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Last month, we told you about a new insurance option for ex-pats living in the Caribbean. Today the folks at Offshore Health Benefits/Caribbean Expatriate Medical Association have asked us to pass along some tips about how to shop for international medical insurance and air ambulance. Here’s what they had to say…
Reinsurance – make sure the proposed international insurance products are underwritten by a strong re-insurer, this is very important (like Lloyds of London and Aetna). Re-Insurers often audit corresponding companies who sell their products. Also, a strong re-insurer should have strict guidelines in place related to Underwriting, Claim Reimbursement, Customer Service, Annual Renewals, Pre-existing Conditions and Product Design. If a corresponding company denies a claim, you should have the right to protest to the Re-Insurer group and this process should be clearly outlined.
Annual Renewals – make sure the international insurance plan that you are considering guarantees an annual renewal each year. Also, make sure that you are not penalized too harshly for poor claim experience. A strong insurance company pools its members by using “age-banded” rating and does not base the annual renewal rate solely on one’s claim experience for the year. This is one of the most important issues related to annual renewals. Many international carriers weigh in a member’s annual claims experience over many other factors. Also, make sure that the international carrier’s international pool of members does not include people who live in the USA for more than 6 months out of any year (may vary). This drives up the rates big time.
Claims Reimbursement – make sure that a reimbursement check can be cut and mailed or wired out within weeks, after a claim filing, and that the member is not penalized with miscalculated exchange rates. DHL or UPS are the preferred carriers for international mailing. On many occasions, monies can be wired to a foreign bank account or directly to a hospital.
Direct Payment & Wire Transfers – make sure that the international carrier can offer a “direct wire” or “guarantee of payment” for costly or expensive procedures. Many carriers require the member to pay for large medical expenses upfront; this is not good, especially for care in the USA. A quality international insurance company and carrier can get on the phone and make things happen and help you with a direct pay to a hospital or provider. You need to deal organizations who will talk over the telephone or in person, as opposed to relying on faxes or e-mails with no or limited follow up. Please note that there are hospitals, clinics and providers abroad which simply do not accept insurance and will require payment ahead of time by a patient. It is good to have a credit card when you travel in case of an emergency.
Brokers – make sure your international broker or consultant has an insurance license. Also, make sure that your broker or consultant has experience in international benefits. International insurance companies often market to domestic brokers who mainly sell in the USA or another country, and dabble in international, as prospects pop-up on their radar screens. Offshore Health Benefits LTD, has been thriving for 12 years, adding new clients each year. Also, it prides itself with a very high annual client retention rate. Experience in international benefit planning is everything, especially in a time of crises. Approximately, 50% of its business comes from client referrals.
Broker’s Fees – make sure your broker or agent is not embedding extra commissions into your rates or charging processing fees. Some brokers add hidden fees and do not mention this to prospective customers. The international carriers pay out commission percentages based on the carrier’s advertised book and annual renewal rates and volume. You should never pay more than the published book rate during your first year of coverage. Many book rates are available on the internet. Beware of “application” fees, it is not necessary to pay these. Also, ask how long they have been in business, many folks dabble and move on to something else.
Medical Air Evacuation and Assistance – make sure that your prospective international carrier has a strong relationship with their Medical Air Evacuation and Assistance partner. Many carriers contract this service out and do not have a solid communication system in place, this is very important. Handling a crises situation correctly and in a timely manner can mean the difference between life and death in some serious situations.
Coverage in the USA – make sure that the international carrier’s PPO (preferred provider organization) or other network (if any) in the USA honors the member’s insurance card at the time of admission or appointment, and has a direct billing relationship. Also, make sure that carrier has provider internet search capabilities that are updated monthly for the members. Members should be free to go to any “western trained” provider of your liking outside of the USA. Many PPO networks offered by international insurance companies in the USA are limited, very limited. Check to see if your current domestic doctor or hospital is in the network prior to joining. If your USA provider is not in the network, ask to see what it would take to have the provider or hospital added. You may consider going out of network, if this is the case, check to see what percentage of the medical visit would be covered. You may also consider changing your provider in the USA. A few international carriers allow the members to “opt out of coverage” and save 20-50% off annual visits; this is good situation for expatriates who have national coverage in their home country. Not every member needs access to medical care in the USA. Don’t waste your annual premium on unnecessary benefits. If you are not from the USA, you may want to “opt” of coverage in the USA.
Annual Deductible and Co-payments – make sure that the international carrier is not imposing a higher deductible for care in the USA. Many international insurance companies out of Latin America and Europe increase deductibles for care in the USA and offer sub par networks. This is not the industry standard. Your overall benefit may be lower in the USA (standard), but your deductible should not change once you return the USA or your home country.
Plan Limitations – always read the plan Exclusions & Limitation Section and ask questions. Please understand that each international carrier has various limitations, especially for pregnancy, organ transplant, mental health, pre-existing conditions, preventive care, RX, air ambulance, and the first 180 days of coverage. There is no such thing as a 100% perfect plan.
Internet Purchase – do not purchase an international insurance plan off the internet without communicating with a knowledgeable broker/consultant first. You may not be getting what you think you are! Some countries are off limits to certain insurers. Offshore Health Benefits audits all of its represented insurance companies and currently has two plans that it does not advise purchasing, contact us for details. Many brokers continue to offer companies & plans who rarely pay claims or put a up a fight to pay claims, it’s unbelievable.
Coverage & Benefits – review the various plan offered by each carrier, many plans do not reimburse on a “Usual, Reasonable & Customary” model. Be aware of this. Also, Outpatient RX Reimbursement, Preventive Care, Organ Transplants, and Pregnancy coverage may not be included with all plans.
Lifetime Coverage Limits – make sure that you review plans that at least offer $500,000 of coverage (for long term 12 month renewable plans). The standard is $500,000 – $2,000,000 per policy. Avoid “travel plans” for stay longer than 12 months. You need a guaranteed renewal.
Choosing Annual Deductibles – check to see if there are limits with annual deductible options. Many carriers do not allow the members to lower their annual deductibles at time of annual renewal or during the contracted year. You may increase it in most cases. Offshore Health Benefits does have a carrier who will allow a decrease in a deductible and allow for a change in coverage (step up rather than down).
Go Direct or Go With a Protected Group or Agency?
Going direct will cost an applicant more in premium dollars and lack of claim services. Offshore Health Benefits uses the power of our client pools to obtain discount not found on Insurance websites. There are so called “groups” out there with no Agent-Brokers or Advocate too assist you with claims (non licensed admin accepting applications) and you may be very upset if these folks can’t help you due to lack of experience, etc.. The main job of any broker is to help choose the correct plan for you and your family and most importantly, fight to have claims paid. It doesn’t charge fees to help, never have, never will. If you talk to people who have had issues with claims, ask them, who is representing you? Every member needs a 3rd party advocate.
The consulting team at Offshore Health Benefits/Caribbean Expatriate Medical Association is available to assist you, your family, or your business group. Its team only works with expatriates, third country nationals and foreign locals.
If you’re interested in learning more about the Caribbean Expatriate Medical Association or for information on plan design, rates, etc., please call (504) 264-3250 or visit its Facebook group page by clicking here.
Click here to read more about obtaining insurance while living in the Caribbean.