International health insurance is an area where quality and service count. Mark Coleman outlines some questions for providers in the international PMI market.
It is relatively easy to deliver high quality medical care in your own domestic environment where the patient is familiar with the language, culture and processes. Delivering the same quality of care – and peace of mind – in unfamiliar, sometimes hostile territory presents its own specific challenges. Where standards and costs vary dramatically and the patient will be feeling at their most vulnerable, expertise and experience at mitigating those risks really comes into its own.
Yet all too often insurers operating in this market have developed their international proposition around what they offer to domestic groups. For example, increasing the benefits levels here and there to make them more useful to international employees – and an approach that has not gained the market a reputation for service excellence among clients. This is partly because the International PMI products available in the marketplace are not homogenous or, indeed, interchangeable. Here are some questions to help uncover the very real differences in the benefits and services on offer, subtleties in policy wording and the practises that need careful analysis.
Q: Which assistance company do you use and how experienced are they?
A: The assistance industry has its share of the very good, very poor and the untested. It is important to explore the vendor’s true capability and experience.
Q: What medical assistance services are included in your basic service offering?
A: Some carriers bundle certain medical assistance services into their core offering, while others make this a fee-for-service option.
Q: Who are the staff delivering international medical monitoring and care management? Where are they located? What is their international clinical experience?
A: The most effective care managers do not simply receive information. Seek an insurer that has a balance of US expertise to manage the high cost situations likely in that region along with regional expertise to provide a broad level of claims management.
Q: Do you employ a full-time international medical director? What is his/her international clinical experience?
A : Few health insurers have a full-time international medical director, much less one with international clinical experience. Their presence indicates a commitment to quality medical care.
Q: What is the selection criteria for inclusion on your international provider directory?
A: There is no single international qualification, accreditation standard or process applied by health insurers. Answers to this question will range from those who simply provide a directory of known providers, similar to the phone book, and compiled without any selection criteria. On-site evaluations by medical professionals represent the ‘gold standard’.
Q: Can we rely on you to ensure our healthcare provision is compliant with international legislation?
A: This is one of the areas where international PMI providers have the opportunity to distinguish themselves. It is easy for employers to fall foul of the frequent changes being made to healthcare legislation around the world. By offering access to expertise and sharing it with their clients, health insurers have the opportunity to add value.
Many clients set considerable store by the information provided as an integral part of their healthcare service because – as primarily Human Resource (HR) people – it is expertise they simply don’t have at their fingertips. Generally, HR specialists have to call upon the resources of an in-house legal counsel, or other back-office support, in order to obtain important information such as changes to international healthcare legislation. This can make them vulnerable to non-compliance over changes such as the recent Dutch Healthcare Act in the Netherlands or the ongoing legislative changes occurring in the UAE at present. Yet international PMI providers have exactly that kind of information at their fingertips. They should be offering clients a full breakdown of legislative changes and the compliance implications. This should be supplemented with the usual information aimed at safeguarding the welfare of expatriates, such as location information, or country guides – usually available online via a secure member website.
Q: As a healthcare provider, can you supply our business with meaningful management information?
A: Without management information, clients can be severely disadvantaged in planning for human resources and financial issues. But it is not simply a matter of providing information. The true value of management information lies in the quality of the data and the contribution it makes to the client’s decision-making process.
For larger clients, effective management information should have both a quantitative and qualitative element. Since claims are the key driver of costs, that means agreeing a set of key indices that will enable them to track claims performance on a monthly or quarterly basis – identifying common healthcare issues, total claims paid and the cost per employee. Without that data, it is impossible for our clients to know how they are performing against budget – with it, they are able to make informed financial plans for the healthcare needs of their international assignees.
In this mutually beneficial process, quantitative management reporting also enables international PMI providers to clearly differentiate their service offering from that of the competition and demonstrate the very real benefits to the client of important initiatives such as networks. For example, CIEB is able to report both gross and net claims figures to clients whose members use its US Preferred Provider Organisation, which will typically demonstrate a real cost saving to the client of 30-40%. For clients to be able to compare and review their healthcare spend, it is also essential that management information is available and reportable. For instance, with US healthcare costs being amongst the most expensive in the world, clients need empirical evidence of the relative difference in healthcare costs in order to draw meaningful comparisons when they come to review.
But most importantly, meaningful management information is not simply about money and metrics. With the welfare of assignees so closely aligned to the success of the business initiative, one of the most valuable aspects of management information is to help employers identify issues, trends and benefit needs – and effectively safeguard the welfare of their assignees.
Q: Why not use the local healthcare provider in the destination country?
A: For brokers and employers, the real challenge of expatriate healthcare is to overcome global variations in healthcare cover. It is relatively easy to arrange healthcare cover for a single country of destination, but in reality most expatriates will be mobile within a region. For some employers, there is the temptation to simply enrol their expatriates into the local domestic healthcare plan but this is a solution with many potential pitfalls. Localised healthcare can be at best expensive for their employer (picking up the bill for additional cover for business travel on a piecemeal basis) or, at worst leaves the expatriate exposed to the risk of finding they are without cover when they need it most.
Global healthcare cover eliminates those risks. At the same time, it is worth asking whether your international PMI provider can also help you close the final loop. Corporate travel insurance may not be a big ticket sale, but it naturally complements International PMI. This gives your clients the opportunity to leverage their relationship with their PMI provider and ensures they receive a seamless service – possibly one that bundles International PMI, UK domestic PMI and business travel insurance into a seamless whole. A situation in which their broker will have added value to their purchasing power.
Mark Coleman, director of international sales (UK) for CIGNA International Expatriate Benefits (CIEB)
