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Integra Global To Focus Exclusively On Locally Admitted Insurance Solutions

Integra Global, an international health insurance provider since 1999, has decided to leave the offshore IPMI market, and focus its sole attention on providing locally admitted solutions with its designated insurance partners. 

As a consequence Integra Global is pleased to announce that it has found a home for its international offshore portfolio and has sold its international PMI and Marine business to Health Care International effective 26 August 2022. 

Philip Catterton CEO Integra Global told iPMI Magazine, “It was a difficult decision to sell our offshore portfolio which we started well over 22 years ago. However, we see this as a great opportunity to focus our sole attention where we see the most growth potential: international health plans under locally admitted solutions. We feel extremely bullish about the GCC and the UAE in particular. We will focus our decades of experience and know-how in these exciting markets for the next few years and expect dramatic growth. We look forward to taking care of the needs of our customers now and into the future as we further develop our proposition for the GCC and UAE markets."

Since 1999, Integra Global has specialised in designing international health plan solutions for a discerning international clientele. 



Expatriate Group Adds Free Upgrades To Corporate iPMI Plans For All New And Existing Policyholders

Expatriate Group commit to upgrade their corporate iPMI policies for all new, and existing policyholders, for free, from New Year’s Day 2022.

They will restructure their group iPMI policy cover following conversations with their corporate and broker partners.
Their feedback clarified the requirement for policies that better suited the needs of businesses seeking to meet the challenges of greater corporate responsibility to their staff and their work environments – both physically and mentally.

From 1st January 2022 all group policies will include, as standard: an Employee Assistance Programme; Business Travel insurance; and Income Replacement cover, integrated into all international healthcare policies.

“From the feedback, it was clear that HR managers want simpler and more cost-effective solutions for managing employee protection” said Amanda Giscos, Head of Business Development.

She also added “COVID-19 often led HR managers to remain with existing providers, even if there were better products on the market, to give employees the feeling of an element of security through consistency. However, with the world easing back to work, the ability to attract and retain staff is vital. Businesses who put employee wellbeing at the heart of their culture and support the transition to the new normal, and beyond, will thrive”.

“We have now reinvented our corporate policies to better meet these needs in a simple, single HR solution” said Lee Gerry, Expatriate Group Director.

“Now, if an employee is travelling on business, they’re covered; if they need immediate access to counselling, they’re covered; if they can no longer work because of their health, they’re covered. These benefits are now core to our comprehensive group iPMI policies.

“What’s more,” Gerry said “following strong underwriting results in 2019 and 2020, the improvement in benefits hasn’t resulted in any change in premium”.

“International HR managers are seeking more from their partners” Gerry continued, “Enabling employee services and risk management to be centralised under a single contract, will streamline administration, and make both time and cost savings.

There’s also the added benefit of claims being handled under the same online platform, which’ll make life easier for the employee too!”

Expatriate Group’s new corporate iPMI policies will be available from 1st January 2022. Existing customers will have the new benefits automatically added to their group policy at renewal.


International Private Medical Insurance Market Updates With iPMI Analyst Ian Youngman

In the article International Health Insurance 2021 IPMI market report author Ian Youngman, looks at the latest developments in the international private medical insurance market including:

  • The recent Bupa/Generali deal;
  • British expatriates in Spain;
  • Changes to the law for foreign investors in Indian insurance companies;
  • How health insurance premiums will grow in China;
  • Opportunities in Health Insurance in Iran.

British expats in Spain

In 2020 there were 360,000 British expats in Spain. Some work there and some retire to there.

Many have a UK home and a Spanish home. They spend 6 months in the UK and 6 months in Spain. This worked when the UK was in the EU. Now they have to choose between living in Spain full time or for less than 3 months. Many are selling up in Spain.

This will hit the IPMI market for those small UK agencies targeting British expats.

Bupa and Generali

There have been rumours on the grid for months that Generali was getting out of writing IPMI.

The Bupa/Generali deal allows Generali to concentrate on other areas it is better and bigger at - while allowing Bupa to enter or expand in many countries without having to build or increase a local infrastructure.

Global IPMI is now something you can no longer dabble in. You either commit globally or where you want to be. So I expect more insurer/insurer deals.

Yes, an insurer can decide only to offer IPMI in select countries. That works for individuals and SMEs. But what happens when your biggest corporate customers decide to become major players in a country where you have withdrawn from or refuse to enter, and you need a local base or partner as offshore IPMI is not allowed?

RELATED READING: International Health Insurance (IPMI) 2021


Indian Insurance Companies (Foreign Investment) Amendment Rules, 2021 apply to new and existing insurers with foreign shareholders.

This increased the foreign investment ceiling from 49% to 74% in the insurance industry from May 2021, as the government seeks capital injections and growth in the insurance sector.

Indian insurance companies that have foreign investors must have the majority of their directors and key management persons as resident Indian citizens. At least one of the following – board chairperson, managing director, or CEO – must also meet the citizenship requirements.

Insurers have until May 2022 to comply with these new rules.

Several IPMI insurers have started the process of increasing their stake in Indian subsidiaries.


Health insurance premiums in China will grow by 14% annually over the next 10 years, and China's share of global health premiums will rise from less than 2% today to 4.2% in 2029, forecasts Swiss Re Institute (SRI) in a Sigma report.

In China, new business will support double-digit growth in PMI premiums. State figures say that by end 2021 1.4 billion people have health insurance plus 236 million with maternity insurance.

In spite of fast-growing household incomes and also insurance penetration, a still-large health protection gap in China exists. The development of private health insurance, in particular products for the fast-growing middle-income class, is a key to closing the gap. The experience of China in effecting greater uptake of private health insurance has reduced high out of pocket expenses.

Foreign ownership in China is complex but IPMI insurers see this as a massive market


Hiss boo - the pantomime villain of the world, if you only read Western media.

The second biggest economy in the Middle East is making massive progress on its own and by new deals with Russia and China on infrastructure and trade, and hard currency that the US and Europe thought they had cut off.

The US, after its massive success in Afghanistan and Iraq somehow thinks it can bring about regime change by economic and political pressure - dream on.

While European and US insurers are banned from Iran by their governments - expect Chinese health insurers to move in.

So if you are a US or EU insurer – if you own or part own a Chinese insurer- it can write offshore business in Iran! 

RELATED READING: International Health Insurance (IPMI) 2021

Leading international private medical insurance publisher iPMI Magazine is excited to announce the launch of the “International Health Insurance 2021" IPMI market report written by leading insurance and healthcare analyst Ian Youngman.

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

How To Buy International Health Insurance (IPMI) 2021

We are selling the report on Research and Markets for £3600 for all 3 volumes. However, if you are an advertiser or iPMI Magazine subscriber, we are offering the report at a reduced price. To take advantage of this offer please complete the form here, or write to ipmi[at]

About The Author

Ian Youngman is a writer and researcher specialising in insurance. He writes regularly for a variety of magazines, newsletters, and on-line services. He publishes a range of market reports and undertakes research for companies and has London market management experience with brokers and insurers. 



The Best And Worst Destinations For Living And Working Abroad

The Expat Insider 2021 Survey is out now, and the results reveal the best and worst destinations for living and working overseas.

Ian Youngman, Author of the International Health Insurance 2021 report comments, "Among all the doom and gloom I have heard suggestions that not only were some companies thinking of moving people away from cities into the country but also thinking of moving people abroad. The other vibe is that rather than moving back home - as the media suggests- most expats have opted to stay but perhaps move to the country or move from cities. This is the first time that I have seen any evidence that more people are thinking of moving abroad.

In the UK there is already a trend to move from cities into the country and either work remotely or commute. In my village, every week estate agents ask if I want to sell up - local house prices have shot up over 10% in a few months. So if you think this through globally, with remote work globally being possible and digital nomads becoming a new breed of expats, people are looking to move from cities- and that may mean moving abroad. Nobody can predict figures but I expect expat numbers to increase every year in the next few years - from individuals and companies.

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

RELATED READING: International Health Insurance (IPMI) 2021

The Best Destinations for Living and Working in 2021

1. Taiwan 

Taiwan ranks 1st out of 59 destinations for the third year in a row in the Expat Insider 2021 survey. It also comes first in the Quality of Life and Working Abroad Indices: Most expats are satisfied with their job security (83% vs. 61% globally) and the state of the local economy (85% vs. 62% globally). Additionally, the majority is happy with their job (75% vs. 68% globally) and their life in general (80% vs. 75% globally). Furthermore, 96% of expats rate the quality of medical care positively (vs. 71% globally), and another 94% are satisfied with its affordability (vs. 61% globally). An expat from Chile shares: “The Taiwanese healthcare system truly considers people as human beings instead of mere numbers.” Moreover, not a single expat (0%) feels personally unsafe in Taiwan (vs. 8% globally). An expat from Canada shares: “I can live independently. I feel safe wherever I go, and everything is convenient.” 

Although Taiwan places slightly lower in the Ease of Settling In Index (13th), it is the best-ranking country worldwide in the Friendliness subcategory (1st). Most expats find it easy to make friends there (62% vs. 48% globally) and describe the Taiwanese population as friendly towards foreign residents (96% vs. 67% globally).  

2. Mexico 

Mexico ranks 2nd out of 59 destinations worldwide. It is even rated the best country for expats in the Ease of Settling In Index (1st): 85% find it easy to settle down in Mexico (vs. 62% globally), and 78% say it is easy to make local friends (vs. 44% globally). A US American expat says that “the culture and friendliness of the local people” is their favorite thing about living in Mexico.  

Mexico also does well in the Personal Finance (2nd) and Cost of Living (4th) Indices. In fact, four in five expats (80%) are satisfied with their financial situation (vs. 64% globally), and 90% say their disposable household income is enough or more than enough to cover their living expenses (vs. 77% globally).  

Mexico performs slightly below average in the Quality of Life Index (31st). It comes in 42nd place in the Quality of the Environment subcategory, with 27% of expats being unhappy with the water and sanitation infrastructure (vs. 12% globally). Additionally, Mexico even ends up among the bottom 10 of the Safety & Security subcategory (51st), with 20% of expats concerned about their personal safety (vs. 8% globally). Despite that, 89% of expats in Mexico are happy with their life in general (vs. 75% globally), placing the country first worldwide for personal happiness.  

3. Costa Rica 

Costa Rica places 3rd out of 59 countries in the Expat Insider 2021 survey. It ranks among the top 5 in the Ease of Settling In Index (3rd), with 91% of expats describing the population as generally friendly (vs. 69% globally). Another 87% describe the local residents as generally friendly towards foreign ones (vs. 67% globally), and 70% find it easy to make local friends (vs. 44% globally). “I love the social life and culture,” shares a US American expat. Maybe this is why most survey respondents find it easy to get used to the local culture (82% vs. 65% globally) and feel at home in it too (80% vs. 63% globally).  

Costa Rica performs well in the Quality of Life Index (14th), coming in second place worldwide for personal happiness — just behind Mexico (1st). All things considered, 88% of expats in Costa Rica are happy with their life (vs. 75% globally). The country comes 10th in the Quality of the Environment subcategory, with the majority of expats rating the natural environment (96% vs. 84% globally) and the air quality (91% vs. 66% globally) positively. However, Costa Rica lands in the bottom 10 of the Travel & Transportation subcategory (52nd): 29% of expats are unhappy with the public transportation system (vs. 15% globally). A Canadian expat shares: “Traffic is terrible because of poor drivers, bad roads, and insufficient infrastructure.”  

On the upside, Costa Rica makes it into the top 10 of the Personal Finance Index (7th), with 84% of expats considering their disposable household income enough or more than enough to cover all expenses (vs. 77% globally).  

4. Malaysia 

Ranking 4th out of 59 countries in the Expat Insider 2021 survey, Malaysia ranks above the global average in every index. The country does particularly well in the Ease of Settling In Index (2nd) — as a US American expat puts it: “It is easy to live here, and the people are wonderful.” In fact, most expats find it easy to settle down in Malaysia (77% vs. 62% globally) and to make new friends there (66% vs. 48% globally). It might help that Malaysia ranks first in the Language subcategory: 92% of expats find it easy to live there without speaking the local language (vs. 54% globally), while 45% also consider it easy to learn (vs. 39% globally).  

The country also does exceedingly well in the Cost of Living Index (2nd), where just Vietnam (1st) performs better. In fact, 82% of expats rate the cost of living in Malaysia positively (vs. 48% globally). With the destination ranking 9th in the Personal Finance Index, 73% of expats are satisfied with their financial situation (vs. 64% globally), and 85% say their disposable household income is enough or more than enough to cover their expenses (vs. 77% globally).  

Malaysia does worst in the Working Abroad Index, but it still lands in a slightly above-average 25th place: 72% of expats are satisfied with their working hours (vs. 66% globally), and 69% are happy with their job in general (vs. 68% globally). 

5. Portugal 

Portugal ranks 5th out of 59 destinations in the Expat Insider 2021 survey, performing best in the Quality of Life Index (3rd) — just behind Taiwan (1st) and Austria (2nd). The country ranks third in the Personal Happiness subcategory of this index, with 84% of expats being happy with their life in general (vs. 75% globally). What is more, 87% of expats are satisfied with the local leisure options (vs. 72% globally), and 90% say the same about the climate and weather (vs. 66% globally). “I like the weather and the laid-back lifestyle,” says a French expat.  

Portugal also makes it into the top 10 of the Ease of Settling In Index (9th), coming sixth in the Friendliness subcategory. In fact, 87% of expats find the local residents generally friendly, compared to just 69% globally. Portugal even ranks second worldwide in the Feeling at Home subcategory, where just Mexico (1st) performs better. The majority of expats feels at home in the local culture (83% vs. 63% globally) and finds it easy to settle down in the country (84% vs. 62% globally).  

Portugal receives its worst — but still fairly average — results in the Working Abroad Index (36th). The destination places 44th in the Career Prospects & Satisfaction subcategory, though, with more than half the expats (51%) unsatisfied with the local career opportunities (vs. 33% globally). However, 70% of expats are at least happy with their work-life balance (vs. 66% globally).  

6. New Zealand 

New Zealand almost makes it into the global top 5 of the Expat Insider 2021 ranking, coming 6th out of 59 countries. It performs particularly well for working abroad (2nd): 81% of expats consider their job secure (vs. 61% globally), and 64% feel optimistic about local career options (vs. 45% globally). At the same time, expats enjoy a great work-life balance (83% satisfied vs. 66% globally).  

The country comes in 11th place in the Quality of Life Index, doing especially well in the Digital Life subcategory (5th): 98% are happy with the cashless payment options (vs. 83% globally), and 89% rate the availability of government services online favorably (vs. 63% globally). What is more, New Zealand has the best ratings worldwide for its natural environment (100% positive vs. 84% globally), coming in 6th place in the Quality of Environment subcategory. Last but not least, it is a very safe and stable country to settle down in: 95% of expats describe New Zealand as peaceful (vs. 80% globally), and not one single respondent rates its political stability negatively, compared to about one in six (16%) globally. “I love my peaceful, calm, and safe existence in New Zealand,” a US expat comments.  

The results for the ease of settling in are only slightly worse (16th). Expats find it easy to settle down in New Zealand (77% positive ratings vs. 62% globally), and 82% describe the local residents as friendly (vs. 69% globally).  

7. Australia 

In the Expat Insider 2021 survey, Australia (7th out of 59) lands among the top 10 destinations worldwide. While it ranks sixth in the Quality of Life Index overall, it comes first worldwide for its local leisure activities (87% positive ratings vs. 72% globally). An impressive 97% of respondents also praise the natural environment (vs. 84% globally). “Living in close proximity to nature — close to the beach and the rainforest — is so amazing!”, says a US expat. Lastly, it ranks very well in the Digital Life subcategory (8th) as, for instance, 89% of expats appreciate the availability of government services online (vs. 63% worldwide). However, opinions are divided on the topic of healthcare in Australia: while 88% of expats are satisfied with its quality (vs. 71% globally), just 68% consider it affordable (vs. 61% globally).  

Australia does well in the Working Abroad Index (10th). Expats are especially satisfied with their local career opportunities (60% positive ratings vs. 45% globally) and their work-life balance (76% positive responses vs. 66% globally). Even Australia’s somewhat worse results in the Ease of Settling In Index (18th) still place it in the top 20. Expats find it especially easy to get used to the local culture (76% positive responses vs. 65% globally) and to settle down in Australia (74% vs. 62% worldwide). However, only a slightly above-average 54% find it easy to make new friends there (vs. 48% globally).  

8. Ecuador  

Coming in 8th place out of 59 countries in the Expat Insider 2021 survey, Ecuador performs best in the Personal Finance Index (5th). Close to three in four expats (73%) are satisfied with their financial situation (vs. 64% globally). Moreover, 91% describe their disposable household income as enough or more than enough to cover their expenses (vs. 77% globally). This places the country third for this factor, just behind India (2nd) and Vietnam (1st). Ecuador also lands among the top 10 in the Cost of Living Index (7th), with 78% of expats rating this aspect of life abroad positively (vs. 48% globally).  

In the Ease of Settling In Index (10th), the country ranks sixth in the Feeling at Home subcategory. The majority of expats (82%) finds it easy to settle down in Ecuador (vs. 62% globally), 80% feel at home in the local culture (vs. 63% globally), and 68% find it easy to make new friends in general (vs. 48% globally).  

Ecuador shows a slightly weaker performance in the Quality of Life Index (24th). Still, nearly all expats (96%) rate the country’s natural environment positively (vs. 84% globally), and 85% are satisfied with their socializing and leisure activities (vs. 67% globally). “The nature and scenery are great,” shares a Venezuelan expat. However, in the Digital Life subcategory (45th), Ecuador comes last worldwide (59th) for cashless payment options, with 37% rating this factor negatively (vs. 9% globally).  

9. Canada 

Making it into the top 10 out of 59 destinations, Canada (9th overall) performs well in most indices of the Expat Insider 2021 survey. The country ranks best in the Quality of Life Index (5th), with the majority of expats finding it easy to get high speed internet at home (92% vs. 79% globally) and to pay without cash (96% vs. 83% globally). Additionally, 86% are happy with the availability of government services online, compared to 63% globally. Most expats are also satisfied with the affordability of healthcare in Canada (85% vs. 61% globally) and the country’s political stability (90% vs. 64% globally). “Healthcare is a basic right, and the quality of life is very good in Canada,” says a US American expat.  

Canada also performs well in the Working Abroad and Ease of Settling In Indices (12th for both). It even lands in the top 10 of the Feeling at Home subcategory (7th), with 73% of survey respondents feeling at home in the local culture (vs. 63% globally). In terms of work, close to two out of three expats (64%) rate the career opportunities positively (vs. 45% globally).  

On the other hand, Canada ends up among the bottom 10 of the Personal Finance Index (50th). Nearly a third of expats (32%) say their disposable income is not enough to cover all their living expenses (vs. 23% globally). An expat from Mexico shares that “the best cities are really expensive. It is hard to become a homeowner with an average income.”  

10. Vietnam  

Coming in 10th place out of 59 countries in the Expat Insider 2021 survey, Vietnam ranks first in both the Personal Finance and Cost of Living Indices. The majority of expats (85%) rates the cost of living positively (vs. 48% globally), and 78% are satisfied with their financial situation (vs. 64% globally).  

Vietnam also does well in the Working Abroad Index (9th), with the vast majority of expats (86%) expressing overall job satisfaction (vs. 68% globally). Placing 25th in the Ease of Settling In Index, Vietnam does especially well in the Finding Friends subcategory (9th). According to 63% of expats, making local friends is easy (vs. 44% globally), and another 67% find it easy to make new friends in general (vs. 48% globally). What is more, the majority (81%) considers the local residents generally friendly (vs. 69% globally).  

Despite its great performance in the overall ranking, Vietnam ends up among the bottom 10 in the Quality of Life Index (53rd). More than three in five expats (63%) rate the air quality in Vietnam negatively (vs. 20% globally), and 42% are unhappy with the water and sanitation infrastructure (vs. 12% globally). A Swiss expat shares: “Plastic pollution is a major problem, especially along the coast.” However, 85% of expats in Vietnam are still generally happy with their life (vs. 75% globally).  

The Worst Destinations for Living and Working in 2021 

59. Kuwait 

For the seventh time in eight years, Kuwait (59th out of 59 countries) comes in last place in the Expat Insider 2021 survey. The country ranks last in the Quality of Life Index (59th), with especially poor results in the Leisure Options, Personal Happiness, and Travel & Transportation subcategories (59th for all). In fact, 58% of expats in Kuwait are unhappy with the local leisure options (vs. 14% globally), and 50% rate the climate and weather negatively (vs. 17% globally). Additionally, 29% state that they are generally unhappy (vs. 10% globally).  

Kuwait comes last in the Ease of Settling In Index (59th), with 46% of expats not feeling at home in the local culture (vs. 20% globally) and 45% finding it difficult to settle down in this country (vs. 22% globally). Moreover, 51% have trouble finding new friends (vs. 32% globally), and 62% find it difficult to make local friends in particular (vs. 36% globally). The country ranks last for friendliness (59th) as well: 36% of expats rate the general friendliness of the population negatively (vs. 16% globally), while another 44% describe the people as unfriendly towards foreign residents (vs. 18% globally).  

Placing 56th in the Working Abroad Index, Kuwait performs poorly in both the Work & Leisure (58th) and the Career Prospects & Satisfaction (57th) subcategories. More than three in ten respondents (31%) are dissatisfied with their job in general (vs. 16% globally), and 34% are unhappy with their work-life balance (vs. 17% globally).  

58. Italy 

Coming in 58th place in the Expat Insider 2021 survey, Italy is the second-worst country for expats — ranking only ahead of Kuwait (59th). In the Personal Finance Index (59th), the Southern European country even lands in last place worldwide: 30% of expats are dissatisfied with their financial situation (vs. 19% globally), 14% even very much so, twice the share of the global average (7%). Furthermore, one in three expats (33%) says their disposable household income is not enough to cover their expenses (vs. 23% globally).  

Italy also performs poorly in the Working Abroad Index (58th), only ahead of Turkey (59th), coming last in the Career Prospects & Satisfaction subcategory (59th). More than half the expats (56%) rate their local career opportunities negatively (vs. 33% globally), and 31% are dissatisfied with their job (vs. 16% globally). An Iranian expat shares: “Finding a job is not easy for foreigners, not even for the well-educated ones.”  

Within the Quality of Life Index (42nd), Italy ranks worst in the Digital Life subcategory (51st): 23% of expats find it difficult to get high-speed internet access at home (vs. 12% globally), 18% consider it difficult to pay without cash (vs. 9% globally), and 40% are unhappy with the availability of government services online (vs. 21% globally). Overall, there are only few upsides about expat life in Italy, such as the climate and weather (71% happy vs. 66% globally) and the travel opportunities (88% happy vs. 84% globally). 

57. South Africa 

Coming in 57th place out of 59 destinations in the Expat Insider 2021 survey, South Africa ends up in the bottom 3 — only ahead of Italy (58th) and Kuwait (59th). It performs worst in the Personal Finance Index (55th): over one-third of expats in South Africa (34%) do not consider their disposable household income enough to cover all their expenses (vs. 24% globally), and just 57% of expats in South Africa are satisfied with their financial situation (vs. 64% globally).  

South Africa also ends up among the bottom 10 of the Working Abroad Index (54th), coming last worldwide in the Economy & Job Security subcategory (59th). Only 47% of expats are satisfied with their job security (vs. 61% globally), and less than a third (31%) are happy with the state of the local economy — exactly half the global average (62%).  

Ranking among the bottom 10 in the Quality of Life Index (52nd), South Africa ranks last worldwide in the Safety & Security subcategory (59th). More than one-third of expats (34%) do not consider South Africa a peaceful country (vs. 9% globally) and just about one in four (24%) feel safe there (vs. 84% globally). An Ethiopian expat even says: “You are not able to walk around safely.” However, South Africa does well in the Leisure Options subcategory (15th), with 87% of expats rating the climate and weather favorably (vs. 66% globally). The majority (95%) is also satisfied with the natural environment (vs. 84% globally). “I like the climate, the diverse coastlines, and South Africa’s natural beauty,” summarizes a German expat. 

56. Russia 

Out of 59 countries in the Expat Insider 2021 survey, Russia (56th) lands in the bottom 10. It performs worst in the Working Abroad Index (52nd): Close to one in four expats (24% each) rate the state of the local economy negatively (vs. 19% globally) and are unhappy with their job security (vs. 20% globally).  

Narrowly escaping the bottom 10 in the Quality of Life Index (49th), Russia performs especially poorly in the Quality of the Environment subcategory (49th). Expats are unhappy with the air quality (31% vs. 20% globally), the water and sanitation infrastructure (21% vs. 12% globally), and the natural environment (14% vs. 8% globally). “I do not like the lack of any meaningful efforts or policies to reduce environmental pollution and to support basic recycling,” shares a US American expat.  

With Russia coming in 48th place in the Ease of Settling In Index, 29% of respondents find it difficult to settle down in this country (vs. 22% globally). What is more, Russia ends up in the bottom 10 of the Language subcategory (58th), only ahead of Japan (59th). Nearly half the expats (48%) find it difficult to live in Russia’s cities without speaking the local language (vs. 29% globally), and two-thirds (67%) find it difficult to learn Russian (vs. 42% globally). Russia receives its best result in the Cost of Living Index (25th): 49% of expats rate the cost of living positively, which is, however, still just one percentage point above the global average (48%). 

55. Egypt  

Egypt (55th out of 59) also ranks the bottom 10 of the Expat Insider 2021 survey. The country performs worst in the Quality of Life Index (57th), where only India (58th) and Kuwait (59th) do worse. In fact, 39% of expats in Egypt rate the water and sanitation infrastructure negatively (vs. 12% globally), and 48% give the air quality a negative rating (vs. 20% globally). “The air quality is bad, and there are only few green spaces,” shares an Afghan expat. Landing at the very bottom, Egypt performs even worse in the Digital Life subcategory (59th). Exactly three in five expats (60%) rate the availability of government services online negatively (vs. 21% globally), 34% find it difficult to get high-speed internet access at home (vs. 12% globally), and 32% consider it hard to pay without cash (% vs. 9% globally).  

Also ending up among the bottom 10 of the Working Abroad Index (53rd), Egypt receives extremely poor results in the Career Prospects & Satisfaction (55th) and Economy & Job Security (53rd) subcategories. A quarter of expats (25%) are dissatisfied with their job in general (vs. 16% globally), and 46% rate the local career opportunities negatively (vs. 33% globally).  

The country performs better in the Cost of Living (19th) and Ease of Settling In (30th) Indices: 61% of expats rate the cost of living positively (vs. 48% globally) and 57% find it easy to make local friends (vs. 44% globally).  

54. Japan 

Japan ranks 54th out of 59 countries featured in the Expat Insider 2021 survey. Performing particularly poorly in the Ease of Settling In Index (58th), Japan only ranks better than Kuwait (59th). Just 36% of expats find it easy to settle down in Japan (vs. 62% globally), and a mere 45% feel at home in the local culture (vs. 63% globally).  

In the Working Abroad Index (50th), 30% of expats are unhappy with their work-life balance (vs. 17% globally). A US American expat living in Hashimoto even says that “the work-life balance here is atrocious”. Japan also receives poor results in the Personal Finance Index (54th), with 26% of expats dissatisfied with their financial situation (vs. 19% globally).  

On the upside, Japan has an above-average performance in the Quality of Life Index (21st). With the country coming 12th for the quality of the environment, 94% of expats rank the water and sanitation infrastructure positively, compared to 77% globally. Additionally, nearly all expats rate Japan positively for personal safety (97% vs. 84% globally) and peacefulness (95% vs. 80% globally). A Brazilian expat shares: “In Japan, there is a low crime rate throughout the country. It is very safe to walk on the streets at any time.” And a South African expat says: “Japan offers a safe environment, and most things are done properly with respect for others in mind.”  

53. Cyprus 

Cyprus lands in the bottom 10 overall, coming 53rd out of 59 destinations in the Expat Insider 2021 survey. It places 57th in the Working Abroad Index — just ahead of Turkey (59th) and Italy (58th). Close to half the expats (49%) are dissatisfied with the local career opportunities (vs. 33% globally), and more than a third (34%) rate the job security negatively (vs. 20% globally). A Nepalese expat shares: “It is difficult to find work, so I cannot afford college or my living expenses.” In fact, Cyprus also places in the bottom 10 of the Personal Finance Index (57th) and comes last for the disposable household income (59th). Close to two in five expats (39%) say their disposable household income is not enough to cover their expenses abroad (vs. 23% globally).  

Cyprus performs best in the Ease of Settling In Index (28th), with 66% feeling at home in the local culture (vs. 63% globally) and 70% describing the local population as generally friendly towards foreign residents (vs. 67% globally). Furthermore, 80% of expats find it easy to get around without knowing the local language(s) (vs. 54% globally).  

With Cyprus placing 34th in the Quality of Life Index, the majority of expats (89%) is happy with the local climate and weather (vs. 66% globally) — ranking the destination 5th worldwide for this factor. However, while 70% of respondents are happy with the air quality in Cyprus (vs. 66% globally), 14% rate the water and sanitation negatively (vs. 12% globally).  

52. Turkey 

Overall, Turkey (52nd out of 59) lands among the bottom 10 destinations in the Expat Insider 2021 survey. Ranking last worldwide in the Working Abroad Index (59th), Turkey ends up in the bottom 10 for every single subcategory: Career Prospects & Satisfaction (56th), Economy & Job Security (58th), and Work & Leisure (59th). In fact, expats in Turkey are dissatisfied with their working hours (32% vs. 16% globally), their job in general (29% vs. 16% globally), and their job security (30% vs. 20% globally). A British expat shares that “for expats, it is extremely difficult to get a work permit”.  

Turkey places 32nd in the Ease of Settling In Index, with more than half the expats (53%) finding it easy to make local friends (vs. 44% globally). Most expats consider the local residents to be friendly towards foreign ones (72% vs. 67% globally), and they are happy with the general friendliness of the population too (72% vs. 69% globally). “There is a general warmth and hospitality among the people around me,” shares a Russian expat.  

Coming in 35th place in the Quality of Life Index, Turkey ranks among the bottom 10 in the Digital Life subcategory (50th), though: 16% of expats find it difficult to get a local mobile phone number (vs. 7% globally), and 21% have trouble getting high-speed internet at home (vs. 12% globally). The country also lands in the bottom 10 for political stability (54th), with more than a third of expats (35%) rating this factor negatively (vs. 16% globally).  

51. India 

Coming in 51st place out of 59 countries, India also ranks among the bottom 10 of the Expat Insider 2021 survey. Despite the poor result overall, the country ranks fourth worldwide in the Personal Finance Index: 82% of expats in India are satisfied with their financial situation (vs. 64% globally), and 89% say their disposable household income is enough or more than enough to cover their expenses (vs. 77% globally). Additionally, India places 13th in the Cost of Living Index (69% positive ratings vs. 48% globally).  

India performs slightly below average in the Ease of Settling In Index (34th). More than three in five expats (62%) feel at home in the local culture (vs. 63% globally), and 79% say the local population is generally friendly towards foreign residents (vs. 67% globally). However, over half the expats (51%) find it difficult to settle down in India, compared to 22% globally.  

India receives the second-worst results worldwide in the Quality of Life Index (58th) — only ahead of Kuwait (59th) — and performs worst in the Quality of Environment subcategory (59th): 67% of expats rate the air quality negatively (vs. 20% globally), and more than half (54%) are unhappy with the water and sanitation infrastructure (vs. 12% globally). The overall quality of life is also lowered by India’s poor performance in the Safety & Security subcategory (56th). Just 29% are satisfied with the country’s political stability (vs. 64% globally) and just 72% feel safe in India’s cities (vs. 84% globally). 

50. Malta 

Malta comes in 50th place out of 59 countries in the Expat Insider 2021 survey, performing worst in the Quality of Life Index (54th). It ends up among the bottom 10 in the Quality of the Environment and Travel & Transportation subcategories (56th for both). More than half the expats in Malta (51%) are unhappy with the transportation infrastructure (vs. 15% globally), and 11% rate their travel opportunities negatively (vs. 7% globally). “There is no nature at all, no green spaces, poor infrastructure for children, and too much traffic and pollution,” shares an Italian expat. In fact, 38% of expats in Malta are unhappy with the natural environment (vs. 8% globally). Moreover, 35% rate the air quality negatively (vs. 20% globally), and 25% are dissatisfied with the water and sanitation infrastructure (vs. 12% globally). On the upside, Malta ranks 7th worldwide for its local climate and weather (92% positive ratings vs. 66% globally).  

Malta receives below-average results in the Cost of Living and Ease of Settling In Indices (35th for both). In fact, 20% of expats rate the friendliness of the local population towards foreign residents negatively (vs. 18% globally). Additionally, 37% of expats find it difficult to make local friends in Malta (vs. 36% globally).  

Expat Life during the COVID-19 Pandemic 

On a global scale, 45% of survey respondents say that COVID-19 had an impact on their current stay abroad or their relocation plans: the share of expats who say so (37%) either decided to not move back home in the near future (18%), planned to move to another country but had to change these plans (8%), will move to another country due to the pandemic (6%), or will move back home sooner than originally planned (5%).  

The share of local respondents whose relocation plans were affected by COVID-19 (61%) is a lot higher: some of them were living abroad but moved home sooner than planned (18%), others were planning to move abroad but had to change their plans (35%), and about one in ten have now decided to move abroad because of the pandemic (9%).  

The Pandemic’s Impact on Everyday Life 

Of course, COVID-19 has not only disrupted the relocation plans of expats worldwide. When asked where they see the biggest impact of the pandemic on their personal life right now, the survey respondents point out its effects on personal travel (25%), social life (23%), and their work or business (16%) in particular. In the long run, respondents are still concerned about the impact of COVID-19 on their social life (17% of all respondents), and there are also considerable worries regarding personal travel (22%).   

How Expats Stay Informed on COVID-19 

Expats across the world mostly rely on official government channels (48%), local news (47%), and social media (40%) for news on the COVID-19 situation and the related regulations in their country of residence. Considering the importance of government channels, just how satisfied are expats with the official communication regarding COVID-19 and related regulations? Worldwide, not quite two-thirds (66%) rate this factor positively, with close to a quarter (24%) saying they are completely satisfied. The main complaint among expats who are not satisfied with the official communication on the pandemic is that the information is unclear, confusing, and/or contradictory (67%).  

For further information on the global impact of COVID-19 on expat life, please take a look at the full press release in the download center of our e-mail.  

About the InterNations Expat Insider 2021 Survey  

For its annual Expat Insider survey, InterNations asked 12,420 expats representing 174 nationalities and living in 59 countries or territories to provide information on various aspects of expat life, as well as their gender, age, and nationality. Participants were asked to rate up to 37 different aspects of life abroad on a scale of one to seven. The rating process emphasized the respondents’ personal satisfaction with these aspects, considering both emotional topics and more factual aspects with equal weight. The respondents’ ratings of the individual factors were then bundled in various combinations for a total of 13 subcategories, and their mean values were used to draw up five topical indices: Quality of Life, Ease of Settling In, Working Abroad, Personal Finance, and Cost of Living. The first four of these indices were further averaged together with expats' general satisfaction with their life in order to rank 59 expat destinations around the world. In 2021, the top 10 are Taiwan, Mexico, Costa Rica, Malaysia, Portugal, New Zealand, Australia, Ecuador, Canada, and Vietnam. Moreover, expats were asked about how COVID-19 has impacted their life abroad; however, these responses did not influence the overall ranking.  

For a country to be featured in the indices and consequently in the overall ranking, a sample size of at least 50 survey participants per destination was necessary. 


Aetna International Appoints Martyn Swann As New SME Sales Director

Martyn Swann has been appointed Sales Director for SME UK and Europe at Aetna International.

He will be responsible for driving growth and retention in the SME sector as Aetna International continues to expand into new markets.

Martyn joined Aetna International in 2018 and brings 20 years of experience across a range of roles within the UK and international health care markets to his new role. He successfully managed the migration of the Aviva International portfolio when they exited the IPMI market, and has been instrumental in driving product and proposition development into new territories.

Martyn reports to Damian Lenihan, Executive Director Operations and Distribution Europe, who comments, “Martyn has been an integral part of the team over the past two years and I’m delighted to welcome him to his new role. With so many innovative plans in motion, Martyn’s proven track record, experience and skills are just what we need to drive forward our SME proposition in Europe. His appointment cements the strength of our sales leadership support, and positions us well for continued growth in our markets.”

Martyn will head up an expanded SME team, and start his new role with immediate effect. He is currently reconnecting with key contacts and intermediaries in the iPMI market so, to find out more about his proposed SME growth strategy, please connect with him directly via LinkedIn



Allianz Care Reports Up To 235% Year-On-Year Increase In Applications For International Health Insurance Policies

Allianz Care reports up to 235% year-on-year increase in applications for international health insurance policies, and significant increases in demand for health and wellbeing advice and digital services-

Allianz Care has reported a significant increase in demand for international health insurance services since the beginning of the COVID-19 pandemic, with year-on-year sales of private individual/family policies up 235% in Germany, 100% in Singapore and 65% in the UAE. Allianz Care is the international health brand of Allianz Partners.

Some of the key uplifts in demand for health and wellbeing advice and digital health services include:

  • 48% increase in web traffic to in March, with a further increase of 83% in April, with visitors keen to keep up to date with the latest information on the pandemic.
  • 6,000 subscriptions to the Allianz Care channel on the BrightTALK platform, which has been used to broadcast webinars on COVID-19. This is up from an average of 380 subscribers before the pandemic. Almost 3,000 insured members attended one webinar alone with Dr. Ulrike Sucher, the company’s Chief Medical Officer for International Health, in which she outlined recommendations on steps they could take to protect themselves.
  • Significant increase in demand for Allianz Care’s Employee Assistance Programme (EAP), with users looking for further information on financial advice, as well as seeking counselling services and advice on stress management.
  • 257% increase in calls made to Allianz Care’s 24/7 medical advice line. The medical advice line is staffed by an experienced medical team that can address queries in real-time, including general medical advice and information regarding self-care. To provide further support, a COVID-19 digital symptom checker was added to the service, which has already been used by more than 46,000 customers to date.
  • Year-on-year increase in sales of individual policies across almost all markets, most notably 235% in Germany, 100% in Singapore, 65% in the UAE, 62% in Italy, 57% in France and 48% in Spain.

Allianz Care has provided ongoing support to members throughout the COVID-19 emergency, confirming that customers contracting the virus are covered by their healthcare policies. It has also made temporary changes to its cover such as extending the period of cover for emergency medical treatment for those trapped outside their normal region of cover, from 6 weeks to 21 weeks.

Speaking about the surge in demand for support services and the action being taken to address it, Paula Covey, Chief Marketing Officer for International Health said: “The global emergency being experienced as a result of the COVID-19 pandemic is unprecedented in its impact on people and businesses. People are understandably worried, not only about their own health, but also about that of their families and loved ones. As well as the general uncertainty, there’s also increased concern stemming from the emotional and financial impact. It wasn’t a surprise that there’d be an increase in demand for support services and advice – whether through our EAP, 24/7 helpline, webinars or the website. However the scale of the demand did take us somewhat by surprise. We were particularly pleased with the strong levels of participation and engagement in the webinars.

 “The reaction to our COVID-19 digital symptom tracker also demonstrated just how much people want to address concerns from the safety of their own home, while some hospitals and clinical settings are either experiencing overcrowding or trying to mitigate it. While our medical advice line gives customers access to more than 120 health professional who can support them regardless of their location.

 “In response to the situations our customers are finding themselves in, through no fault of their own, we’ve temporarily changed some of the terms of our policies. We want to support people who are stuck outside their normal region of cover due to global travel restrictions. So our cover for medical emergencies outside the normal region of cover has been temporarily extended from 6 weeks to 21 weeks. When we say we care about our customers, emergency situations like this are where we really get a chance to prove that. It’s not an empty promise. We have to be there for our customers and from a business continuity point of view, we were already set-up for staff to work from home. So this has been a seamless transition and it’s very much business as usual.”

For more information about Allianz Care, visit: and for the latest news about COVID-19, go to:


Integra Global Launches New IPMI Inpatient Plan Range – InCare

Integra Global, a leading provider of international health insurance, today launches two new health plans to the IPMI market. 

The new plans are available for individuals and groups.
The InCare plan range has been designed specifically for the needs of both individuals and companies wanting a health plan with rich inpatient benefits, useful services for global mobility, and market-leading value. 
InCare plans include comprehensive hospitalisation and rehabilitation benefits, along with 24/7 emergency medical assistance, life cover and mental health benefits. The InCare Premier plan offers a higher overall policy limit, private room cover and increased limits for Accidental Death and Dismemberment. 
In addition, InCare plans include a number of helpful expat services, including a Life Aware Programme for daily life challenges, 24/7 emergency medical assistance and evacuation, and access to a mobile app and claims portal. InCare policies, like all Integra Global health plans, do not exclude natural disasters or pandemics, such as coronavirus (COVID-19).
InCare policies are underwritten by MGEN; part of the largest mutual health group in France VYV Group, which has a turnover of €9 billion, 35,500 employees and an AM BEST Financial Strength Rating of A (excellent). Medical Administrators International (MAI) is the global claims administrator for InCare health plans and will manage all pre-authorisations, direct billing and claims management services.
Integra Global has been successfully partnered with MGEN and MAI since the launch of their comprehensive Worldwide health plans in 2018. MAI and Integra Global have together consistently achieved claims processing times within 5-7 working days over the last two years, offering first-class customer service to members.  
Integra Global's emergency medical and security assistance provider, Northcott Global Solutions (NGS), will serve InCare plan members across the globe, managing all medical emergencies, evacuations and issues of civil unrest or natural disaster. 
Philip Catterton, Managing Director at Integra Global Group, commented, "Inpatient treatment is by far the most expensive aspect of healthcare, but also the most important. It's essential that anyone living abroad, or any company employing overseas staff, has a health plan that safeguards them in the event of an emergency or serious illness. 
"Our InCare plan range is perfect for individuals who want protection against high-cost inpatient care or expensive treatment, but don't want to pay for a comprehensive health plan.
"We've also seen a growing demand among price-conscious companies for a plan that will protect their staff to a high standard, without paying for benefits that are outside their requirements or budget. 
"Our InCare plans are here for anyone wanting high-quality inpatient cover, fantastic services, and exceptional customer support."

Pacific Prime Dubai Receives Cigna’s Individual Broker Of The Year 2019 Award


Pacific Prime has been awarded Individual Broker of the Year 2019. They received the award at the Cigna Partner Seminar (Middle East and North Africa [MENA] region), which took place on December 14th, 2019 in Cape Town, South Africa.

Richard Rilesone (Cigna’s Director of Sales and Client Management for the MENA region) and Jerome Droesch (CEO of Cigna for the MENA region) presented the award to representatives from Pacific Prime Dubai at the seminar.

CEO Jerome Droesch said, “I would like to extend my congratulations to Pacific Prime for winning the IPMI Broker of the Year award. This award recognizes their unique contributions and dedication which have helped us build our IPMI offering and broaden our services to our customers.”

RELATED: iPMI Magazine Speaks With Jerome Droesch, CEO, Cigna, MENA

“Pacific Prime’s approach with clientele in the SME and individual health insurance space has set them apart this year and we look forward to continuing our relationship to deliver excellence and meet our customers’ needs.”

Nageen Sattar, Director, Regional Client Services at Pacific Prime Dubai, was one of the recipients who received the award on behalf of Pacific Prime. “It’s rewarding to see the results of working closely with Cigna regarding their individual product in such a short time span. We have advised, and worked with, Cigna on their DHA plan since their initial launch in late 2017.”

“In 2018, we sat with Cigna numerous times to design a new plan that would be competitive in the marketplace, resulting in a complete redesign of their UAE product followed by a relaunch in February this year. We have now increased the policy count by 70%, and are getting close to USD $1 million in premium with them this year. We look forward to continuing to work closely with Cigna and achieving mutually beneficial results.”

Pacific Prime is a global health insurance broker that provides health insurance coverage to over half a million people in more than 130 countries. Along with health insurance, Pacific Prime also provides comprehensive company insurance and employee benefits solutions, with over 4,000 corporate clients around the world.

As a global health service company, Cigna offers a variety of personalized insurance solutions including health, dental, pharmacy, and supplemental. Cigna has over 165 million customers in over 30 countries, making it possible for them to make use of their insights to improve healthcare results.


Globality Health Withdraws From UK IPMI Market

In light of the compliance challenges created by Brexit, Globality Health is withdrawing from the UK IPMI market. Customers are offered a continuation option with Bupa Global.

Globality Health shall continue business as usual in other key markets such as Germany, Spain and others, which are completely unaffected by this decision.

Globality Health confirms key dates and collaborates with Bupa Global to help honour all customers

From 11 January 2020, Globality Health will no longer quote for any new business or renewal terms with start dates from 1 May 2020 onwards.

All existing policyholders will remain fully protected until the policy’s renewal date - should an illness or injury happen while they are living or working overseas.

Globality Health and Bupa Global have achieved a mutual agreement that allows Globality’s customers to continue their international health plan with Bupa Global. At renewal time, Bupa Global will offer each Globality customer a new quote on favorable and comparable terms.

Globality’s gradual withdrawal from the UK will therefore take until the middle of 2021 to complete.

Why Globality Health is withdrawing from the UK market

Globality is withdrawing from the UK market due to the changes and challenges caused by Brexit. The move shall allow Globality more focus on other markets where it can continue to achieve scale and profitability.

Globality shall continue business as usual in other key markets such as Germany, Spain and others, which are completely unaffected by this decision.

How Bupa Global will deliver continuation cover

Bupa Global’s brand, scale, expertise and strong service model convinced Globality that customers would be in great hands. Dr. Cornelia Roeskau, Globality Health, CCO commented, “After very careful consideration, we have taken the difficult decision to withdraw from the IPMI market in the UK after Brexit. With Bupa Global we have found a partner who shares our values of customer focus and high-end client services. We are happy to be in a position to offer continuity to our valued customers and to know they are in the care-taking hands of this strong and reliable partner.”

At renewal time, each customer will receive a personalized communication including the option to contact Bupa Global. In this context, customers who accept Bupa Global’s terms will do so on a non-advised basis, with Globality acting as an introducer. Customers choosing to accept their policies with Bupa Global will become Bupa Global customers and will no longer have a relationship with Globality.

Teresa Wighton, Bupa Global, UK Group Sales Director, commented, “We are working with Globality following their decision to withdraw from the UK market and look forward to welcoming their customers to Bupa Global. We are offering Globality customers a comparable product so they can continue to be covered for international private medical insurance and get access to leading healthcare, when they need it. We will ensure there is a smooth transfer and fast-track registration to Bupa Global.”  

Globality Health are confident that the customer communications programme they have in place shall help make this a smooth transition process.  Both Globality Health and Bupa Global customer and broker service teams will also be available to further smooth the transition.


APRIL International Care UK Appoints New Business Development Manager

APRIL International Care, a leading international private medical insurance provider to the individual, student, SME and corporate markets, has announced the appointment of Amanda Barrett as business development manager to be based in their London office.

With over 15 years’ experience in the private medical insurance industry, Amanda previously worked at Towergate Employee Benefits and Aviva where she had responsibility for developing and driving the success of international sales and leading the company’s move into the IPMI market.

Commenting on her appointment, managing director of APRIL International Care UK, Joe Thomas said, “Amanda has a proven track record of delivering new sales and positive working relationships with brokers in our core IPMI market. She is an important hire for APRIL International Care, as we move to build upon our growing share of the IPMI market.

APRIL International Care offers brokers and clients a global platform combining expertise and proximity through a network of worldwide offices. Feedback from brokers tells us that this combination of a service and knowledge led approach is popular in the market and it is certainly contributing towards our drive to deliver high quality international private medical care to a worldwide clientele.”

Amanda adds, “APRIL International Care is well advanced in terms of delivering against its clear growth strategy. I am looking forward to continuing the success that the team has delivered by identifying new IPMI intermediaries and accounts for development.”

APRIL International Care offers a range of standout international private medical insurance plans delivered by 280 staff members, across 12 countries worldwide.

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Medical, Healthcare, Expatriate And Travel Insurance

A guide to leading international medical, healthcare, expatriate and travel insurance underwriters, companies, providers, operating within leisure, expatriate and corporate travel business markets, globally.