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BBC Highlights Travel Insurance Fraud With CEGA

Thousands of BBC viewers will find out about the folly of travel insurance fraud in February, when Head of Special Investigations for CEGA, Simon Cook, takes to the screen to explain that no stone is left unturned in the industry's quest to expose fraudsters - wherever they are in the world.

BBC One's Claimed and Shamed will see Simon talking viewers through a supposed car break-in near Mumbai, a fictitious death in Nigeria and cosmetic surgery posing as emergency medical treatment in Lebanon - all exposed with the help of CEGA's investigators "on the ground" overseas. Meanwhile, Simon and his team also get to the bottom of a suspicious mobile phone theft in Spain, after desktop investigations back in the UK.

"The message to travel insurance fraudsters is clear," says Simon. "We will go to great lengths to investigate suspicious claims all over the world  - however complex and distant they may seem."

This is CEGA's third appearance on the successful Claimed and Shamed series, which attracts over a million morning viewers. By shining a spotlight on fraud, the series has acted as a catalyst to increase the volume of reports of suspected insurance fraud submitted to the Insurance Fraud Bureau's (IFB) Cheatline.

You can watch CEGA in Claimed and Shamed on Thursday 18th, Friday 19th, Monday 22nd and Wednesday 24th February: BBC One at 11am.


APRIL Group Strengthens Its Activities With Two Acquisitions: Avilog In Third Party Administration And Globalhealth In International Medical Insurance

APRIL group continues to expand its third party administration activities (TPA) as part of its key accounts development with the acquisition of 100% of the capital of Avilog.

Thanks to this operation, the group is able to consolidate its position in the TPA market for group health and personal protection insurance. Its activities with institutional clients (banks, provident institutions, private health insurers and insurance companies), brokers and businesses, both in France and abroad, will therefore be able to draw upon tailored and differentiating solutions.

Established in 1987, Avilog specialises in handling group medical health insurance policies. Today it has almost 30 staff members based in La Valette du Var as well as Paris, and has a turnover of over 2 million euros.

Sébastien Boizou, Managing Director of AVILOG, stated, "We are looking forward joining a large-scale, dynamic and innovative group such as APRIL. This merger opens up new prospects for working together and for business development."

With the acquisition of 100% of the capital of GlobalHealth, the APRIL group consolidates its wholesale broker activities in international private medical insurance (IPMI).

The acquisition of GlobalHealth enables APRIL to extend its operations in Asia, beyond its current activities in Thailand, China and Singapore. It also strengthens its market share in International Private Medical Insurance and accelerates the development in this historical business line, supported by its 9 assistance call centers. Finally, it enables APRIL to pool medical expenses and therefore increases its negotiating power with healthcare providers, for the benefit of its policy holders and risk carriers.

With operations on every continent, the APRIL group will be able to address the requirements of individuals living abroad more comprehensively, regardless of their country of origin, by offering solutions which are tailored to the local context, but also to the expectations of the group's key accounts partners, brokers, international institutions and businesses.

Established in 1997 in Hong Kong, GlobalHealth has 60 staff members and a turnover of around 6 million euros. Specialised in designing, marketing and managing international group and individual medical insurance products, GlobalHealth makes its products available in 6 different countries: Hong Kong and Singapore for the majority of its current activities, but also Vietnam, the Philippines, Indonesia and China.

Both transactions were funded with the group's available cash. They will be commented on during the presentation of the 2015 annual results, on 3rd March 2016.

Emmanuel Morandini, Deputy CEO of the APRIL group commented, "We would like to welcome the Avilog and GlobalHealth teams which will strengthen and extend our areas of expertise. These acquisitions support our ambition to become a leading provider of products and services to French and international institutions, and an IMPI and assistance key player outside France. The integration of Avilog and GlobalHealth also marks the cautious return of our external growth dynamic in support of our strategic development."

RELATED READING: APRIL Group Announces Acquisition Of GlobalHealth Asia 


Insurance Companies And Products As We Know Them Today Will Have To Evolve

That's according to Griselle Chernys, CEO, at Wellaway, who took an executive seat on a recent iPMI Magazine round table business forum.

Although global risks have changed dramatically, medical inflation and the cost of employee benefits continues to cause concern. In the most recent iPMI Magazine Round Table Business Forum we spoke with leading C-Level executives from the world of International Private Medical Insurance about the rising cost of healthcare and medical inflation.

An AON report report shows that in 2015, medical costs are expected to increase by 10.15 percent before plan design changes and vendor negotiations—6 percentage points higher than the average inflation rate. In 2014, the global average medical trend was 10.34 percent. While the global average medical trend is expected to decline, three regions--Asia Pacific, Europe and Latin America--are projected to see an uptick in rates for 2015.

Talking to the IPMI round table group about the Aon Hewitt report Griselle Chernys, CEO, at Wellaway told us, “I think that the data is pertinent and probably correct. Healthcare is a commodity that providers will control and deliver as they want, especially in the private sector with IPMI coverage. Hospitals and physicians have the upper hand in the delivery and pricing, thus the need for integrated services. As I heard a physician administrator in a hospital say once, during some insurance pricing negotiation, “this is our price and if you do not like it, I would like to see you admit and deliver the medical care the member needs." As long as the relationship of providers and insurance is antagonistic, a solution will not be able to achieved. More and more hospitals and physicians will develop and deliver health plans via their medical facilities and I predict that the multi-hospital system will develop internationally as it has happened in the USA or as we see with Hospiten and the like.

Insurance companies and products as we know them today will have to evolve.”

ANDREW APPS, HEAD OF GLOBAL HEALTHCARE, BELLWOOD PRESTBURY added, “Competition between iPMI insurers is intensifying and will continue to do so as new entrants dip their toe into the market and dream of taking a slice of the ever expanding market. Price cutting particularly amongst the employer-sponsored plans is inevitable as the larger players jockey for position and greater market share, all of which is good for the employer in the short term at least. As the saying goes, there is always someone out there who will take the risk. But there has to come a point where underwriters have to make a return on their investment. At this point premiums have to rise and with the relationship between insurers and medical service providers becoming all the more strained as medical treatment fees increase, that day is not too far away. This makes the job of the adviser /broker all the more important."

ROMAN BEILHACK, CEO, GLOBALITY HEALTH said,Employers are operating in an environment where they need to provide high levels of healthcare for their employees, sometimes due to statutory requirements and other times due to the natural tendency of employers to look after the well being of their workforce. Employers are typically under pressure to keep their operating costs low and when they review their budgets during their annual business planning cycles they will aim to minimise the cost of employee benefits. Due to these cost pressures, there may be situations where employers will downgrade the insurance coverage so that they can afford a plan rather than removing the plan altogether. Globality seeks to find solutions for their clients in these situations.

The global average inflation rate is interesting for comparing one year to the next. However, when it comes to employer-sponsored plans then the specific features of those plans should be considered. This means considering the locations of the insured members, the benefit levels, the treatment providers and network access. Referring to a single global average can be misleading for many employers.”

One of the most common questions we hear within the IPMI industry is: how will the cost of international private medical insurance rise in the next 5 years?

ROMAN BEILHACK, CEO, GLOBALITY HEALTH told us, “Costs are expected to continue to rise at levels above general price inflation. There are continual advances in medical science with new treatments and medicines being developed all the time. It is normal that insured members will demand the best treatments and services available, particularly for expatriates. In order for insurers to offer these new treatments then there will inevitably be premium increases.

However, insurers should not use this as an excuse to increase premiums beyond what is necessary. As can be seen recently, Globality is holding 2016 rates at 2015 levels for many categories of its business."

ARJAN TOOR, MANAGING DIRECTOR, CIGNA GLOBAL IPMI added, “Medical inflation is driven by unit cost, i.e. the price of each service; and utilization, that is how many and what type of services are used. As the world’s health care standards continue to rise and the range of treatment facilities and breadth of treatment options available continues to increase, it is without doubt that both unit cost and utilisation will also continue to increase.

It’s our job as the insurer to understand these risks and continually evolve our proposition to protect our customers from the impacts of medical inflation as far as possible. We’re continually working on initiatives to help minimize the impact of inflationary volatilities including investments in expanding our medical network and claims teams globally, meaning we can counteract medical inflation spikes to a certain extent as we build long-term relationships with hospital groups. It’s a lot about experience as well - it’s imperative that our claims advisors know the expected cost of a hip operation in Singapore, for example, and can ask the right questions to ensure the costs are appropriate.

Ultimately, it’s impossible to say exactly how premium costs will rise over a 5 year period, but our focus will continue to be on driving forward our mission of helping the people we serve improve their health, well-being and sense of security.”

ANDREW APPS, HEAD OF GLOBAL HEALTHCARE, BELLWOOD PRESTBURY commented, “If I had a crystal ball, it would be easy to answer this; however, the reality is that no one really knows to what extent iPMI premiums are going to rise over the next few years. What is certain is that premiums will continue to increase due to the rising cost of medical treatment along with the ever popular demand for private medical treatment.

That said, increased competition amongst the iPMI providers has, to some degree, helped to keep premiums palatable for most policyholders (putting to one side the notion that nobody likes to see their premiums increase), with average year on year increases running between 5-10% depending upon where a person is living and working. How long this will continue is anyone’s guess, but the market is hotting up with yet more new provider entrants trying their hand.”

GRISELLE CHERNYS, CEO, WELLAWAY added, “The cost of international private medical insurance will rise dramatically and this will be driven by the development and demand for new treatments, pharmaceuticals and technology. Longevity is also playing a role in the inflation and utilization of medical services which creates more demand and demand will drive costs.”

















Now Health International Reveals Top Twenty International Private Medical Insurance (iPMI) Claim Diagnoses

Leading international private medical insurance provider, Now Health International ( has analysed almost 120,000 claims made by its customers and can now reveal the top twenty diagnoses in terms of frequency since the company started trading in 2011.  

Topping the list is Acute Bronchitis followed by sprains and strains and then lower back pain.  The full list is as follows:

  1. Acute Bronchitis
  2. Sprains and strains
  3. Lower back pain
  4. Acute Nasopharyngitis (common cold)
  5. Diarrhea and Gastroenteritis
  6. Fever
  7. Cough
  8. Urinary infection
  9. Conjunctivitis
  10. Gastritis
  11. Chest pain
  12. Rashes
  13. Headache
  14. Cervicalgia (neck pain)
  15. Vitamin D deficiency
  16. Influenza
  17. Asthma
  18. Eczema
  19. Abdominal and pelvic pain
  20. Dizziness and giddiness 

The top ten claims accounted for 77% of all claims made and the top twenty, 17%. Claims for list-topping Acute Bronchitis/Bronchiolitis amounted to 16% of all claims spread across the four years.

Although it didn’t make the top 20, Now Health has also somewhat interestingly received 29 claims for dog/other mammal bites over the last four years.  

Now Health’s Marketing and Ecommerce Director, Alison Massey, said, “As an Asian-headquartered business, much of our customer base reside in this part of the world. The region often experiences poor air quality due to pollution and other factors such as haze that comes from crop burning so it seems logical that a respiratory illness should top our list.” 

Massey continued, “We were also initially surprised at the number of claims associated with Vitamin D deficiency. However, we have discovered that it is the most common nutritional deficiency worldwide for both adults and children. And with many of our members based in the Middle East who spend much of their time in indoors and out of the blazing hot sun, it’s more understandable.”

Now Health International is one of the fastest growing providers of IPMI solutions for Global Expatriates, High-Net-Worth individuals and Small to Medium Sized Enterprises.  Just four years old and with more than 130 years of collective IPMI management experience, Now Health already has offices in the UK, Dubai, Hong Kong, Singapore, Shanghai, Beijing and Jakarta, with Abu Dhabi coming soon.



Pacific Prime Launches Asia’s Largest Claims Resource Center

Pacific Prime's new claims center is Hong Kong's, and possibly Asia's, largest collection of health insurance related claims documents. Quickly find and download insurer claim forms in order to start a claims process.

Pacific Prime is proud to announce the creation of Asia's largest claims resource center. Focused on Individual health insurance, this claims center provides clients with easy access to the claims forms they will need during the claims process.

Accessible now via the Claims Center button on Pacific Prime's website, or directly via this link, clients in Hong Kong, China, Singapore, and the UAE can access and download a variety of claims forms.

Features of the first version of our claims center include:

  •     Forms for both local (plans that provide local coverage) and international (plans that provide worldwide coverage) providers that Pacific Prime works with.
  •     Medical claim forms
  •     Maternity claim forms
  •     Dental claim forms
  •     Pre-authorization forms
  •     Easy to download forms, all in PDF format.
  •     Access to the claims center via the local Pacific Prime website for each location.

Thomas Freemantle, Medical Claims Manager for Hong Kong, further explained, "This new claims center is by far the largest and most comprehensive centralized resource center – for claims forms at least – in Asia. This claims center gives our clients a simple way to access the essential forms they will need in order to make a claim or to help arrange scheduled treatment, in essence speeding up the process."

Freemantle also explained that the center will continue to evolve over time with the addition of new forms as they come available, and new insurers that Pacific Prime established relationships with.


CEGA'S Holiday Advice Aims To Reduce Insurers' Exposure To Risk

Extreme travel insurance claims have included luggage stolen from a treetop room by indigenous warriors, a home destroyed by a digger that veered off-course and a fire display that consumed its tourist audience, according to leading medical assistance and claims handler CEGA. 

But not all travel mishaps are as unpredictable. Many can be avoided or resolved with minimum stress, says CEGA, as it launches a media campaign to advise the millions of Brits expected to travel abroad this summer and to reduce their insurers' exposure to risk.

CEGA's campaign urges holidaymakers (over a third of whom are expected travel to new* destinations) to buy a comprehensive travel insurance policy and to understand the limits of the European Health Insurance Card (EHIC). It also advises them, among other things, to take adequate supplies of prescribed medicines abroad with them, to avoid theft hotspots and to be discerning about food in developing countries.  CEGA directs insurers and businesses to its pre-travel risk management service for further information.

CEGA's research shows that, last summer, Spain, France and Turkey topped the list of European countries producing the most travel insurance claims, with the US top of far-flung destinations for claims. Medical expenses, lost possessions and travel delays or cancellations made up the bulk of travel claims, with the majority of medical claims caused by illness rather than injury.

* Source: ABTA Travel Trends Report 2015:



Organised Fraud Up 28% As Gangs Continue To Exploit “Cash For Crash”

Aviva detected over 14,000 fraudulent claims worth £95 million in 2014 – equivalent to 39 fraudulent claims worth an average of £260,000 every day*. The insurer also detected more than 6,300 instances of motor insurance application fraud – highlighting that fraud isn’t just a claims problem.

Motor injury fraud – including bogus claims, cash for crash and organised fraud – continues to be the biggest problem area and now accounts for 60% of all claims fraud Aviva detects. Organised fraud increased 28% in 2014 to £38m – an increase of £8m against 2013. Aviva currently has more than 15,000 suspicious claims under investigation - 6,000 of these are motor injury claims linked to known fraud rings.

Tom Gardiner, Head of Fraud at Aviva, said, “Our figures show that insurance fraud remains a significant and complex challenge, but the biggest threat to customers continues to be fraudulent motor claims, which puts innocent motorists at risk of physical harm, while pushing up premiums for everyone.

“While genuine claimants have absolutely nothing to fear, our success challenging, defending and prosecuting fraudulent whiplash claims and organised fraud – even where it is not economic – sends a clear message that if you commit fraud against our customers, then it’s increasingly likely that we will catch you and prosecute you.

“We are here to pay genuine claims quickly and fairly. For example, last year Aviva paid more than £2.3bn settling 873,000 claims. However, in the case of motor whiplash claims, we are finding that 1-in-9 claims are tainted by fraud.

“Although Aviva has continued to invest in its ability to detect, challenge and prosecute the plague of fraudulent whiplash claims, and supports steps taken by Government to address the problem, we believe that further steps must be taken to deal with the root cause of the UK’s “cash for crash” industry. Changes we are calling for include removing the cash and profit incentives from the system, such as replacing cash compensation for minor, short-term injuries with rehabilitation.”

Application Fraud
Aviva believes that the fight against insurance fraud needs to move from “detection” to “prevention” – and has taken significant steps to prevent fraudsters from accessing Aviva products and targeting Aviva customers.

Aviva detected more than 6,390 instances of motor insurance application fraud in 2014. This ranged from people deliberately misrepresenting their claims history, convictions and addresses on their insurance application to obtain cheap cover, to organised gangs buying policies to make bogus claims. Aviva has also detected ‘ghost broking’ operations - where unauthorised people sell invalid motor insurance policies, often to innocent motorists, leaving many customers out of pocket and uninsured.

One example of large-scale application fraud detected by Aviva was seen in Norwich, where fraudsters set up hundreds of motor policies using addresses in the city without the knowledge of the householders. Within days of the policies coming into force, Aviva began receiving claims from these policies. Aviva declined the fraudulent claims, cancelled the policies and liaised with local media to alert customers and householders to the threat. In total, this ring generated 157 claims with an estimated value over £3m.

Tom continued, “The fight against fraud begins at the front door. We are now screening our personal and commercial motor business at the point of sale and we are committed to protecting our brokers and innocent customers from being targeted by fraudsters and ensuring that fraudsters cannot buy Aviva products.”

Members of the public can play their role in fighting back against ‘crash for cash’ scams and other types of insurance fraud by reporting what they know to the Cheatline. The Cheatline, powered by Crimestoppers, is a free service that enables members of the public to anonymously report information or suspicions about insurance fraud by calling 0800 422 0421 or reporting online at All information provided to the Cheatline is treated in the strictest confidence. 

*Aviva 2014 Claims Fraud figures


Accenture Awarded Contract to Enhance Finnish State Treasury Insurance Claims System

Accenture has won a public tender and signed a four-year framework agreement with the Finnish State Treasury to develop and maintain a range of IT applications that support the State Treasury’s effort to digitalize its claims management system and enables the State Treasury to further improve and expedite its claims service.

Under the agreement, signed 14 January 2015, Accenture will develop and maintain new functionalities, expand the processing scope of the claims system to cover additional insurance products, and integrate online services into the service processes. Accenture will also help the State Treasury upgrade its claims system and implement statutory updates. The State Treasury’s claims system, which is based on the TIA Technology® end-to-end integrated core solution, was implemented in 2012, and currently processes statutory work and military accident insurance claims and payments.

“Accenture has the extensive experience in insurance claims management systems that we needed and a deep understanding of the TIA software in particular,” says Jyri Tapper, director, Insurance, at the Finnish State Treasury.

The Finnish State Treasury is a multidisciplinary government agency that develops internal corporate services for the central government, such as financial and personnel administration. One of its key functions is providing benefits and compensation for citizens and institutions. It handles compensation to criminal liability and military injury customers as well as compensation for occupational and military injury and traffic accidents for which the government is liable.

“The Finnish State Treasury is a very important client for us, and the framework agreement is a significant step in our co-operation. Accenture offers an optimal combination of in-depth insurance, methodology and technological capabilities to fit the State Treasury’s needs,” says Marko Rauhala, managing director for Accenture’s Health & Public Service business in Finland.

“The claims process represents the quintessential ‘moment of truth’ for any insurance customer,” said Risto Sandberg, managing director for Accenture’s Insurance practice in Finland. “It’s where an insurance provider is put to the test in terms of its ability to delight or disappoint the customer. We are proud to team with the State Treasury and help the agency further enhance its compensation services.”


CEGA'S Special Investigations Unit Gains Industry Awards

Claims and assistance provider CEGA reports that every member of its Special Investigations Unit (SIU) has achieved the Level 3 Award for Professional Investigators.

"The awards demonstrate our commitment to deliver the very best investigative service to insurers," says Simon Cook, Head of CEGA's Special Investigations. "They allow us to meet future Home Office licensing regulations in advance of their enforcement ​ ​in April and enable clients to feel confident that they are using fully certified professional investigators."

CEGA's SIU underwent nearly forty hours of training to achieve the awards. This covered every area of personal investigations, from surveillance to confidentiality: taking in, among other subjects, ethical standards, human rights, and vulnerable witness protocol. From April 6th 2015, under the Private Security Industry Act, the undertaking of investigative activity by an unlicensed person will be an offence. The new regulations have been created in the wake of the Leveson Inquiry.


CEGA Group Appoints New Chief Executive To Drive Future Growth Plans

CEGA Group ("CEGA"), the independent medical assistance and claims business, is delighted to announce that it has appointed Alistair Hardie as its new Group Chief Executive with effect from 30th January 2015, strengthening its management team and continuing its on-going investment in its core business.

Alistair will focus on driving an ambitious growth agenda with both existing and new clients, building on international partnerships and developing further propositions for insurers and the increasingly active standalone corporate market. Alistair has 30 years' experience delivering solutions to the insurance and corporate sectors with a particular focus on Travel, Health and Accident Insurance and outsourcing. Most recently Alistair was CEO Europe for Cigna's Individual Health, Life and Accident business, having previously been part of the management team of FirstAssist Insurance Services when it was acquired by Cigna in 2011.

Out-going CEO, Graham Ponsford, who will become Group Chairman, commented, "CEGA has built a market-leading range of propositions from international assistance and medical transfers to claims management and pre-travel consultancy. This further investment will help us drive these further into our chosen markets, both in the UK and internationally through our global partners. As a result of Alistair's appointment CEGA will strengthen its relationships with its blue-chip partners, and develop additional long-term revenue streams."

Alistair Hardie said "CEGA's reputation for excellence in patient care and exceptional customer service is a fantastic foundation on which we can build further success. I look forward to working with the management team and all the committed staff across the business to create a full service, end-to-end range of solutions for insurers, corporates and public sector bodies who have customers or staff requiring medical advice or assistance when travelling, need help in planning or risk assessing their activities, or require cost-effective delivery of outsourced claims services.”

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