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iPMI Magazine speaks to Mr. Brian Piper, Head of Business Development, Integra Global

iPMI Magazine speaks to Mr. Brian Piper, Head of Business Development, Integra Global

Mr. Brian S. Piper, MBA, is the Head of Business Development for leading international private medical insurance provider Integra Global. Integra Global provides private medical insurance and expatriate health insurance worldwide. Mr. Piper started his career after completing business school at the Babcock School at Wake Forest University working with the Chamber of Commerce in Business Development and an adjunct professor at Winston-Salem State University. Following, he came to then Czechoslovakia as a volunteer in 1992 to teach business principles to local managers and he has been based in Czech Republic and the USA since.

As a management consultant he started working in Healthcare Industry in the field of Cost Containment in the USA from 2006 first as an outside consultant and latter as an employee as Director of Business Development for the company GMMI. This position exposed him to the medical claims process, provider networks, and a wide range of commercial payers and industry stakeholders globally. His current position with Integra Global has him traveling frequently around the globe developing the distribution network for Integra Global.

Serving our members since 1999, Interga Global’s mission is to offer an international health insurance plan that gives you access to the best health care worldwide. Coverage that provides direct access to world leading centers of excellence and additional benefits like medical evacuation, in-patient and out-patient care, direct billing, 24x7 assistance, maternity care and wellness benefits that include vaccinations. Integra Global delivers the care you deserve, when and where you need it. A comprehensive lifestyle health plan for the best care available worldwide.

Please introduce yourself and background in the international healthcare industry?

I have been an expatriate and management consultant living in Prague, Czech Republic, since 1992. In 2006, my wife and I relocated back to the United States both working for GMMI, a leading cost containment firm. I started on with a temporary consulting assignment, which lead to the position as Director of Business Development. In this position, I was in contact with a wide range of international payors including expatriate, travel insurance, re-insurance, self pay, accident insurance, student travel, assistance companies and social insurance. This position gave me a broader vision of the various types of commercial payors and how they approached handling and paying claims. In late 2008, we relocated back to Prague and friends asked who I suggested for expatriate insurance.

As a European Provider Integra Global impressed me as a unique expat provider particularly for Americans, as their plan design was similar as one would find in the USA, and they had direct bill access with United Healthcare a former competitor. Integra Global was a lesser known provider among the industry giants and I saw an opportunity to work with them to develop their distribution channels globally. The expatriate insurance model is unique due to the movement of an expatriate; coverage is inherently more elastic - think of it as a hybrid between traditional healthcare insurance for comprehensive coverage with the ability to seek treatment, with wider area of coverage like travel insurance. Insured’s are not limited to where they may access treatment, and they can seek medical attention globally - typically with any provider according to their chosen area of coverage.

How should we define a medical tourist in today’s unstable world?

The term Medical Tourism seems to have evolved as a catch phrase for seeking treatment abroad and it often denotes cost savings. Further, it seems to be targeted at individual or self-pay patients. For this reason I would perhaps rephrase cross border healthcare to align with commercial payors and the insured’s seeking treatment abroad. Cost is one issue but main drivers are quality, access to leading facilities and technology, which are much stronger reasons for seeking treatment abroad.

What will a medical tourist look like in 5 years time?

Hopefully the Medical Tourist will be a more educated consumer – the current trend for many patients is self diagnosis by researching symptoms and enlightening themselves on potential remedies. In the future, if payors and providers can realize the potential of collaboration, the patient may seek treatment outside of their immediate vicinity, to access facilities that has immediate access, the best outcomes, and most advanced facilities; not only the facility that is nearby. For insured’s they have access to the best facilities covered by their healthcare insurance. With the onset of telemedicine, there is no reason why a patient cannot be monitored from abroad. Payors should welcome the potential for cost savings along with better outcomes, as it lowers the need for continuing care. By aligning with providers that are best in class, and making these facilities accessible to insured’s, they improve their overall market position. For healthcare providers this is a near limitless pipeline of potential patients. Travel and Medical Assistance companies they can serve to facilitate the process of transferring the patients to and from treatment.

iPMI Magazine hosted you as a VIP speaker at the 4th Medical Tourism conference in Istanbul, Turkey, last year; you made a speech about medical tourism and insurance. What was the aim of the speech?

Essentially, my speech was first to debunk some of the myth and outlandish claims about the size of the medical tourism industry. Next is to help identify and understand the potential market of commercial payors and how to approach this core sector. Next, to help forge an understanding of facilitating business - commercial insurers generally are willing to cover the costs of treatment abroad particularly if they can realize savings, but they are not inclined to incur any additional risks. Further, to outline the complexity of facilitating patient’s treatment abroad and the necessity to have a solid plan in place for treating patients from abroad, and having a follow-up plan in place once they are home, service enhancements and methods to mitigate risks. Finally to illustrate to medical providers that expatriates are a solid base of clients, and how to attract this business, and to consider the model of expatriate insurance as a consideration for other healthcare providers allowing treatment abroad.

You presented a number of very interesting facts and figures relating to numbers of medical tourists – what were the numbers and what does it mean to the industry?

There have been claims that the medical tourism industry could reach upwards of $100 billion dollars in 2012 up from $40 billion in 2004 and estimates of some 6 million American’s going abroad for treatment. These numbers are quoted extensively on the Internet but I found it ironic that no one seems to question the source of the information or validity of the statements. Certainly, the market is large and the OECD monitors exports of healthcare services among the member countries and pegs the market in 2009 was more the $6 Billion and the largest market and health-related travel in is the USA with $2.3 Billion in exports.

These figures seem to more accurately reflect the market globally for medical tourism. Certainly, growth potential exists to expand market share but stakeholders must take a sober approach to the fact that this is competitive environment a business if you will and to penetrate the market they need a solid strategy and sellable product to draw in patients from abroad. With a Google search on medical tourism, I found the following information:

“More and more countries are becoming medical tourism destinations. Medical tourism statistics revealed an anticipated growth of the industry from about $40 billion in 2004 to $100 billion by the year 2012. The estimate was made by the Confederation of India and the McKinsey Company. Another report disclosed that an estimated 750,000 Americans seek treatment abroad in 2007. It was also estimated that a million and a half Americans sought healthcare outside the US in 2008”

“The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. India is a recent entrant into medical tourism. According to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $1 billion business by 2012. The report predicts that: "By 2012, if medical tourism were to reach 25 per cent of revenues of private up-market players, up to Rs 10,000 crore will be added to the revenues of these players". The Indian government predicts that India's $17-billion-a-year health-care industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which industry watchers say is growing at 30 per cent annually.”

How can a medical tourist travel for healthcare abroad, safe in the knowledge that if anything goes wrong, they will be fully covered?

This is an interesting question as expectations vary around the globe of what one considers as “fully covered”. At a healthcare conference in South Korea, one of the first questions from an American was “Can we sue” as if the monetary gain would somehow satisfy or resolve the problem. In other less litigious societies the patient may be satisfied with having the treatment repeated either at the location abroad or back in their home destination without further expense. Still others may seek compensation in some form or another. Any medical treatment has inherent risks of complications and at the extreme medical malpractice. There are also risks such as time off work, changing travel plans, unanticipated extended stays in the event of complications. Medical Travel insurance was one of the factors I suggested as a way of mitigating risks both for self pay clients and commercial payors alike. Travel insurance is not sufficient What insurance products exist that could provide the right insurance coverage for medical tourists? There are some medical travel insurance products on the market, but from what I have personally researched the field remains open to creating a solid product that takes into consideration the specific factors dealing with treatment abroad and the complications that may occur. The plan should include appropriate financial coverage to compensate the risk of going abroad.

Typical coverage:

  • Coverage for medical expenses due to complications that result from your treatment.
  • Coverage for trip cancellations if the treatment or trip is cancelled for a covered reason.
  • Coverage for evacuations if you must be evacuated to another medical facility.
  • Coverage for unexpected medical costs not related to your treatment.
  • Coverage for flight accidents while on a covered trip. Travel delays, missed connections, and lost luggage coverage are also included.

This would include, but is not limited to, travel insurance for the patient and travel companion, to include changes in travel plans, personal effects and the like.

  • Political Risk & Emergency evacuation.
  • Extended coverage of the medical procedures; along with any complications arising from treatment both immediate and long term (after one year).
  • Extended stay at the facility, and if needed, additional accommodation and daily out-of-pocket expenses or per diem for the companion traveler.
  • The option to have the treatment repeated either abroad including: all related travel costs; medical and recovery; or with an option to have the treatment done at home.
  • Financial compensation for the unexpected: time off work; short term or permanent disability; and/or unplanned financial loss as a result of the medical treatment. Medical Malpractice independent of the medical facilities or physician’s insurance.

What is, or what should be, the role of the: 1- Insurance Company 2- Assistance Company, in the medical tourism business?

An insurance company assumes risk and has the role of the payor when medical treatment is needed. They accept premium and pay claims according a schedule of benefits and under a binding contractual agreement with the insured. To be profitable insurers have to create a marketable product, develop a large enough pool of insured’s to offset the balance of incoming premium revenue against outgoing claims, operating and administrative expenses. The payer needs to manage their risk effectively. If they can find opportunities to contain costs, or provide services that are better, faster or cheaper, it puts them at a competitive advantage. The question is where the insured is entitled to seek treatment? Expatriate healthcare insurance is unique and is a business model for other healthcare insurers to consider.

Due to the nomadic tendencies of expatriates - Insurance providers typically do not specify which provider the insured uses, as long as they are within their defined area of coverage. On the contrary, domestic insured’s with traditional private or social healthcare insurance tend to seek treatment close to home; and insurance payors work with local providers most typically in their own country. So what if the paradigm shifts – barriers are reduced for seeking treatment abroad - people are easy to move and medical facilities abroad have capacity. If a model exists where the insured chooses to go abroad for treatment and it’s less expensive, the facility has better outcomes or quicker access (or all of the before mentioned) would the insurance company be willing to pay the bill? From my discussions with commercial payors they were not (in theory) opposed to paying for the treatments abroad.

Insurance companies are inherently risk adverse - why would they take on additional risk and responsibility if the existing system functions? There has to be a cost benefit.

Commercial Payors are also not in a position to facilitate the patient’s trip or to take on additional risk of sending the patients abroad in the event something went wrong. Bridging the gap Travel and Medical Assistance companies are uniquely positioned to handle emergency cases of all sorts. Typically, they have the professional staff in house to handle all sorts of travel and medical emergencies. Nevertheless, they tend to be reactive by meeting the challenges of the clients in a wide variety of situations and circumstances, when they arise and they are called on to intervene.

For Commercial payors: Assistance companies are uniquely positioned to handle both simple, and if necessary, complicated cases of facilitating patients treatment abroad. In many cases both have established relationships with both payors and provides, and have built up trust from both sides. Assistance companies may also have existing relationships with medical providers, and can negotiate volume discounts or more competitive pricing, in return for higher volumes of patients. Once again for the assistance company, there should be a cost benefit for extending this service, but the potential exists to create a new platform of services by being more proactive, rather than reactive to facilitating patients for treatment.

Which medical tourist destinations do you feel provide safe, quality driven healthcare services and medical procedures?

This is a very difficult question to answer on several levels. First, every country and culture is unique and has something to offer and learn from. Medical practices, methods and standards may differ but it comes down to positive outcomes, results and customer satisfaction.

Secondly, from the perspective of the user, and what you are accustom to as a client or patient. What may seem totally unacceptable to one patient may be far beyond another’s expectations, as to the quality of the facility and healthcare services delivered.

Third, Language, cultural, tradition and religious beliefs also factor into ones consideration into selecting a destination, as does the length of time to reach the location and ease and cost of travel. Forth, in the increasing volatile world, safety is a not only the facility itself or physicians and care givers, but one must take into account for example political stability, weather and other variables which could adversely affect going abroad for treatment. Personally, I believe quality and value should be the goal of medical providers around the world and the foundation should be an exchange of ideas and knowledge.

If a model of treatment is successful it can be replicated. I can envision the creation of global network of Centers of Excellence that are best in class - no matter where the location people will always seek the best treatment no matter the cost. If proven methods and medical procedures can be analyzed, showcased, studied and replicated elsewhere, eventually they will be available to a wider audience of patients and perhaps enhanced over time.

What areas of medical tourism need development and improvement, and how can facilitators work with payors and assistance companies on larger volumes of patients?

The term “Medical Tourism” as an industry and “Facilitators” as agents seem have been synonymous with tarnishing the concept of cross broader treatment, healthcare or health tourism. For some, Medical Tourism conjures the notion of having a face lift, tummy tuck, implants and returning from vacation looking fabulous. Medical Tourism seems to be directed primarily at the self pay market and cost is the main driver for seeking treatment abroad. Further, it would seem there have been attempts to monopolize the term “Medical Tourism” and to create the belief that the size of the market and industry is enormous and everyone should jump on the band wagon to get a piece of the action. Despite all the hype and no matter what the label - this is a very serious industry dealing with real people who have real medical concerns.

There are some fine medical facilitators I have met personally and they are passionate about their work and not only for making a profit but they have a genuine concern for helping others. This passion and concern seems to be core to the healthcare profession. The self pay market is large but it’s also highly fragmented and the purchasing power is questionable. Facilitators service a purpose - if individuals cannot afford medical insurance they most likely cannot afford treatments abroad, but if they can, everyone should however be entitled to receive treatment, and facilitators can play a crucial role in bridging this gap and finding the right facility at the right price. It is my belief that commercial payors are the real market for volume, they have the client base and money and can realize positive results by sending patients abroad.

Unlike self pay individuals that may commonly utilize the services of a medical facilitator with limited skills or resources, commercial payors are much more demanding, and expect a higher level of service and professionalism. There is an opportunity for facilitators to market their skills and expertise to commercial payors to creating a value proposition. The market is in an early stage and commercial payors may be willing to take a chance on smaller service providers; mistakes may be tolerated as the learning curve is steep for everyone. However, for those looking to make a quick buck, or do not look after the best interests of the client, there is no room for dealing with commercial interests.

How will the medical tourist industry develop over the coming 5 years and how can Industry and Government maximize opportunities?

Medical Tourism is an industry and governments should recognize that healthcare and tourism are high value fields and that have long term growth perspective. People are living longer, globally there is an aging population, but more and more people are travelling freely. Education is a core component to the field of healthcare, and the criteria necessary to enter the field is getting more difficult and increasingly challenging. Governments should embrace the reality and start looking at the future, how to deal with future demands and costs, and to ramp up programs to support the field accordingly.

Healthcare and related services including insurance, medical equipment, pharmaceuticals; the list is endless - the result is tremendous economic spin off particularly for medical tourist that do not utilize the local infrastructure as a local person would - they come and seek treatment and leave their money behind. These are well paid positions in a market that will continue to grow in the future. Quality not cost is the main criteria as people around the global are becoming more resourceful in finding the best money has to offer, no matter where the location. However, to get a piece of the business they have to carve out a niche and to promote their position.


iPMI Magazine Speaks with Mr. Christopher Percival, Director, HealthCare International

iPMI Magazine Speaks with Mr. Christopher Percival, Director, HealthCare International

Christopher has been a Director of HealthCare International since 2004 and prior to that held senior positions within the Banking and Financial Services industry in London. He is recognised, fully qualified and authorised by the Financial Services Authority in the UK and has over 25 years experience in the industry. HealthCare International has an energetic, dynamic and successful team, with more than 35 years’ experience in the Global International Health and Private Medical Insurance arena.

HealthCare International is a specialist provider of global private health and related personal insurances, designed to provide not just the basic health cover, but also a wide range of benefits for expat employees and families. HealthCare International’s renowned HealthCare and Risk Management experience has brought to the market a comprehensive, transparent and easy to understand range of private international medical and life insurance solutions. HealthCare International is constantly seeking to refine and improve their solutions and to build successful client relationships wherever possible.

Please provide an overview of your role at Healthcare International, its infrastructure, and core business products and services?

I am fortunate to work within a really experienced team and I have been a Director of HealthCare International since 2004. Prior to HealthCare International I held senior positions within the Banking and Financial Services industry in London. HealthCare International pride themselves in offering a suite of specialist and innovative products which include comprehensive Private Medical Insurance, Travel Insurance, Life Assurance and Income protection for the global expatriate market for both the Personal and Corporate client sectors whilst ensuring members the highest standards of service at affordable levels. HCI has a substantial Broker Client base of which my team and I look after.

What current trends exist in the expatriate health and travel insurance markets, and what is your company doing to maximize on these opportunities?

The variables in an expatriate life cycle and in the changing circumstances of an individual are many, and we are in the business of providing International Medical Insurance and expatriate assistance in the form of Travel Insurance, International Life and Income Protection, both directly and indirectly. For over 35 years, and during this time have responded to the need for flexible insurance cover and adapting to the protocol of the destination country. Our product development is the key to our success and each year we are able to analyse data and world trends in terms of health care and, along with personal feedback from our clients, improve our plans and benefits where necessary to deliver the most comprehensive cover available. Innovation is a key consideration for us. Technological advancements mean that we are continually monitoring and evaluating developments in the market that will allow us to communicate better with our clients or to manage their policies and personal data even more efficiently.

While we feel our delivery times are excellent in areas such as policy administration and claims processing, if there is a way to improve the service that we provide to our clients, we will be sure to investigate it and to apply it to our industry. Ultimately, healthcare insurance is not something that a client wants to worry about. A company wants to feel comfortable that they are catering to the needs of their employees by providing the best possible benefits and cover. They also want to feel secure in the knowledge that the company they have selected to work with is able to do this. Historically, HCI have not specialised in indigenous populations, but this is very much on the agenda.

What key industries represent the core focus of your expatriate insurance business?

Until recently we have majored in the individual and the small corporate sector of the market. The expatriate movement is growing significantly and we find the majority of our policy holders are in the industries of finance, teaching and natural resources such as oil, gas, and mining. These industry growth trends tend to be grouped in particular areas internationally, but ultimately you will always find expatriates based at different levels in their various industries and our plans and solutions cater for high level individuals as well as for core/bottom line employees - , so we are well equipped to respond to sophisticated needs as well as large claim events.

What emerging industries represent good market potential & growth rates for your products and services? Can you explain the geographical markets in which you operate, and the present challenges your organisation faces there?

Aside from the obvious growth areas in Asia, Europe and the Middle East, we are always pleasantly surprised to hear from a broker who has recommended HCI and feels strongly about the opportunity in their specific market that we can cater to, as often, smaller pockets of incremental business is overlooked in an effort to focus on growth rather than the quality of niche markets. It would be easy to turn this answer into a summary of world trends in industry and expatriate growth, however, what remains essential to us is our relationships that we have with our supporting brokers and existing companies, many of whom refer new business to us. Furthermore, industries such as construction, technology and financial services will always provide us with consistent business growth.

What emerging markets require expatriate health insurance and services, and how do you adapt your services and policies for the new markets and industries?

Everyone is aware of the emerging expatriate markets in Europe and the Middle East, and indeed industries and opportunities are highlighted in Russia and Asia. With more and more countries closing their doors to expatriates’ medical needs, companies like ours need to fill the gap. The trend today is linking closely with local companies who have vast knowledge of local rules and regulations whilst creating successful strategic partnerships. We are already equipped to provide an expatriate with comprehensive and easily managed policies in the health, travel insurance, life and income protection sector. Trends in world industry growth and the location of this growth may shift, but we are there! Wherever the expatriate may be, our policies are designed to be flexible. Introducing local claims administration teams and services in particular, can be done at the request of large corporate groups or a large expatriate presence, and in this way we will continue to strongly align ourselves with both local brokers and international companies, reinforcing local confidence and claims control.

Can you name some key clients, and provide an overview of the type of health insurance solutions they require?

With respect to clients and brokers, due to confidentiality we are unable to name specifics. We look after international plans for some of the largest operations worldwide which include international pharmaceutical agencies, school and educational institutions, as well as those leaders in emerging industries like sports professionals and VIPs. Our focus is on personal service, the speed of this service, and ultimately, customer satisfaction. Every client has their unique circumstances, and our policies and procedures are designed to respond to a variety of needs. We are continually evaluating the market and our operations to ensure that our knowledge, expertise and service best aligns with their requirements. A large part of this relies on open communication between the client and ourselves, and while we believe that our system design and technology is one of the more advanced available to service our client base, without the input from our business partners and choosing to listen to the feedback from our customers, we would not have policy holders as satisfied as our research shows us they are.

How can Healthcare International support and manage the life cycle of an expatriate, mobile and remote workforce?

When evaluating a client and their personal circumstances there are a number of aspects to consider such as age, profession, current health and health needs, work circumstances and destination. A client may require a stand-alone policy, or may have to consider the needs of his or her spouse and dependents. Or they may intend to start a family. Our plans are designed to meet the needs as a person’s life progresses through different and personal stages and circumstances.

For example a British expatriate who is based in China. He joins us at the start of his career, working for a particular company. He regularly travels to other areas of the world during the course of his job, and may be relocated and have a new country of residence. During the course of his career he marries, and he and his wife start a family. They then go from job to job, and country to country. Years later he retires, his children leave home, and he and his wife settle permanently in a foreign country. Assuming this client remains an expatriate throughout, we are able to cater for his International Medical Insurance, Travel Insurance, and Life and Income Protection needs. While we would assist the client to evaluate the plan benefits on the occasion of his annual renewal, the majority of his changing circumstances will be accommodated in the same way throughout his guaranteed cover for life with HCI.

The primary variable is whether a client requires cover for longer than our 90 day emergency cover in the USA on a policy that is essentially excluding USA cover. A client would need to select a plan to include the USA as part of his cover otherwise he would not be covered for full benefits in the USA. Due to the high cost of medical treatment in the USA, it is necessary to select a policy with a premium that factors this in. All his other personal factors are negligible, which is due to the simplicity of eliminating restrictions relating to service providers. The structure of our plans means that a client has the freedom to travel or move to virtually any destination of their choice, and their policy circumstances will remain the same. In other words, we do not have the need to inform them of our local networks in the area, or to advise them of where they may or may not seek treatment. The client comes first – we do not want to compromise the best possible treatment, and thus we provide them with freedom of choice.

We find that this is of huge benefit to our clients, as many may have a personal or family doctor that they would prefer to use, or they may be referred to a treatment facility or doctor by colleagues who have experienced a particularly high level of assistance. We believe that the level of comfort that a client has is to know that treatment comes first, rather than having the hassle of having to go out of their way instead of using their nearest facility, wherever they may be in the world.

How would your International Expatriate Health Insurance Plan, support consistent cover for the life cycle of the employee and family?

Once an expatriate and family have been accepted onto a HealthCare International policy, they are guaranteed cover for life while their period of coverage remains unbroken and they remain expatriates. It is a fact of life that circumstances may change and work requirements can be unpredictable, and rather than having the complications associated with a change in location affecting a network of service providers and having to update details on our systems to cope with a change in their treatment area, we have designed our policies to make this as efficient and client-friendly as possible. A client is free to choose where to receive their treatment and with whom. As long as it is a recognised medical facility or service provider of the country that they are in, and providing the claim is within the benefit level, we are happy to accept the claim or to receive a claim directly from the service provider. Thus, clients are free to travel or relocate without needing to consult with us except to update their contact details. By removing the need for procedural requirements related to networked doctors and hospitals, we are able to put clients’ needs first and provide them with an International Insurance policy that has as little chance for error and frustration as possible.

What services do you offer besides travel, health and expatriate insurance cover i.e. medical consultation, employee assistance programs, medical and travel assistance, travel warnings, cultural training etc?

A HealthCare International policy holder is paying to have security in knowing he has someone who will take care of his Health Insurance needs efficiently. We deliver a service that is personal and we are approachable 24/7. Our claims department is fully trained to be able to process and work with foreign claims. Clients can refer to us for information on local service providers and for assistance in arranging and authorising their treatment. The combined experience of our claims team means a wealth of information from people who are always on hand to assist the policy holder. We organise help in an emergency, and policy benefits include flight arrangements home in the event of the death of a loved one. Insuring an expatriate is not just providing medical benefits and cover, it means realistically assessing what eventualities may affect them. Benefits like paying for accommodation in the event of a parent or child being hospitalised for a specific length of time, are small things that are important to the individual should it occur. It’s not something that they are aware of or may think of here and now, but chances are high that this may occur, and it is our job to provide the services and to consider those unexpected events. A client is placing not only his premium, but also his faith and trust in us.

Are you in a position to offer everything under one roof, to cover all the expatriates healthcare requirements?

Yes. We are one of the few companies that are able to do this on an individual and corporate level with bespoke schemes for the larger corporate. With the strength of major re-insurers behind us we are secure in our operation and development, and are able to provide almost anything that the individual or corporate entity requires. We are not restricted in our development and plan structures, as are some of the larger competitors in the market.

Do you offer EAP (employee assistance programs) and if so can you explain the key features and benefits of this service?

While HCI is a smaller company, this remains one of our greatest strengths as we are able to assist our policy holders in many areas. With regards to EAP, these are individually tailored programs and subject to company type, location and size, and with the systems and technology we have, almost anything is possible.

What support do you offer to enable a corporation to guarantee a seamless transition?

We are comfortably equipped to manage a seamless transition of most company schemes. We are able to match terms and tailor packages - in fact, anything that the employer requires for his staff. A seamless transition from an existing insurance provider or indeed, self administered scheme, into HealthCare International is subject to the information, communication and systems of the corporate company. With modern technology and our recent investment in this sector we have installed a new and comprehensive system – literally one of the most advanced in Europe – we are well placed to manage any transfer of business. Because we do not restrict a member to a particular network of doctors or hospitals, we do not need them to familiarise themselves with this or have any particular procedures for them to follow, other than normal authorisation and claims requirements. Emphasis rests on our office based team and claims team being available 24 hours a day telephonically or via e-mail, to enable us to assist with any specific queries.

What is the strategy to develop Healthcare International in the future?

Our aim is to continue to remain flexible, based on the needs of our existing policy holders and to continue to exceed their expectations when it comes to service delivery. As a company, we are committed to our personal approach and concern for our clients. We are excited about the challenge to continually improve our products, and have a structured business expansion programme. We feel confident that we are ahead of the pack in terms of service and international insurance solutions, and have our eye firmly set on existing and future markets that can benefit from our services and products.

iPMI Magazine Speaks with Mr. Christopher Percival, Director, HealthCare International

Contact Healthcare International

Company: Healthcare International

Address: UK Administration, 160 Brompton Road, Knightsbridge. London SW3 1HW, United Kingdom

Phone: +44 (0)20 7590 8800

Fax: +44 (0)20 7590 8815

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.


Insurance, Expat Insurance, Health Insurance, Travel Insurance, Healthcare, Private Medical Insurance, International Private Medical Insurance

Healthcare International Full Buyers Guide Listing on iPMI Magazine



African, European And Asian Cities Dominate The Top 10 Most Expensive Locations For Expatriates

Although more European cities dominate the world’s top costliest locations for expatriates, according to Mercer’s latest Cost of Living Survey, several cities in Asia are among the top 10 while Luanda holds the number one position. Mercer's 2013 Cost of Living Survey is one of the world’s most comprehensive, and is designed to help multinational companies and governments determine compensation allowances for their expatriate employees.

New York is used as the base city, and all cities are compared against it. Currency movements are measured against the US dollar. The survey covers 214 cities across five continents and measures the comparative cost of over 200 items in each location, including housing, transportation, food, clothing, household goods, and entertainment. The difference in cost for these items can be dramatic.

For example the cost of a cup of coffee in Managua, Nicaragua is $1.54 compared to $8.29 in Moscow; a fast food hamburger meal is $3.62 in Kolkata (Calcutta), India, versus $13.49 in Caracas, and a cinema ticket is $5.91 in Johannesburg compared to $20.10 in London. These are but a few examples of the thousands of comparisons to be found in Mercer’s full report that aid employers in setting cost of living and other expatriate allowances. Mercer produces individual cost of living and rental accommodation cost reports for each city surveyed.

The cost of expatriate housing is typically the biggest expense for employers, and it plays an important part in determining the rankings. The Russian capital of Moscow follows Luanda as the second most expensive city because of high costs for rental accommodation and imported goods and services commonly purchased by expatriates commanding a premium. A luxury two bedroom unfurnished apartment rental for one month in Moscow is $4,600 a month or 14 times as much than Karachi. Rounding out the top five most expensive cities for expatriate living, which also have pricey rental accommodations, are Tokyo, the Chad city Ndjamena, and Singapore.

“Recent world events, including economic and political upheavals, which resulted in currency fluctuations, cost inflation for goods and services, and volatility in accommodation prices have impacted these cities making them expensive,” said Barb Marder, Senior Partner and Mercer’s Global Mobility Practice Leader. “Despite being one of Africa’s major oil producers, Angola is a relatively poor country yet expensive for expatriates since imported goods can be costly. In addition, finding secure living accommodations that meet the standards of expatriates can be challenging and quite costly." The other cities appearing in Mercer’s list of top 10 costliest cities for expatriates are Hong Kong, Geneva, Bern and Zurich.

According to Ms. Marder, “A recent Mercer global mobility survey shows that all different types of international assignments are on the rise. Given the increasing numbers of business travelers, global ‘commuters’ and longer-term expatriates, companies are keeping a close eye on the cost of living for international assignees in different cities around the world. Organizations need to evaluate the impact of currency fluctuations, inflation, and political instability when sending employees on overseas assignments while ensuring they can facilitate the moves they need to drive the business results by offering fair and competitive compensation packages.” Currency fluctuations and the impact of inflation on goods and services have affected the cost of expatriate programs as well as the city rankings.

“Overall, the cost of living in cities across parts of Europe has gone up in the ranking as a result of the slight strengthening of local currencies against the US dollar, whereas in Asia about half of the cities went down in the ranking – Japan especially – due to local currencies’ weakening against the US dollar,” said Nathalie Constantin-Métral, Principal at Mercer with responsibility for compiling the survey ranking.

Four European cities are among the top 10 most expensive despite moderate price increases in most European countries. Switzerland remains one of the costliest locations for expatriates despite decreasing or stable accommodation costs and a robust Swiss franc. Some African cities rank high in Mercer’s 2013 survey, reflecting high living costs for expatriate employees. In the Americas, cities in South America are the most expensive locations for expatriates.

Some cities dropped in the ranking as a result of local currencies weakening against the US dollar such as Brazilian cities, while others jumped as a result of high inflation on goods and services and rentals. New York, the base city for Mercer’s Cost of Living ranking, is the most expensive city in the United States.

“Overall, US cities either remained stable in the ranking or have slightly decreased due to the movement of the US dollar against the majority of currencies worldwide,” explained Ms. Constantin-Métral. ”Yet several cities, including New York, moved up in the ranking due to a rise in the rental accommodation market.” Canadian cities generally moved down in the ranking this year as a result of a slight decrease of the Canadian dollar against the US dollar, and because the prices of goods and services increased at a lower pace than in New York.


Bupa Appoints Patricia Hewitt As Board Director

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

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

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


Air Medical Transportation Europe


Air Medical Transportation Europe

Düsseldorf 08:00 AM: A call comes in to operations of Jet Executive, JEI: a 30 year old man vacationing on Mallorca, Spain is suffering from a fracture of leg and rip after a motorcycle accident. While speeding on the highway he hit a pole. The girlfriend of the patient was sitting in the back but luckily she didn’t have any injuries. They need to be repatriated back to Switzerland. Dennis Stoffel, ground operations manager, who is on duty while the call comes in probably won’t have any unpredictable difficulties with the organization of this flight. It is within European borders so no permissions will be required.

Considering the routing Spain to Switzerland the Munich based Learjet 35 is in a slightly better position than the company’s aircrafts which are based in Frankfurt. And with a total flight time of four hours this operation will be managed within one day even if the patient needs to be picked up from the hospital on Mallorca and dropped off at his new destination in Geneva.

“The crew will return to their Home Base so I don’t need to worry about hotel bookings nor minimum crew rest times,” he finishes his explanations. Having a strategic geographic base of operations is essential to the success of any air ambulance company. Primarily serving the European market, Jet Executive’s headquarters its operations in Frankfurt and Munich. “Geographically Germany is the centre of Europe, no matter if you fly from south to North, or West to East you will most likely overfly German territory which gives us a competitive advantage to other providers”, argues Irena Dimitrijevic, the new Marketing and Sales manager of JEI. “Our position enables us even to serve the Northern African countries and the Eastern part of Russia without a fuel stop.”

The bulk of such air ambulance work comes from insurance companies repatriating tourists. With a large number of vacationers from all over Europe to the top holiday destinations such as the Canary and Balearic Islands, Italy, Greece or even Northern African destinations like Sharm el Sheik in Egypt there is increase the demand for patient transfers during the summer months. The patients need to be brought back to their home countries which in most cases are Germany, Austria, France, Swiss, the UK or one of the Scandinavian countries. However, insurance companies are not the only ones that request patient transfer charters. Quite often, wealthy private citizens and foreign nationals seeking high-end European and US health care are willing to pay the price to have a private jet taking them to internationally recognized health clinics. For long distance flights the Challenger 600 comes more likely in action compared to short distances due to comfort reasons.

“The Challenger 600 operating under D-Busy is Jet Executive’s flagship and can be equipped with up to three stretchers”, reports Irena Dimitrijevic. Next to the insurance companies many brokers all around the world request ambulance flight each day. If they are specialized in the business they can be very useful as they are specialized certain geographical areas and are in contact to many end customers. Others have their key business focused on executive flights so the potential outcomes of their requests are rather ineffectual. Occasionally companies receive calls to retrieve injured soldiers, after acts of terrorism or humanitarian disasters, government personnel or ambassadors and their families.

Larnaca airport, Cyprus 12:30 PM

Captain Meyer and his Co-Pilot Wischer just landed on the 9800 feet long runway in 37 degrees of Mediterranean heat. Once again the job of getting the patient home has fallen to the flight crew and medical staff of the Learjet 35 D-CGRC. The aircraft is equipped with an incubator for the little patient. Baby L.S., born on the sunny island a few months ago. Unfortunately his short life hasn’t been as sunny as the weather so far. His mom had a premature birth and since then she hasn’t left the island due to the critical condition of her son.

Both parents haven’t seen their home in Leeds, England for almost a year now because the doctors refused to risk any repatriation up unti today. The baby suffers from prematurity symptoms for an indefinable time and therefore the flight is life-threatening. Captain Meyer will have this in mind for the whole five flight hours up to the British Island.

“As in most cases, organizing the actual flight was the easy part; the hard part is always coordinating the logistics between the two countries such as the destination hospitals”, says Dennis Stoffel, “We had to reschedule the flight three times before we were able to finally operate it. The client kept cancelling last minute due to a missing bed in the receiving hospital in Leeds and even surrounding areas. At the same time we had to coordinate the time schedule of the accompanying child doctor. She is usually working shifts in a hospital but needed to be available on the exact date of the repatriation. Hospital beds in England are rare compared to other European countries.

“Certain countries are well organized and the clients are taking care of all logistics. But other once expect you to be responsible for the arrangement of a suitable ground ambulance and a bed-to-bed service is taken for granted.”

Despite a continuously merging Europe each country still remains different in their way of living and their medical provision so that at the end of the day these are the challenges an International Air Ambulance Operator has to cope with. Considering the advantages of a united Europe one can say that open borders and a visa free layover is one of them. In contrast to Executive flights there aren’t any countries in Europe left which are claiming permissions for an air ambulance operation.

“As soon as we operate into neighbouring countries we often have a handling Agent who supports us with individual Customs and Immigration inspectors”, explains Mr. Stoffel.

“Russia for example is showing signs of a maturing market and growing demand for any kinds of flight operations. As more and more Russian citizens are indulging themselves a German medical treatment an intermediary becomes essential. The operations staff navigates the bureaucracy and receives information about operating airports, fuel and visa policies. Then there are the medical logistics to address. Jet Executive is using a pool of more than 70 doctors and further 60 flight-paramedics, all of them with a lot of experience in ICU air ambulance operations. “We have medical crews based in Munich and Frankfurt.

They are responsible for arranging ground transportation and ensure that the Aeromedical staff must have all necessary equipment on board. Therefore the medical report is always a key factor. It decides the compilation of the Medcrew and the necessary equipment on board.

“A few weeks ago we flew a pregnant lady from Spain back to her home town Bristol, UK. We had a Medcrew consisting of four people on board: One child doctor, one midwife, one doctor for the mother and one nurse. We were prepared for every possible case,” demonstrates the Irena Dimitrijevic.

Bernd Ringelmann, president of Jet Executive said preparing for the unexpected and managing it when it happens is crucial to effective international air ambulance operations. “Every trip is different; sometimes the shorter once within Europe can be harder than the once abroad.” Consideration on every patient transfer include an assortment of “known issues,” such as monitoring duty days, pre-positioning crews worldwide as required, obtaining foreign visas for medical staff and aircrew, landing rights, over flight permits (particularly Middle Eastern countries such as Iran and Iraq). Moscow Vnukovo for example charges a fee for each passenger when using the terminal even if it is a patient; London Heathrow is very expensive to operate so that London Gatwick is usually considered for an air ambulance operation,

Bolzano airport in Italy can be only operated by a King Air turboprob and not a Learjet and specific airports in Europe are only operable with decent weather conditions. These are just a few pieces that need to be considered for the whole puzzle. But even some parts of Europe still remain difficult because of political issues.

“If we have to quote a flight to Kosovo we need to calculate approx. half an hour on top of the actual flight time because it’s not permitted to fly straight to Kosovo over Serbia and vice versa. It is defined by the NATO that you need to fly a curve over Montenegro while avoiding Serbia”, explains Sebastian Mueller from the operations department.

The front line of any air ambulance company will always be the aircrew and medical staff on board each flight “So you need the right people to come to solutions and decisions quickly. The pilots making the decisions have to be enthusiastic, committed individuals prepared to make the necessary short-term sacrifices inherent in the job.

“We depend on the pilot’s ability to think and act for themselves. The rules apply for example when operating unknown airports especially in African countries or war zones like Afghanistan. “Being able to adapt to unpredictable developments on the scene goes with the territory. The challenges are there every day,” said Bernd Ringelmann.

All air ambulance providers need to have a necessary authorization with the LBA (Luftfahrt Bundesamt) and comply with appropriate rules and regulations. Air ambulance providers in particular need to be provided with known and registered ICU Equipment in order to be put on a provider list with many customers. Beside these few requirements it’s all about the geographical positioning of the Home Bases and the company’s strategy. While there are many commonalities among aeromedical companies, each one seems to have its own business philosophy, structure and ideas about how to get the job done.

Munich airport, 22:30 PM

The engines of the Learjet D-CGRC are slowly calming down. Captain Meyer and Co-Pilot Wischer are climbing out of the aircraft and checking out. Baby L.S. has been dropped-off at the airport in Leeds- Bradford and brought to the St. James Hospital in Leeds. The patient was delivered in a stable condition and finally brought back home.

The Medcrew packs up the medical equipment and finishes their medical reports. Captain Meyer makes a call to Düsseldorf operations to sign off from the job. Air ambulance flying can be physiologically exhausting considering that crews are operating in challenging and difficult location and that the all the employees are putting in long days and a lot of night shifts. But nevertheless, very often they get the reward of retrieving sick and injured people back home.

Düsseldorf 00:35

Christian Dörken is working the night shift and has just completed the flight plans for an ad-hoc flight tomorrow morning; Frankfurt-Adana-Stuttgart-Frankfurt. The booking just came in two hours ago. The flight crew is briefed and the ground ambulances will be organized first thing in the morning. He has also completed the record from this morning regarding the injured young man from Mallorca who was brought back home to Switzerland safely.

Mission completed for now – until the next call comes in to operations!

Written By Irena Dimitrijevic,Marketing & Sales Manager, JET EXECUTIVE International Charter GmbH & Co. KG.


Raffles Health Insurance Launches 2 New International Health Insurance Plans In Conjunction With Bupa

Raffles Health Insurance Launches 2 New International Health Insurance Plans In Conjunction With Bupa

Raffles Health Insurance Pte Ltd (RHI), a wholly-owned subsidiary of Raffles Medical Group has launched two new international health insurance plans targeting next generation expatriates and international businesses in the Asia Pacific region, in conjunction with international health insurer Bupa. The plans, insured by Raffles Health Insurance and administered by Bupa, are called RHI-Bupa Company Health Select Asia Pacific and RHI-Bupa Company Health Choice International.

The Company Health Select Asia Pacific plan is designed for businesses that operate in the Asia Pacific region, whose employees do not need worldwide cover, while the Health Choice International plan covers members in three different countries. Members on the Company Health Select Asia Pacific plan are covered for treatment in more than 40 countries in the Asia Pacific region, with the exception of Hong Kong; while the Company Health Choice International plan covers members in three countries, for which Singapore has to be their residency country with members choosing two additional locations of choice (excluding the USA).

These new tailored plans provide an affordable and flexible option of healthcare for a next generation of expatriates and the businesses employing them. Rather than offering worldwide cover, the plans are tailored to the specific locations to provide the individual with the right treatment, at the right time and in the right place.

Danny Yap, Principal Officer and General Manager of RHI, said, “We are delighted to see our relationship with Bupa continue to grow. These new products broaden our offerings and further position RHI as one of Singapore’s leading healthcare insurance specialists.” Wayne Close, Managing Director at Bupa International said, “We are very happy to be working with Raffles Health Insurance. The launch of these products further demonstrates Bupa and RHI’s commitment to providing access to high quality healthcare in the region and to the international businesses operating from Singapore.”

He added “With international businesses increasingly moving their Asia regional headquarters to Singapore, we expect the number of next generation expatriates in Singapore to continue to grow. These two new plans have been developed in response to the needs of these businesses and expatriates.”

Both plans include comprehensive in-patient cover and assistance cover, including emergency evacuation and repatriation. Members can also increase the cover to include an additional out-patient module or extend it to their families. In addition, RHI and Bupa have a dedicated 24-hour multi-lingual team to provide medical assistance. Bupa offers quality individual and group medical cover to people who are in their home country or living and working abroad. Under this relationship, RHI will directly insure the plans while Bupa is the administrator.


Independence Blue Cross Introduces Global Blue Coverage for Individuals and Families

Independence Blue Cross Introduces Global Blue Coverage for Individuals and Families

Independence Blue Cross (IBC) announces the availability of GeoBlue Travel Medical and International Health Insurance products for individuals and families in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Since 2011, IBC and GeoBlue have collaborated to offer group coverage for international business travel and expatriate insurance products and services. This coverage is now available for both IBC members and the general public. The new IBC travel and expatriate plans offered through GeoBlue will expand the availability of Blue coverage for all travelers. As well, expatriates will be covered in both the country where they live and anywhere they visit.

For example, if a GeoBlue customer relocates to a European nation, but travels to Asia or Africa, the customer will have health care coverage in each destination. Additionally, GeoBlue policies are available for purchase for both single-trip purposes and multi-trip needs.

"Consumers who purchase GeoBlue products can travel with confidence knowing they are covered worldwide by the trusted Blue brand," said Richard J. Neeson, IBC executive vice president and president of expanding markets. "At IBC, we're working to help the residents of our region stay healthy and ensure that, when they do get sick, health care is safe, coordinated, and available -- no matter where they are in the world."

"GeoBlue provides peace of mind to world travelers and expatriates as they pursue their personal goals," said Brendan Sharkey, director of individual products at GeoBlue. "Given the global arc of business and leisure activities today, the need is clear: timely access to an international network of carefully selected doctors and hospitals to meet whatever health needs arise, and GeoBlue delivers."

In order to use GeoBlue for short-term travel insurance, consumers must have U.S.-based primary health coverage in place. However, that coverage does not need to come from a Blue Cross® or Blue Shield® health plan. GeoBlue is a trade name of Worldwide Insurance Services, LLC, an independent licensee of the Blue Cross and Blue Shield Association and a subsidiary of Highway to Health (HTH). GeoBlue markets a full line of group and individual health insurance programs for expatriates and business travelers through arrangements with local Blue plans.


You Are Global

You Are Global Overseas Health Insurance


You Are Global is a leading international health, expat, life and travel insurance broker and intermediary, based in Brazil. You Are Global works with leading private medical insurance providers and companies like IMG, Cigna, HCC, Now Health International and Allianz Worldwide Care. You Are Global caters specifically for expatriates, travelers and tourists, working, living and visiting Brazil. You Are Global has specific expertise working with Spanish speaking cultures around the world whilst also proving international health, medical, travel, expat and life insurance plan to the out bound travel market in Brazil.


You Are Global

You Are Global Overseas Health Insurance

You Are Global is a leading international health, expat, life and travel insurance broker and intermediary, based in Brazil. You Are Global works with leading private medical insurance providers and companies like IMG, Cigna, HCC, Now Health International and Allianz Worldwide Care. You Are Global caters specifically for expatriates, travelers and tourists, working, living and visiting Brazil. You Are Global has specific expertise working with Spanish speaking cultures around the world whilst also proving international health, medical, travel, expat and life insurance plan to the out bound travel market in Brazil.

How can we help?

If you are an international citizen and need a medical coverage which knows no boundaries, you are in the right place. We understand the world has evolved and business and study programs are not limited to the place we live. And this also happens to international travel opportunities: nowadays, travel abroad is easy due to globalization. In the other hand, we know that having a comprehensive, continuous and worldwide medical coverage is mandatory to an international citizen. Therefore, from now on you can access all solutions ValenteRocha provides throughout “You are global – SeguroSaúdeemViagens” program.

You can have a global support, with online assistance, quoting and contracting your international medical coverage with adjustable options as you have never seen. Now you have access to the most comprehensive medical coverage plan available in the American Health Insurance Style. *You are Global – Seguro Saúde em Viagem”isValenteRochaproperty for international medical coverage plans.

Safe On-line Shopping

The whole process of your international medical coverage shopping can be on-line, throughout the internet. In this channel, you can have the quotation you need, revise the offered coverages, fulfill your personal data and send, directly to the enterprise, your international medical coverage request. We know that, due to the nature of our solutions, some personal information is confidential. Then, the entire information submitting process is confidential and all personal information is sent directly to underwriting department which is under a severe clause of confidentiality regarding our clients` information. All this provides you peace of mind. All the shopping system is secured by a safe site and digital certificate, which ensures the online shopping. In other words, we are ready for you to have what is the top of the best medical coverage available, aligned with an customer service and underwriting processes with are modern, safe and dynamic.

Company: You Are Global

Address: R.Lima Barreto, 442, Curitba, Brazil

Phone: +55 41 3527 2680

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.



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