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CMS Proposes Rule To Strengthen Managed Care For Medicaid And CHIP Enrollees

The Centers for Medicare & Medicaid Services (CMS) has proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries.  This proposed rule is the first major update to Medicaid and CHIP managed care regulations in more than a decade.

It would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage.  Overall, this proposed rule supports the agency’s mission of better care, smarter spending, and healthier people.

“A lot has changed in terms of best practices and the delivery of important health services in the managed care field over the last decade. This proposal will better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing quality, coordinated care to millions of Americans with Medicaid or CHIP insurance coverage,” said Andy Slavitt, Acting Administrator of CMS.

Since CMS last issued managed care regulations in 2002 and 2003, the health care delivery landscape has changed and grown substantially.  States have expanded managed care to several new populations including seniors and persons with disabilities. The growth of managed care in the Marketplace and Medicare Advantage further highlights the importance of policy alignment when appropriate across programs in order to ease the transition for consumers whose circumstances change during the year.

CMS proposes to modernize Medicaid managed care regulations in the following ways:

  • Supporting states’ efforts to encourage delivery system reform initiatives within managed care programs that aim to improve health care outcomes and beneficiary experience while controlling costs; and
  • Strengthening the quality of care provided to beneficiaries by strengthening transparency and measurement, establishing a quality rating system, and broadening state quality strategies and consumer and stakeholder engagement;
  • Improving consumer experience in the areas of enrollment, communications, care coordination, and the availability and accessibility of covered services;
  • Implementing best practices identified in existing managed long term services and supports programs;
  • Aligning Medicaid managed care policies to a much greater extent with those of Medicare Advantage and the private market;
  • Strengthening the fiscal and programmatic integrity of Medicaid managed care programs and rate setting;
  • Aligning the CHIP managed care regulations with many of the proposed revisions to the Medicaid managed care rules strengthen quality and access in CHIP managed care programs.  

The proposed rule is available at and can be viewed at starting June 1. The deadline to submit comments is July 27, 2015.

For more information, visit  


ACE Launches ACE Business Class In Sweden; New Corporate Travel Solution Including Wording And Mobile App

ACE Group have launched its new corporate travel proposition ACE Business Class in Sweden, as it continues to enhance its multinational offering for companies in the Nordic region.

ACE Business Class provides comprehensive travel insurance cover by means of a dedicated policy wording for Sweden, combined with market-leading medical and travel assistance services. Features include:

  • 24/7 worldwide insurance and assistance coverage supported by a hotline for travellers
  • New benefits related to personal belongings such as cover for fraudulent use of SIM card and stolen credit cards
  • Personal security and assistance cover including for cases of kidnap
  • Security evacuation covering a wide range of perils, including political and social unrest, terrorist attack and natural disaster
  • ACE Travel Smart, a new mobile app for travellers giving direct access to ACE’s medical and emergency assistance partners, live location-specific safety alerts and pre-travel destination advice and information.

ACE Business Class has been designed to offer flexible cover for the bespoke needs of Swedish companies with different risk profiles. Equally important, the cover can be structured as a multinational insurance programme, with an insurance policy issued to the parent company and local policies issued to subsidiaries. This innovative business travel cover approach ensures compliant local insurance cover, backed-up by a comprehensive global service that can be adapted to suit companies of all sizes.

Over the summer, ACE Travel Smart app will be updated to incorporate additional innovative functionality, including an online dashboard for risk-, insurance-, HR- and benefit managers that will help them track and communicate with travelling employees in real-time and connect them to the award-winning ACE Worldview technology platform.

Stephane Baj, Regional Director of A&H Corporate & Affinity, for ACE in Europe, Eurasia and Africa said, “With employees increasingly travelling to less familiar destinations, European businesses need a solution that offers comprehensive insurance cover, combined with high-quality 24/7 emergency and medical assistance and the technology that helps them stay in control. ACE Business Class is an innovative solution that brings all the elements of ACE’s business travel proposition together, helping employers to fulfil their duty of care while providing the information that staff need to make their travel safer and easier.”

Anna Orhaug, Head of Accident and Health for the Nordic countries at ACE, said, “ACE Business Class brings to the marketplace a comprehensive proposition which has been well received elsewhere in Europe and combines the best of ACE’s knowledge and experience elsewhere around the world with a dedicated policy wording for Sweden. With ACE Business Class, we can tailor our offering to the specific needs of each client to ensure that they have the bespoke support they really need as their risks evolve.”


Healix Wins Global Health And Wellness Award

Healix International has taken the ‘Global Health and Wellness awardat the prestigious Relocate Global Awards held in London.

The Global Health & Wellness award is now in its second year with entry open to the wide range of companies that supply health and wellness solutions, as well as employers’ in-house wellness schemes.

Healix International, which won for the second time, provides medical, security and travel assistance services.  Its entry showcased its Global Travel Risk Management service – described by the judges as “a cost-effective and integrated service operating in challenging locations” – which is designed to help employers to fulfil their duty of care towards staff travelling and working abroad.

In the entry, said the judges, relevant factors and potential pressure points were highlighted, clearly related to relocation and the issues of risk and duty of care.

They added, “Duty of care is an important area that all companies have to address, and by combining medical care, risk management and health screening, with a point of contact for each case from end to end, Healix provides a very personal service for client companies and their employees.”

Dave White, Global Director of Sales & Marketing at Healix International said, “We are delighted to have won the Relocate Global Health and Wellness Award for the second year running.   We pride ourselves on service excellence and it is gratifying to have our global travel risk management service recognised with this award. 

“By co-ordinating all services needed for travel, health and security risk management through one central point, we are able to help our clients fulfil their duty of care and ensure that their employees get the most appropriate support and protection whilst working abroad.  This Award is a testament to the hard work of the whole team.”

To find out more about Healix International visit their micro website on iPMI Magazine, click here now.



New Protection System Helps Advisers Protect More Lives, More Easily

Aviva has launched a new dedicated protection system to help advisers protect more lives, more easily. Called Aviva Life Protection Solutions (ALPS), the new end to end platform represents the largest change to happen in the Aviva protection business for many years.

With more people than ever taking steps to protect their families from the unexpected by taking out life insurance, income protection and critical illness cover, Aviva’s new ALPS system provides advisers with a user-friendly, interactive and intuitive way to help clients get tailored protection cover, whoever they are and whatever their needs.

Key features of ALPS include:

  • At the heart of ALPS is a slicker, quicker ‘quote and apply’ system. With multi-product applications advisers will, for the first time, be able to offer clients income
  • protection, life insurance and critical illness cover on the same application.
  • Signature free applications (e-sigs) for own life cases makes the application process simpler and quicker.
  • Aviva quotes multi-product quotes are now available on all major portals. See ‘quote and apply in action’ video here.
  • Using a bank of over 500,000 questions, 600 different conditions, interactive underwriting mode is expected to produce 75% immediate acceptances, giving more certain customer outcomes, immediately.
  • Nine out of 10 customers can also expect to receive a decision based on application alone [no further evidence required] within 24 hours.
  • Extra and quicker commission payments for advisers using interactive underwriting.
  • New end-to-end system is accessible through one single portal (Aviva for Advisers website) making it quicker and easier than ever to provide clients with all the cover they need, instantly.
  • A broad range of flexible, new protection products for Life, Critical Illness and Income Protection cover will allows advisers to provide clients with tailored solutions to meet their changing needs, both now and in the future (See Technical Guide to Protection)
  • New and improved features, like family income cover on Life and Critical illness options, and comprehensive critical illness cover for 56 conditions, as well as up to £3 million sum assured, makes a more flexible and appealing offer for customers.
  • Quick and easy, real-time case tracking provides advisers with the ultimate control 24/7. Self service status; progress and ‘next action’ reports and the ability to view and download case documents instantly, gives advisers the information they need, when they need it, to manage their business efficiently.

Louise Colley, protection director at Aviva says, “Protection is the bedrock of financial planning, giving people the confidence to build their futures without fear of the unknown.  We believe everyone deserves to understand both the financial risks they face, and the importance of protection.  

“The introduction of Aviva Life Protection Solutions has helped us transform the way advisers do business with us so they can protect more lives, more easily.

"ALPS is an intuitive and interactive system which I’ve no doubt will save advisers valuable time and money, at the same time as better identifying customers’ protection needs and providing them with that all-important peace of mind.

“By totally re-engineering our system, the journey from quote through to claim is much cleaner and easier to navigate and this will revolutionise how advisers will write protection business with us in the future.”

Access to the new ALPS digital services and Aviva’s complete (online) product range is available through all major portals including Aviva for Advisers, using existing sign on details. Available free of charge to all Aviva for Advisers registered users, advisers have everything they need to fully support and service their clients quickly and securely.


Hardworking SME's Rely On Family And Friends For Advice Rather Than Experts

SMEs are failing to make use of expert advice when setting up their business, according to new research from Aviva*, leaving them vulnerable to costly mistakes. Two in five (38%) rely on advice from family or friends, while just 13% consult financial advisers, 9% use legal advisers and 6% turn to insurance providers.

SMEs found that the top three hurdles when setting up their business were financial administration (32%), marketing and sales (31%), and understanding and fulfilling legal obligations as an employer or business owner (30%).

All were areas that they had little or no knowledge of when setting up – three quarters of SMEs knew little or nothing about bookkeeping or marketing and sales. An even greater proportion (85%) said they knew very little about their legal obligations as an employer.

Having established their businesses SMEs say the top three hurdles that they have still not been able to overcome are marketing and sales (26%), getting financial help (18%) and understanding legal obligations as an employer (also 18%).

Employer obligations, for many businesses, will include overcoming hurdles like pension auto-enrolment for the first time. Whilst our research shows a third have done so already, one in five (21%) say they haven’t yet set up a workplace pension but know they need to at some point and over a third (36%) of micro employers (those with 1-5 employees) don’t think they need to. Along with its pensions schemes Aviva has created some helpful tips and advice about auto-enrolment and when to start thinking about setting up or preparing for their ‘staging date’.**

Angus Eaton, managing director of commercial lines at Aviva, said: “Making the time to balance the management of day to day customer, employee and supplier demands with protection against nasty surprises is a perpetual challenge for any business. Great advice helps.

“It’s only natural to want to consult with your family and friends but advice from professional experts can save time and money, helping small business owners with practical solutions, learnt from similar experiences in other businesses.

“Whether it’s getting hands-on help with bookkeeping, or getting to grips with the legal obligations associated with being an employer, there is a wealth of advice and material designed to support SMEs along every step of the way. Government resources such as those on the Great Business website - particularly for fledgling SMEs - are a great place to start."

Failure to understand legal obligations leaves SMEs at risk of breaching the law

Not being able to understand legal obligations as an employer or business owner is leaving some SMEs in danger of breaking the law.

Employers’ liability insurance is a legal necessity for the vast majority of businesses with staff however one in ten (11%) SMEs thought it wasn’t a legal requirement in any scenario. A quarter (25%) of SMEs also wrongly believe that employers’ liability insurance is only legally required once a business has more than one employee.

Employers’ liability provides vital cover should a member of staff make a claim for illness or injury caused by their job and it is a legal requirement. Failure to have it carries the risk of fines of £2,500 for every day the business is not properly insured***.

Almost nine in ten (87%) SMEs did not know that the minimum legal requirement for employers’ liability insurance is £5 million, with a fifth (19%) believing the minimum legal cover to be less than £500,000.

And it isn’t only employers’ liability insurance that some businesses are unsure of. When we asked about all types of business insurance less than a third (29%) of SMEs said they are very confident that they have the right cover, and one in ten (12%) admitted to having no business insurance at all. That is potentially leaving more than 600,000**** SMEs financially vulnerable should a claim arise.

However, it seems that the longer they are in business the higher the priority for insurance becomes. A quarter (25%) of SMEs that have been in business for less than a year have no insurance but this fell to 5% for more established businesses who have been operating for 8-10 years.

Eaton continued: “Clearly SMEs need a strong understanding of their legal obligations and how they can protect their business and employees to keep it trading - one claim without adequate cover could easily be enough to put severe financial pressure on an organisation or even close it down completely.

“It seems from our survey that the longer they are in business the more likely SMEs are to have taken out business insurance and my advice would be, don’t wait – make sure you have the right insurance from the start. Making the time to get the right advice and protection for your business could be the best investment you make so if you don’t already have one speak to your local broker as soon as you can.”

* Research was conducted online by RedShift among 1,507 SMEs in February 2015.
** For more information on auto-enrolment visit:
****According to Government statistics, there were 5,163,600 SMEs at the start of 2014 in the UK


Three North Texas Medical Groups Start Cigna Collaborative Care Programs to Improve Health and Lower Costs in Metroplex

Cigna (NYSE: CI) has launched collaborative care initiatives with three North Texas medical groups. The new arrangements with Catalyst Health Network, Dallas Methodist Physicians Network (DMPN) and Genesis Accountable Physician Network (GAPN) aim to improve patient access to health care, enhance care coordination, and achieve the goal of improved health,affordability and patient experience. With the launch of these three programs, which became effective April 1, Cigna now has nine collaborative care initiatives in the Dallas/Fort Worth Metroplex.

Cigna Collaborative Care is the company’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs. These three new programs will benefit more than 22,000 individuals covered by a Cigna health plan who receive care from more than 260 primary care doctors at the three groups.

In places where it’s been introduced, Cigna Collaborative Care is helping to improve the health of Cigna customers while effectively managing medical costs. The programs are helping to close gaps in care, such as missed health screenings or prescription refills, reinforcing the appropriate use of hospital emergency rooms, increasing the number of preventive health visits and improving follow-up care for people transitioning from the hospital to home.

“We’re looking forward to this collaboration with Cigna, which is an excellent opportunity for our independent physicians to continue bringing real value to our communities by delivering superior quality of care while holding the line on cost,” said Dr. Christopher Crow, president of Catalyst Health Network.

“Improving the lives of our patients through quality care is at the heart of our mission, which is why this collaboration with Cigna is a great fit for us,” said Michael S. Marshall, M.D., chair of the DMPN board of directors. “Care coordinators will play a pivotal role because better coordinated care is fundamental to better health and lower costs.”

“We believe that health care relies on solid relationships, and this new collaboration builds relationships between our independent physician members, patients, and Cigna,” said Dr. Jim Walton, president and CEO of Genesis Physicians Group. “Care coordination, which is central to this collaboration, supports our members as they help patients manage chronic conditions and live healthier lives.”

“Through these types of collaboration we have the opportunity to help transform the health care delivery system,” said Dr. Frederick Watson, Cigna’s senior medical director for North Texas. “When we reward doctors for results and focus on prevention, wellness, health improvement and care coordination, we can create a system that works for everyone who uses, pays for or delivers health care.”

Under the program, the medical groups will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current physicians and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from these medical groups will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes, heart disease and obesity.

Critical to the program’s benefits are the registered nurse clinical care coordinators, employed by the medical groups, who will help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators are aligned with a team of Cigna case managers to ensure a high degree of collaboration between the medical groups and Cigna, which will ultimately provide a better experience for the individual.

The care coordinators will enhance care by using patient-specific data from Cigna to help identify individuals being discharged from the hospital who might be at risk for readmission, as well as individuals who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators are part of the physician-led care teams that will help people get the follow-up care or screenings they need, identify potential complications related to medications and help prevent chronic conditions from worsening.

Care coordinators can also help individuals schedule appointments, provide health education and refer people to Cigna's clinical support programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.

Cigna will compensate the medical groups for the medical and care coordination services they provide. Additionally, the physician groups may be rewarded through a “pay for value” structure if they meet targets for improving quality and lowering medical costs.

Cigna has been at the forefront of the accountable care organization movement since 2008 and now has 122 Cigna Collaborative Care arrangements with large physician groups that span 29 states, reach more than 1.3 million commercial customers and encompass more than 50,000 doctors, including more than 24,000 primary care physicians and more than 27,000 specialists.


Aetna and the Value Care Alliance Reach New Accountable Care Agreement

Aetna (NYSE: AET) and the Value Care Alliance (VCA), the state’s largest collaboration of independent health care providers, today announced a new accountable care agreement that is designed to improve the coordination and delivery of patient care to Aetna members in Connecticut.

The VCA comprises seven member hospitals and their affiliated physicians in Fairfield, Litchfield, Middlesex, New Haven and New London counties. The hospitals are: Griffin Hospital in Derby; Lawrence + Memorial Hospital in New London; Middlesex Hospital in Middletown; St. Vincent’s Medical Center in Bridgeport; and the Western Connecticut Health Network which comprises Danbury Hospital, New Milford Hospital and Norwalk Hospital.

Aetna members who receive care from VCA providers will experience more coordinated care, and will benefit from the improved flow of information to treating physicians in the ACO, particularly those patients with chronic or complex conditions. Aetna nurse case managers will work with the ACO to assist in care coordination, outreach and follow-up services.

“This agreement builds upon a strong foundation of collaboration already at work within the VCA and will enable Aetna to add support for the care delivered by the VCA to our members,” said Mark Santos, president, Aetna – New England. “Aetna will work closely with VCA physicians and member hospitals to find opportunities to share health information to improve care for Aetna members, close gaps in care and reduce waste. We are creating a loop of improved information to drive better care.”

Covered under the new agreement are more than 40,000 Aetna commercial health plan members who primarily received care from participating VCA providers over the last 24 months, as well as those who seek care from VCA providers following the start of the agreement. While health plan benefits will not change, members can expect a more highly coordinated, personalized level of care. To support these members, care coordinators at VCA member hospitals will complement Aetna’s care management programs in an effort to lower the number of days patients spend hospitalized and improve member health outcomes.

“This innovative approach to the delivery of health care strengthens our community’s access to affordable, high-quality care,” said John M. Murphy, MD, president and CEO of the three-hospital Western Connecticut Health Network. “The real beneficiaries of this agreement are the people we serve every day in our communities. This partnership will produce tangible and meaningful improvements in our ability to coordinate care, which is why we are so pleased to be a part of this progressive collaboration.”

This agreement includes a shared savings model that rewards VCA providers for meeting certain quality and efficiency benchmarks that have been proven to improve the health of members and reduce healthcare costs, such as:

  • The percentage of Aetna members who receive recommended preventive care and screenings;
  • Better management of patients with chronic conditions such as diabetes and heart failure;
  • Reductions in avoidable hospital readmission rates; and
  • Reductions in unnecessary emergency room visits.

“The focus of the VCA is to provide high-quality and low-cost health care including effective prevention and wellness services that benefit Connecticut consumers, employers and health plans,” said Vincent Capece, CEO of Middlesex Hospital. “Our accountable care partnership with Aetna will enhance our ability to provide care that is patient-centered, high-quality and efficient in a more coordinated manner.”

Aetna is working with health care organizations nationwide to develop products and services that support value-driven, patient-centered care for all health care consumers. Nationally today, about 3.2 million Aetna members receive care from doctors committed to the value-based approach, with 28 percent of Aetna claims payments going to doctors and providers who practice value-based care. Aetna has committed to increasing that number to 50 percent by 2018 and 75 percent by 2020. This accountable care agreement with the VCA is in keeping with the transition to more value-based care arrangements.

“The VCA has evolved quickly since its founding in 2014, with its members working collaboratively to enhance quality and reduce cost by identifying and sharing best practices and to develop the capabilities necessary to effectively manage the health of populations,” said Patrick Charmel, chairman of the VCA and president and CEO of Griffin Hospital. “We welcome Aetna’s industry-leading effort to motivate, facilitate and reward the delivery of high-value, patient-centered health care. We also appreciate Aetna’s accountable care partnership and the confidence in, and support of, the Value Care Alliance that it demonstrates.


Group Risk Insurance Continues To Show Strong Growth In The UK

  • 200,000 more people received life and disability insurance cover arranged by their employers in 2014, adding to the very strong growth of 300,000 new people last year;
  • Since 2010, the number of people insured under group risk schemes has grown by almost 1.25 million;
  • Good premium growth of 7.9% across all lines; 8.9% increase in in-force death benefit premiums, 6% in long-term disability income premiums, and 7.8% increase in critical illness premiums;
  • Excepted group life premiums grew 27.9% and benefits by 29.4%, reflecting the response to changes to the lifetime allowance;
  • Number of new schemes grew as more employers set up excepted group life policies and critical illness schemes, but long-term disability income schemes continue to decline.

The excellent growth in the UK group risk insurance market continued in 2014, according to Swiss Re'sGroup Watch 2015. Premiums were higher in all product areas, with an overall growth of close to 8% for the year. Importantly, over 200,000 more people are now benefitting from life and disability insurance products arranged through their employer. The report finds that the market is resilient, but that there are still challenges, most particularly where the number of new to market disability income schemes remains disappointing.

"These are good figures for the group risk market – but they hide the fact that this industry is at a crossroads," says Russell Higginbotham, CEO Swiss Re UK & Ireland. "The welfare state cannot continue to fund at current levels and the next Government will have to make cuts to the welfare budget. Insurers need to be ready to step up and adapt to that new reality. If we don't, we may find existing models under threat in the same way that reforms have reconfigured pension provision."  

Group Watch 2015 reported steady growth across most lines of products. Premium growth was again very strong in the group death benefits sector with GBP 1.25 billion in-force premiums reported for 2014. This strong growth continues the trend from previous years, and is the first time the market recorded annual growth in excessive of GBP 100 million.

As in 2013, excepted group life premiums performed very well, with premiums growing by 27.9%. The move reflects the reduction of the lifetime allowance, which imposes a cap on pension savings of GBP 1.25 million. With the limit set to be reduced further to GBP 1.0 million from April 2016, employers are likely to continue preferring the simplicity this option presents.

The number of people insured for long-term disability income protection through their employers increased by 1.9% for 2014, building on the important milestone of two million people insured which was reached in 2013. In-force premiums were up 6.0% to nearly GBP 634 million. There was a decrease in the number of in-force schemes of 0.4% to 17,119.

Critical illness covers again experienced strong growth. In 2014, almost 475,000 people were covered, an increase of more than 90,000. In-force premiums increased by 7.8% and sums assured by 15.2%. The number of in-force schemes increased by 7.0% to 2,840.

"The results show solid growth once again but we need to decide if we want to carry on as we have done for the past few years or offer something more ambitious," says Ron Wheatcroft, author of the report.  "Auto-enrolment could be the way to increase coverage if we are unable to deliver growth to begin to fill the gap which will be left by declining state provision. Employees tell us that they would value greater workplace access to products and services but, somehow, this hasn't translated to more coverage."

Key figures from Group Watch 2015 (in GBP millions)

Total In-force premiums at end of year

Product Type







Death benefits







Long-term disability income







Critical Illness







Group Watch 2015 analyses and summarises group risk business results at the end of 2014. It also uses a qualitative survey among 34 insurers and intermediaries in the group risk market, conducted in February 2015.

The Swiss Re Group is a leading wholesale provider of reinsurance, insurance and other insurance-based forms of risk transfer. Dealing direct and working through brokers, its global client base consists of insurance companies, mid-to-large-sized corporations and public sector clients. From standard products to tailor-made coverage across all lines of business, Swiss Re deploys its capital strength, expertise and innovation power to enable the risk-taking upon which enterprise and progress in society depend. Founded in Zurich, Switzerland, in 1863, Swiss Re serves clients through a network of over 60 offices globally and is rated "AA-" by Standard & Poor's, "Aa3" by Moody's and "A+" by A.M. Best. Registered shares in the Swiss Re Group holding company, Swiss Re Ltd, are listed on the SIX Swiss Exchange and trade under the symbol SREN. For more information about Swiss Re Group, please visit: or follow us on Twitter @SwissRe.


Over 40% Of New Zealanders Consider Health Insurance More Important Than Contents Or Home Insurance

In a recent survey of New Zealand consumers, Canstar discovered that over 40% of New Zealanders consider health insurance more important than contents or home insurance. With so many health insurers, brokers and plans on the market – some of which don't cover surgery - it's important to understand how to differentiate between providers and work out which is the right plan.

One of the most controversial negotiation points is pre-existing conditions, as many health insurance plans do not cover pre-existing medical conditions. Six in 10 New Zealanders with health insurance won't switch insurer because they fear losing cover for pre-existing conditions, the Canstar survey found. "It's a bit like you can't insure your house after it's burnt down. You can't insure your health if you know there is something serious wrong," says Roger Styles, chief executive of the Health Funds Association.

The main way people get cover for pre-existing conditions is via a group insurance scheme arranged by their employer, or on a case-by-case basis if it can be proven that the condition has been treated effectively. Health insurers often offer cover for pre-existing conditions as an incentive if the size of the company meets minimum criteria and the premiums are being paid by the employer, and cover can vary from fully covered to covered with some form of limitation.

There are two types of employer schemes: voluntary vs subsidised schemes. Voluntary schemes are where health cover is offered to staff at a discounted rate, with premiums paid individually by employees. Subsidised health cover is where the premiums for employees (and sometimes family members) are paid by the employer.

Ali Wilkinson, Manager Risk Acceptance and Claims at UniMed who specialise in employer provided health insurance, says that "subsidised schemes don't cost the earth. We tailor company health insurance plans so that different levels of staff can have different benefits for different premiums". For the second year in a row, UniMed were rated Number 1 for Most Satisfied Customers in the health insurance industry in the Canstar survey, getting 5 stars for speed of response, ease of claim, quality of service, communication and overall satisfaction.

Another factor to consider when weighing up health insurers is the financial rating which gives an indication as to vulnerability. A++ and A+ are Superior, A and A- are "Excellent"; B++ or B+ mean Good and anything less shows "vulnerability" according to AM Best global credit rating agency.

Compare too the percentage of premiums paid out as claims – too low and they are milking you for profit, but some not-for-profits like UniMed have a policy of being prudent in all operational spending to keep the claims ratio payout high at over 85% of premiums to benefit members.

How long a company has been around is an indication of whether they've been able to weather storms and got the payout ratios right to keep members well but also remain financially solid.

Another pitfall is to check that the treatment costs allowed for various conditions cover current actual costs, rather than just historic procedure costs, because health procedures get more and more sophisticated each year, and costs go up, so you don't want to discover you've got a large gap to pay for. One way of finding this out is to ask what date the procedure prices are benchmarked on and how often the benefit limits are reviewed and increased.

Some companies also place restrictions on where the patient can go to get treatment so either the surgeon will have to register to become accredited with the insurer, or in some cases, if the surgeon's costs are out of whack with what the insurance company deems to be fair, the insurer may fund only what they believe is a fair rate for that procedure leaving the patient with a hefty gap to cover.

There's certainly a wide array of options on offer. If you do switch, you can't be too careful", says Insurance Ombudsman, Karen Stevens. "The best way to cover yourself is to attach your full medical records to the application."


Welcome To iPolicy Magazine: For International Expatriate Medical Health And Travel Insurance Brokers Agents And Intermediaries

Welcome To The 1st Issue Of iPMI Magazines Medical Health Travel and Expatriate Insurance Broker And Intermediary Report, iPOLICY.


Rounding up the last quarter's most important International Medical and Health Insurance Plan and Product News, iPOLICY is the essential digital report designed specifically for International Health Insurance Brokers and Intermediaries.

Read iPolicy by iPMIM now, click here.

Welcome To The 2nd Issue Of iPMI Magazines Medical Insurance Broker And Intermediary Report, iPOLICY.


Rounding up the last quarter's most important International Medical and Health Insurance Plan and Product News, iPOLICY is the essential digital report designed specifically for International Health Insurance Brokers and Intermediaries.

Read iPolicy Issue 2 by iPMIM now, click here.

Welcome To The 3rd Issue Of iPMI Magazines Medical Insurance Broker And Intermediary Report, iPOLICY.


Rounding up the last quarter's most important International Medical and Health Insurance Plan and Product News, iPOLICY is the essential digital report designed specifically for International Health Insurance Brokers and Intermediaries.

Read iPolicy Issue 3 by iPMIM now, click here.

For more International Private Medical Insurance Magazine medical insurance, health insurance, medical assistance, expatriate healthcare insurance and risk-protection news go to

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Travel Insurance Industry Analysis News Press Releases Company Announcements

Read all the latest travel insurance industry news stories, press releases, views and analysis with the iPMI Magazine travel insurance news section. Find great value travel insurers for people with pre-existing medical conditions, travellers over 65 and those visiting dangerous remote hazardous locations offshore. Comprehensive and dynamic international travel insurance plans and solutions are of critical importance for individuals, groups and families travelling, working or living abroad answering key questions like Will your travel insurance cover you if an airline goes out of business? Should I buy travel insurance for European weekend breaks? iPMI Magazine looks at Discount Excludes Optional Extras. Medical Expenses Covered. Learn about a range of travel insurance options from single trips to annual cover. Insurance coverage: Medical Emergencies, Stolen Documents, Cruise Cover, Golf Cover, Gadget Add-On, Cancelled Flights, Lost Luggage, Missed Flight, Personal Accident, Lost Documents, Stolen Cash. Types: Annual, Multi-Trip, Single Trip plus much more. Subscribe to the iPMI Magazine travel insurance news letter, delivered via email free of charge, most days. Click here to subscribe now to travel insurance news and press releases.