health goals.
Adam Paice, director, Medical & Life Solutions
There are two areas to focus on here: the technical and the geographic. From a technical point only, we would initially need a full application and probably the completion of a diabetic questionnaire. Unless he is 6ft 7in plus tall and very muscular, he can expect a high loading, as his body mass index calculation could come out extremely high, so linking with the known chronic condition.
An exclusion for diabetes and any related condition/complications is guaranteed. Some insurers may/will require full medical and the end result may still be a full-decline-of-terms letter.
Geographically, details of where the client will reside in Chad and for how long will be required. With any cover it is essential he has evacuation and repatriation without restriction.
Ideally, this would mean evacuation that is not just upon a life threatening medical condition. This is because in general, medicine and medical facilities are in very short supply in Chad. In the capital of N'Djamena there are only two medical clinics which offer international standards.
Before going, the client will need to have a yellow fever vaccination. Failure to do so may result in a vaccination being administered, for which a charge will be made.
If the client is fit and well, with his condition under medical control, he may consider Chad a safe bet. If not, he may find the change difficult, and without the NHS handy to treat his diabetic condition he may wish to re-consider the posting.
