Sick and stuck abroad: IPMI in the Covid crisis

Does an international health insurance policy cover the Coronavirus Covid-19 Outbreak?
While most domestic private health insurers in the UK are offering limited or no cover, numerous International Private Medical Insurance providers have been at pains to point out that they are providing full cover for the Coronavirus Covid-19 outbreak. However, the stance taken can vary between insurers, and in an increasingly widely spread outbreak, where the local state healthcare systems are taking the lead on treatment, and may start to creek under its pressure, you may find yourself asking… What protection can my international healthcare policy offer me, in reality?

Are pandemics excluded from international private medical insurance?
Some IPMI providers include blanket exclusions for pandemics and epidemics. There is some sound logic which sits behind this, given the lead that central government and state healthcare systems take in these situations, the lack of critical care and isolation facilities in many private hospitals, and the desire to avoid a scenario of mass unpredicted claims that would put any senior actuary or finance director into a cold sweat.

The opposing view is that, due to the above factors of a pandemic / epidemic, it is unlikely to cause a flood of high cost claims in private facilities and therefore the plan should be available to cover what it can for its members who find themselves in this scenario.

At the time of writing, the International Health Insurance providers who do have a pandemic / epidemic exclusion on their policies are choosing to not apply them. However, this is at their discretion and that stance may change as the outbreak develops.

Below is a summary of 15 common International Private Medical Insurance providers and their current stance on COVID-19:

If an individual contracts Coronavirus Covid-19 and get admitted to hospital, will their international health insurance cover them?
Currently all IPMI providers are covering treatment for Coronavirus Covid-19. This does provide some peace of mind, however treatment is very likely to be in a state facility and, in the UK the cost of this would be borne by the government. In the vast majority of countries this would be the case, but some countries may look to bill the cost back to the insurer and so may have an impact on the individual if you they a deductible/excess on their plan, or if they are part of an experience rated scheme.

There are a couple of other benefits, which most international health insurance plans now offer that may also be useful in this current outbreak.

• Virtual GP or Telemedicine services are a key tool in allowing people to get medical advice without going to see a doctor. Most IPMI plans now offer this service as a core part of their offering.
• International employee assistance programmes (iEAPs) are also a standard offering on many business health plans and may also provide a useful service in this outbreak. With many employees facing a stressful and uncertain period; job pressure, isolation, financial worries and potentially dealing with family bereavements, having independent, expert advice and counselling on hand could be crucial in helping to steer and support people through a very challenging few months ahead.

Does an International Health Insurance policy cover Coronavirus Covid-19 testing?
All International Private Medical Insurance providers have previously advised that testing would be available via the standard outpatient diagnostic benefit, if you have it included on your plan. However, on Friday 20^th March, Bupa Global advised the UK government is trying to channel all its testing through the NHS and is restricting private testing and so they will no longer pay for “any private screening/diagnostic testing, home testing kits in the UK, this includes any screening/testing undertaken in a private full health screening.” This only applies to members resident in the UK and other international insurer have not all followed suit, we would therefore advise that you check with you own insurer if you develop symptoms and wish to be tested, as this is a quickly moving area.

To claim private Coronavirus Covid-19 testing on their plans, most International Health Insurance proviers require some or all of the following criteria to be met for a private test claim to be accepted:

• To have developed symptoms including a high fever, cough and /or shortness of breath
• If you have been in contact with someone who is infected
• Some insurers require a referral from your GP or medical practitioner
• Please also note that some insurers are placing a cap on the cost of a Coronavirus Covid -19 test. Bupa Global for example has placed a cap of £100 on Coronavirus Covid-19 testing.

What if a country’s state facilities are at capacity and an individual needs emergency medical care. If the policy includes medical evacuation, will they be transported to a country which has the facilities to treat them?
This is a simple one in principal but a particularly tricky one in reality. The short answer is yes, if there is an evacuation benefit on the IPMI plan and the individual is unable to access suitable treatment for their condition locally (some insures stipulate this needs to be a medical emergency). A few insurers would also allow repatriation to country of nationality as standard for an expat who is medically safe to travel.

The reality in the current situation is that this medical evacuation would be very complicated and the ability to evacuate someone would vary significantly from country to country and member to member. This is for a few main reasons;

• Border closures and travel restrictions:

This may stop a member leaving their city or country and other countries will not let them enter. A number of usual evacuation hubs have closed their boarders to people from heavily impacted countries for example South Africa is the main evacuation hub for Africa but now has boarder restrictions in place. Some countries are also allowing travel if a person can prove they are Covid-19 negative.

• Reduced resources available:

As an increasing number of countries find their medical systems swamped with Covid-19 patients, finding available facilities will be significant challenge, especially as a number of countries have also restricted beds to citizens.

• Transportation requirements:

Medical transportation of a person with an infectious disease is complex, expensive and there is a limited availability of the required equipment and expertise. Some of the areas of consideration in addition to the above two points are;

o   Clearance by governments to allow the flight over their airspace, especially if a stop for refuelling is required.

o   The medical staff running the transportation all need to be specifically trained in infectious disease management

o   There is a limited availability of air ambulances who have the required equipment (such as a bio containment unit) and a limited amount of expertise in using these specialist facilities.

Considering all of the above, insurers are going to assess and review requests on a case by case basis and they will need time to talk to air ambulance partners and work through the logistics and paperwork of any potential evacuation, more so than normal.

Our recommendation to business clients would be to review the plans for any employees in a country which is likely to run out of appropriate facilities quickly. Also consider the plans in place for employees who may require an evacuation for a non Covid-19 condition, should something happen to them, as all medical evacuations are likely to be impacted by this outbreak and the general travel restrictions in place.

What about cover once Coronavirus Covid-19 travel restrictions are lifted?
One of the most useful features of any International Health Insurance plan is the ability for it to cover you for medical treatment in your region of cover, which in a lot of cases is worldwide, including or excluding the USA.

Once travel restrictions around the world are eased and people are allowed to travel again, it may be the case that there is still no vaccine available and this Coronavirus Covid-19 is still transmitting in the population at varying levels in different countries. In this scenario again policy coverage would be available via any International Health Insurance Provider covering Covid-19, for treatment in the country the virus is contracted.

Some insurers do limit cover if travel is against FCO (British Foreign and Commonwealth Office) or CDC (US Centres for Disease Control and Prevention) advice.

Are all state healthcare systems around the world bearing the cost of treating Coronavirus Covid-19?
The answer to this varies from country to country, which isn’t surprising given that state healthcare systems in place across the world can vary significantly. However, generally speaking most countries with developed state healthcare systems are taking on the vast majority of the cost of treatment.

We have highlighted four countries below as examples of the similarities and variations in approach:

Dubai: Free telemedicine consultations for all residents. Treatment for Coronavirus Covid-19 is being provided free of cost to all residents. However, those with insurance in place will have their treatment billed to the insurers.

France: Treatment is free for all residents.

Hong Kong: Free treatment for all residents and visitors.

USA: This is a changing situation, legislation passed in the US on the 19^th March 2020 provided free testing for Coronavirus Covid-19 and covering the cost of a doctors, or emergency room, visit to get the test. If you need hospitalisation that can be a little more complex as if you are insured you may still be liable for you out of pocket expense or deductible, although this may stance may change and health regulation is often made a state level, so we would advise to check with your health insurer what coverage is available to you dependant on where you are resident. Aetna is one insurer in the US who has confirmed they will not apply any deductibles or co-pays for inpatient treatment and we expect others to follow this. If you are uninsured in the US, there is no firm commitment yet that this cost will be picked up by either the state or federal government.

By Ian Abbott, Engage Health Group