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iPMI Magazine

International Private Medical Insurance Magazine (iPMIM) is the ultimate Health and Medical Insurance Digital Media serving expatriate, corporate, health and travel insurance markets. Due to the nomadic nature of the international healthcare industry iPMI Magazine is an internet based news service, for worldwide healthcare professionals, who need to understand the impacts of healthcare and insurance policy, regulatory, and legislative developments. Combined with in depth health insurance industry analysis, best-in-class health insurance industry data, and exclusive, C-Suite Executive health insurance interviews and round tables, iPMI Magazine bridges an information gap between healthcare payor, provider and patient. Written by the health and medical insurance industry, for the health and medical insurance industry, iPMIM is supported and designed by leading international medical insurance companies and service providers.

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FAI Air Ambulance Update #2: Wuhan Coronavirus (2019-nCoV)

FAI Air Ambulance has been closely monitoring the evolution of the novel coronavirus outbreak since we provided our first summary of the situation.

Here is our 2nd update on the now officially named Wuhan Coronavirus (2019-nCoV) together with our latest position on assisting you in the repatriation of your clients out of China. As anticipated, case volumes throughout China continue to grow, as well as the number of cases and their distribution within other countries around the world. Clinical evidence and epidemiological information regarding the behaviour of the virus is accumulating rapidly, and is being circulated widely both through global official channels, and through the media.

From our perspective as an air ambulance operator, the most important findings of the last days are:

  • There is clear evidence now that human to human transmission is readily occurring;
  • Infected persons in their incubation period of 3-5 days can transmit the virus to others, even in the absence of fever or without respiratory symptoms;
  • Virus transmission does not require very close or intimate contact;
  • The contagious nature of the virus is expected to change, depending on the rate of viral mutation, based on evidence from previous novel coronavirus outbreaks;
  • Likewise the severity of infection, and case fatality rates, will remain difficult to predict, and subject to change from what is currently being observed.

FAI Operational Position Statement #2

1. Confirmed cases of Wuhan Coronavirus (2019-nCoV)

Based on the current situation FAI will for the time being adhere to our previous position, and will currently not consider transporting patients with confirmed “2019-nCoV“ infection.

  • This position will be reviewed after a definitive response has been received from a submission FAI has made to the German Federal Ministry of Health;
  • FAI is mobilising our PMIU capability meanwhile and a further update will follow in the coming days.

2. Case contacts

Contact-only cases will be reviewed on a case-by-case basis, under the following circumstances, which will define our ability to perform any such mission:

  • Health authorities of all involved countries do not decline the transport;
  • The receiving hospital is fully informed and willing to accept the patient;
  • The involved ground ambulance services are briefed accordingly and accept the patient;
  • FAI flight crew and medical crew retain their personal right to decline the mission;
  • The patient has a negative 2019-nCoV test by a methodology recognised by the WHO/CDC.

Please note: Such patients will require to be transported via a PMIU, depending on our case risk assessment. This will be discussed closely between FAI Medical Director/s and the Client.

3. Patients with conditions unrelated to Wuhan Coronavirus (2019-nCoV)

Air ambulance transports for patients with unrelated diagnoses, from locations where the outbreak is established, will similarly be reviewed on a case-by-case basis, subject to the following considerations, which will define our ability to perform any such mission:

  • 2019-nCoV case load of the patient’s hospital at the location concerned;
  • The patient has a negative 2019-nCoV test by a methodology recognised by the WHO/CDC;
  • The patient does not meet the criteria to be regarded as a de-facto Contact case as above.

Please note: Such patients will require to be transported via a PMIU, depending on our case risk assessment. This will be discussed closely between FAI Medical Director/s and the Client.

4. General Principles

In ALL accepted cases, FAI will apply strict hygiene measures, including, but not limited to:

  • FAI Medical Crew will wear FFP3/N95 masks, disposable protective gowns and gloves at all times;
  • Flight Crew will do so only when assisting in patient loading / unloading or other close contact;
  • Patients will wear surgical face mask or FFP3 mask subject to individual case by case decision;
  • Strict adherence to hand hygiene;
  • For intubated/ventilated patients: closed suctioning system; double filters at the ET/trach tube, and at the ventilator; very restrictive use of aerosol / droplet generating procedures;
  • No relatives or other non-medical escorts allowed on board (exception: parents of small children subject to individual case by case decision);
  • Meticulous attention to medical waste management sealed in biohazard – proof plastic bags;
  • Meticulous aircraft post-mission disinfection according to FAI advanced hygiene plan.

5. Limitations

Please note the following limitations:

  • FAI reserves the right to modify all items listed above on a case by case base, including the possibility that individual cases might be declined;
  • All cases will be discussed closely between FAI Medical Director/s and the Client, and close liaison will be maintained throughout the progress of any case;
  • The viability of all missions is subject to many factors still evolving, and beyond the control of FAI: Port Health restrictions, overflight permissions and clearances, screening and quarantine regulations specific to individual locations;
  • It should be assumed that obtaining many of these clearances and permits will be subject to unusual delays, outside of normal flight operations per location;
  • Such delays may affect the patients’ overall Fitness to Fly if their condition has changed in the interim. This could lead to delayed or cancelled missions, in extreme cases.

Director-General Of World Health Organization Meets President Of The People’s Republic Of China To Discuss The Battle Against Coronavirus

The Director-General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, has met President Xi Jinping of the People’s Republic of China in Beijing. They shared the latest information on the novel coronavirus 2019 (2019-nCoV) outbreak and reiterated their commitment to bring it under control.

Dr Tedros was joined by WHO Regional Director Dr Takeshi Kasai and Executive Director of the WHO Health Emergencies Programme Dr Mike Ryan, and also met State Councilor and Minister of Foreign Affairs Wang Yi and Minister of Health Ma Xiaowei.

The National Health Commission presented China’s strong public health capacities and resources to respond and manage respiratory disease outbreaks. The discussions focused on continued collaboration on containment measures in Wuhan, public health measures in other cities and provinces, conducting further studies on the severity and transmissibility of the virus, continuing to share data, and for China to share biological material with WHO. These measures will advance scientific understanding of the virus and contribute to the development of medical countermeasures such as vaccines and treatments.

The two sides agreed that WHO will send international experts to visit China as soon as possible to work with Chinese counterparts on increasing understanding of the outbreak to guide global response efforts.

“Stopping the spread of this virus both in China and globally is WHO’s highest priority,” said Dr Tedros. “We appreciate the seriousness with which China is taking this outbreak, especially the commitment from top leadership, and the transparency they have demonstrated, including sharing data and genetic sequence of the virus. WHO is working closely with the government on measures to understand the virus and limit transmission. WHO will keep working side-by-side with China and all other countries to protect health and keep people safe.”

The WHO mission comes as the number of people confirmed with the virus rose to over 4500 globally on 28 January, the greatest number being in China.

The WHO delegation highly appreciated the actions China has implemented in response to the outbreak, its speed in identifying the virus and openness to sharing information with WHO and other countries.

Much remains to be understood about 2019-nCoV. The source of the outbreak and the extent to which it has spread in China are not yet known. While the current understanding of the disease remains limited, most cases reported to date have been milder, with around 20% of those infected experiencing severe illness. Both WHO and China noted that the number of cases being reported, including those outside China, is deeply concerning. Better understanding of the transmissibility and severity of the virus is urgently required to guide other countries on appropriate response measures.

WHO is continually monitoring developments and the Director-General can reconvene the International Health Regulations (2005) Emergency Committee on very short notice as needed. Committee members are on stand-by and are informed regularly of developments. 

Germany's 1st Coronavirus Case Is Human-to-Human Transmission

As Coronavirus becomes increasingly important to manage from a personal perspective, with the first human-to-human transmission of the virus happening in Germany yesterday, businesses should be taking measures to ensure the employees they serve are as protected as they can be.

Simon Worrell, Global Medical Director at Collinson, told iPMI Magazine, “While the first priority must continue to be the protection of people, Chinese businesses are also starting to feel the impact of the spreading Coronavirus. The impact on businesses globally will only worsen as the Coronavirus spreads further into Beijing and around the world, with supply chains and offices at risk. Businesses must be thinking about business continuity plans and ensure that they have Infectious Disease Protocols in place. 

These plans should account for when someone presents ill, where they go and who looks after the process, as well as logistical matters, like cleaning and closing canteens. Businesses can be fundamentally affected by infectious diseases such as this, altering organisational function, culture, and decimating both upstream and downstream processes, which is why preparation is key.”

The Challenges Of Living Abroad With Cancer

Written by Andy Edwards, Global Head of International Health Insurance, AXA – Global Healthcare.

Receiving a cancer diagnosis is always daunting, but when that diagnosis is delivered in a foreign country, it can be particularly frightening and potentially, quite a lonely experience. Without warning, someone with a new cancer diagnosis may have to navigate an unfamiliar healthcare system, arrange treatment – sometimes in a foreign language – and in certain countries, find a way of funding their treatment themselves.

At AXA – Global Healthcare, our experience shows that there’s no one-size-fits-all approach to tackling cancer, and that each patient will face their own set of specific circumstances.

The patients that we help, however, do sometimes share common challenges. For anyone planning a move abroad, I recommend considering the following factors, so that you feel reassured you can access any medical treatment you might need whilst overseas:

Is the right medical expertise available locally?

For expats leaving a country with a good standard of state healthcare, it could be easy to take for granted all of the medical facilities that were readily available. However, the importance of specialist equipment, treatment and medical expertise becomes painfully apparent when you suddenly find that you can’t access them easily in your time of need.

With large countries like China, for example, expats living in more remote locations could be several hundred kilometres away from their nearest hospital or clinic. Likewise, those diagnosed with cancer while living in the Channel Islands often have to travel to the UK mainland in order to receive treatment, because there is no access to radiotherapy on the islands.

I would always recommend researching the local healthcare system before relocating; whether that’s simply pinning down your nearest clinic or more extensive fact-finding on what facilities are nearby. That way, you won’t be taken by surprise if you need to travel for medical attention.

Can I overcome the language barriers?

Learning the local language is an important part of preparing for a move overseas and many expats will learn the basics, giving them enough of a foothold to have conversations with the bank, at the supermarket or in a restaurant. Very few, unless they’re relocating with a pre-existing condition, will learn how to hold a conversation with a local doctor about medical treatment.

Trying to explain symptoms, make sense of treatment options and process complex paperwork can be daunting enough in your native language. Having to do so in a foreign tongue can add an entirely new layer of stress to the process.

In big cities and popular expat destinations, you’re likely to find international hospitals, which may be able to provide doctors who can speak your language or even a translator. When such facilities aren’t available, patients with international health insurance may be able to contact their provider for translation support. For instance, we have a network of hospitals in which we can settle our members’ bills directly, so they don’t have to worry about arranging payment and deciphering hospital paperwork themselves in an unfamiliar language. This can be a huge source of relief at an already stressful time.

Can I cover the cost?

Healthcare systems and treatment costs vary significantly around the world. In many countries, treatment, medication and even doctor’s appointments need to be paid for upfront. And when we’re talking about cancer treatment, these costs can be significant.

Expats who relocate in good health may not have considered how they’d cover the cost of treating an unexpected illness, and as a result, coping financially can be one of the largest sources of stress. In South Korea, for example, most medical practitioners and hospitals don’t accept the concept of an insurer settling the bill directly on behalf of the member, so expats could quickly find themselves burdened with several months’ worth of steep medical bills.

Many expats will set aside money for emergencies, but none will move abroad with any desire to spend their entire nest egg on medical bills. Make sure you’ve considered the cost of seeking medical attention before relocating to a new country and think about taking out an insurance policy. Many offer extensive cover for conditions like cancer and can offer protection from unexpected costs.

How will we manage if my child gets ill?

We often assume that adults are the most likely to develop cancer, but there are, sadly, exceptions to the rule. For a child to be diagnosed and treated for a serious illness can be an upsetting experience for the whole family. However, to receive such a diagnosis abroad, while adapting to a new environment and culture, can put even more strain on the situation.

At such a difficult time, parents need all the support they can get, to be strong for their child and help them through what is bound to be a frightening experience. Whether that’s flexibility at work, understanding from school or a strong network of friends and family, that support could mean the difference between staying abroad or returning home.

All of our members who are diagnosed with cancer receive a dedicated case manager to support them throughout their treatment, and we find that this single point of contact can be a great help to families in situations like this. It means they’ve got one less thing to worry about and they can spend extra time with their child, rather than chasing hospitals, sorting out paperwork and finding information to support their claims. 

How can you prepare for these challenges?

There are so many things to prepare when you’re moving overseas and unless someone has a pre-existing condition, healthcare is rarely a consideration. However, I would advise anyone who is relocating abroad – whether they be in the “nice idea one day” stage or are just weeks away from moving day – to ensure that they have considered what would happen if they were to become ill while overseas. Even if you’ve had no prior reason to expect an illness, research the local healthcare system, understand what support and treatment is locally available, and make sure you’re comfortable with your options.

We could all use a little help from time to time. So, whether you’re moving to a bustling city or somewhere more remote, consider an international private medical insurance plan for extra reassurance.

FAI Air Ambulance Update #1: Medical Flights In Context With A “Novel Coronavirus” Outbreak In Wuhan, China (2019-nCoV)

With an initial alert on 31 December 2019 and several follow-up reports, China has informed the WHO of an outbreak of a new viral respiratory illness originating in the city of Wuhan in Hubei Province.

The infective agent was found to be a new type of Coronavirus, preliminary labeled “2019-nCoV”, and while cases were initially limited to visitors of seafood and livestock markets, isolated cases of human-to human infection have been seen meanwhile and Korea, Japan and Thailand have reported imported cases, which could all be traced back to the Chinese province Hubei.

Based on the current situation with still limited information regarding contagiosity, incubation periods and unknown availability and reliability of laboratory test, FAI will for the time being adhere to the previous CDC-recommendations regarding air-transport of SARS- and MERS patients, and will currently not consider transporting patients with confirmed “2019-nCoV“ infection.

Contact-only cases can be accepted on a case-by-case basis, if the following requirements are met:

  • Health authorities of all involved countries are permitting the transport.
  • The receiving hospital is fully informed and willing to accept the patient.
  • The involved ground ambulance services are briefed accordingly and accept the patient.
  • FAI pilots and medical staff are not making use of their right to decline the mission.

In accepted cases, FAI will apply strict hygiene measures, including, but not limited to:

  • Medical staff to wear FFP3 (=N95) masks, disposable protective gowns and gloves at all times;
  • Pilots only, when assisting in patient loading / unloading or other close contact;
  • Patient to wear surgical face mask (if tolerated also FFP3 mask);
  • Strict adherence to hand hygiene;
  • For intubated / ventilated patients: closed suctioning system, double filters (e.g. PALL), one at the ET tube, the other at the ventilator, very restrictive use of aerosol / droplet generating procedures;
  • No relatives or other non-medical escorts allowed on board (exception: parents of small children subject to individual case by case decision);
  • All waste to be collected and sealed in biohazard – proof plastic bags;
  • After mission is completed: all surfaces in the cabin subject to meticulous disinfection according to hygiene plan, textiles (e.g. seat-covers) to be changed / washed.

FAI Air Ambulance reserves the right to modify the items listed above on a case by case base, which includes, that individual cases might be declined.

Employee Health Inertia A Rising Risk To Businesses As Employees Reveal Lack Of Action Against Long-Term Health Worries

Despite over a third (40%) of workers globally revealing they are worried about their long-term health, 40% admit they haven’t had a health check in the last year and a significant number have no idea about simple measures of health, such as cholesterol levels, according to new research published today. Inflexible and long working hours are compounding the problem, as employees feel unable to take time off to manage their health.

The findings are revealed in the second of two new Business of health 2020 reports, How organisations can overcome employee health inertia, from Aetna International, a leading global health benefits provider, which explores the attitudes to health of 4,000 office workers in USA, UK, UAE and Singapore, focusing on the health fears of today’s workers and probing the gaps in their own health knowledge.

Despite the fact that 96% of those surveyed think about their health at least some of the time, 40% do not go to the doctor to get health issues checked, even if they are concerned, and nearly a quarter (24%) say they are too scared to get a health check.

To compound this, very few know basic indicators of their own health – only 1 in 3 (33%) people know their cholesterol level or body fat percentage (29%). Although, overall, employees in the UAE and Singapore have a better knowledge of health measurements like blood pressure, cholesterol and body mass index (BMI) than those in the US or UK.

Most workers globally acknowledge they could do more to improve their health, with over half (55%) admitting their diet needs improvement and nearly three quarters (72%) saying they need to exercise more. When people do feel ill, however, 40% say they tend to look up symptoms online and self-medicate rather than seeking out a doctor.

Dr Sneh Khemka, President, Population Health & vHealth, Aetna International, said: “While the majority of workers are aware they need to do more to improve their health, fear and worry is causing a huge number to avoid the situation. More should be done to empower people to manage their own health, with a focus on changing company cultures to promote prevention and early intervention. It is not only the responsibility of the employee but that of the employer to ensure people are equipped to lead healthy lives.”

Increasing pressure in the workplace is having a significant impact on how people prioritise their health. Almost half (47%) of those surveyed admit that they often feel stressed because of work but don’t see a health care professional about the issue. Long and inflexible working hours may be to blame, as a third say they don’t have time to be ill at work and nearly a quarter (21%) cite lack of time off from work as the reason behind their health inertia.

Results also indicate that employers could play a bigger role in encouraging people to look after their health, with over a quarter (27%) of office workers admitting they would go to the doctor if their boss told them to. Nearly half (46%) also said the ability to take time off work to go to the doctor would encourage them to make an appointment.

Additionally, better access to online health consultations would encourage nearly a third (31%) to get regular check-ups, while over a third (35%) would like the use of an app or online service.

Dr Khemka continued: “Expanding access to health care is imperative to ensure today’s time poor workers prioritise their health. Technology can undoubtedly play a role here, but businesses also need to ensure they create a culture where people can talk about and take time for their health needs.”


Coronavirus: Are We Overreacting?

Written By Danny Kaine, Head of Assistance at Traveller Assist.

Let’s put this into perspective. In 2019, the Centre for Disease Control reports that 61,200 people died from the common flu virus. That’s 168 deaths per day! Compared to Coronavirus that was first reported on December 31st with 213 deaths in total until January 31st. Based on last years statistics, 5,208 people have died of the common flu in that same time period.

As a qualified Critical Care Paramedic and a graduate of Harvard Medical School’s, Preventing the Next Pandemic program - I was also on the ground in Sierra Leone in 2014 during the outbreak of Ebola and have coordinated several complex medical evacuations for Lassa fever and SARS patients. Over the years, I have also personally contracted West Nile virus, Zika and Malaria due to operating in complex regions, at short notice, for long periods of time.

As the Head of Assistance for a medical assistance company, it is quite literally my job to stay on top of the latest health issues that threaten travellers around the world, and more importantly; how to respond. Traveller Assist has received over 30 separate queries from corporate and insurance clients to ask what they should do.

Wuhan Coronavirus, while highly infectious, is reported to have a low fatality rate, with a mortality rate of only 2%, compared to SARS that had a mortality rate of 9.6%, Lassa at 10-20% and Ebola at 50%.

As employers, educators and insurers, we all have a duty of care to our travellers and want to provide them the best possible advice, to keep them as safe and stress free as possible.

The coronavirus is spread through respiratory vapour, such as when someone sneezes or coughs into the air around you. Influenza viruses and common cold viruses are also spread this way. As with all viruses, practicing basic hygiene is the best thing you can do to protect yourself and the spread to others:

  • Wash your hands with soap or use a hand sanitiser that contains alcohol.

  • Sneeze and cough into tissues or the crook of your elbow.

  • Avoid touching your face with unwashed hands.

  • Avoid close contact with people who are sick, especially people exhibiting respiratory symptoms and fever.

  • Stay home when you're sick to stop of the spread of any virus.

  • Regularly and thoroughly clean surfaces, such as counter tops and door handles, with a disinfectant.

Even though the risk is low right now, it does not mean that the virus will not mutate, and everyone should be armed with the facts. You shouldn't discount or disregard the virus completely just because you don’t live in or travel to China, but don't get overly stressed or anxious about it either. 


Nepali Government In Collusion With Private Clinic And Helicopter Company To Close IPPG Volunteer Clinics

Written by Jonathan Bancroft, Managing Director of Traveller Assist.

For the past two-years, the Nepali government has vehemently denied their involvement in the helicopter rescue scam that has defrauded millions of dollars from foreign insurers and claimed the lives of several trekkers. In fact, the Tourism Ministry has not only denied that the fraud happens at all, but they have also gone as far as to accuse the accusers of lying to frame them, in what has been assessed by PR and legal experts as a coordinated media campaign attempting to cover up the governments involvement.

However, a new deal that has been announced in Nepal appears to show collusion between the Government, a private clinic and at least one helicopter company.

Two well-respected, volunteer mountain and travel medicine clinics that have saved the lives of hundreds of travellers have been forced to close down by the local government who have been pressured into ending their agreement with International Porter Protection Group (IPPG) and Community Action Nepal (CAN).

IPPG had in the past provided free care for porters and local people, as well as providing treatment for trekkers with acute mountain sickness. Only 5% of patients that they saw were evacuated by helicopter, and only then in life-threatening situations.

But, since the new clinic has taken over, it’s estimated that over 60% of patients have been evacuated to Kathmandu to a hospital that is partly owned by the same people who also own a helicopter company; and profits greatly from medical rescues.

Gokyo International Medical Centre is a relatively new private clinic set-up to replace IPPG clinics in the Khumbu Region on the Gokyo trekking route, but instead of treating patients in place as IPPG had expertly done in the past, a majority of trekkers are now lifted by helicopter and taken to a hospital in Kathmandu.

Who owns what?

On the face of it, Gokyo International Medical Centre is owned by Tenzing Sherpa who is the owner of Namaste Lodge in Gokyo, and he runs the clinic with his brother who is a junior doctor.

However, the clinic itself is partnered with ERA Health Centre in Kathmandu and is financed by Mr. Bhanu Dhakal (who also owns First Assistance Nepal), Kumar Thapaliya (also owns Mountain Heli Charter Service) and Tashi Lakpa Sherpa (also owns Seven Summit Treks, 14 Peak Expeditions and Sherpa & Swiss Adventures).

The clinic is partnered with Easy Heli Charter Service, a company also owned by Tashi Lakpa Sherpa.

Both ERA Health Centre and Easy Heli Charter Service have both been named by the Government’s own investigation in a Kathmandu Post article for billing exorbitant rates, being involved in unnecessary helicopter rescues, over-treatment of patients to increase medical billing and misdiagnosis of patients.

In 2019, Seven Summit Treks were also fined for issuing fake permits to climbers for Everest and in addition, lost seven climbers on 8,000m peaks in Nepal. The family of one trekker was asked to pay $750,000 USD to recover his body.

Nick Mason, Chair of IPPG, a UK-based charity said, “The business model for the new clinic would appear to be to evacuate as many trekkers as possible to Kathmandu where it is alleged they are often subjected to excessive or fictitious investigations and treatment.”

IPPG said its doctors faced hostility and abusefrom local lodge owners with close ties to the new private clinic.

Heli rescue scam

In 2018, medical assistance company Traveller Assist announced that after a 12-month investigation, they had uncovered a helicopter rescue scam that had defrauded millions of dollars from foreign insurers and had claimed the lives of several trekkers.

On one side, officials from Nepal’s Tourism Ministry admitted that the fraud was happening and promised to investigate it, while on the other side, other officials were denying that it happened at all and instead pointed the finger at Traveller Assist. They issued a press release to say that an international assistance company had used lies to frame the governments involvement.

Danny Kaine, Head of Assistance at Traveller Assist, who also spearheaded the insurance fraud investigation said, “Just when we started to gain the cooperation of Tourism Ministry officials to stop the fraud from happening, other government officials derailed these talks by issuing bogus press releases to the local media who of course printed them and by doing so, became complicit in enabling the fraud to carry on.”

Nepal’s Tourism Ministry said last year that it investigated the scams, issued a report and drafted new rules governing helicopter rescue and medical treatment of trekkers to stop the fraud, but the rules were never implemented.

A government official inside the Tourism Ministry who does not wish to be named has said that the new rules were not implemented because the media pressure was no longer on them to do so and he also admitted that the government does profit, both directly and indirectly from the fraud.

Since 2018, Traveller Assist has deployed expat medical and rescue staff to Nepal at the beginning of each busy season, based at common rescue points, but they have received hostility and threats against them from local business owners who are losing money due to the crackdown on unnecessary helicopter rescues and over-treatment at hospitals.

Between October and December of 2019, Traveller Assist provided medical assistance for 113 cases, 51 of which required a helicopter rescue from 17 different rescue points, and included three horseback rescues to lower altitudes.

Jonathan Bancroft, Managing Director of Traveller Assist said, “It's worth noting that in the same time period, our in-country team has stopped an additional 17 unnecessary helicopter rescues from happening whereby the travellers' said they were almost being forced by trekking companies to be 'rescued' and Guides were using 'scare tactics' to panic the travellers. Our company also investigated over 100 invoices from four different hospitals in Kathmandu that were considered exorbitant and also billed for unnecessary treatment and fictitious treatment.”

The fraud is still happening.

Visit Nepal 2020

In a year that is being promoted by Nepal as ‘Visit Nepal 2020’ where the Government hopes to attract over 2 million visitors to the country, it’s imperative that all travel insurance companies educate their travellers on how to avoid being caught up in the scams in Nepal, and for all assistance companies to implement measures to protect both travellers and insurers.

Teladoc Health To Acquire InTouch Health

Teladoc Health, Inc. has announced it has entered into a definitive agreement to acquire InTouch Health, the leading provider of enterprise telehealth solutions for hospitals and health systems.

This acquisition positions Teladoc Health as the partner of choice for health systems seeking a single solution for their entire virtual care strategy, and establishes the company as the only virtual care provider covering the full range of acuity - from critical to chronic to everyday care - through a single solution across all sites of care worldwide.

''Today marks a bold leap forward in Teladoc Health's mission to transform how high-quality healthcare is accessed and experienced, making virtual care available for patients with even the most critical care needs," said Jason Gorevic, chief executive officer, Teladoc Health. "Bringing these companies together will make Teladoc Health the clear virtual care leader across every front door of healthcare, further accelerating the adoption and impact of virtual care for millions of people around the world."

This announcement comes at a time when demand for virtual care services within the provider market is poised for significant growth, as favorable reimbursement tailwinds increasingly equip hospitals and health systems to fully realize the value of virtual care. According to 2019 JPMorgan research, 40% of hospitals surveyed reported planning to increase their budgets for telemedicine solutions. With 61% of hospital revenue forecasted to come from managed and value-based care models by 2021, (L.E.K. 2018 Hospital Study Survey), virtual care will be a crucial strategy to improve consumer engagement, ensure consistent quality and manage health care's rising costs.

Health System's Single Solution for All Virtual Care Needs

Partnered with more than 450 hospitals and health systems with more than 14,500 physician users globally, and supporting 40+ clinical use cases, InTouch Health provides an award-winning, integrated suite of technology, software, purpose-built devices and a secure global network offering a high-quality managed experience for global health care providers. Together with Teladoc Health, the newly combined entity will be uniquely equipped to meet the growing needs of the provider market with one single, integrated solution spanning both consumer and provider-to-provider applications.

"Now is the perfect time for us to join together with Teladoc Health and deliver to hospitals and health systems everywhere what they've been asking for - a single, enterprise solution to support their virtual care strategies and enable them to better engage with patients at every point along their healthcare journey," said Joseph M. DeVivo, chief executive officer at InTouch Health. "Whether it's extending clinical capabilities, augmenting physician resources or supporting optimized outcomes, we are that trusted single partner to support them."

Expanding Care Capabilities and Supporting improved Outcomes

Virtual care will increasingly be adopted to improve patient outcomes as the need for care is expected to increase, driven by aging populations and the increasing prevalence of chronic diseases. Teladoc Health will be uniquely equipped to redefine the standard for where critical and specialty care can be accessed through a single virtual care solution that delivers longitudinal patient care — from the everyday to the most complex — anywhere, anytime. From stroke care to cardiology and more, this unmatched range of capabilities will enable clinicians to provide the best patient care both in medical facilities, as well as new locations such as home, transport and retail.

"With a continued focus on extending virtual care to new settings, expanding access and improving care coordination, our unmatched capabilities will extend both inside and outside the four walls of the hospital and empower care providers and patients alike," added Gorevic.

Transaction Summary

The transaction is expected to close by the end of Q2, subject to customary closing conditions. Under the terms of the agreement, the purchase price of $600 million will consist of approximately $150 million in cash and $450 million of Teladoc Health common stock. Lazard acted as sole financial advisor and Latham & Watkins LLP acted as legal advisor to Teladoc Health in the transaction. J.P. Morgan acted as sole financial advisor and Wilson Sonsini Goodrich & Rosati LLP acted as legal advisor to InTouch Health.

Financial Reporting and Business Outlook

InTouch Health is expected to generate 2019 revenues of approximately $80 million, growing approximately 35% versus the prior year.[1]  Upon closing of the transaction, Teladoc Health will provide an updated full-year 2020 financial outlook and guidance for the combined company after adopting recent U.S. GAAP accounting pronouncements as well as completing valuation and related purchase accounting considerations for InTouch Health.

Management Presentation

A live webcast of the presentation and supplemental presentation materials will be available on the investor relations section of the company's website at


Fox Flight Air Ambulance Expands Lear 40-XR Fleet

Fox Flight Air Ambulance has recently welcomed a third Lear 40-XR to its fleet of specially configured air ambulances.

This aircraft features state-of-the-art avionics and has been custom fitted for dedicated aeromedical operation. It joins two other Lear 40-XRs that were added to the fleet in April of 2019. Company president David Fox says the addition of the third Lear 40- XR completes the company’s planned overhaul of its equipment.

“Just over a year ago we made a decision to update our aircraft and move on from our old Lear 35s and Lear 36,” Fox explains. “After researching our options, we determined that the best aircraft for us was the Lear 40-XR. The longer fuselage has room for a washroom and extra baggage, which means more comfort and convenience for the patient, their companions and our crew. Plus the taller and wider cabin makes it easier for the medical crew to load and unload the patient and provide in-flight care.”

In addition to improved cabin amenities, flight crews on Fox Flight’s new Lear 40-XRs have benefited from a roomier cockpit, the up-to-date cockpit display and the latest aviation technology. “Our pilots are really enjoying flying the Lear 40-XR for a lot of reasons; it’s a big step up from our old fleet and takes our standard of service to the next level,” says Katrina Rankine, Fox Flight’s director of operations and chief pilot.

In addition to improving the repatriation experience for patients, companions and crews, Fox says the impetus to move to the Lear 40-XR was also driven by the ongoing maintenance demands of older aircraft. Says Fox: “Newer planes are just more reliable, and they are easier to fix if you do have a problem because there are abundant replacement parts available; that means it’s easier for us to keep our planes in the air and available for our clients.”

The latest Fox Flight air ambulance will operate under the tail designation C-FEMT, which stands for “Emergency Medical Transfer.” It joins C-FEMF (Emergency Medical Flight) and C-FEMC (Emergency Medical Care) to round out the fleet.

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