iPMI Magazine Is Proudly Sponsored By:
For a healthier journey.

AXA – Global Healthcare Appoints Andy O’Cain As Global Head Of Distribution

International healthcare specialist, AXA – Global Healthcare, has announced the appointment of Andy O’Cain as Global Head of Distribution, effective on December 1st 2021.  

Joining from Aetna International, O’Cain will oversee the strategic development of all aspects of global distribution across individual, small business and corporate client segments. He will lead the regional distribution activities delivered from AXA Global Healthcare’s sales hubs in the UK, Europe and Asia, and oversee the development of strategic distribution partnerships, to further strengthen AXA’s growing footprint in the IPMI market.

Andy Edwards, Global Head of International Insurance, AXA Global Healthcare, comments, “We’re excited to welcome Andy to our senior leadership team, and it comes at an opportune time in the evolution of our business. Since separating from AXA PPP Healthcare in 2017, to become an independent Managing General Agent, we’ve developed a strong brand presence in the IPMI market. We’ve enhanced our value proposition, expanded our global reach, and despite some of the challenges the market has experienced over the past few years – from Brexit to the Covid-19 pandemic – kept an uncompromising focus on delivering for the customer. And it’s this unwavering determination to put the customer first that drives our evolution."

“The last 18 months have prompted rapid changes from all of us. Expectations of what makes a good customer experience have changed, people’s trust in digital healthcare services has risen, people’s lifestyle priorities have adapted. We have some exciting developments ahead to meet these emerging needs and ensure our customers can continue to depend on us, wherever they are in the world. With Andy O’Cain joining our senior leadership team, we’re confident in our continued growth in both new and existing customer segments in the global healthcare market.”

With over 20 years’ industry experience, O’Cain has previously held several distribution and senior management roles within the global insurance market. Most recently, he was Distribution Director for Aetna International, where he led the distribution of international health insurance products, prior to which he was Head of Sales and Business Development at Cigna Insurance Services. He has also held a variety of other managerial roles within Allianz and Direct Line Group. From this experience, O’Cain brings excellent knowledge of distribution to individuals, SMEs and corporate businesses in the global market.

Commenting on his new role, O’Cain said, “I’m delighted to be joining the AXA Global Healthcare team and look forward to driving new opportunities for growth in all customer segments. The strength of the proposition and the customer first mindset gives me great confidence in what the future holds.” 


Will Bupa And DNI Now Compete In Several Countries Where Generali And Generali Employee Benefits Are Both In Business, Or Just The Middle East, Or Just The UAE?

In this article, Ian Youngman, leading insurance analyst and author of the leading iPMI market report, “International Health Insurance 2021" talks about the DNI takeover of the Global Choice international medical insurance portfolio of Generali Global Health.

A few weeks ago Generali and Bupa announced a deal on IPMI.

Generali Employee Benefits (GEB) and Bupa Global announced a strategic partnership to offer “best-in-class” international private medical insurance and global employee benefits solutions to their new and existing corporate customers.

RELATED: Generali Employee Benefits And Bupa Global Announce Strategic Partnership To Offer International Private Medical Insurance

GEB customers will have access to Bupa Global’s quality, expertise, and comprehensive health and wellbeing offering, when and where they need it, across 190+ countries. Bupa Global customers will also have the ability to access global health and benefits solutions provided by GEB’s worldwide network.

What is easy to miss here is that it only refers to corporate business.

So what happens to the individual business of Generali Global Health?

The implication is that Generali Global Health would cease trading and leave the IPMI market.

I expect details to be explained on December 15th, 2021 when Generali will hold a virtual Investor Day to present its new strategic plan.

One part of the future was leaked – but it leaves gaps in knowledge.

Dubai National Insurance & Reinsurance (DNI), one of the leading insurance companies in the UAE, has partnered with Munich Re to take over some of the Global Choice medical portfolio of Generali Global Health.

Munich Re took over the reinsurance of Global Choice in July 2021.

DNI and Munich Re will maintain the existing policy benefits and terms and conditions of Global Choice.

Abdulla Al Nuaimi, CEO of DNI said, "We are delighted to officially announce the takeover of the GGH portfolio in collaboration with Munich Re. This exciting new collaboration affirms our commitment to continuously provide the same level of benefits and enhanced quality services to our clients and existing policyholders. We are dedicated to working with and strengthening our relationship with our partners to ensure seamless integration, giving customers peace of mind that they will not only continue to enjoy the benefits of GGH but take advantage of the combined expertise that DNI and Munich Re have to offer on the international medical front.”

Dr Frank Mayer, CEO, Munich Re comments, "DNI has been a trusted partner, and we are eager to work together and continue to expand our portfolio of services in the coming years. We believe that, together, we are in the best position to cultivate an even stronger and more comprehensive ecosystem that will allow us to serve our customers and partners better."

To ensure seamless operations following the takeover, DNI has continued working with Munich Re subsidiary MedNet as the third-party administrator owing to their familiarity with the scheme. The process will continue under the new partnership with Munich Re. The international network direct billing facilities previously through GGH will now be offered through the MedNet Global Network.

Although MedNet has a global network, DNI is limited to the Gulf and most of that is in the UAE.

Will Bupa and DNI now be competing in several countries where Generali and Generali Employee Benefits are both in business, or just the Middle East or just the UAE?

What will happen to the rest of the Generali Global Health portfolio?


There is a trend for even leading global insurers to decide to stop competing in PMI and IPMI in selected countries.

There is also a trend for insurers to work in partnership with local groups and TPAs.

Regional groups see gaps.

What is interesting is to look at the plans of Oman Insurance to offer PMI/IPMI in six more countries from 2022 in association with four named and two yet unknown local insurers.

Looking at other recent deals, there is a move for insurers in Africa and The Gulf to offer PMI and IPMI across borders in association with others from the region.

While this may or may not have anything to do with Afghanistan it is very clear that American and European insurers are going to have to compete with strong local rivals.

My tip for 2022 is watch for more country exits by USA and European insurers.

But it is not all one way traffic, with Zurich quietly entering in some countries and the expected IPMI launch from HDI Global - ironically bringing us full circle as they have been recruiting from Generali Global Health.

READ THE LATEST REPORT ON IPMI: International Health Insurance (IPMI) 2021





BLACK FRIDAY: Save Up To 33% When You Purchase International Health Insurance (IPMI) 2021 Report

With Black Friday almost upon us, iPMI Magazine announces a sale price on the current iPMI Market research report, International Health Insurance 2021.

There are now 80 million expatriates, 5 million international students, 4 million temporary foreign workers, and 18 million high net worth individuals of which 2.7 million are ultra high net worth. All of these are targets for iPMI.

If you are an iPMI Magazine Subscriber you may now access the complete report, with a 20% subsidy on the RRP. So, £3600 becomes just £2,880.*

If you are an iPMI Magazine Advertiser you may now access the complete report, with a 33% subsidy on the RRP. So, £3600 becomes just £2,412.*

Learn more about this report click here.

Order your own copy of International Health Insurance (IPMI) 2021, or ask questions, write to ipmi[at]

*Offer ends 1/12/2021. This offer is only available when you purchase the report directly through iPMI Magazine. The report is still selling at full RRP on Research and Markets.


The Death Of The Credit Standard In IPMI & Travel Insurance

Written by Scott J Rosen, Founder and CEO, MDabroad.

The pandemic has impacted the travel and IPMI policy service industry in many fundamental and some unexpected ways. As the near cessation of cross-border travel caused a sharp drop in revenue followed by drastic cost reduction measures, the specter of a prolonged depression in our industry has forced us to look introspectively to examine the efficiency (or inefficiencies) of our organizations and to challenge the prevailing models of how we do business.  We are now forced to rethink the long-held paradigms, business models, practices and workflows that have existed virtually unadulterated for decades, such as the unsecured payment guarantee that has been the tool for payers to access credit.

The economic crisis of our industry exposed the dysfunctional claims payment cycle with a series of defaults of healthcare payers concerning their obligations to providers and correspondents. We have seen thinly capitalized businesses fail and others simply not honor obligations, resulting in a cascade effect across the entire value chain, specifically impacting medical service providers. The “GOP” (or Guarantee of Payment) and its several iterations[1] were defaulted upon as insurers and their representatives were unwilling to pay bills, using the pandemic as a pretext to avoid payment for services rendered in good faith by medical providers. This has created a “never-again” moment for many medical providers and correspondents, whom have now made institutional decisions to heavily restrict credit to mitigate the risk of doing cross-border business with limited recourse.

As the travel market wakes up, the international insurance sector anticipates a revival in demand for travel medical cover that will be met with service capacity shortages and above all, distrust by the many medical providers who lost faith in a payment system that for years neglected to pay them in a timely manner and eventually left them with unpaid claims under the guise of the pandemic. Many providers are forced to continue working with the segment to recoup or dilute away their losses by securing future business, yet they are challenged by old credit system that has failed us all in the past.

In my view, the prolonged Covid crisis will result in the slow death of provider credit for small claims and hardening of credit criterion by hospital providers. Today, the industry is seeing hospital groups take measures to more carefully underwrite international risk, such as demanding audited financial statements and deposits, which should probably have been the case even prior to the pandemic. The death of credit, or the credit standard, as we can call it, impacts the ability of assistance companies to service policies and challenges the ability of indemnity payers to execute contractual obligations, which means a new standard shall be introduced: payment at time of service, instant settlement, or a cash standard.

The Credit Standard

As an industry, we have strived for decades to build global, all-encompassing networks that allow for direct cashless access for our members. Whether the provider relationships are direct or are accessed through the circuitous route of correspondents or intermediaries, the underlying tenet of the network relationship is predicated on the desire to obtain credit with our providers. Credit is offered across and between various entities and perpetuates a network effect where offered, ensuring the greater use of providers that extend credit to foreign insurers and reliably service members. While the network model is generally “good enough”, the functionality of it certainly lacks sustainability or optimal efficiency due to the mere fact that it runs on credit, a concept that in and of itself is an inefficient manner of settlement, fraught with uncertainty for providers and carrying many hidden costs and risks for all. While the credit standard is something the industry has sought out for the sake of delivering on the cashless access promise, it is not the answer to reducing administrative expenses, medical loss, and may not even provide for the best member experience as we thought in the past.

The Credit Premium

Working on the basis of credit comes at a premium. What is the incentive for a service provider to accept any transaction on the basis of credit when a far superior alternative is cash settlement at the time of service? For providers and vendors, credit implies the cost of credit risk, cumbersome invoicing, collection and recovery efforts, transaction fees and time. To work under the credit standard creates a layer of cost that necessitates charging a premium over the preferred method receiving payment: payment at the time of service. There is no doubt that medical expenses are loaded with a credit premium; if one would argue against that, I would pose the question to any provider: would you charge less to be paid right here, right now? The answer would be a resounding “yes”. By accomplishing instant payment to providers this in our international healthcare transactions, we have the ability to do away with the credit premium, thereby reducing medical expenses and improving loss ratios. While this premium may vary by location, jurisdiction, and even on a provider-by-provider basis, our experience has demonstrated a consistent savings when working on the cash standard (i.e. paying on the spot). Ask any negotiation department of an insurer or third-party administrator (TPA) what their historical average discount achieved for prompt payment is and we would have some idea of the price we pay for that credit premium. It is safe to say the credit paradigm costs us money and we have no choice but to migrate from a credit standard to a cash standard for us (payers and provider) to cost contain in the most pure and honest sense.

The Cash Standard

Imagine a process by which a member requests care, a contact center intelligently directs a member to a provider, the provider receives a cash-secured guarantee, and, upon sending in a standard claims form through an online application, instant payment for that service is sent directly to the provider’s account. Case settled and closed… at the cash rate. No credit premium applied.

The departure from the credit standard and the imminent adoption of the cash standard in accessing services and paying invoices poses an opportunity to introduce smart technologies for case coordination, claims adjudication and the settlement of invoices. The decades-old credit model – consisting of unsecured GOPs, VOBs, LOGs and other head-spinning IOU instruments – involve an endless revenue cycle involving billing agents, manual invoicing, requests for medical records, denials, appeals, patient balance billing, collection agencies and many touch points that typically result in dissatisfaction for members and network providers. By abandoning the credit model, we uncomplicate life and reduce the cost of doing business. The new model, using a smart contract and instant settlement results in less friction. Migrating to a cash standard, will help us achieve the experience we ultimately seek out for members, network providers and our internal stakeholder, the company.

Our customers and our network providers demand change to more sophisticated means of accessing service and settling claims. At the same time, diminished industry margins demand that we evolve to a more savvy and tech-oriented method of operation. In order for cashless access continue, the industry must evolve from the credit standard to a cash standard, utilizing smart contracts. We must replace the risky IOU (i.e. GOPs, VOBs, GOPs) with cash-secured smart contracts backed by a real guarantee to create an sustainable that perpetuates value for all parties (insurers, providers, members).

MD Group is committed to working with our industry partners to developing and improving our industry. We welcome feedback on the topic and really to look to hear our colleagues’ thoughts and opinions and as we evolve towards the new reality. To learn more about MDabroad, click here, to visit their website.

[1] GOP: guarantee of payment

LOG: letter of guarantee

VOB: verification of benefits


DIOT-LSN And SIACI SAINT HONORE Finalize Their Merger And Create A Leading Independent European Insurance Broker

The merger between the DIOT-LSN and SIACI SAINT HONORE groups has been given the green light from the European Union and the regulators and authorities in the various countries where the new Group will be operating.

The birth of the leading independent European insurance broker operating worldwide took place on November 16, 2021. The new group will generate turnover of almost €700 million, with 5,000 employees in 42 countries.

The transaction signed on July 2 between the BURRUS GROUP, headed by Christian Burrus, and SIACI SAINT HONORE, chaired by Pierre Donnersberg, was completed on November 16, paving the way for the creation of a new European leader in insurance brokerage, reinsurance and risk management consulting.

The Burrus Group and the management of the new entity will hold the majority of the capital and voting rights, thus guaranteeing its independence. Alongside them, the presence of leading investors, led by the Canadian pension fund Ontario Teachers' Pension Plan with a 30% stake, Bpifrance with 10%, Cathay Capital with 5% and Mubadala and Ardian, already shareholder in the SIACI SAINT HONORE Group, confirms the international ambitions of the new Group.

Pierre Donnersberg will be Chairman of the new "DIOT-SIACI" group and Christian Burrus will become Vice-Chairman and Managing Director within an Executive Committee of directors from both entities.

By becoming one of the world's top 10 players in large corporate risks, the new group is positioning itself as a key player in this market alongside the global brokers from across the Atlantic. In France, thanks to its national network, it is strengthening its position in the Large Companies, Mid-cap and SME-SMI market in personal insurance, international mobility, property and liability, marine and transport, and credit insurance and reinsurance.

Pierre Donnersberg said: "We are delighted to be able to finalize our corporate venture which now positions us as the French leader in our sector with a clear international strategy. We will seize new growth opportunities and make the most of all our synergies to better serve our clients all around the world”.

Christian Burrus emphasized: "We share an ambition and values that place people and jobs at the heart of this project. We are committed to our independence, guaranteed by a strong family shareholding which safeguards the interests of our employees, our clients and our investors”.


International Private Medical Insurance Magazine Provider Network Directory November 2021

The November 2021 edition of the International Private Medical Insurance Magazine Provider Network Directory, is out now, featuring over 80 pages of international private medical insurance and medical assistance company intelligence.

The iPMI Magazine network consists of a wide range of leading international medical payors and service providers, on call, 24/7 to assist you manage worldwide medical risks during a global pandemic.

The international medical network covers all sectors of the global medical insurance business, and you can use the directory to source new partners and service providers. Simply use the the contact details within the network directory to connect with new partners and customers. 

IPMI Market Network Sectors: IPMI, Assistance, Air Ambulance, Cost Containment And Claims Management, Funeral Directors, Ground Ambulance, Insurance Technology, Healthcare Insurance Management and Pharmacy Benefits Management.

    Enter full screen click the small rectangle above ↑

The IPMI market use the iPMI Magazine Provider Network Directory to source the best information and data on international private medical insurance payors and providers. They may be searching for a new partner, looking for a contact number of a current provider, or researching the payor and provider market for future cross border network development.

Classifications include: IPMI, Assistance, Air Ambulance, Cost Containment And Claims Management, Funeral Directors, Ground Ambulance, Healthcare Insurance Management and Pharmacy Benefits Management.

Current Advertisers 

Click a company name below to visit their micro web site on iPMIM and learn more or download the brand new e-directory using the above link. To add your business to the e-directory and launch a micro website please write to David Bond, CIO, iPMIM on ipmi[at]











Designing A Benefits Package For Assignment Success With Caroline Walmsley, Global Head of HR, AXA Global Healthcare

The success or failure of an international assignment will often boil down to how supported the assignee feels during their time abroad, and how the assignment is managed. As an employer, one of the best ways to provide that support is with a well-designed benefits package.

The best benefits package is one that can adapt and be updated to meet the ever-changing needs of your employees, and the local requirements in their new home. With that in mind, it’s common for benefits to vary, depending on factors such as the duration of the assignment and the assignees’ personal and family circumstances.

But what do these packages actually look like? What are the fundamentals that should always be on offer and what are assignees looking for?

Cost of living allowance (COLA)

Most expats will expect to receive a cost-of-living allowance during their assignment. This is on top of their salary and is intended for any daily costs they might need to cover during their time abroad. Usually, these allowances are based on the difference in the cost of day-to-day goods and services between their host and home locations, and can be particularly important if the assignee is stationed somewhere with a high cost of living, such as Singapore.

The cost-of-living allowance is designed to ensure that an assignee is no better or worse off financially when living overseas. That said, in some cases where the host location is less expensive to live, employers won’t reduce a salary to make up the difference. This effectively increases the assignee’s standard of living for the duration of their assignment.

Relocation expenses

This benefit should cover all of the expenses an assignee might face when relocating. These expenses typically include the cost of flights (including for family, if applicable), international removals, temporary accommodation (if required), and visa and work permits. This often takes the form of a lump sum, which allows for out-of-pocket expenses to be covered.

Housing allowance

Housing allowance is another common feature of an expat benefits package and may include costs for basic utility services and domestic help. In some cases, assignees might even be provided with accommodation, at least on a temporary basis upon arrival, whilst they look for somewhere to settle for the duration of their assignment.

Home travel expenses

A typical expat package is also likely to include travel costs for assignees and their family to visit loved ones back home. Most packages cover the cost of a flight home once a year, although assignees may be able to negotiate more depending on personal circumstances. If there are children involved, their travel costs may need to be factored in from the start. Our research has actually found that nearly one-in-five (16%) assignees would consider travel insurance to be one of the most valuable benefits their employer could offer. It seems many want the support to fly home, and to be covered for things like lost luggage and cancellations, should there be any disruption.

Education allowance

Our research also found that nearly a third (31%) of international assignees have their immediate family with them in their work country. If that family unit includes children, it’s likely they’ll need to cover the cost of schooling. International schools are preferable for expats, and whilst they can be expensive, they do offer a higher standard of education. Access to these schools may well be a dealbreaker for an assignee with school-aged children.

This can be particularly important if an international school is the only viable option in the host destination, where there would be language or cultural barriers holding children back from being schooled locally. An international school will also ensure they can continue with the same curriculum in a similar environment to that in their home country.

On the flip-side, there will also be expats seeking support with schooling for children who have remained at home. Teenagers sitting important exams, for example, may prefer to stay behind than try to pick up their schooling in another country. For an employer to be considerate and supportive of this kind of family dynamic would certainly be appreciated by the assignee.

Healthcare costs

International health insurance should be the cornerstone of any expat package and is even a prerequisite in some locations. More than that, though, it’s something expats are keen to have. Our research has actually found that IPMI is two-in-five (39%) expats’ most valued benefit.

As an employer, it’s important to ensure the health and safety of your employees, so providing access to a robust healthcare package is imperative. It’s also important to show your team that you care about their wellbeing. Employees are keen to succeed in their assignment. To perform at their best, they need to know they have the best support: that they can count on medical treatment and advice whenever they need it. 

To that end, a healthcare plan should ideally include access to a 24-hour helpline - something assignees can turn to with any medical or security questions, or even to ask for help if they’re facing an emergency.

By listening to their needs, you’ll be in the best position to provide measures that will help them in their new home.


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 SIR Zahal Levy, President of MediHelp International

In this exclusive iPMI Magazine interview, Christopher Knight, CEO, iPMI Magazine, met with SIR Zahal Levy, President of MediHelp International. They discuss in detail MediHelp International iPMI plans, developments and markets plus where the iPMI market is heading, and the affect of the COVID-19 pandemic. 

Please introduce yourself and background in the international private medical insurance market:

My name is Zahal Levy and I am the president and founder of MediHelp International. I have a wealth of experience in the medical and in the medical insurance industry, having managed as many as 2,000 employees in companies with turnovers reaching €50 million. I have led these companies through start-up, survival, turnaround and growth modes.

Before assuming my current role in 2007, I was Vice President Business Development for Euromedic (Affidea) International, based in Budapest. I came to Eastern Europe in 1997 to set up a challenging business enterprise, SOS Medical and Ambulance Emergency Services (in Romania). Previous to this, I held various management positions and shareholdings in insurance enterprises in Israel.

As an expatriate living in Central Eastern Europe for 15 years, I understand the specifics of the area and I designed appropriate health insurance packages for both expatriates and locals while at the same time creating a dedicated team to professionally and efficiently meet customer demands.

Who is MediHelp International and what do you provide the international private medical insurance market?

MediHelp International is the leading private health insurance provider in Central Eastern Europe, with offices in Romania, Hungary, Poland and Bulgaria.

We have been present on the health insurance market for more than 15 years and we have a clear mission: to create and develop innovative solutions adapted to the needs of our clients and partners. We have been pioneers in providing comprehensive health insurance plans, along with health care and high-standard customer care services.

We have become a well-recognized company, constantly growing, respected and appreciated by the most important international health insurance companies, as well as by our business partners, employees and customers around the world.

Can you walk us through the range of international private medical insurance plans MediHelp International provides?

Our international private medical insurance plans offer coverage from €500,000 up to €3,000,000 per policy. The MediHelp plans cover, but are not limited to hospitalization, emergency transportation and treatment, outpatient medical services, maternity care, preventive treatment.

MediHelp International health insurance policies cover hospital and treatment costs for severe illnesses such as cancer or chronic diseases and even tissue and organ transplant, which would normally be extremely expensive.

We invite you to discover all the benefits of our plans on our website (

What are the advantages of MediHelp International IPMI plans?

With international private medical insurance, our customers can choose the clinic and the specialist for their treatment, thus ensuring that all medical procedures are performed so that the diagnosis and treatment are the most appropriate for them.

If our customers choose private health insurance with international coverage, they will benefit from direct settlement for a series of medical services in a network made up of more than 1.4 million of private clinics and hospitals throughout the world.

We have a dedicated Customer Care department and we offer assistance in local languages as well as provide fast reimbursement of medical costs.

Geographically speaking, where does MediHelp International do business?

We have a strong presence in Central and Eastern Europe with offices in Romania, Poland, Hungary and Bulgaria.

We are currently carrying out market research into the possibility of expanding our reach into other countries.

How has the international private medical insurance market changed in the past 15 years?

In the last 15 years the market has changed like this: 15 years ago, we could only insure ex-patriots. They came from abroad, from countries where they knew what health insurance was.  They were used to buying a health insurance policy and making the most of advantages that come with having health insurance, so it wasn’t a strange idea for them. Health insurance for themselves or for their families was a priority. At that time locals did not know what health insurance was or involved. Then those same people, those managers from overseas, started to worry about their senior employees and they asked us to also insure these employees as well. This was the catalyst for the provision of private international health insurance to local residents. Today, senior managers who are nationals within a firm owned by foreigners tend to get medical health insurance included in their salary package in the way many foreign employees have done for decades. The ‘product’ has now become localised and there is far greater take-up from local owners of companies. At the same time, over the years more and more Romanians have travelled further afield and now either work, study or go on holiday abroad. What they saw in many foreign countries was a healthcare system different to the one at home, one which provided services to many who had health insurance. While medical facilities in Romania might not have matched those in other foreign countries, international health insurance gave Romanians access to better, international hospitals. Now, the standard of healthcare for Romania has improved and the demand for proper healthcare has grown, healthcare that still isn’t fully available in Romania. 

COVID-19 has had a dramatic impact on travel and global mobility. How has COVID-19 affected the IPMI market?

I think the effect of the pandemic is waning and international travel is starting up again. Consequently, where before we have had little demand for assistance to seek overseas treatment for medical conditions, that is once again on the increase, even though in an emergency we would have been able to arrange foreign travel for a patient. With a sense of things ‘getting back to normal’, it seems that everyone is beginning to accept that COVID-19 is just something we will all just have to learn to live with. Normal life now means normal healthcare when needed, whether it is treatment abroad or at home.

What are the biggest risks the international private medical insurance market currently faces?

I am afraid that the risks are going to materialize in front of our eyes very soon. The pandemic has dealt a big blow to the international health market, to the local health markets, and the amount of money that was invested in healthcare. The pandemic has actually coloured the black spots of healthcare. Some of them we had known before, while some we found out during the time we were busy with the pandemic. Europe is going to see an exhausted medical system after the pandemic, and the situation will probably be even worse than before, and I think we’ll see a big increase in the price of private health care. And that represents a risk for us because we do not want to sell our products at higher prices than we sell them now, but on the other hand we need to pay claims for services that are being provided by private medical facilities around Europe, and we are subject to their prices and to medical inflation. So it is a huge risk because we still want to make sure that we keep the affordability of our products.

In the next decade, how will the international private medical insurance market develop?

I feel that the idea of the state being the one responsible for an individual’s health in Romania is slowly disappearing. I think everybody understands that if they want to have proper healthcare, they have to have some kind of medical insurance and to assume the responsibility for the health and well being of themselves, their families, and where appropriate, their employees. The way to do this is not to look to the state for the provision of all your medical needs, but nor should you expect your employer to pay for any medical expenses.. So if your boss does not want to pay for your “abonament” or for your health insurance then you don’t have one. I think that is changing though. There are more ways of assuming responsibility and I believe that in the end in Romania the “abonament” will probably be discontinued and will pave its way to private medical insurance. This is a trend that we see everywhere. Medical providers such as Medlife, Sanador or Medicover will probably sell their services for a fee. It means that you will go to a clinic, get your treatment, and you will either pay with our payment card which we are already providing to our customers, or you will be reimbursed for your costs.

Last, but not least, if you could live anywhere in the world, on land, or at sea, where would it be?

This is a very good question which I don’t have an answer to. Sometimes when I am working in my garden, I have these moments when I think that one day, I will buy a small plot of land on a nice small island or by a nice beach in Greece and I could build a nice house where the front is made of glass and looks out over the beach. I could swim and ride my bike as why do I need all these headaches that come with my work? At my age, most people are retiring. But then I say to myself “No”. The time isn’t right yet to travel across the globe in search of a dream location for my retirement home. I am happy for now living in a place called MediHelp. This is where I live. It is a place where I am still developing, creating, working, growing with my wonderful team and this is the place I have chosen to remain. I want a life that is interesting, has wonderful moments and development options which I do not want to miss out on. So, in short, the place that I want to be is called MEDIHELP.


We Need Better Communication To Make International Assignments A Success 

By Tom Wilkinson, CEO of AXA Global Healthcare 

While international working can often be a breath of fresh air, it can also be an isolating experience; one that expats enter into eagerly but might not always be best prepared for. Combined with the expectation of delivering strong enough results to justify the cost of being sent overseas, all while trying to adapt to a new environment, it can be easy for an expat to begin to feel overwhelmed.  

With this in mind, it isn’t surprising that a fifth (21%) of all assignments end earlier than planned. Now, this can’t just be down to the work environment expats enter into. And it isn’t.  

Research we commissioned involved hearing from almost 600 HR Decision Makers and 600 Globally Mobile Workers, to see if there was a disconnect between what support was being offered to expats and what they felt would actually benefit them throughout their assignment.  

The communications gap 

We found that 82% of expats felt supported when they had a health issue, but they consistently weren’t aware of the full range of benefits on available to assist them. What’s even more revealing is the fact that HR directors knew, in every category asked, a great deal more than the assignees about the benefits available.  

If we dive a bit deeper, it became clear that the most commonly offered benefits were travel insurance (64%), accommodation costs (62%) and international health insurance (58%). Yet for expats, the benefits they wanted the most were international health insurance (39%), income protection (38%) and accommodation costs (34%).  

How to close the gap 

For businesses, focusing on communication will have a greater effect than they may realise. After all, the differences in understanding of available benefits is something that can be clarified and dealt with.  

If employees aren’t aware of what’s available to them, this could be perceived as a lack of support, and in extreme circumstances even contribute to the placement ending. Likewise, if they aren’t drawing on the benefits provided, employers aren’t reaping any rewards and are wasting money. These can both cause major problems for any employer.  

So, what should you focus on? 

Earlier research we commissioned  has shown that assignments are being designed with more of a focus on employees’ lifestyle ambitions. This is a step in the right direction, but further work is needed to ensure the wants and needs of assignees are being met.  

Listen to what is being asked  

We’ve seen already that international health insurance is the most valued benefit for international assignees, however, it is only the third-most commonly offered benefit.  Listening to what is being asked for is an easy win, ensuring happier, healthier expats and then in turn, more successful assignments.  

Make it flexible  

Each employee has a unique set of requirements and expectations when it comes to their benefit requirements. As an employer, recognising these and providing the right support, can help assignees make the most out of their time on assignment, so if, and when, challenges arise they feel supported and ready to face them.  

We found that a quarter (24%) of employees are left having to select their benefits from a pre-set list, and only 29% are offered the opportunity to negotiate the benefits they receive. It seems there is still a heavy reliance on a ‘one-size-fits-all’ approach to benefits for internationally based employees.  

Perhaps put in place a more flexible healthcare package that allows for an assignee to choose which benefits would be best for them.  

Check in regularly  

In our research, we discovered that two-thirds (64%) of companies carried out a review of the assignment at least every six months.  

How often do you check in with your assignees? How often do they come forward to raise a concern? In all cases, better communication, and action off the back of that communication, can help everyone involved, both financially and emotionally. I know from my own experience living as an expat that working around the globe can be hugely rewarding, but it does come with challenges and requires a great deal of planning.  

What HR managers do to accommodate and listen to the needs of an assignee, before they make the move, makes a huge difference. As leaders, we must constantly be seeking ways to create an inclusive, productive and supportive work environment. The relationship between HR mobility managers and expats is essential and addressing any gaps in communication will put your business in a better position for success.  


Subscribe to this RSS feed