How One Company Repatriated a Complex Claims Patient.

Introduction

Managing a complex claim is one of the biggest challenges faced by medical assistance professionals. Each claim requires a highly adaptive approach, using specialized techniques, robust multidisciplinary strategies and flawless communication. Harmonizing these elements for success demands a very high degree of flexibility and creativity, in-depth medical knowledge and astute discernment, especially when working within different medical and cultural contexts around the world.

While the stakes are usually high – life & death, or permanent impairment – prognoses are often guarded, as the outcome depends almost entirely on ensuring the right care in a very complex situation. Additionally, teams must manage family members’ expectations, anxiety and the way they might interpret their loved one’s condition – well beyond the scope of simple medical assistance.

The following case, from Global Excel Management, illustrates just how demanding multidimensional complex medical claims can be, and how critical the very time-sensitive decision-making process is, where every move can have heavy human and financial repercussions.

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In light of recent news headlines regarding the poor state of some NHS hospitals, Over 50s personal finance comparison site Over50choices announces alternative healthcare solutions with the launch of their new affordable Private Health Insurance comparison tool. As a nation, over the years the majority of people in the UK have been proud of the NHS, a service that has been the envy of other countries.

Now as a result of relentless bad press (BBC Website 13th August 2013), regarding poor healthcare, hospital super drugs and increased death rates, the quality of service provided really has come into question. Little wonder then that people are looking for alternative solutions. Over50choices, a personal finance comparison website designed specifically for the Over50s, has a dedicated section on affordable Private Health Insurance, an option for those looking for an alternative to the NHS. It explains all about the different types of cover, how to reduce monthly premiums for people on a budget and provides a comparison service so visitors to the site can compare healthcare plans and be sure to choose the right level of cover for their needs. Private Health Insurance can be of benefit for those looking to have more control over the treatment they receive.

It provides speedy access to specialists and consultants avoiding lengthy NHS queues; more accommodating appointment times arranged to suit the individual; the use of private hospitals which usually includes en-suite rooms with good quality food, TVs and private phones; unrestricted visiting times and access to new drugs and treatment that may not be available on the NHS.

Over50choices Managing Director Ashley Shepherd speaks from personal experience when talking about the benefits of Health Insurance. “Having been diagnosed with Prostate Cancer 3 years ago, I found the support and protection my health insurance gave me invaluable. I was able to explore all the options available to me and had access to one of the countries’ leading urologists, a point I whole heartedly believe was life changing." Of course Private Healthcare does not negate the need or use of the NHS which still provides emergency support and care for long term illness but it can help people stay in control of their healthcare. We all lead busy lives these days so if we have an illness, the last thing we need is the additional strain and pressure brought on by waiting for appointments, test results and treatments. By speeding up the process with health insurance, life doesn’t necessarily have to come to a standstill.”

The website explains the differences between the main types and different levels of health insurance and how to reduce costs by increasing the excess which is the amount the insured person is prepared to pay towards each claim, agreeing to be treated by the NHS if treatment takes place within certain time frames or by paying a certain percentage of costs. In addition to affordable Private Health Insurance, the website also helps visitors review, compare and buy Over 50s life insurance, car insurance, travel, pet and home insurance, energy suppliers and funeral plans.

One Hundred Years launches in the UK today, providing global, best-in-class private health management services. The service identifies individual client health and lifestyle goals and delivers those outcomes via personalised health programmes managed by dedicated Private Health Advisors, physicians and scientists.

The strength of its medical expertise is illustrated by the organisation’s Global Faculty of Advisors and National Medical Advisory Board, which is responsible for designing solutions and providing access to the latest medical treatments and research. It is convened by One Hundred Year’s Chief Medical Officer Dr. Jack Kreindler and led in the UK by Medical Director Dr. Sundeep Dhillon MBE.

Among over 20 Board members, including leading international experts in medicine and science, are:

• Professor Hugh Montgomery, who discovered the first human gene for fitness and activity (ACE)
• Professor Greg Whyte, specialist in exercise physiology, sports performance and rehabilitation
• Dr Michael Loosemore, who on behalf of LOCOG selected doctors for the London 2012 Olympics
• Dr Richard Budgett, Chief Medical Officer of the International Olympic Committee and formerly CMO of the London 2012 Olympics and Team GB

One Hundred Years differentiates its health programmes by focusing on improving the trajectory of each client’s health by executing highly personalised optimisation, prevention, and treatment strategies. The network of senior international healthcare figures, together with the pro-active management of clients' individual health programmes, is at the heart of One Hundred Years' model to deliver health programmes that are personalised, proactive, and built around medical centres of excellence. The company’s health management services can be fully integrated with comprehensive health insurance solutions to provide exceptional global cover to each individual client programme. One Hundred Years offers the first complete health service to consolidate all medical, administrative and financial functions into a single, professionally managed offering.

“One Hundred Years is the first company to professionally manage health and healthcare spending,” says co-founder and CEO Virgil Bretz. “Our health management model is analogous to the best examples in wealth management. Wealth managers have long understood that no two clients are alike. Our clients greatly value health. Personalised, strategic, and coordinated expert advice is as important in planning a long life of great health as it is a portfolio of wealth.” Dr. Jack Kreindler comments “We are building the first care management and insurance programmes that focus on medical excellence instead of the prevailing model of cost containment. Our motivation is to learn what health means to individual clients and then help them achieve that via access to the best minds in each field. We have built a strong community of medical and science professionals and we continue to welcome many more high-achieving practitioners into the fold. One Hundred Years is intensely focused on identifying, working with and rewarding the world’s best health professionals. ”

Globality Health responded to the need for appropriate insurance for seafarers by partnering with Crewsure (crewsure.com) to offer clients innovative insurance products. From August 20th 2013 all vessels over a certain size have to comply with a new labour convention known as the Maritime Labour Convention (MLC) 2006.

New product, Crewsure Marine, supports the health and wellbeing of onboard crew and also fully meets the revised Maritime Labour Convention (MLC) regulations. Crewsure Marine is a composite ‘no fault’ insurance policy, paid for by the Employer, providing personal insurance for seafarers. This includes medical care, personal accident cover, loss or delay of baggage and repatriation in the case of abandonment. Although the Crewsure product has been designed as a single solution, should a ship owner have sourced elements elsewhere the product can be separated as appropriate.

“It is our firm belief that the best partners have joined forces to deliver first class care and the best insurance service to the maritime industry. We give Crewsure clients the strength of one of the world’s leading insurers and reinsurers, so crewmembers can feel safe and secure whatever ocean they cross.” Philip Wright, Chief Commercial Officer, Globality Health.

“Crewsure will work harmoniously with the maritime industry to give seafarers the security and benefits they deserve. Crucially, we engage with unions, shipowners, ship managers, manning agents and the insurance industry and will continue to do so to ensure that Crewsure remains evolutionary.” Robert Johnston, Crewsure Marine.

Crewsure Marine is underwritten by Globality Health and KA Köln.Assekuranz Agentur GmbH on behalf of Great Lakes Reinsurance (UK) PLC – all part of Munich Re.

About Crewsure

Managing Director Robert Johnson is a well-known figure in the maritime insurance world. He recently retired as Chairman of British Marine after 10 years as Managing Director, following his 25 years with the Steamship Mutual P&I Club.

About Globality Health

Globality Health is the international health insurer with a special focus on expatriates. People who study, live or work abroad are assured that their health is always in good hands, no matter where they are. As an integral part of Munich Health, with more than 5,000 experts at 26 locations, we offer innovative healthcare solutions for clients and partners all over the world. As a member of Munich Re, we give you the strength and security of one of the world’s leading insurers and reinsurers.

UltraCare Power a medical insurance plan especially for the oil and gas industry in Asia has been launched today. The new plan has been developed by international health insurer InterGlobal for brokers with clients in the regional energy sector. UltraCare Power will initially be available in Singapore and eventually rolled out across Asia.

UltraCare Power keeps premium levels highly competitive for workers in the energy industry by focusing on core benefits. Two levels of cover are available, UltraCare Power Select and Power Plus. Both give members and their families access to emergency, hospital and out-patient treatment, when and where it is needed. UltraCare Power Plus also covers dental treatment, wellness benefits and cover for chronic conditions. Emergency medical evacuation and repatriation is available as an option. Most workers have evacuation cover provided by their employers, so making the benefit optional avoids the risk of members paying for a benefit they do not need.

Alistair Dickman, Country Manager and Chief Executive, InterGlobal Singapore said: “Singapore is an important centre for the oil and gas industry in Asia, with thousands of people involved in onshore and offshore production. They need top quality, affordable medical insurance matched exactly to their working lives. Many work offshore or travel extensively to remote locations. There are also a high number of contractors in the industry which means that people need to be able to access quality cover at an affordable premium without joining an employer’s scheme. “We launched UltraCare Power to give energy workers a real choice when choosing medical insurance. It gives employers, individual contractors and their families the reassurance that they can receive treatment when they need it for a cost effective premium. “The launch of UltraCare Power is great example of our strategy to focus on developing products to meet the exact needs of local markets. When our intermediary partners told us there was a real demand for a competitive oil and gas IPMI plan across Asia, we went all out to develop a plan that fitted the needs of the industry in the region.”

Summer travel insurance claims from Brazil have risen by more than 60% in two years, according to research carried out by CEGA Group, the claims management and international assistance provider. The new research covers the two years from summer 2010 and takes into account all types of travel insurance claims, including theft, travel delays and medical expenses.

“With Brazil hosting the 2014 World Cup and 2016 Olympics, the number of travellers to the country is only going to rise,” says CEGA’s Head of Corporate Specialty Risks, Juan Peña Núñez, “and we are already being asked by clients to carry out comprehensive medical risk assessments of World Cup host venues, to support their own risk management strategies. “Together with Chile and Colombia, Brazil is home to some of the best medical facilities in South America, but the vast majority are based in the larger cities such as Rio de Janeiro, Brasilia and Sao Paulo.

“Medical care in rural locations is limited, so it is essential for an assistance provider to be able to evacuate patients from even the most remote areas in an emergency. Hence they must understand not just the medical but the topographical landscape as well. It is vital to have an established network of trusted medical evacuation partners and hospitals right across the country to cover any eventuality.”

The most common medical risks in Brazil, according to CEGA, include gastro-intestinal problems, acute trauma, particularly from road traffic accidents, and diseases such as Dengue Fever, Malaria and Hepatitis A.

PruHealth has today announced that the transfer of its servicing operation from South Africa* to the UK has now taken place, resulting in the creation of 150 new jobs in the UK in one of the biggest and fastest staff expansion programmes seen in the PMI market. This completes Phase One of its programme to deliver world class customer service and the overall project will be finished in 18 months time.

Key elements delivered to date include:

• A work transfer programme, in which PruHealth’s South African servicing operation, including all telephony and back office claims processing, has been fully migrated to the UK. This has created 100 new jobs in Stockport and 50 new jobs in Bournemouth. Customers now have all their claims, servicing enquiries and Vitality wellness programme support delivered by the UK team, which provides local knowledge and expertise.
• PruHealth’s successful Indian offshore operation which provides back office administration support through its strategic partner, Serco, has also been expanded with an additional 50 people.
• This work transfer programme is already having an impact, resulting in significant operational savings and improvements in the overall customer experience.
• The launch of a dedicated Distribution Services Division provides tailored servicing to PruHealth’s various distribution channels. A number of operations have been integrated to provide a seamless service, and instead of a one size fits all strategy, PruHealth has segmented how it works relating to each of its sales channels.
• PruHealth has built the ability for customers to submit claims online and for 90% to be processed within 24 hours.

PruHealth is already seeing tangible results delivered as a result of these key changes. Lapse rates have reduced by a third since the customer service programme began two years ago, and the volume of complaints has halved and is still reducing.

According to Neville Koopowitz, Chief Executive at PruHealth: “Our vision is clear and we are investing heavily to ensure we achieve it. We have delivered an enormous amount of work to lay the foundations to enable us to deliver world class customer service, but we still have a lot more to do. Going forward in the second phase of the project we will be looking at areas that will add real value and help us go that extra mile for our customers. We are embarking on some exciting new initiatives that mean we will be covering previously unchartered ground.”

Phase Two will comprise a series of projects designed to improve every dimension of the business, all focused around the customer journey and improving service for individuals, employers and intermediaries, as well as increasing engagement with the Vitality wellness programme.

* All South African staff have been deployed into new roles within Discovery, with no loss of jobs.

The CNV (National Federation of Christian Trade Unions in the Netherlands) and Achmea, the largest insurance company of the Netherlands, recently signed a declaration of intent to cooperate on providing personal legal assistance services and non-life insurance as from 1 January 2014. Cooperation will enable the CNV to expand its range of legal services and thus make it more attractive to existing and new members. The trade unions affiliated to the CNV will continue doing what they are good at: providing legal assistance for their members with issues relating to employment and income, such as dismissal procedures, reorganisations and pay disputes. ​

As well as help with employment and income issues, the four largest CNV-affiliated trade unions have been providing personal legal assistance for their members for many years. Until now, CNV has provided personal legal assistance via its own insurer. The plan is for these activities to be taken over by Stichting Achmea Rechtsbijstand (Achmea Legal Assistance Foundation), to which the staff of CNV Rechtshulp (CNV Legal Assistance) who are affected by the change will be transferred, together with the active files.

Pieter de Vente, General Secretary of CNV: "The CNV-affiliated trade unions are the only trade union organisations in the Netherlands to offer their members basic insurance cover for personal legal assistance. The basic cover will still be free: members will pay only their monthly trade union contributions. By working more closely with Achmea, we can not only improve this basic package, but also augment it substantially with the addition of Centraal Beheer Achmea non-life insurance at a member discount." De Vente continues: "This is a carefully considered move on the part of the CNV-affiliated trade unions. Our own insurer is in good financial health, but we are so small that a relatively large part of the premium income is spent on complying with the legislation and regulations for financial institutions. While the CNV agrees that robust and effective regulation is essential, it would prefer to spend as much as possible of the premium income on achieving its intended goal: providing legal assistance for the members. Working with Achmea will mean that costs will absorb a smaller proportion of the premium income, so more can be done for the members."

Danny van der Eijk, a member of Achmea's Executive Board, describes it as a win-win situation: "This alliance is good for the CNV, good for the members and good for Achmea. It is our ambition to create links with employers and employees across a broader front. Given our cooperative background and the social themes in which Achmea seeks to play a leading role, the social partners (employers' and employees' representatives) are ideal partners in both dialogue and cooperation. By working together with the CNV, we can come closer to achieving that ambition. The opportunity to provide legal assistance services and offer Centraal Beheer Achmea non-life insurance is, of course, an added bonus." CNV and Achmea expect to finalise the agreement in the coming months, so that they can start working together on 1 January 2014. The employee consultation bodies will of course be involved in this process.

Bupa, the international healthcare company, have announced the appointment of Rt Hon Patricia Hewitt to its board as a non-executive director. Ms Hewitt joins Bupa following an extensive parliamentary, government and business career. She was MP for Leicester West for 13 years, holding the positions of Secretary of State for Health between 2005 and 2007 and Secretary of State for Trade and Industry and Cabinet Minister for Women between 2001 and 2005.

Before joining the Cabinet, she was Minister for e-Commerce and Small Business, and Economic Secretary to the Treasury. Ms Hewitt left Parliament in May 2010. Ms Hewitt is the senior independent director of BT Group plc, non-executive director of Groupe Eurotunnel SA and chair of the UK India Business Council, an organisation that promotes trade between the two countries.

Lord Leitch, chairman, Bupa, said: “Patricia’s extensive government and international business experience will bring valuable insight to Bupa as we deliver on our vision to make a positive difference to health systems, reaching millions more customers around the world.” Ms Hewitt joins the Bupa Board on 1 July 2013. Bupa has no shareholders and reinvests its profits to provide more and better healthcare.