With restrictions on international travel, and medical services focused on treating Covid-19 patients, the pandemic has been a testing time for the international PMI market. But, although there were challenges, it adapted well and provided the service and support clients needed throughout the crisis.
The speed at which Covid-19 switched from a small outbreak in Wuhan to a global pandemic caught many expats off-guard. “When it first kicked off, we had loads of calls from clients asking how they could get home,” says Linda Beavis, principal, global benefits at Aon. “It was difficult: governments wouldn’t let them in and it wasn’t something that IPMI could help with as they didn’t have a medical reason to leave.”
Subsequently, while some returned home, others stayed put, either through choice or as borders closed and events overtook them. “Insurers – and governments – were good about enabling people to retain cover wherever they ended up,” adds Beavis. “Even in Switzerland where a mandatory health policy is required, the government didn’t enforce this.”
Care standards
For the IPMI insurers, one of the key challenges was the availability of treatment for members, especially as the effects of the virus varied from country to country. Aetna International executive director, Europe Damian Lenihan says it was a really mixed picture. “We saw inpatient treatment stop completely in the Middle East, in much the same ways as it did in the UK, but in other locations there was much less disruption,” he explains. “We also had some emergency evacuations, which were very tricky especially at the beginning of the pandemic, but we were able to use private services to help our members.”
The risk of contracting the virus meant some members were reluctant to access treatment but Sheldon Kenton, chief executive officer at Bupa Global, says that, where treatment had to happen, it happened. “The situation on treatment availability did vary from country to country and although we saw a reduction in minor consultations, emergency care was still available and babies continued to be born,” he explains. “And, where there was less availability, services did open up again quickly.”
Cover changes
Insurers also factored Covid-19 into their cover. While pandemic exclusions were being slapped on many other lines of insurance business, the IPMI market did the opposite, as Howden divisional director, international benefits Adam Harding explains: “Insurers removed the pandemic exclusion on their policies, extending cover to include Covid-19. This covers the cost of any treatment required but also testing, although this is generally caveated to GP referral or once a month now.”
Co-payments were also removed for any treatment relating to the virus to ensure cover was as straightforward as possible. In addition, insurers looked at other ways they could support members during the pandemic.
As in the UK, this meant that virtual and digital services were supercharged to support members unable to access healthcare support. Although services such as virtual GP and EAPs had long been part of the IPMI proposition, many insurers ramped up these services or provided them free to their customers. “We gave our Virtual Doctor service to everyone and introduced our digital mental health service, Mind Health,” says Axa Global Healthcare global head of international health insurance Andy Edwards. “This gives our members access to psychological support for any mental health issues they’re facing.”
With pandemic li fe so dependent on virtual services, usage rocketed. For instance, Lenihan says that at Aetna nternational, the number of virtual consultations being accessed increased by up to 400 per cent while at Bupa Global, 67 per cent of members now interact with the insurer digitally.
Claims fluctuations
The IPMI market is also watching carefully how claims patterns were affected by the pandemic. With restrictions on treatment, and some caution around accessing healthcare facilities, claims levels fluctuated. “We saw a drop off in claims during the first wave of the pandemic,” says Kenton. “But, by mid-summer levels were rising again and it was close to normal by September. We’re still waiting to see what the full impact will be: there’s a catch-up on non-acute surgeries and preventative services but I imagine most people will wait for their next dental appointment rather than catch up on the ones they missed.”
It’s also been a gradual return to normality. Lockdown restrictions have been eased at different rates and second and third waves of the virus have affected countries at very different times.
The growth of virtual services could also have an effect on claims. Beavis says that fewer people end up going for follow-up treatment when they’re seen by a virtual GP. “In some parts of the world, being sent for lots of tests and scans is a standard part of the GP consultation,” she says. “This shift to virtual consultations could reduce claims costs significantly.”
Cost considerations
Whether due to the switch to digital or restrictions around treatment availability, insurers are paying close attention to claims costs to ensure that customers get a fair deal. “Some have offered a rebate on premiums but it’s been a bit of a mixed bag,” says Harding. “Unlike the UK, where private treatment was unavailable as the providers supported the NHS, the availability of treatment has varied greatly around the world.”
One that did return premium was Aetna, which gave its medium- sized clients a month’s discount on renewal as a gesture of goodwill. Others, such as Bupa Global, are waiting to see how costs pan out. “There are still some unknowns,” says Kenton. “What will be the impact of long Covid on claims costs? Or the mental health issues that will emerge as a consequence of the pandemic? It’s too early to say where premiums will go.”
Harding agrees. He says insurers are struggling to know how to price renewals this year, with pricing decisions changing on a monthly basis. “Worldwide medical inflation runs at between 8 and 12 per cent but medical facilities are also having to factor in the cost of PPE, testing and social distancing. This could add to the costs.”
Future proposition
As well as the effect of the pandemic over the last 16 months, insurers are also mindful that it could have long-lasting consequences for international assignments. Technology has made it easy to conduct business from anywhere, with the potential to render business trips unnecessary.
The insurers aren’t so sold on video calls killing the international business traveller. “You can do so much by video but it’s not the same,” says Edwards. “Initially, the pandemic will make companies wary about who they send and where they send them but there is still a need for business travel. It may become more focused around flexible, short-term assignments.”
Kenton is also optimistic, pointing at the trend to work from anywhere that has resulted from the pandemic. “We’ve seen some new customers during the pandemic,” he adds. “Where they relied on domestic medical insurance and travel insurance, the pandemic has highlighted the gaps in their cover.”
As working habits change, more innovation could also be on the cards. Harding would like to see a product that bridges the gap between domestic and full blown IPMI to give more flexibility to those who work across locations.
Beavis is also keen to see insurers following workplace trends. “There will always be a need for an international policy,” she says. “With so much changing, insurers must ensure they continue to develop their proposition to match needs.”