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8 Tips For "Long-Term"
(Expatriate) International Health Insurance.
Tips for expatriates, missionaries,
and anyone living outside the USA. |
Key Concept:
The most significant differences in international health insurance are not
in the benefits and rates, but rather in the wording of the plan
definitions and exclusions by which your
insurance
benefits are
actually paid . . . or not paid.
Here are 8 tips and suggestions
intended to help you identify the best choice
for your exact needs and situation.
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| 1. "Pre-Existing Condition"
- Look at the Plan Wording Carefully. |
Virtually all private-sector health insurance plans exclude
coverage for "pre-existing
conditions." A small difference in the wording can make a big
difference in whether or not a medical insurance claim is actually paid .
. . or not paid.
Here are two
examples for illustration purposes:
1. Pre-existing condition: "Any condition which
existed at or prior to the date the policy went into effect."
2. Pre-existing condition: "Any
condition which was diagnosed, treated, or manifested itself in such a
way as to exhibit recognizable symptoms, prior to the date that the
policy went into effect."
Note that in example #1, the definition is very
ambiguous. In this example, you could have a "pre-existing condition"
and not even be aware of it. Examples might include slow growth cancer such
as colon cancer. Another example might be any type of heart disease, which often
goes undetected for years.
If you happened to have a health insurance policy with
such ambiguous wording and came down with a major illness, you could be
in trouble. If doctors determined that your illness existed in any form
at the time your policy went into effect, even if you didn't have any
noticeable symptoms, your claim would be denied.
Important: If
you are over age 40, I strongly recommend that you avoid any insurance policy which
contains an ambiguous definition of "pre-existing condition"
as described in example #1 above. Even if you are under age 40, this
may be a good idea as well.
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| 2. A
Recent Routine Check-Up Is Recommended For Ages 40+ |
For people over age 40, if you are in good health, then having
your good health documented
prior
to becoming insured (or soon thereafter) could be of great value
in the event of a significant medical claim later.
This documentation could be in the form of a recent routine
physical exam. Or, it might be the records of one or more recent visits to a
family doctor (for a cold or flu for example), where your doctor would have gathered routine medical information such as height, weight,
blood pressure, etc.
If you do not have any such documentation of good health, then we recommend
that you have a routine physical exam before, or soon after your insurance
goes into effect.
Unless you are over age 60, having recent documentation of good health is
usually not a requirement when you apply for most insurance plans. We
make this recommendation because we work for you (guarantees)
and in our experience, claims disputes are not uncommon.
In the event of a
dispute, your having recent documentation of good health helps us to help you.
While we strongly recommend this for people over age 40, we also believe
that having recent documentation of good health is a good idea for
everyone.
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| 3. Who
Regulates Your International Insurance Company? |
In the USA, health insurance is primarily regulated by the
individual States. If you are a USA resident traveling abroad or a
visitor to the USA, we strongly recommend that you seek out insurance
from companies that are registered (either "admitted" or
"approved") to legally conduct business in your State.
Here is a brief look at two ways an insurance company
might be registered to legally conduct business in your State. (The exact
terminology may differ from State to State.)
"Admitted" - The insurance company is
fully
regulated under your State's "life and
health" insurance laws.
"Approved" - The insurance company operates
under "surplus lines" insurance laws and is not fully regulated.
However, if the State obtains credible evidence of unsatisfactory claims
practices or unsatisfactory financial condition, then the State may revoke the
"certificate of authority" under which the insurance company legally
operates in that State. Such action could influence or encourage similar action in
other US States and even in other countries.
Note: We avoid
insurance plans from companies that are not registered. All plans found here
are backed by insurance companies which are either "admitted" or "approved"
where offered.
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| 4. When
Comparing Health Insurance Plans, Check The "Exclusions." |
One of the first things that experienced insurance
agents look for in a health insurance brochure is the summary or list of
"exclusions." Often found in smaller print,
"exclusions" are not covered under the plan. Sometimes, what's NOT
covered can be just as important as what
IS
covered.
Many exclusions are typical (i.e. acts of war,
self-inflicted injuries, custodial care, etc.), while others are not and
should be carefully considered when comparing health plans.
All comprehensive international insurance plans contain an
exclusion for "pre-existing" medical conditions. You
should carefully read and understand this exclusion.
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| 5. The
Health Questionnaire - "Medical Underwriting" |
Long-Term, Annual-Renewable or "Permanent" medical
plans are designed to
provide comprehensive health insurance coverage for at least one year
or longer. These plans are issued based on "medical
underwriting" through the use of a detailed health
questionnaire.
Personal medical history could be a determining factor
when selecting a company to apply for insurance. Based on personal medical
history, some people could be declined for insurance by one company,
but accepted (or accepted with a medical "exclusion rider") by a
different company.
Note: For the plans found here,
if your health questionnaire is answered
truthfully and accurately, and you are accepted for coverage, you cannot be
cancelled or singled-out for future rate increases due to medical claims.
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| 6. Activate
Your Best Memory When Completing The Health Questionnaire. |
It is important to
remember that by nature, the human mind tends to forget or minimize past or
present illness. A positive mental attitude can beneficial in the healing
process, but failing to properly disclose a material health condition on your insurance
application could jeopardize your coverage entirely.
A "medical audit"
(obtaining prior medical records, researching medical information bureaus,
etc.) is often done when there is a major
claim. By contract, the insurance company can revoke coverage and return all
premium if it can be shown that the policyholder failed to disclose a material condition on the application.
Never give the insurance company a potential way out
of paying a major claim. Activate your best memory when completing the
health questionnaire. (Your
questions are invited.)
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| 7. For A "Yes" Answer on Your Health Questionnaire - Note
The Positives. |
For every "yes" answer
on your health questionnaire, be sure to give a clear and complete explanation.
Your completed health questionnaire becomes a part of your
insurance contract, so it is important to be complete
and truthful
when answering all questions. When applicable, be sure to state the
positives when giving an explanation to any "yes" answer.
If you have a condition that is well controlled by medication, give
complete details. For example: thyroid, take 5mg (medication) daily, well controlled
for (x) years.
If a previous medical outcome was good,
clearly state so in writing. When appropriate, consider descriptive terms such as "full recovery," "no
further symptoms," and "no further treatment or
consultation required."
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| 8. Lower Your
Premium By Electing A Higher Deductible. |
The "deductible" is the amount you pay in
eligible expenses before your insurance begins to pay. Most plans offer a choice
of deductibles, such as $250, $500, $1000, etc. Today, most plan
deductibles are cumulative, i.e. one deductible per policy period (up to one
year), rather than a separate deductible "per incident."
There are 2 reasons why we normally recommend that you
elect a higher deductible.
1. A higher deducible lowers your
premium.
For long-term plans on average, the savings often exceed 10%
on the next higher deductible option.
2. In the event of a medical claim, insurance companies often
request copies of
prior medical records. This is to show that your claim is not the
result of, nor related in any way to a "pre-existing" medical
condition. In the event of one or two small dollar-amount claims, the
need to provide prior medical records may not be worth
your time and effort.
Remember, health insurance is primarily for the
big expenses.
Consider
saving money by electing the highest deductible with which you
feel comfortable. (Your
questions are invited.)
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Key Concept:
The most significant differences in international health insurance are not
in the benefits and rates, but rather in the wording of the plan
definitions and exclusions by which your
insurance
benefits are
actually paid . . . or not paid!
Here are 8 tips and suggestions
intended to help you identify the best choice
for your exact needs and situation. (Note: Comparisons below are for guidance
purposes only. Please confirm all details in plan brochures.)
Top of Page
|
1.
Coverage Period (or
Policy Period) |
This is a seemingly obvious definition, but we start with
this term as it is used in other definitions here.
If a medical condition is
first diagnosed or treated during the
"Coverage Period," then eligible insurance benefits will be paid (subject to policy
limits).
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| 2.
Benefit Period (very important!) |
* The "Benefit Period" is
not the same as the
"Coverage Period." The "Benefit Period" is the maximum period of time
during which an insurance policy will pay benefits for a covered
condition that was first diagnosed or treated during the "Coverage
Period."
The
"Benefit Period" may extend beyond the end of the "Coverage Period"
(and often does). In many cases, a longer insurance Benefit Period
is desirable.
* If temporary insurance is your only health insurance,
then an extended Benefit Period is a vital feature.
Note: There are temporary
international health insurance plans being sold today whereby
the Benefit Period ends when the Coverage Period ends (unless
hospitalized or some other extreme contingency). This is OK if you have
full coverage upon return to your Home Country. Otherwise, if your plan
has no extended Benefit Period, then the last few days or weeks of your
insurance coverage could prove
to be of limited value.
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| 3.
"Pre-Existing Conditions" (very important) |
All private health insurance plans contain "exclusions," which are
conditions, circumstances, or treatments which are expressly not covered.
One common exclusion is for "pre-existing conditions."
The definition of "pre-existing condition"
varies by plan. Some plans have a clear or less ambiguous definition,
using terms such as "symptoms," manifested," "diagnosed," etc.
On the other hand, some plans have an ambiguous definition of
"pre-existing condition," which could be interpreted less
favorably for you.
(
)
A check mark indicates some coverage for pre-existing conditions.
A Comparison of the "Pre-Existing Condition"
Wording:
|
Diplomat
Plans - Pre-existing Condition Definition:
Any injury or illness which was contracted or which
manifested itself, or for which treatment or medication was prescribed 3
years prior to the effective date of this insurance.
Coverage for pre-existing,
Diplomat
Plans - The "Emergency
Medical Evacuation" benefit is not subject to the "pre-existing
condition" exclusion on Medical Benefits.
|
|
Liaison International
- Pre-existing Condition Definition: Any
Injury or Illness which meets the following criteria: a) condition(s) that
would have caused a person to seek medical advise, diagnosis, care or
treatment during the 36 months prior to the Effective Date of coverage under
this Policy; b) condition(s) for which manifestation, medical advise,
diagnosis, care or treatment was recommended, received, or noticed during
the 36 months prior to the Effective Date of coverage under this Policy.
*** For travel outside the United States and Canada, the period
is 12 months instead of 36 months.
Coverage for pre-existing,
Liaison International
- if the Insured Person is a United States citizen, the
exclusion is waived for the first $15,000 in eligible medical expenses
incurred outside the United States and Canada (for persons age 65 and
over, the amount is $2500). This waiver does not include coverage for
known, scheduled, required, or expected medical care, drugs, or
treatment existent or necessary prior to the effective date of this
program. (There is no minimum purchase required for this benefit.)
Coverage for pre-existing,
Liaison International -
The "Emergency
Medical Evacuation" benefit is not subject to the "pre-existing
condition" exclusion on Medical Benefits.
|
|
Atlas Series
- Pre-existing Condition Definition: A Pre-existing Condition is any Illness, Injury or medical condition or chronic or recurring Illness or Injury or medical condition, including any associated complications or consequences, which existed at or during the
2 years immediately preceding your Effective Date.
Coverage for pre-existing,
Atlas
International
- if you are a US citizen under age 70, you are covered for
a sudden and unexpected Acute Onset of a Pre-existing Condition up to a maximum of $15,000 (see
"Review Coverage" at bottom of
quote page for details).
Caution: In
the Atlas Series, the wording of the definition of "pre-existing condition" is
more ambiguous and can
be broadly interpreted, as it reads "any
medical condition which existed . . . ," even if there were
no recognizable manifestations or symptoms. On the other hand, the Atlas
Series offers certain advantages (limited coverage for "pre-existing"
conditions, the option of home country
treatment) which for some people would more than offset this
disadvantage. |
In Summary:
The plan definition of "pre-existing
condition" and possible coverage for such conditions (if any)
can be key factors to when reviewing temporary insurance plans. (Your
questions are invited.)
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| 4. Do
You Want The Option Of Home Country Treatment? |
On occasion, someone traveling abroad suffers an injury or
illness, whereby they wish to return to their home country
(including to the USA) for follow-up treatment and
recuperation.
If you maintain domestic health coverage during your
travel abroad,
then this plan feature may not be of importance to you. However, if temporary international health insurance
will be your only health insurance, then how a policy treats
"Home Country Treatment" can be a very important consideration.
A Comparison of Plan Options for Home Country
Treatment:
|
Diplomat
Plans - This plan contains a unique Home Country
option (add 10% of premium). If elected, this option allows for (1) Home Country
Coverage during one incidental trip back home (including to the USA) and (2)
Home Country Treatment for an
illness or accident first diagnosed or treated while abroad. The
Home Country Treatment coverage limit is $75,000 maximum (see brochure for details). |
|
Liaison International
- This plan shall pay for Covered Expenses incurred in your
Home Country up to $5,000 maximum, for conditions first diagnosed
or treated while traveling outside of your Home Country. (This
$5000 limit does not apply for Emergency Evacuation or
Repatriation benefits.) |
|
Atlas Series
- Currently contains no exclusion for travel for treatment. Therefore, follow-up treatment
for a covered condition first
diagnosed or treated while outside of your Home Country, will continue
to be covered for the remainder of the Benefit Period, anywhere you
wish, including the USA. |
Note: This is
NOT the same as "Home Country
Coverage," which is an optional or built-in benefit on many temporary
international plans. "Home Country Coverage" provides limited,
short-term medical coverage during one or more short-term trips back home.
In Summary:
* If you are a US citizen and you will NOT
maintain
domestic US health insurance while traveling, consider
the
Diplomat
Plans (with Home Country option) or the
Atlas
Series.
*
If you are a visitor to the
USA, or a US citizen who maintains USA health insurance while traveling abroad, consider the lower-cost
Liaison
International.
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| 5.
Definition of Home Country |
Temporary health and travel insurance plans cover you while
traveling "outside of your Home Country." For most people, this definition is straightforward. However, you should
understand how each plan defines "home country" to be sure you
are eligible.
A Comparison of Plan Definitions of "Home
Country:"
|
Diplomat
Plans - The country where an eligible person(s) has
his/her "true fixed and permanent Home established and to which he/she
has the intention of returning." Under this definition, your
citizenship
is not a factor. |
|
Liaison International
- The country where an insured
person has his/her "true fixed and permanent Home and Principal
Establishment." Under this definition, your citizenship is not a
factor. |
|
Atlas Series
- If you are a US citizen, your Home Country is the United States,
regardless of the location of your Principal Residence. If you are not a US citizen, your Home Country
is the country where you "principally reside and receive regular mail."
|
Note: temporary health insurance plans
do not go into effect until you leave your Home Country (as defined in
the policy), and
coverage typically terminates upon your final return. Exception: many plans contain limited coverage
during one or more "incidental trips" back to your Home Country for a
limited period of time, when you are able to demonstrate (for
example, with a
round trip plane ticket, etc.) the intention of resuming your travel abroad.
Important note for US Immigrants:
If
you are a recent US immigrant, please see our plans designed especially for
you (see US
Immigrant). As noted above, temporary travel insurance covers you while
traveling outside of your "Home Country." As an immigrant, the USA is now your home country and
ordinary temporary travel plans are not intended for you.
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| 6. Who
Regulates Your International Insurance Company? (important) |
In the USA, health insurance is primarily regulated by the
individual states. If you are a USA resident traveling abroad or a
visitor to the USA, I strongly recommend that you only consider insurance
from companies that are registered (either "admitted" or "approved") to
legally conduct insurance business in your State.
Here is a brief look at two ways an insurance company
might be registered to legally conduct business in your State. (The exact
terminology may differ from State to State.)
"Admitted" - The insurance company is
fully
regulated under your State's "life and
health" insurance laws.
"Approved" - The insurance company operates
under "surplus lines" insurance laws and is not fully regulated.
However, if the State obtains credible evidence of unsatisfactory claims
practices or unsatisfactory financial condition, then the State may revoke the
"certificate of authority" under which the insurance company legally
operates in that State. Such action could influence or encourage similar action in
other US States and even in other countries.
The Insurance Company:
|
Diplomat
Plans - insured by The Insurance Company Of Pennsylvania (a
member of the AIG Group), rated A++ by A.M. Best (their highest rating).
This company is "admitted" (fully regulated) in all 50 states and D.C. |
|
Liaison International
- insured by Virginia Surety Company, rated "A-" by
A.M. Best.
This company is "admitted" (fully regulated) in 47 states and D.C. (In
NY, OR, & KS, the insurer is Lloyd's of London.) |
|
Atlas Series
- insured
by Lloyd's of London, rated A- by A.M.
Best.
Lloyd's operates as an "approved,"
non-admitted insurer in all states of the United States except IL and KY,
where they are "admitted."
|
Why
depend on
insurance from a company that is not legally registered in your State?
(Your
questions are invited.)
Top of Page
| 7. Lower Your
Premium By Electing A Higher Deductible. |
The "deductible" is the amount you pay in
eligible expenses before your insurance begins to pay. Most plans offer a choice
of deductibles, such as $250, $500, $1000, etc. Today, most plan
deductibles are cumulative, i.e. one deductible per policy period, rather than a separate deductible "per incident."
Here are 2 reasons why we normally recommend that you
elect a higher deductible.
Reason #1.
A higher deducible lowers your premium.
For temporary plans, you save on average about 10% with the next higher
deductible option.
Reason #2. In the event of a medical claim, insurance companies often
request copies of
prior medical records. This is to show that your claim is not the
result of, nor related in any way to a "pre-existing" medical
condition. In the event of a small claim, the
need to provide prior medical records may not be worth
your time and effort.
Remember that insurance is primarily for the big expenses, to keep you from going broke or possibly to save your life.
Consider
saving money by electing the highest deductible with which you
feel comfortable.
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| 8. A
Higher Coverage Maximum for USA Visitors. |
Temporary health insurance plans offer a choice of
coverage maximums, typically ranging from $50,000 minimum up to $1,000,000 or
more.
When considering
Temporary health insurance, realize that medical bills exceeding $50,000 are not uncommon in today's
world, especially in the USA.
Suggestion: For travel
to the USA, we
recommend electing a medical maximum of at least $100,000 or higher. Simply put, what good is a $50,000 policy if you
require $100,000 or more in medical treatment?
Diplomat
Plans
Liaison International
Atlas Series
Your questions are invited
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