Research* commissioned by AXA Global Healthcare has revealed that anxiety is the number one challenge facing expats in some of the world’s key destinations, ranking higher than depression and stress.   

Anxiety has been described as the biggest health and wellbeing concern by a third of expats in the UK (32%), approximately one in four of those in Scandinavia (27%), France (24%) and Dubai (23%), and one in five of those residing in Hong Kong (22%) and Canada (18%).   

Anxiety was followed by depression as the next biggest challenge reported by those expats in the UK (13%), Canada (12%), Scandinavia (12%) and France (9%), whereas pregnancy and early-stage parenthood in Dubai (12%) was the second biggest issue expats faced.  

By comparison, chronic conditions such as diabetes were described as a challenge by 15% of expats in Hong Kong, 9% in Canada and the UK, 7% in France, 6% in Scandinavia and just 5% in Dubai.  

Caroline Walmsley, Chief People Officer at AXA - Global Healthcare, commented: “As concerning as it might be, it’s perhaps unsurprising that anxiety seems to be the greatest challenge for expats. When we consider the circumstances they face – far from home, in a new environment and potentially even contending with a different language all in the confines of a global pandemic – it’s easy to see why they might be suffering with anxiety. There are small actions that we can all take every day to improve our mental wellbeing. However, it’s just as important to be able to recognise when it’s time to seek help.”  

In terms of taking steps to manage their general mental and physical wellbeing, using professional healthcare services seemed to be the most popular port of call for a third (33%) of expats in Canada, a quarter in France (24%) and nearly one-in-five of those in Scandinavia and Hong Kong (17%). Expats in the UK, however, relied most heavily on their relationships (17%) and those in Dubai on mindfulness (12%).   

In all six locations, practices such as exercise, nutrition and therapy were also highlighted as ways to manage mental and physical health. Exercise was a support mechanism for 9% of those in Dubai, 6% in France, Hong Kong and Scandinavia, 5% in the UK and 4% in Canada. Meanwhile, 6% of those in France and Hong Kong, 5% in the UK, 4% in Dubai and Scandinavia and 3% in Canada turned to nutrition.  

Caroline Walmsley concluded: “While it’s reassuring that large numbers of expats feel comfortable contacting their healthcare provider, we would hope to see those quick wins like eating well and exercising regularly to have been more popular. We know that keeping active and good nutrition are of huge importance, so we would highly recommend that expats do what they can to take care of the basics in this way. However, we’ve also seen that mindfulness is a popular coping strategy for expats in some locations and virtual tools, such as AXA’s own Mind Health service, are now providing this kind of support remotely.”  

To compile this social listening report, AXA commissioned Listen + Learn to observe thousands of social media comments, shared by expats in six key locations during discussions about health and wellbeing. The main findings were based on 15 key online domains, with the conversation proving to be most concentrated on Twitter and Reddit.  

In this article, iPMI analyst Ian Youngman, author of the IPMI market leading report, International Health Insurance 2021 talks about how AXA has left the Middle East and why the press announcements underplay how big a deal this is.

AXA has almost completed an exit from Abu Dhabi, Bahrain, Dubai, Oman, Qatar, Saudi Arabia and all UAE states.

It still has a presence in Lebanon but a local TPA manages health insurance.

That it has sold to a local group – is huge. That the local group is part owned by a Canadian group  seem incidental until you get that Canada goes its own way from the USA and Europe in global politics.

There is a shift to local regional groups in Asia, Europe and the Middle East.

The Middle East was once the go to place for brokers and insurers in health insurance- it is being replaced by Africa and South America- and China.

With compulsory health insurance in many countries the region has almost peaked. The competition is hot and with increasing regulation and competition from local insurers, making a profit may be Ok now but not in five years time.

Expats are being replaced- often by law- with locals. Most expats are not the “white middle class Europeans and Americans" that you still see pictured in IPMI brochures – but low paid Asians and Africans- with an increasing number of professional Chinese.

Some US and European insurers and brokers also see that as the US and Europe are losing influence in the region- to be replaced by China, Iran and Russia.

That the US, UK and some European allies tried to import their democratic and business models into Afghanistan and Iraq for 20 years and dismally failed- does have a knock on effect on insurance groups.

Insurers may think they are above politics, but what your country does to other nationalities does rebound onto your company in those countries - we do not live in a bubble.

Insurers and brokers may still make money out of health insurance in the region but rising healthcare costs and increased regulation is going to make it harder.

Many Gulf countries are still trying to move away from dependence on oil to other industries but from being cash oil rich they are all – to some degree- struggling. Many saw tourism and inbound international investment as their saviours – Covid has damaged the first and there are not enough international investors to go round as they too see better long-term potential in Africa. China or Latin America.

What is certain is that other insurers will follow AXA out of the region as they look at their 5 year strategies on where they want to stay, move into, expand, or exit.

For the author it means daily work updating my country and company databases - to ensure my IPMI market reports are up to date.

Looking back at what happened in the last five years and extrapolating that forward is how many reports still work – but that process is so out of date.

RELATED READING: International Health Insurance 2021

CEGA, a Charles Taylor company, and AXA are driving innovation in the travel insurance sector with the Travel Health Calculator.

In October 2019, the Travel Health Calculator was launched by travel insurer AXA. Enabled by technology developed by claims and medical assistance providers CEGA, a Charles Taylor company, the online tool offers a unique solution to travel insurance uncertainty. In short, it helps to empower people with pre-existing medical conditions to find the right travel insurance at a suitable price.

Background: addressing a market need

It was important to address the need for travel insurance transparency for individuals with pre-existing medical conditions.

To put this into context, the Financial Conduct Authority (FCA) estimates that there are up to 14.1 million consumers with a pre-existing medical condition (PEMC), who are looking to purchase travel insurance each year. The FCA recently launched a consultation on proposals designed to help consumers with PEMCs have better access to travel insurance products. In addition, recent industry revelations1 show that three fifths of consumers believe that the responsibility lies with insurers to make sure customers purchase the right level of cover.

The solution

The Travel Health Calculator now provides simple and easy-to-access medical assessments. A traveller with one or more pre-existing medical conditions can use the tool to enter details of these online. They will then receive immediate digital feedback, with travel insurance tips that take these conditions into account; covering everything from single trip vs annual policies, to the importance of checking with their GP that they have declared all that they should. They will also receive a list of brokers and insurers who specialise in providing travel insurance cover that meets their specific medical needs – or, if these needs are less complex, they may be directed to price comparison sites.

To assess the level of risk related to each user’s medical history, the Travel Health Calculator is supported by CEGA’s specialist automated medical screening solution, Antidote. This provides medical ‘thresholds’ for over 3,000 conditions; from asthma and high blood pressure, to diabetes and heart problems.

Wider benefits

Benefits offered by the tool extend beyond increasing consumer choice and reducing the risk of medical and other emergency costs abroad. They also include access to general guidelines about buying travel insurance; not least the importance of checking that a policy includes travel disruption cover and of updating ongoing cover in line with any health changes.

Feedback

Nel Mooy, Travel Director, AXA Insurance, says of the Travel Health Calculator, "As insurers, we want to help customers understand their cover options regardless of their previous or existing medical conditions. While in some scenarios, certain channels such as specialist brokers or underwriters may be more appropriate than others, our aim is to empower travellers so they can find cover that is right for them. Many people see health as a barrier to finding insurance, but our new tool can help make things that much clearer.”

Angela Smith, Head of Propositions at CEGA, says, “We’re thrilled that AXA are leading the way in the implementation of this innovative new tool. As always, we’re committed to providing end-to-end solutions that support insurers and their customers alike and look forward to continuing to play a pivotal role in the insurance sector’s innovation agenda.”

See the Travel Health Calculator in action here: https://www.axa.co.uk/travel-insurance/travel-health-calculator/

1 Figures obtained from research commissioned by AXA of 2000 UK adults. The research was carried out by OnePoll in July 2019.

Living the expat dream is a lifestyle choice that many people would seize if they had the opportunity. The chance to experience different cultures, climates and lifestyles is a prospect too exciting to ignore, and with international travel and trade opening up employment opportunities across the globe, the global expat population is estimated to rise from 66.2m last year to 87.5m in 2021.   

But what happens when the adventure comes to an end and it’s time to go home? For many, it’s an experience which can prove just as challenging as relocating in the first place. HR and Global Mobility Managers can often overlook this feeling – why would someone be worried about returning to a lifestyle and a country in which they’ve happily lived before?

Below are some of the common worries those returning from a spell abroad may encounter, and how HR can help address these.

Logistics

While many would expect the process of moving abroad to be difficult, returning to your home country can be just as challenging. With a to-do list that might include reclaiming a property that was rented during your time abroad and shipping clothes and furniture back home, as well as updating financial arrangements and securing access to transport, the process can quickly become overwhelming.

Whilst many companies will offer support, HR Managers should check in with employees regularly, to ensure the process isn’t too onerous. It’s important to start communicating about relocating well in advance, so the employee knows what will happen and when – allowing them time to organise logistics or to get a grasp of what support will be available.

Re-acclimatisation

Returning to something you’ve left behind can be surprisingly challenging. It’s easy, if not comforting, while living abroad to imagine that things at home are just as you left them, and expats can be surprised to find that time has marched on when they return. Friendship groups may have changed, colleagues might have moved to another department or even to another company, the working environment may have changed and family responsibilities will evolve. HR needs to be aware that settling back in isn’t always a straightforward process, and that adjusting to the new lay of the land can weigh upon employees’ wellbeing. An appropriate action would be to check in with returning employees, to ensure they’re settling back in comfortably.

Cultural differences

Even for expats who spent their whole lives in their ‘home’ countries before taking on an international assignment, coming home can still require some adjustment. Even old commutes, for example, might suddenly seem more demanding than before – if you’ve got used to using the MRT in Singapore, returning to the Tube in London will be a very different experience. Likewise, driving in snowy weather can suddenly seem more daunting than it used to be after a couple of years’ driving in a warmer country. These challenges can ultimately contribute to a sense of ‘culture shock’, causing an employee to feel distracted as they re-familiarise themselves. So, it’s up to HR to be aware of how these changes could affect their employees and ensure that realistic expectations are formed upon their return home.

Political changes

It’s difficult to imagine now, but just three years ago, nobody had ever heard the word, ‘Brexit’. Whilst returning to a country with a markedly different political environment to that which was in place when they left might not have a significant affect an employee’s day-to-day role, HR managers should still consider how adjusting to this new climate could prove challenging. Politics is, of course, a matter of personal opinion, but it’s worth speaking to returning employees about how any political changes might impact their role in the company, in particular.

Job concerns

Returning to an old workplace can be daunting. Whilst employees may know the role and the culture, colleagues move on and team dynamics change. There’s also the role. If an employee has been away for three or five years, will their old role still be there? Will it have evolved? Will it be as fast-paced or carry as much responsibility as it did before? After all, personal development is a key factor in employee motivation and engagement. Therefore, HR needs to have an open dialogue with returning employees about what they can expect in the job they are coming back to. This means any potential issues can be ironed out in advance, lessening the impact of change.

Whilst it may seem easier to return home than leave in the first place, the process can come with its own challenges. The reality is that the fear of change can be stronger than that of the unexpected. My advice would be that communication is key – keep returning expats informed and engaged, and have open, honest conversations to gauge how they’re coping. A happy employee is an engaged employee, so for the good of the company and the wider team, don’t be afraid to have difficult conversations. It will pay off in the long run.

Written by Caroline Walmsley, Global Head of HR, AXA – Global Healthcare

Insurance companies that want to expand internationally face substantial distribution challenges: how do they establish their brand and how do they reach new customers? One way for them to try to solve these problems is through creating sales partnerships with leading banks, which gives them access to a new customer base using the bank's own brand. According to new research about global bancassurance strategies published by Finaccord, BNP Paribas Cardif is the insurance group holding the most bancassurance partnerships among the world's 500 largest retail banking groups, followed by AXA and MetLife.

Based on an investigation into the consumer banking operations of the top 500 retail banking groups worldwide (spanning over 100 countries), Finaccord's research established that BNP Paribas Cardif was being utilised as an insurance partner for at least one bancassurance product by a total of 81 of the 500 banking groups. The France-based insurance group was followed by AXA with a total of 78 partnerships, and MetLife with a total of 75 agreements. Overall, among the 20 most prominent insurance groups in terms of their number of relationships with the top 500 banking groups, ten originated from Europe, five from North America and five from the Asia-Pacific region.

"Competition among international insurance groups for bancassurance partnerships has been intense in recent years", comments Stefan Wagner, a Consultant at Finaccord. "This is a consequence of the high or rising importance of bancassurance as a distribution channel in a number of insurance markets including China, Indonesia and Thailand in the Asia-Pacific region, Poland and Spain in Europe, and Brazil and Mexico in Latin America. In addition, many banks have expanded substantially their offering not only into new product areas but also into alternative sales channels, including digital distribution, which has created more partnership opportunities for insurers."

Finaccord's research also classified insurance groups' partnerships with the 500 banking groups according to whether they were set up either as joint ventures, as strategic, long-term relationships, or as less substantial, ad hoc distribution partnerships. With regards to joint ventures and strategic agreements among the 500 banking groups, AXA is the insurance group with the most such arrangements at 15 (breaking down between eight joint ventures and seven strategic relationships). It is followed by BNP Paribas Cardif with ten, Allianz with nine, Aviva and MAPFRE with eight each, and MetLife with seven.

"While the total number of partnerships is certainly a helpful measure to identify key insurance groups in the global bancassurance market, it is also important to look at joint venture and strategic partnerships as these commonly have a long-term focus and often generate substantially more revenue than looser distribution agreements", concludes Stefan Wagner. "As such, international insurance groups are increasingly seeking these types of deal. For example, major agreements established during 2017 included those of Allianz with Standard Chartered and of Chubb with DBS, both for non-life insurance and spanning multiple countries in the Asia-Pacific region."

Aid-Call Limited has been operating in the UK for over 35 years. Based in Ashburton, Devon, and employing around 140 people, Aid-Call Limited provides personal alarm services for over 50,000 people throughout the UK.

The acquisition, which is subject to FCA approval, will further strengthen and extend AXA’s presence in the UK health and care markets and evidences its commitment to developing trusted propositions that enable older people to maintain their independence, dignity and wellbeing while living in their own homes.

Keith Gibbs, Chief Executive, AXA PPP healthcare said, “We are delighted to be acquiring Aid-Call Limited from Age UK – an organisation with whom we have a shared ethos and a shared commitment to delivering exceptional customer service. Aid-Call Limited, with its size, well established operating procedures, direct to consumer experience and its deep understanding of the needs of older people, is an excellent fit for AXA.

“Strengthening and extending our presence in the health and care markets further signals AXA’s ambition to become the trusted partner that enables people to live life well and to the full – whatever their age.”

Tom Wright, Chief Executive, Age UK said, “We are delighted that AXA PPP healthcare is taking on ownership of Aid-Call Limited and firmly believe this is in the best interests of both today’s and tomorrow’s users of the Age UK Personal Alarm. Current Age UK Personal Alarm users can expect the same level of care and service they enjoy now and AXA PPP healthcare has committed to further investment in the platforms that support the service. Age UK’s trading arm will continue to be involved for the foreseeable future and, in our fast changing technological world, we think it makes a lot of sense for us to be partnering on the Personal Alarm with such a major company as AXA PPP healthcare, with its impressive global reach.”

International health and medical insurance industry news

AXA has announced it had entered into an agreement with Vienna Insurance Group to sell its Life & Savings insurance operations in Romania and exit the Romanian market.

Under the terms of the agreement, Vienna Insurance Group would acquire 100% of AXA Life Insurance SA1 through its BCR Life and Omniasig entities. The parties agreed not to disclose the terms and conditions of the transaction. Completion of the transaction is subject to customary closing conditions, including the receipt of regulatory approvals.

Africa Internet Group (“AIG”), a leading e-commerce group in Africa, and AXA, a worldwide leader in insurance and asset management, announced a partnership whereby AXA will become the exclusive provider of insurance products and services through Jumia and other AIG online and mobile platforms in Africa.

Going forward, AXA’s African insurance companies plan to propose custom-made insurance products to Jumia and AIG’s e-commerce client base through its ecosystem of marketplaces and classifieds services. As part of the partnership, AXA will also become a shareholder of AIG, along with MTN, Rocket Internet and Millicom. AXA and Jumia view Africa as a fast developing market for financial services and insurance products, benefitting from strong fundamentals such as low penetration rates, rise in middle class, urbanization as well as the youth of its population.

“Internet is creating unparalleled opportunities for consumers and businesses in Africa to connect and do business in a new way. We continue to be very excited about the growth prospects of Jumia and this new partnership will enable us to capture them,” said Sacha Poignonnec and Jeremy Hodara, founders and co-CEOs of Jumia and AIG. “We expect Africa’s e-commerce and online businesses to develop rapidly as a result of the strong growth of the middle class coupled with the increasing mobile phone and internet penetration. With Rocket Internet’s extensive background in online business models, MTN as leading mobile carrier with its broad African presence, and now the partnership with AXA in insurance products and services, we are in a great position to continue to innovate and connect businesses to the fast growing consumer demand.”

"This transaction confirms AXA's long-term commitment towards the African markets and represents another step in our development on the continent. Africa is home to some of the most dynamic and promising insurance markets in the world and our partnership with Africa Internet Group will enable us to accelerate materially our development by having access to their rich customer base and to their state-of-the-art e-commerce technology. Going forward, we aim to enable African consumers to better access insurance solutions to create sustainable financial well-being throughout their lives and those of their dependants", added Denis Duverne, Deputy CEO of AXA.

As a result of the transaction, AXA will invest Euro 75 million and own approximately 8% of the capital of AIG. Completion of the transaction is subject to customary closing conditions, including the closing of the previous investment round, and is expected to take place in the first quarter of 2016 The additional capital contributed by AXA will further strengthen the balance sheet and support AIG’s continued growth. Jumia, AIG’s main subsidiary, is currently present in 11 African markets and grew its transaction volume (GMV) by 265% during first 9 months of 2015 to reach Euro 206 million. Jumia is part of broader ecosystem of services providing opportunities for local African businesses to do business with the fast-growing African consumers and middle class. Other services include Kaymu, a leading online shopping community, as well as leading marketplaces in food delivery (Hellofood), travel (Jovago) and leading classifieds in real estate (Lamudi), jobs (Everjobs) and cars (Carmudi).

February half term is the most dangerous time of the year for a trip to the slopes, with more than twice the average number of winter sports travel claims this week, compared to the rest of the ski season. This is according to travel insurance claims data revealed by Aviva.¹

New research from the travel insurer also reveals that six out of 10 (57%) parents would consider taking a winter sports break with their family², citing good activities for children (23%) and health and fitness benefits (22%) as their main reasons.

Accessibility and location (15%) are also popular motivations for parents, although one in eight (13%) say that they would consider winter sports holidays because summer breaks during school holidays are too expensive.

Accidents on the slopes

Additional Aviva research shows that health and safety at winter resorts is a top priority for many parents, with more than half admitting that either they or an immediate family member had suffered an accident or near-miss while on the slopes³. However, more than half (55%) say they only sometimes take out travel insurance when going on holiday with their family2, and a similar number (47%) say they don’t always make sure they have cover that specifically covers winter sports.

Adam Beckett, propositions director for Aviva, said:

“A medical emergency is the most common reason for claiming on winter sports insurance and the cost of treating minor injuries can be expensive – the average cost of a winter sports claim is around £1,000. The largest winter sports claim settled by Aviva in recent years was for a customer who suffered a hip injury while skiing in Austria, the cost of which was over £15,000.

“The EHIC card offers state-provided emergency medical treatment in EEA countries. However, the level of treatment varies between countries and it may not cover all the treatment costs and services that are free through the NHS. It will not provide the same levels of cover that insurance does and would not cover a rescue from a mountain top or repatriation home if you needed it.

“For example, the cost of bringing someone with a damaged spinal cord home to the UK by air ambulance could be in the region of £20,000 from the European Union, or even as much as £80,000 from the United States.”

In spite of parents’ attention to health and safety, not all insist that their children wear helmets when taking part in winter sports. The Aviva poll showed that only four out of five parents would insist their children always wore helmets2, potentially meaning a heightened risk of injury for some youngsters on the slopes.

Adam Beckett adds: “Some resorts may not enforce the use of helmets for children, so check their guidelines. If they don’t, and your children are hitting the slopes this half term, make sure their equipment is in good order and they wear a helmet.”

For more tips and advice for a safe winter sports holiday, visit: http://www.aviva.co.uk/life/family-life/ski-hacks/

Aviva’s top 10 tips for staying safe on the slopes

1. Take out the right winter sports travel insurance package. Make sure your travel insurance suits your needs before you buy it and keep your travel insurance medical emergency helpline number and your policy number to hand.
2. Make sure your skiing equipment - or the gear you hire - is in good order. 
3. Don’t borrow skiing equipment - it should fit your height, weight and skill level.
4. Wear a protective headgear or a helmet - make a helmet mandatory for your children.
5. Take lessons if you’ve never skied before. If you haven’t been on the piste for a while, a lesson or two will polish up your skills.
6. Remember that skiers or boarders in front or below you on the piste have right of way. 
7. Know your limits - ski or snowboard to your skill level on the nursery slopes, the green (beginner), blue (intermediate), red (intermediate/advanced) or black (advanced) runs.
8. Respect the mountain and make sure you obey all warning signs - especially during avalanche season. Never go off-piste unless you are authorised to do so by the resort. If you are authorised to go off-piste, don’t ski or board alone, go with a qualified guide. Under Aviva Travel Insurance, you will not be covered for off-piste skiing unless you are accompanied by a qualified guide.
9. Carry a fully charged mobile phone with you. 
10. Don’t drink and ski. Excess alcohol will slow your reactions and affect your observation and balance.

1 Based on Aviva claims data, 01 January 2012 to 31 December 2014 (inclusive).

2 Based on a study of 537 parents who take holidays with children aged 0-16. Research commissioned by Aviva and carried out by ICM research 29-31 January, 2016.

3 Based on research commissioned by Aviva in a One Poll survey of over 1,000 parents who go on winter sports holidays with their children (aged 0-16 years old).

* The EHIC card entitles you to: state-provided emergency medical treatment in European Economic Area (EEA) countries. However, the level of state-provided emergency medical treatment will vary between countries and it may not cover all the treatment costs and services that are free through the NHS. For example, the following ARE covered by a typical travel insurance policy but NOT by the EHIC:

- Rescue services (eg from mountain in ski resort)
- Additional accommodation & travel costs if you need treatment or need to return to the UK
- Accommodation you have lost through being hospitalised
- Repatriation back to the UK
- Support and advice through 24 hour helplines with multi-lingual staff