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iPMI Magazine Speaks With Global General Managers At Aetna international

In this exclusive iPMI Magazine interview, Christopher Knight, CEO, iPMI Magazine, met with Global General Managers from Aetna international. The group interview focused on international health and medical insurance regional trends; the impact of COVID-19 on iPMI; plus predictions for the coming year. As always the interview raised some excellent points for the international private medical insurance market.

Have you recognised any notable trends in health insurance from your region over the past year?

Damian Lenihan, Executive Director - Operations and Distribution, Europe, Aetna International: The COVID-19 pandemic has amplified the importance of good physical, mental and emotional health for employees of all ages across Europe. This translates directly into employees having greater expectations for health insurance benefits from their employers. This is what we discovered in our research. Our ‘Polarised Perceptions of Corporate Health and Wellness’ study shows that in global business, 70 percent of employees feel that their mental health is most important and that they have been negatively affected during the pandemic. They expect employers to provide comprehensive mental health and well-being services as standard. Research also shows that these services are more important to employees now than previously. A real desire for digital services was also communicated. Results show that employers need to carefully choose the best comprehensive plans for their valued workforce. Plans that cover everything from health support, advice and guidance through to telemedicine services and the latest digital tools.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

Damian Lenihan, Executive Director - Operations and Distribution, Europe, Aetna International: The health insurance market has clearly evolved from helping people to recover to supporting prevention. Empowering people is much more of a focus. It is vital for individuals to manage their own physical, mental and emotional well-being and this should become a daily routine. The “well-care model” as we refer to it comes with an excellent set of tools and resources that we provide for members which supports them to lead happier, healthier lives. Prior to the pandemic, we were determined to provide mental health support. We invested in product enhancement and innovation. For example, our members have access to the award-winning chatbot app, Wysa, access to doctors via our sophisticated telemedicine service, vHealth, and to counsellors through the Employee Assistance Programme (EAP). To put all of this into context, we know that corporate and SME clients want to be cost efficient and are less likely to want to switch insurers at the moment. Preferences are for continued long-term relationships with a trusted health insurer.

What are your predictions for health insurance trends in your region over the next year?

Damian Lenihan, Executive Director - Operations and Distribution, Europe, Aetna International: Many of the trends from the past 18 months will continue for the next year. Health insurers will continue to offer all-round health care. We’ll see an acceleration in the roll-out of digital services, such as telehealth. This will be driven by members’ demand for services, which will be due to convenience and safety. Also, it goes back to people feeling empowered to self-manage health concerns. Preventative measures that will reduce the need for in-person medical care and potentially the number of claims and therefore costs. That being said, the continuing degree of global uncertainty indicates that we will likely work in an agile way for the foreseeable future. The investment will be in efficient operations.

Have you recognised any notable trends in health insurance from your region over the past year?

David Healy, CEO EMEA, Aetna International: COVID-19 has increased expectations from employees about health insurance benefits packages. Recent research we conducted found that 76% of UAE employees believe comprehensive health insurance is more important now than before the pandemic. A further 66% said their employer should be spending more on health benefits. Two thirds of UAE-based HR professionals also agree that there’s an expectation for employers to take more responsibility for their employees’ health. Consequently, plan sponsors are balancing workforce expectations with budget restrictions and are working with health insurance providers that offer holistic plans.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

David Healy, CEO EMEA, Aetna International: COVID-19 has had a negative impact on mental health and well-being. This ‘second curve’ of the pandemic is likely to be relevant for some time as people grapple with uncertainty. We believe we have a duty to champion change and our commitment is to ensure that mental and physical health are prioritised equally. We have made several product enhancements to meet the health needs of our members in the short and longer-term, regardless of location. For example, enhancements have been made to Focus, the health insurance product designed specifically for UAE small- and medium-size enterprises (SMEs). This includes inpatient and outpatient psychiatric treatment and psychotherapy for patients with non-emergency medical conditions.

What are your predictions for health insurance trends in your region over the next year?

David Healy, CEO EMEA, Aetna International: Arguably the biggest trend will be health insurers’ continued focus on providing their members with accessible telehealth services. There are a few drivers that make telehealth a key cog in the primary care model. The first is convenience — across the Middle East, telehealth services afford ready access to experienced doctors and some services take it a step further by combining primary care with concierge-style diagnostics and prescription services, where patient samples are taken, and medicines are delivered, to the office or home door.

Second, telemedicine doctors provide the full range of primary care. They take patient histories and either prescribe treatment plans or arrange specialist referrals, after considering the physical and mental effects of a range of afflictions. This approach is vital in a post-COVID world where we have seen an increase in the number of patients with comorbidities.

Third, is the treatment of extant comorbidities. Through 2020 and beyond, the pandemic made it harder for patients with chronic conditions such as diabetes to keep up with their medication and regular check-ups. Telehealth played a vital role in delivering uninterrupted care including diagnosis, treatment, home blood-monitoring, delivery of prescriptions and consultation when needed.

Last but not least, telehealth has the potential to drive down premium costs. While the economic recovery is well underway in the region, businesses are still watching costs. Data from our vHealth service shows that the more employees use telehealth services, the bigger the potential reduction in claims. Around 75% of vHealth users completely resolve their condition without the need for onward care and over 90% admit they would have gone to a hospital if a remote consultation hadn’t been available.

Have you recognised any notable trends in health insurance from your region over the past year?

Hemal Desai, Global Medical Director, Aetna International: The most significant trend over the past year has been the increased acceptance from people to consume multi-channel health care. People can choose how they interact with their health and well-being providers whether it be via chat, voice, video or physical services. This has resulted in a significant uptick in telemedicine and other digital health services.

One area that has benefited most from this multi-channel approach is mental health care, which has traditionally been difficult to access in the past. As a consequence, it is a greater part of the health insurance agenda than it ever was before. We have seen a major push for mental health and well-being provision which wasn’t something actively discussed in previous years. Corporate insurers across the board have seen that the COVID pandemic has triggered mental health concerns. With this, insurance providers are organically becoming health partners offering holistic solutions to drive positive health outcomes. Primary care is central to the health and well-being of individuals. Whilst the global trend is to live longer due to improved preventative care, people need to be able to have the resources to self-manage their health concerns.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

Hemal Desai, Global Medical Director, Aetna International: Many people avoided seeking health care when they needed it during the height of the pandemic. In some cases, people that actively needed treatment could not access it as hospitals were full dealing with COVID-19 patients. Those with mild symptoms or well-controlled long-term conditions hesitated to consult with their health care provider, which has led to accumulating burden of illness.  We’re seeing chronic conditions like hypertension and diabetes that are less well managed, resulting in longer-term complications or an increase in undiagnosed or late presenting cancers leading to poorer health outcomes and costlier treatments. Insurers may have seen an initial lag on claims as people avoided or could not access their health care settings, but this is more than likely to result in more disease complications and higher-value claims in the future. Many people think it will come back harder due to undiagnosed illness.

What are your predictions for health insurance trends in your region over the next year?

Hemal Desai, Global Medical Director, Aetna International: The impact of technology on the health sector is going to be profound over the next year and beyond. Artificial Intelligence (AI) together with remote patient monitoring will create a huge step change in how people access and are managed within virtual health care settings. It will enable new methods of diagnostic support for clinicians, new options in digital therapeutics and allow people to be more engaged in their own well-being. Accurate remote diagnosis of eye, skin conditions and heart arrythmias have already been achieved. The combination of AI and remote diagnosis and telemedicine will be game-changing for health care.

Digital health care is stickier than before - people now trust telemedicine, and this provides a platform for further growth and adoption. Accessible, consumer centric health care is appropriate for modern lives. Additionally, AI will continue to revolutionise remote diagnosis. The challenge for insurers will be developing the right funding environment to accommodate these newer technologies.

One such area of rapid advance is gene and cell therapies. A significant pipeline of exciting new therapies is due to come on to the international market to treat previously untreatable health conditions. 

COVID-19 has also potentially accelerated vaccination production for other illnesses such as malaria, HIV, and some cancers. It is very exciting that COVID-19 has accelerated this by improving vaccine technologies, such as mRNA, but also the vaccine development process and regulatory approval cycles. Preventing illnesses is really important from a health insurance perspective.

The impact of post-acute COVID syndrome (or long COVID) is also an area that health insurers will need to monitor closely. The impact and extent of long COVID may be significant but is not yet fully understood and extremely hard to predict. Long COVID potentially presents a significant challenge for health care systems, payors, employers and, most importantly, those suffering from the illness.

Have you recognised any notable trends in health insurance from your region over the past year?

Derek Goldberg, CEO APAC, Aetna International: There is an increased need for mental health support and services due to the toll the pandemic has taken on mental health in the region. We’re also seeing ‘flight to safety’ behaviours whereby customers are choosing to purchase insurance from more established insurers.

Driven by the prevalence of work-from-home and a reluctance to venture out into a physical health care setting when avoidable during a pandemic, there has been an increased demand for digitisation of customer processes. Telemedicine is one of the key capabilities required to support this demand, and we have seen an increase in both registrations and utilisation across our telemedicine programmes.

How has the COVID-19 pandemic impacted the private medical insurance market in your region?

Derek Goldberg, CEO APAC, Aetna International: Many insurance providers are removing their pandemic exclusions or developing dedicated products to cover pandemic risks. Unique to this pandemic, insurance may be used as an incentive to drive vaccination, for example new regulations allow Singapore employers to exclude unvaccinated employees from COVID-19 coverage under their health insurance plans.

What are your predictions for health insurance trends in your region over the next year?

Derek Goldberg, CEO APAC, Aetna International: Employers will continue to be conscious of budgets as the economic outlook remains uncertain in many countries, and, as insurers, we’ll be called upon to work collaboratively and creatively with our clients to devise health benefit programmes that manage costs and meet their financial objectives. Digitisation will continue to accelerate across all industries including health care. Long COVID (symptoms of COVID that persist long after the initial infection has cleared) and its implications for longer-term support and follow-up treatment will be an emerging part of the landscape.



iPMI Magazine Speaks With Ian Youngman About International Private Medical Insurance (IPMI)

Please introduce yourself and background in the international private medical insurance industry?

I was an ACII and for many years worked for brokers and insurers in the London insurance market in a range of roles. These included negotiating national schemes and policy wordings, market research, product development, product comparisons and marketing/advertising. And I was a co-founder of the General Insurance Market Research Association.

In the last - cough - years I have made a living by writing and researching about insurance, financial products, global healthcare and medical tourism for a wide range of magazines and websites. This includes various activities for the Chartered Insurance Institute and editing parts of Kluwer's Handbook of Insurance.

Books include ones on international directors and officers liability, and on competitor analysis in financial services. I have also published 200 plus research reports on insurance, health, medical tourism and finance. Until recently I actually forgot that I had written the first ever study of international health and health insurance for a publisher now long gone. The 2016 IPMI report is the sixth one in over a decade- and at 1500 pages the biggest ever.

In your most recent report, International And Expatriate Healthcare And Insurance 2016, you layout how IPMI, healthcare and health insurance works in over 150 countries. Why do 1- insurers; 2- corporations; 3 - brokers; 4 - international hospitals; 5 - assistance providers; 6 - ground and air ambulance providers, need this information?

Keeping up with what is happening on healthcare, insurance, legislation, expats insurers and brokers- takes me a couple of hours a day at least. By speed reading and knowing what I need to find and how to find things, it is manageable. So if you have to do your normal job and then keep up with all that too it is impossible and easy to miss trends, new competitors, new product and marketing ideas and all the techie stuff too.

244 Million People live away from their country of birth. There will be 60 million expatriates by 2020. What does this mean for payors and providers in the business?

It used to be easy- you had locals, refugees, and expats. Some workers are now global rather than temporary expats- and then you have economic and social and political migrants. When does an expat become a migrant? Many countries now refer to citizens and non citizens- and have rules on who gets what on healthcare. So referring to expats as a specialist class is out of date and not how laws and rules are made. In a global business world, with increased rules on who they can and cannot employ- it is hard for insurers to offer cover A to expats and cover B or no cover to locals. For each country you have to understand the rules on healthcare, health insurance, local cover, and even price and cover regulation-before you even try to offer a policy. There are far more risks on offering offshore covers than five years ago - and sadly, some insurers and brokers still offer a " one size fits all" cover that may neither be legal nor appropriate.

Risk is changing. Does insurance require reinvention in 2016 to mitigate new risks that pose major threats to global travellers and expats? 

The number of insurers rushing to add health information and help on relocation has been overtaken by those offering help and information on terrorism, political risk and other non-medical help. What concerns me is that some just offer advice, which to my mind is useless unless you have a way to evacuate or protect people who suddenly become at risk.

How can we educate the entire IPMI industry about global trends and what do payors and providers need to get their head around?

As well as all the factors I mentioned before, you need to keep up to date with the way technology and social media is changing how insurers, intermediaries, customers and healthcare providers work and interact. There are mind blowing changes happening and those that do not keep up will vanish. For insurers and brokers there are companies from Asia, China, Africa, The Middle East and Latin America who want a multi country presence on health insurance- and some of these are so new that they look at new ways to design products and link technology with health. Stand still and you risk being trampled.

Insurers are rebranding as global health services companies. Insurance is a given. What opportunities exist?

With PMI, IPMI, health cash, major medical, micro health and other variations there is a health policy for everyone. But many insurers are stuck with just offering one or two of these. Some new insurers have combined categories or change how it is done. It is easy to get into a UK, US or European mind set of what a health insurance product is and ignore how technology can be used to simplify the historic practices.

How can we define IPMI in 2016?

Health insurance with an increasing raft of add-ons, extra services, options and non-insurance extras ranging from cheap cinema tickets to a risk profile of the country you may move to next. This is in danger of being a car that has been retuned, added to and with so many functions that the focus is lost. Car dealers reckon that motorists use, or even know about, only a fraction of the features in their car- and health insurance is going that way.

How will we define IPMI in 2021?

Those thinking ahead see that it is no longer about having insurance and tacking everything else on to it like some mad scientist- but in offering health and lifestyle assistance and protection to individuals and companies- where insurance is just a back stop when everything else fails. It is bringing wellness, health (in mind and body) and humanity to the forefront and hanging on services of which insurance is just a part. But at the other extreme you have micro health cover with low price, simple cover, little or no choice or extras, direct billing and all done by social media in the cloud so hardly any admin. You could have virtual insurers with no offices- and before dismissing this as barmy, publishers of web magazines are closing their offices and just have a handful of people working remotely.

What more can be done to assist the under insured and those on low incomes access decent healthcare globally?

Micro health insurance targeting people who would not normally buy health insurance is a huge growth market in Africa and Asia - where major insurers see that if they can make money on low price products they can use that technology and methodology to simplify how they handle PMI and IPMI. One country has 34 people with micro insurance including micro health and expects that to be 50 million by 2020.

What reports are you working on next?

My annual Medical Tourism Facts and Figures one is being updated- but that has become a settled market.

After that I am doing a brand new one on micro insurance - with a focus on micro health. That is something I have followed for years but only recently have major insurers taken it seriously.

And then - some time off; with the next one and area that insurers are struggling with- peer-to-peer insurance. I have done reports on peer to peer lending but how p to p insurance works and why it is different from traditional mutuals is something to get my head round.

What annoys you?

As well as lying politicians, celebrities who are famous for nothing, techies of driverless cars that think lorries and buses will give way to cars at junctions- and the way my football team is playing - boiler plate research reports which confuse PMI and IPMI, mix both in with accident and critical illness, mix it with life insurance and income protection cover- and most recently, thinking medical cover under travel insurance is part of health insurance and not part of travel insurance. Other pet hates are press releases with" we are delighted to" or " we are announcing the launch" or " really unique" or " X will help us take the company to the next level' or" Z has been specially designed to cater for".

What enthuses you?

Insurers and brokers used to be grey men in grey suits with grey minds, with a few girls there for show.  It is now far more equal and with many bright people using technology and ideas that perhaps those running the companies do not really get. If it can bring in more scientists, engineers, social thinkers and not just those with a financial background or are happy to follow orders-then it can thrive.  It needs disrupters, people who annoy bosses by challenging how anything is done, and those who can look at health insurance upside down and insight out.

iPMI Magazine Speaks With Ian Youngman About International Private Medical Insurance (IPMI)


AIG Announces Actions Executing Strategy Of Leaner, More Profitable And Focused Insurer

AIG has announced a series of strategic actions, organizational changes, and operating improvements to create a leaner, more profitable and focused insurer.

The Board of Directors has committed to return at least $25 billion of capital to shareholders over the next two years via buybacks and dividends without compromising the utilization of the Company’s deferred tax assets (DTA); approved the IPO of up to 19.9% of United Guaranty Corporation (UGC) as a first step towards a full separation; and approved the sale of AIG Advisor Group to Lightyear Capital LLC and PSP Investments.

In addition, the Board approved a number of organizational changes, including the creation of nine “modular” business units with greater end-to-end accountability, each with its own specific financial metrics. AIG will create a new “legacy” portfolio to hold non-strategic assets and has appointed Charlie Shamieh as Legacy CEO.

In related operational actions, AIG also announced targeted expense reductions of $1.6 billion within two years, representing 14% of 2015 gross general operating expenses; a target of improving the Commercial P&C accident year loss ratio by six percentage points; and a consolidated ROE target of ~9% by 2017, reflecting 10.3% to 10.7% in the operating portfolio.

“With these actions, AIG has taken another major step in simplifying our organization to be a leaner, more profitable insurer, while continuing to return capital to shareholders and improve shareholder returns,” said President and CEO Peter Hancock. “The creation of more nimble, standalone business units that can grow within AIG or be spun out or sold allows us to do what is in our shareholders’ best interests.”

Douglas M. Steenland, AIG’s Non-Executive Chairman, said, “The Board’s actions reflect its full support for the plans that Peter Hancock and his management team have put forward, and we are aligned that these steps will deliver strong results while creating more options for shareholder value creation in subsequent years.

“AIG is committed to serving all its stakeholders by delivering first quartile total shareholder returns to its shareholders; providing risk expertise and dependable long-term balance sheet strength for its customers; having a culture of strict adherence to both the letter and spirit of regulatory requirements; and maintaining an environment that attracts and retains world-class employees.

“After careful consideration, AIG believes that a full breakup in the near term would detract from, not enhance, shareholder value. A lack of diversification benefits would reduce capital available for distribution, and there would be a loss of tax benefits. Being a non-bank SIFI is not currently a binding constraint on return of capital,” said Mr. Steenland.

Strategic Actions

Capital Return

AIG is committed to returning at least $25 billion of capital to shareholders over the next two years (via buybacks and dividends), on top of the $12 billion returned in 2015. The capital return is expected to be sourced from a combination of improved operating performance, divestitures, reinsurance transactions, a shift in asset allocation, a modest increase in leverage, and the release of capital over time from low-earning legacy assets. This commitment to returning $25 billion of capital can be achieved notwithstanding the strengthening of reserves and associated capital contribution announced today.

IPO of up to 19.9% of United Guaranty Corporation (UGC)

AIG will pursue an initial public offering of United Guaranty Corporation (UGC) in mid-2016 to sell up to 19.9% of the outstanding shares, subject to regulatory and GSE approval, as a first step towards a full separation.

Divestiture of AIG Advisor Group

AIG has announced the sale of AIG Advisor Group to Lightyear Capital LLC, a New York private equity firm focused on financial services, and PSP Investments, one of Canada’s largest pension investment managers. The transaction is expected to close in second quarter 2016.

Organizational Changes

“Modular” Business Units

AIG is overhauling its management model to improve transparency, accountability and operating performance improvement throughout the organization. The new structure, composed initially of nine “modular” business units within AIG’s Commercial and Consumer segments, will decentralize decision-making, provide more accountability to business leaders, and allow for migration to a more variable cost structure. The reorganization will give AIG options to retain and grow the businesses, or take public or sell the units if they don’t adequately contribute to financial targets, or if it becomes apparent that they are worth more outside of AIG than within, or if they represent an efficient means of returning capital to shareholders. The Company could consider the separation of even the larger modular units of its Commercial and Consumer segments over time with utilization of the DTA, contingent on improvements in the credit risk profile and operating performance. Within AIG’s Commercial segment, the modular business units will be Liability and Financial Lines; Property and Special Risks; U.S. Commercial; and Europe Commercial. Inside the Consumer segment, the modular units will be U.S. Individual Retirement; U.S. Group Retirement; Life, Health and Disability; Personal Insurance (P&C); and Japan.

New “Legacy” Portfolio Management

The Company will create a new “legacy” portfolio composed of non-strategic assets and businesses that it intends to exit or run off. This portfolio will be managed in a way to monetize assets in a timely manner in order to return capital to shareholders. The Company will also introduce new disclosures later in 2016 to clarify sources of financial returns and enhance focus on a goal of releasing $9 billion of capital by 2017.

Operating Improvements

Expense Reductions

AIG is also undertaking further substantial expense reductions of $1.6 billion within two years, representing 14% of 2015 gross general operating expenses. The savings will be driven by an acceleration of our current initiatives to rationalize the Company’s global structure, including consolidation of activities and de-layering, increased utilization of shared services and outsourcing, continued movement of operations to lower-cost locations, and further increased automation.

Underwriting Improvements

Aggressive actions will be taken to improve the Commercial P&C accident year loss ratio by addressing unprofitable clients purchasing one or two products, expanding and optimizing the use of reinsurance, and exiting or remediating targeted segments of underperforming portfolios. These actions are expected to result in accident year loss ratio improvement of six percentage points by 2017. In addition, we will undertake actions to sharpen our consumer focus and improve profitability, including narrowing our footprint in Personal Insurance, expanding reinsurance utilization for inefficient segments of the U.S. life business, achieving maximum benefits from investments in Japan, and growing our U.S. Retirement business.

ROE Improvement

AIG has set a consolidated normalized ROE target of ~9% by 2017, reflecting 10.3% to 10.7% in the operating portfolio. The increase will be driven by the operating improvements, capital actions and profitable growth outlined in the strategic plan. At the same time, legacy assets and liabilities will release low-earning capital over time.

Mr. Hancock concluded, “We have set substantial financial goals for AIG and will continue to improve shareholder return by thoughtfully managing the trade-off between book value per share growth and improving ROE. By overhauling the way the company is organized and creating modular, self-sufficient businesses, we will drive substantial operating performance improvements and maximize value for shareholders.”


iPMI Magazine Speaks With Arjan Toor Cigna Global iPMI Managing Director

Arjan brings over 18 years of experience in financial services across Asia, Europe and the US to his new role. With proven expertise in the development, marketing and distribution of a broad variety of insurance solutions, he is well positioned to lead Cigna’s Global IPMI business as they build out their position as a leader in the individual PMI industry.

Please introduce yourself and background in the international medical insurance industry:

Let me first say how pleased I am to be joining Cigna’s Global Individual Private Medical Insurance business. We launched this business back in 2011, and since then the business has grown exponentially to become one of the leading providers of health and wellbeing solutions for individual expatriates around the globe.

This is a great time to be joining the business. The team here has done great work over the last four years in building a very strong proposition, and we have built deep relationships with a large number of distribution partners who are now strong advocates for the Cigna brand and share our commitment to customer centricity. We have established a very successful business, and I’m honoured to take on the challenge of taking this business to the next level.

As for my background, I’m joining Cigna Global IPMI after spending four years in Hong Kong as Chief Marketing Officer for Cigna’s International Markets. In this role, I had responsibility for the development and execution of Cigna’s global marketing strategy, with a strong focus on individual customers. While working with our teams in Asia, Europe and the US, I was able to spend a lot of time with our customers and distribution partners in these markets. This cross-cultural exposure will undoubtedly be a great asset to me in my new role, and I fully intend to continue listening to our customers and distribution partners as often as I can.

You are now responsible for the continued profitable growth and expansion of Cigna’s Global IPMI business. What's the plan?

We’ll only be successful if we continue to listen to customer and brokers. We need to understand their needs and expectations deeply so that we can shape our future propositions accordingly.  Every Friday I spend time analysing feedback from our customers, and I frequently listen to the conversations we have with our customers on the phone. I’ve been very pleased with how open our customers are with us – they will tell us when things are going great, but they’ll also tell us how we can improve – something I really value.

Based on the insights that we are gathering from customers and distribution partners, Cigna will continue to innovate our products, services and distribution channels.  We have never been a follower; we always find our success in breaking new ground. That’s why we’ll continue to work closely with local regulators to expand our global licensing capabilities, continue to enhance our proposition for our distribution partners, and develop new products and services for new and emerging customer segments.

What challenges are you currently facing when it comes to worldwide iPMI plan distribution?

Undoubtedly the biggest challenge is keeping ahead of the latest trends in the market. In the last couple of years we have seen new technology become increasingly important in supporting the sale of IPMI plans, and we have been at the forefront of that, particularly in the broker market, with the launch of our AppLink and Broker Quote Tool platforms.

The other big challenge that I see is around licensing and regulation. If you take the US for example, the Affordable Care Act continues to present challenges for all providers of expatriate health insurance plans. In other markets we see similar challenges, with expats finding themselves having to purchase mandatory local health insurance plans, even though these plans do not always provide the comprehensive global cover that globally mobile individuals require. As a global leader in this market, we will continue to leverage Cigna’s extensive global footprint and capabilities to find compliant solutions that meet the needs of these customers. 

For those global brokers, agents, intermediaries and IFAs who aren't currently offering iPMI, what is the Cigna message to them?

First of all, I would tell these partners that the IPMI market will continue to grow, as more and more people see the need to purchase comprehensive medical insurance.

We also see a big increase in the number of globally mobile individuals which further reinforces this trend. This presents a big opportunity for brokers and other distributors, and Cigna is very willing to partner with you to get you set up to offer these plans in addition to your current product range. We have invested heavily in state-of-the-art technology solutions, and we can now offer brokers a very easy-to-use Broker Quote Tool for generating quotes on behalf of clients, or a complete online affiliate solution whereby customers can hit the broker's site, get quotes themselves and proceed to buy online. The broker can get involved by calling out on these leads, or alternatively a lot of brokers are seeing success with this by allowing Cigna to follow-up and convert the leads on their behalf. You should really view us as an addition to your own sales team!

Can you tell us more about AppLink?

AppLink is a tool we launched last year to help support a growing band of brokers who prefer to trade online. We essentially provide a unique tracking URL which the broker can place on their site, drive traffic towards it, and allow their customers to get an instant price online for expatriate cover. We then send an automatic email to the broker every 24 hours to advise when there are new leads, and the broker has the option of whether to follow-up on these themselves, or ask Cigna to do it on their behalf. It’s a really simple way of driving more international health insurance leads and finding different ways to support customers based on the ways people like to interact with their broker these days.

January 2014 and Cigna announces the launch of local language sales and service capabilities for expatriate individual health insurance products. How has the roll-out progressed and what challenges have you had to overcome?

Since 2014, we’ve expanded our language capabilities from English to include full French, German, Spanish and Dutch sales and service. This includes every touch point through which we interact with our customers , and means we have native speakers on hand to pick-up any customer service or claims enquiry.

The transition has actually been very smooth. The key here is finding people who speak the local language as their first language. This ensures we have someone who can effectively interact with customers and understands the cultural nuances that the customer experiences. After all, it’s not just about the words we speak, it’s about understanding where our customers are coming from and putting ourselves in their shoes.

It’s also worth pointing out that we have native  speakers on our broker teams as well, offering an additional service to brokers who would rather communicate with us in their mother tongue.

Based on where we see the opportunity for further geographical expansion, we will continue to expand our language capabilities.

Over the next 5 years, which geographic markets will represent your core strategic focus, and why?

We’ve built a strong business over the last few years by focusing on key expatriate markets around the world. We will continue to look at where the ‘up and coming’ countries are for expatriates, and expand our capabilities in those markets. That said, we are a global business, and I fully believe over the next 5 years that country boundaries will continue to blur and we will see a true ‘global marketplace’ emerge. Of course, there will always be local market regulations we need to adapt to, but my goal is to be able to support our customers and distribution partners anywhere in the world.

How will the cost of iPMI rise in the coming year and why?

This is a question I get asked a lot, and it’s not necessarily an easy one to answer. We all know that medical cost trends are highly dependent on where in the world medical treatment takes place. We will continue to be transparent with our customers and distribution partners about specific increases, but we will also continue to manage the overall cost of treatment for the benefit of our customers.

At Cigna, we can offer our customers access to over 1 million doctors, hospitals and clinics around the world. This extensive network allows us to negotiate substantial discounts on the cost of care in a lot of cases which means we can pass this saving back to our customers. This helps offset some of the rising premium costs, and in the case of our customers moving inbound into the US, this has actually let us reduce premiums by 25% for these customers in the last few weeks.

iPMI buyers have become more demanding. Insurance is a given and it's about the entire package and added value. How do you add value? 

I completely agree. It’s no longer enough to just provide a good quality insurance product, customers are now seeking a lot more value from their expatriate health insurer and it’s up to us to continuously challenge ourselves to think about what more we can provide. Let me give you an example:

Living as an expatriate can clearly be very stressful at times, and we know our customers travel a lot – both for business as well as for pleasure. So we’re now providing all our Gold and Platinum customers with access to the new Safe Travel by Cigna app for Apple and Android devices.

This app has been developed in close collaboration with expats to support them when moving to a new country, but also while they are travelling.

For example, the app pushes dynamic travel safety alerts which keep expats informed of emerging risks which may impact them on their travels, and secure document storage meaning the customer always has a copy of their insurance documents and passport electronically stored in case of emergency.

Other than the app, we also regularly communicate with our customers to provide them with health and wellness tips, a quarterly customer magazine providing useful articles and hints for living well away from home, and a health and wellness portal providing access to online health risk assessments and wellness guides.

Again, it is about listening to our customers, understanding what their needs are, and then making sure we deliver added value while we continue to nail the basics.

What should customers consider when choosing an IPMI plan with real global access?

There are a few key factors customers should take into account when looking for a high quality health care plan which offers true ‘global’ peace of mind.

Firstly, service is really important. At Cigna, we aim to consistently deliver high quality service, and part of this service is the ability for customers to get access to an actual person – our customers won’t have to press a series of numbers in a telephone menu to access who they need to speak to.

Next, it’s about our customers knowing they have access to treatment nearby when they need it, regardless of where they are in the world. As I said before, Cigna customers have access to over 1 million doctors, hospitals and clinics around the world. Customers can search these on their online Customer Area to find the nearest specialist wherever they are, and brokers can also do this on their customers’ behalf in the Broker Portal.

Finally, I’d say providing different products and levels of cover to give customer more choice is essential. We offer plans with varying cover levels, different module options and flexible deductibles and cost shares to let customers build a totally customized plan. We’re continuing to build this range of products by listening closely to our customers and distribution partners, and using solid insights to determine which products and services will be most valued by each segment.

Last and not least, what do you think of iPMI Magazine?

iPMI Magazine? My one-stop resource to stay on top of what’s going on in this very exciting industry!

Interview originally published in iPOLICY issue 4. Click here to read.






iPMI Magazine speaks with Phil Austin, Head of Global Individual Private Medical Insurance at Cigna

Phil Austin runs Cigna’s Global Individual Private Medical Insurance business, based in Glasgow, Scotland. He first joined Cigna International in 2002 as Partnership Director for the UK corporate business.

As Head of Cigna’s Global Individual Private Medical Insurance division, Phil is developing and implementing the company’s individual consumer strategy on an international scale and creating a world-class international individual business. He is also responsible for building the business segment and driving profitable growth, targeting high net worth and globally mobile individuals through various channels such as the internet, bancassurance and intermediaries in key global markets.

Phil brings over 20 years of experience in global sales, marketing, product strategy and general management to the Cigna Global Health Options team. He returns to Cigna after serving as Vice President of the European Group A&H (Accident and Health) Business for Chartis.

Phil first joined Cigna International in 2002 as Partnership Director for the UK business. He went on to hold several positions within the organisation, including Health, Life & Accident (HL&A) Europe Sales & Marketing Director and Interim CEO for HL&A Europe.  

Cigna, the US based global health insurer posted a staggering $29bn revenue last year, and has over 14 million customers on its books. They have just launched a new set of IPMI products targeted at global expatriates and iPMIM finds out more.

You rejoined Cigna in 2011. Why did you return?

We launched our global individual PMI business in 2011, and it was an opportunity I simply couldn’t miss. This is clearly a market which is seeing exponential growth, it’s a very fast moving market, and that’s something I really wanted to be part of. Getting the chance to run our global individual expatriate business has certainly presented its own challenges. In a lot of ways it’s very different from the Corporate business, but the principles are still the same – Cigna have a reputation for high service, high quality plans, and that is now being continued in the individual market. The other thing that really excites me about Cigna is the way that the customer truly is at the centre of everything we do – everything is focused on the needs of the individual, and we don’t get closer to this than in the expatriate individual business.

What is Cigna’s take on iPMI?

Our individual iPMI products have been built around the needs of customers and brokers. We stripped back the concept of what an iPMI plan ‘should’ look like, and rebuilt this with things like flexible module options, cost shares and deductibles. What we have now are 3 plans which give our customers and brokers absolutely flexibility and choice to build a plan which meets their unique needs and fits their budget. Our top level Platinum product has some of the richest benefits on the market; whilst our Silver and Gold products present options for expatriates who are still looking for a quality plan, but perhaps don’t need cover for things like maternity. Every customer still benefits from the customer service which Cigna is known for, and gets access to our 24-hour global control centre and network of over 1 million hospitals and physicians worldwide.

Cigna has a huge amount of experience in the expatriate market, primarily through Corporate plans. We’ve also worked extensively in global markets for the last 30 years offering individual health, life and accident plans – so moving into iPMI was a natural next step in this journey. We’re now taking those years of experience and learnings and applying them to the iPMI market, which has given us a really great platform to provide our customers with what they want.

The expat market is clearly growing. Where are you seeing trends?

We are offering a truly global product, serving expats all around the world. I’m seeing a lot of movement out of the US and Europe into Asia, and when you look at where we’re selling policies, there is a growing trend towards Asia. Whilst the new plans expand into the mid-market, we still see a lot of demand at the upper end of the market for our Platinum plan. This goes to show that when moving abroad, people don’t want to take chances with their healthcare and are often quite willing to pay to get the very best - both in terms of ease of access to and the quality of the providers themselves.

As an insights-driven organization, we commissioned proprietary, independent research to look at market sizing and distribution channels in this market and to understand the core needs of the stakeholders (customers, brokers, medical providers, etc). We have grown a very successful direct to consumer business online, we have a growing intermediary channel and we also sell our range through bancassurance partners.

In 2013 insurance is a given. What are consumers looking for when selecting private medical insurance coverage?

We are more and more seeing customers ask what else we can give them over and above just paying their claims, and we’ve recognised that insurance is a given. Consumers are becoming much more discerning and demanding of insurers. We’ve recognised this and are leading the way in developing additional value add tools and services which customers value.

We recently launched a travel toolkit which provides consumers with an array of tools and services fitting for the traveler on the move – for example, online eDocument storage, emergency travel alerts, and dynamic country guides which our customers can refer to as they travel. Marry this with our online Health Risk Assessments (HRAs), and focus on preventative health, and our customers are getting a lot more than just insurance.

Globalization is driven by technology, consumerism and the search for new business. What role is technology playing in your private medical insurance plans?

Of course, health insurance has moved on from just paying claims. Whilst the ability to do that efficiently is crucial: making it simple and easy for our customers is among our top priorities, we’ve asked what else we can do to improve our offering for the broker market through better technology. We can offer full online medical underwriting which will often give you an instant decision in many cases, provided no additional information is required. This forms part of the online Intermediary Zone through which brokers can generate quotes, manage their client database and view clients’ documents online.

Whilst the online functionality is great to have, we know brokers often want to be able to speak to someone directly, so we support this with a real-time Intermediary Support Team who have the capability to generate quotes, and set up policies on a broker’s behalf.

Whilst the majority of our team is based in Glasgow, Scotland, we have local Business Development Managers (BDMs) in Central Europe, Hong Kong, Singapore and the US. Such is the value we feel local decision makers can make to our broker community, we have plans in place to increase the size and footprint of our BDM team and provide more localized Intermediary Support agents to support brokers in market. Each market has its own legal, regulatory and cultural nuances, its own ways of doing business, and its own approach to healthcare - so it’s crucial we have local people in the local market who can bridge those needs.

What is important when designing a private medical insurance product?

You absolutely have to listen to your customer, and listen to the market. We spent a lot of time carrying out research to build a unique proposition in the market, and this has been critical to our success. There’s a lot to be said for asking customers and brokers a direct question – ‘what do you want from a health insurance plan?’ 9 times out of 10 you will get an answer along the lines of making it easier to build a plan that suits their needs – both in terms of plan design and budget. That’s why we’ve invested a lot in building out or proposition, launching 3 brand new products, and creating completely modular plans.

How do you see the cost of expat healthcare changing in the next five years?

Rising medical costs are a universal challenge. Aging populations and increased global health risks have driven up medical trend over the years. We’re seeing this starting to stabilize in some markets, but the research is telling us this is only likely to grow further elsewhere, especially in Asia. This is where our product development team comes in. By developing modular products which give our customers and brokers the maximum level of choice and flexibility, they can build a plan which is customized to what they need. After all, if you know you’re not going to have a baby, you don’t necessarily want to include maternity care on your plan.

It’s all about choice. Our customers get the opportunity to manage their premiums with cost share and deductible options across the core inpatient and outpatient modules on all of our plans. In addition, by looking at preventative health management and offering things like online Health Risk Assessments (HRAs) which are available in our Health & Wellbeing module, customers can proactively manage their own health before they get to the stage of a doctors’ or specialists’ visit - reducing costs accordingly.

For worldwide insurance brokers who want to better understand International Private Medical Insurance, what advice would you give them?

Every time I go out and meet a broker, the lasting impression I get is that people are often surprised about the level of opportunity in this market. There’s a lot of interest out there both at the upper end of the market with Directors and Consultants following their careers, and also at the mid to low end, particularly in the student and retiree markets. The research only points to further growth, with increasing numbers of expatriates becoming ever more globally mobile.

There is undoubtedly a distinct lack of information out there for people looking to move abroad, which is where I really see the broker adding value. Brokers can position themselves as the experts and offer the solutions that best meet the ever-changing needs of their customers.

If you are an insurance broker, intermediary or agent, interested in selling Cigna Global Health Options Individual Medical Insurance Plans, simply click here to register.

iPMI Magazine speaks with Phil Austin, Head of Global Individual Private Medical Insurance at Cigna

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