With all but a handful of countries lifting their pandemic travel restrictions, the world is open for business again. As corporate and expat expectations have shifted, the international medical insurance market has had to adapt too.
For those taking out cover, health has never been more important and advisers report a hunger for business amongst insurers in the sector.
“People are less trusting of healthcare systems than they were before the pandemic,” says Andy Edwards, global head of international health insurance at Axa Global Healthcare. “They never used to look at what healthcare provision was in place but now they are really keen to understand how they would access treatment before they start an overseas posting.”
Virtual services
To support employees overseas, telehealth and other virtual healthcare services have become a key part of policies. These include services such as GP appointments, physiotherapy and counselling, all delivered by video or phone at a time that’s convenient and in their native language.
And, while the widespread adoption of video calls may have led to many business trips being cancelled, it’s boosted usage across these virtual services. For example, at Axa Global Healthcare, utilisation increased by a multiple of four during the pandemic, with it only falling back slightly since face-to-face appointments have become more easily available again.
Part of this success is down to how effective these services are. Joe Thomas, managing director of April International UK, explains: “Seventy-two per cent of the GP consultations don’t require further assistance, with more than 90 per cent of customers saying they are happy with this service.”
Providing these services can also feed into a preventative health strategy, with benefits for cost as well as employees’ health and wellbeing. Sarah Dennis, head of international at Towergate Health & Protection, explains: “Improving access to telemedicine would increase utilisation and assist in cost containment by helping to reduce a lot of unnecessary small claims and the need to seek additional treatment that may not be required.”
Delivering wellbeing
The addition of virtual services is a major benefit for all parties but Beavis says that some insurers are going further and becoming much broader health and wellbeing providers. “We’ve seen a push from clients around diversity and inclusion and the range of benefits that can be included on international medical insurance plans,” she says. “Multinationals want consistency across their employee benefits so they’re looking to include cover for infertility, menopause and gender dysmorphia as well as more mental health support.”
This is something that has been noted at Axa Global Healthcare. It ran a survey, Mind Health and Wellbeing Study, in 2021 across 11,000 people, which found that mental health was regarded as the second biggest casualty of the pandemic, just behind the economy.
The importance of providing easy access to mental health services sparked some changes to its benefits. “We revised our psychologist-led mental health support, enabling employees to self-refer rather than go through a GP or doctor,” says Edwards. “This can help people access the treatment and support they need more quickly, which can often make it easier to treat mental health issues.”
Another post-pandemic must-have is health screening and wellness checks according to Heppard, who says the pandemic has made people more conscious of the need to get regular health checks. A regular check-up can detect many health issues early, when they’re easier to treat, but also, when carried out before an overseas assignment, can provide reassurance to both the employer and employee.
Alongside adding in more benefits, Heppard says insurers are getting more amenable when it comes to stripping them out. “Insurers are being much more accommodating when it comes to tweaking benefits. If a client already offers a global EAP or they don’t want to offer a particular benefit, insurers are much more flexible now and will let them tailor their cover,” he explains.
Staying home
Appetite for overseas assignments is reduced. “We’re starting to see more business travel again but demand is definitely not back to 2020 levels,” says Linda Beavis, senior consultant, global benefits at Aon. “The pandemic has made businesses realise just how much can be done remotely. I’d be surprised if it ever returns to pre-pandemic levels. It’s sad: nothing beats face-to-face.”
As well as the realisation that a few video calls can replace a stint overseas, the global economic climate is putting costs under the spotlight. Sending someone overseas is expensive.
David Heppard, head of global at IHC Employee Benefits, says these pandemic-related influences feed into a trend that was already in place before the pandemic. “International medical insurance group sizes have been contracting for some time,” he explains. “As well as the cost of sending someone overseas, legislation often forces companies to hire locally first. It’s become much
more common to put employees onto local policies rather than international ones and we’ve
also seen more organisations with large corporate schemes funding them through captives and trusts to give them greater control over the costs.”
Premium pressure
Cover on IPMI policies does come at a cost in today’s environment. Inflation, both general and medical, rising wages and a lack of capacity in healthcare facilities following the pandemic mean that premiums are under pressure.
“We’re seeing very significant increases in premiums,” says Dennis. “This makes it particularly important for clients to understand the value of the support provided. This needs to come from the industry as well as advisers.”
The level of increase varies, with Beavis saying that she’s seen book rate increases of between 5 per cent and 7 per cent while on large schemes, where performance dictates pricing, premiums have gone up by anything from zero to 30 per cent. “There was more of a push to increase price last year,” she adds. “It is difficult for insurers as they have seen costs increase but we did push back on some of the increases for our clients.”
There are also concerns that there could be a spike in claims as missed treatments and screenings during the pandemic become diagnoses of serious health issues such as cancer and heart disease. This has resulted in some insurers pushing through Covid loadings of around 7 per cent to account for potential future claims.
Edwards admits he’s watching for any signs of the anticipated increase in claims but hasn’t seen anything yet. “Premiums are going up but we’ve tried to avoid being overly reactive so we can keep increases as smooth as possible,” he says. “I know there are concerns in the domestic market about a claims spike but the situation could be different for the international market. During the pandemic, employees were able to access virtual health services but also travel to countries where facilities were open for treatment. If they had any health concerns, these could still be addressed.”
The other factor helping to keep premium increases relatively under control this year is competition. “Insurers are hungry for business, especially in the SME space, says Heppard. “There been some movement among insurers, for instance Aetna leaving the market and Axa selling its insurance business in the Gulf, but the market remains competitive.”
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