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Accessing Medical Care Abroad: More Expatriates Look Locally

Cigna Global Health Benefits® (NYSE: CI) and the National Foreign Trade Council (NFTC) recently surveyed more than 2,700 expatriates working in 156 countries to better understand how they and their families experience, perceive and value various elements of assignment terms and programs.

While many surveys tell the global mobility story from the perspective of the employer, this survey is unique because it gathers candid feedback from the globally mobile themselves—information employers are rarely able to gather on their own.

Expat profile

Among people who work outside of their home country, three things are true: they are male (81%), middle-aged and have a family. Beyond that, all bets are off.

The globally mobile are growing older; Gen X is entering its peak earning years and Baby Boomers are remaining in the workforce longer than did previous generations. According to the survey results, many expats are leaving their families at home for various reasons. Today, many assignment locations are in emerging markets or a remote location, which is one reason expats might leave their families at home. In recent years, there has also been a dramatic increase in business and technology-related assignments with shorter durations; generally between six and 12 months. Thirty-eight percent of respondents reported that they did not bring their children with them during assignment.

Although most expats still hail from the U.S., their numbers are down by 10% from just two years ago (and down 24% from the 2001 survey). Globalization is likely a factor with more companies having operations across the globe with access to qualified local talent. The U.S. tax regulations may also be a reason for the decline, making expatriation of U.S. nationals more expensive than expatriates from other countries.

Accessing medical care abroad: more expats look locally

The proportion of expats accessing medical care on assignment stayed consistent from 2013 at 79%. Seventy-five percent of expats said they access local providers for routine medical care.

Gender appears to play a role in which type and where expats and their families access care during assignment. While the rate at which men accessed care stayed about the same (78% this year versus 77% in 2013), the share of women accessing care rose five percentage points to 83%. Even though a larger percentage of women are accessing care while abroad, they are slightly less likely than men to seek care locally. However, more women (47%) said they were much more likely to seek treatment locally for serious medical care than they did in 2013 (38%).

Mobility benefits packages: Flexibility and customization

Greater flexibility in plan design was a common theme when employees were asked what employers might change or add to their global mobility assignment packages to make them more useful.

“Similar to what we saw in the 2013 results, a one-size-fits-all approach to mobility program services can lead to potential dissatisfaction, or worse, an unexpected end to a global assignment,” said Leah Cotterill, vice president, North America Client Management, Cigna Global Health Benefits. “Global mobility directors have to be cognizant of striking a balance between the needs of the business and those of the expats and their families. While the trend toward managing costs through benefits reduction might save companies money in the shorter term, the approach may not lead to longer term satisfaction, loyalty, trust or success.”

Support and communication

Results from this year’s survey indicate that certain gaps – whether real or perceived - still exist between the resources employers say they provide to expats in comparison to what employees say they need.

Communications – before, during and after assignment – are critical to expats and the success of their assignment. Survey responses indicate that employers shouldn’t be worried about over-communicating.

  • 38% of respondents received only one communication prior to departure and nearly a third received two to three.
  • More than 75% received information about their global mobility program benefits during assignment. Of this group, one in four received messages on a quarterly basis.
  • Email and phone calls with HR/global mobility representatives were the top two forms of communication with 90% and 70%, respectively.

Overall, the support employers have traditionally made available aligns with what expatriates say is needed. More than three-quarters of respondents said their employer provides help with moving household goods; setting up utilities and other settling-in needs, as well as help with finding doctors and getting vaccinations. Yet, globally mobile employees say they need more, particularly related to local culture and lifestyle.

Only 20% of information sent to expats before assignment covered local lifestyle resources such as grocery stores, child care, etc. “Prepare employees better for the cultural shock they will experience, particularly for newcomers,” said one respondent.

The use of digital communications, particularly social media, increased dramatically since the 2013 survey. More than twice as many expatriates chose Facebook this year than they did in 2013, which reflects the increasing use of social media as a human resources portal by employers.

There also appears to be a dramatic change in the perceived usefulness of digital resources. Nearly twice as many expatriates in 2015 said their employer intranet is an effective communication tool. Interestingly enough, almost half (44%) said that they either didn’t know or their employer didn’t offer online access to information concerning their mobility benefits program.

“Globally mobile employees and their families want reliable and consistent communication from employers from preparing them for assignments before they depart and ensuring they feel appropriately supported and connected while away,” commented Cotterill. “While many employers are making strides in this area, more can be done to better facilitate communication concerning global mobility program features and services for employees and their families.”

“As businesses continue to expand and compete in today’s global marketplace, the importance of global mobility has never been greater,” said Bill Sheridan, NFTC Vice President of International Human Resources. “This year’s survey results not only reflect this, but also reveal key insights into how global mobility and the expectations of expats have changed since 2013 – insights that should influence how employers meet the needs of their expats going forward.”

Expatriation: A lifestyle choice, not just an economic obligation.

This year’s results demonstrate that global mobility is no longer just an economic obligation, but is instead a lifestyle choice evolving into a career unto itself. The spirit of adventure, the potential to hone one’s qualifications and the appeal of living abroad remained the greatest influences on the decision to accept a first assignment.

One key difference to note is the proportion of expats who indicated they went abroad because they wanted to versus feeling they had to—down by 12.5% since the 2013 survey. Additionally, the number of expats who have been on five or more international assignments increased sharply to 25% from 18% in 2013. This may indicate that global mobility is becoming an occupation in its own right.

Repatriation: Just as difficult as expatriation.

Slightly more than half (54%) of expats who responded to the survey say their employer has a formal repatriation program – and yet most employers report they offer one. In fact, many respondents expressed that repatriation is effectively as difficult as expatriation.

Expats find a return home can result in culture shock. Changes in finances and taxes for the household were a big concern, as was finding new employment. “My family and I will probably need as much (if not more) help repatriating than we have needed on assignment,” said a respondent.

Many expats recommended beginning repatriation arrangements at least three months before departure. Commenting on a return home after assignment, one respondent said, “I’d like to see a repatriation program in which we are given news of the return home at least three months prior to the move so we can prepare.”


Yemen Travel Warning News Advice: Attack on MOD Hospital - Failed Kidnapping Attempt

Take out comprehensive travel and medical insurance before you travel. On 5 December, an attack on the Ministry of Defence Hospital in Bab Al-Yaman, Sana’a, left at least 52 people dead and many more injured.

On 15 December a Japanese national was seriously injured during a failed kidnap attempt in Sana’a.

The Foreign and Commonwealth Office (FCO) advise against all travel to Yemen and strongly urge British nationals to leave. If you don’t leave the country now while commercial carriers are still flying it is extremely unlikely that the British government will be able to evacuate you or provide consular assistance.

There is a high threat from terrorism throughout Yemen. Terrorists continue to threaten further attacks. There is a very high threat of kidnap from armed tribes, criminals and terrorists.

Al-Qaida in the Arabian Peninsula has previously targeted western interests and there could be a threat to diplomatic missions, commercial sites, transport infrastructure and any place where westerners gather. The situation in Yemen remains volatile with continuing unrest and violent clashes. The threat of an escalation of violence and disorder remains.

Since the end of October 2013 there has been a significant outbreak of hostilities between the Huthi movement and the Salafi community in the Dammaj area of northern Yemen, with significant numbers of casualties. If you travel to Yemen against our advice, you should regularly reassess your security and plan any movements around the country carefully. The provision of close security protection and/or a military escort is extremely important for those working and moving around in Yemen.

On 26 November, 2 Belarusian nationals were shot dead outside their hotel in the Al Sabeen district of Sana’a.

On 6 October 2013, a German national was shot and killed outside a supermarket in the Hadda district of Sana’a. While it is not yet known who was behind these attacks, you are reminded of the ongoing threat against foreigners and are strongly advised to avoid places visited on a regular basis by foreign nationals.

The level of consular assistance available to British nationals is limited.

If you need urgent consular assistance call either +967 1308 114 to be redirected to the FCO in London or +44 (0) 20 7008 1500.

Piracy is a significant threat in the Gulf of Aden and Indian Ocean. 


MSO is a new IAG Assistance Partner in South Africa

Since January 2012, International Assistance Group has set the course for a new strategy: forge partnerships with quality providers. Meant to help its 49 partners grow organically, offering true quality and health-focused outcomes, IAG constantly develops, recruits and trains a comprehensive global network of quality assistance experts and accredited provider partners.

Today, International Assistance Group is happy to inform you that a 14th Partnership has been signed since January. MSO (Medical Services Organisation) has been approved as a new IAG Assistance Partner after a strict selection process. MSO, located in South Africa, is operational for medical cases in Republic of South Africa as well as in sub-Saharan countries.

Glenn Staples, Business Dev Director is happy to present MSO: "MSO International provides healthcare risk management services to the African and South African market with over 1 million contracted lives from private healthcare and insurance companies. MSO's strategy of providing a comprehensive managed care solution across Africa provides healthcare funders with significant and unique advantages that improve their competitive position. Since 2008, MSO has expanded its operations to include a dedicated international division with over 50 staff to manage claims, cases and admissions for international clients with members in Africa. With its head office based in Johannesburg, South Africa and access to more than 6,000 contracted providers across the African continent, MSO International provides the optimal healthcare solution for Africa".


Expats In The UAE Urged To Write Will

Expatriates living in the United Arab Emirates (UAE) have been advised to write a will in order to ensure that their assets are divided how they wish in the event of their death. Emphasis has been put on this legal process in a recent report published in the country's Ministry of Interior publication, 999 Magazine. It is particularly important for those living in a Muslim country, such as the UAE, otherwise Sharia law or local rules could be placed on inheritors. Under Sharia law, the majority of an estate passes to the male bloodline, which can mean wives and female partners are left with just one-eighth of their partner's assets if no will has been drawn up.

Emirati lawyer Hussain Al Jaziri told Gulf News: "Oftentimes the family of the deceased can obtain official documents from their country of origin asking that distribution of assets be done according to their country of citizenship."

Despite this relatively straightforward process being open to expats, only ten to 20 per cent of those resident in the UAE have carried it out to cover them should they die unexpectedly. Also important for expat families is to ensure that clear instructions as to who looks after the children are also left behind. Otherwise it will be up to the courts to decide and could mean that the intentions of the parents are not followed.

Without a last will and testament, it can take a long time for assets to be released and when they are, large taxes are often inflicted upon them. This means that the financial burden of looking after the children can be passed onto grandparents or other relatives for a long time after the parents' death.

Lieutenant Colonel Awad Saleh Al Kindi, editor-in-chief of 999, told the news provider: "There's a need for residents to be aware of the inheritance rules in the country. This is important to preserve peace and harmony within the family, which forms the basic unit of our society." Expatriate Healthcare specialise*s in providing international health insurance. Make sure you're protected.

© Expatriate Healthcare


Archipelago Insurance Ltd Enters Malaysian Medical Insurance Market

Archipelago Insurance Ltd Enters Malaysian Medical Insurance Market

Archipelago Insurance, a general insurer, licensed by the Labuan Financial Services Authority is launching Ultracare medical insurance plans, developed by InterGlobal, a UK private health insurer. Ultracare will be marketed through both offshore and locally registered insurance brokers, plus through licensed financial advisors at the Bank Negara Malaysia.

Commenting, Archipelago Insurance Group director Alan Chew Cheong Yew said: “We hope to attract 500 clients within our first year of selling the product, generating about RM7.5 million in gross premiums.”

According to Chew, the target market will be expatriates and high net-worth individuals looking for customized comprehensive international private medical insurance plans that will provide the right cover, at the right time. Target market will initially focus on the Klang Valley growing to include areas with high a concentration of expatriates like Johor Baru, Penang and cities in East Malaysia.

The International consultant company Roland Berger Strategy Consultants recently reported, that Malaysia’s medical and insurance sector is expected to more than triple by 2020 to reach US$5 billion, from its current US$1.5 billion, presenting excellent growth opportunities for the health insurance sector.


Travel Industry Targeting High-End Families, the social trends catalogue for trendsetting ideas, products and experiences, is reporting a growing trend in travel and tourism in looking to attract families in general, and wealthy families in particular. Family travel is growing, but high-earning families are traveling even more, and their spending is increasingly attractive to travel providers.

State and city Convention and Visitor Bureaus (CVBs) are reporting a rise in destination family reunions, which guarantees a large number of people traveling to the same location on any given date. Meanwhile, airlines and hotels are competing for the privilege of pampering families seeking luxury travel experiences. Etihad Airways, the national airline of the United Arab Emirates, is now offering on-board nannies to watch and entertain children in-flight.

The Trump SoHo, an upscale hotel in New York City, is offering children under the age of 17 the opportunity to live like young entrepreneurs, equipping them with business cards, monogramed robes, and etiquette classes.

The Mark, another New York City hotel offers branded MacLaren baby strollers designed in the hotel's signature black and white stripes for high rollers with tots in tow. The sell to guests is that they can leave their strollers at home, and not have to lug this unwieldy piece of equipment. Instead, they have full use of the hotel's very chic strollers for the entire length of their stay.

"As people look towards family travel to fulfill their need for meaningful experiences, the competition for this business will heat up even further," says trends expert and keynote speaker Daniel Levine, who is also the Global Editor of, "With an increasing number of wealthy families looking to share experiences, travel stakeholders are becoming ever more innovative in making high-end travel more appealing for kids and parents alike."


Updated daily, is the home of trendsetting ideas, products and experiences for fun, insight, inspiration and profit. For thinkers, entrepreneurs, innovators and marketers, is a fantastic resource offering powerful insight into what global consumers are thinking and feeling. Find them on the Web at


National Geographic Society Announces New Travel Group

National Geographic has formed a new Travel Group that consolidates all of the 125-year-old Society's travel assets, including National Geographic Traveler magazine, National Geographic Expeditions, photo workshops and seminars, travel books, maps, apps, digital travel content and travel community.

The new group is led by Lynn Cutter, executive vice president, National Geographic Travel. "National Geographic has built up vast travel assets over the years, from our compelling travel editorial content to our unique access to people and places around the world to our thriving National Geographic Expeditions business," says Lynn Cutter. "By bringing together our publishing, expeditions and digital teams, we believe National Geographic Travel can harness these extraordinary resources and extend our leadership in authentic, meaningful and engaging travel."

The group's efforts are resonating with travelers. Expeditions' sales have increased by 80 percent in the past two years, traffic to the website is up 30 percent in the past 12 months, and the social travel community has doubled in the last year. Proceeds from all travel programs and products support the Society's aim of increasing global understanding through exploration, education and scientific research.

At a time when many media companies are moving away from print products, National Geographic is reinvesting in National Geographic Traveler magazine — increasing trim size, using heavier paper stock and unveiling a bold redesign with the October issue that allows for richer photography and a cleaner reader experience. The enhanced product will feature new columns from celebrated voices like Andrew Evans, National Geographic Traveler's Digital Nomad; Chris Elliott, one of America's best-known consumer travel experts; and leading sustainability expert Costas Christ, who will write a new column, "Trending." The redesign extends to the digital iPad/tablet version.

Keith Bellows, editor-in-chief of National Geographic Traveler and senior vice president of National Geographic Travel, leads the editorial vision for the group, and notes that, "National Geographic is a brand that inspires us to reach beyond our front doors to explore the planet and everything on it. Traveler is for real travelers and has long been driven by great photography and storytelling and an emphasis on culture, experience and authenticity. These are the principles that drive all of National Geographic Travel."

The National Geographic Society has long been an innovative leader in the travel space, pioneering initiatives such as the prestigious 25-year-old Traveler photo contest; the Traveler Writers Series, one-on-one live interviews with the world's best travel writers; the Places of a Lifetime series of magazine issues, apps and coffee-table books; the Apple-design award-winning National Parks app; and the "Travelers of the Year" program, which recognizes those who travel with purpose and to make a difference in the lives of others. New hire Andy Coleman, vice president of digital travel, joined National Geographic Travel to shape strategy for creating a comprehensive travel experience for users.

The new digital team rebranded all travel social media under one name, NatGeoTravel, across Facebook, Twitter, Instagram and Tumblr. Among drivers of the digital and social growth are "Best of the World Weekly" destinations hand-picked by National Geographic Travel editors; daily "Travel 365" photos; tips from the field in the "Intelligent Travel" blogs; and programs like Digital Nomad, which has Andrew Evans traveling the globe and sharing stories in real-time through his Digital Nomad blog, Facebook and @WheresAndrew Twitter feed.

The nomad franchise continues to expand with the addition of Urban Insider Annie Fitzsimmons. Contributors such as Evans and Elliott will appear throughout National Geographic Travel properties. For example, Evans writes a column for the magazine, contributes daily posts and videos on his Digital Nomad blog, will take part in October's signature 125th Anniversary "125 Years of Exploration" private jet trip and wrote the introduction to the new book, "Four Seasons of Travel" (Oct. 15, 2013). Elliott, in addition to his column, is also the author of a new book, "How to be the World's Smartest Traveler" (March 4, 2014).

National Geographic Travel is the travel arm of the National Geographic Society, one of the world's largest nonprofit scientific and educational organizations, founded in 1888. National Geographic Travel creates authentic, meaningful and engaging travel experiences through National Geographic Traveler magazine; National Geographic Expeditions; travel books; maps; apps; digital travel content; and travel photography programs. National Geographic Traveler (8 issues per year) is the world's most widely read travel magazine and has 17 international editions. It is available by subscription, on newsstands in the United States and Canada, and digitally for tablets.

National Geographic Expeditions, the travel program of the Society, offers a variety of unique travel experiences led by top experts to more than 60 destinations across all seven continents. Travel opportunities include family and student expeditions, active adventures, private jet trips and voyages on the six expedition ships in the National Geographic-Lindblad fleet, as well as photography workshops, expeditions and seminars. The National Geographic Travel digital group offers inspiring and authoritative digital content such as trip ideas, photo galleries, blogs and apps, including the award-winning National Parks app. National Geographic Travel Books bring readers curated travel advice, photography and insider tips.

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