A lot of people living in the EEC and relying on the European Health Insurance Card may be in for a rude shock but what exactly does it cover – and what doesn’t it cover?

The EHIC exists to provide cardholders, travelling on a temporary  basis, access to state-provided healthcare in all European Economic Area (EEA) countries, plus Switzerland, at reduced cost and possibly free of charge.

Medical conditions that arise during a cardholder’s trip are covered on presentation of the card, but the EHIC does not entitle you to travel to an EEA country with the intention of receiving planned treatment. Exceptions to this include maternity care, renal dialysis and the management of symptoms of pre-existing chronic conditions.

The EHIC does not guarantee to reimburse 100% of the cost of treatment received. Many countries expect patients to contribute towards the cost of their treatment and an EHIC cardholder may be expected to do the same. Although it may be possible to seek reimbursement for a shortfall when the cardholder returns to the UK, this might not be possible in all cases.

The EHIC is not a panacea when travelling abroad, as it does not provide cover for treatment in private medical facilities, repatriation to the UK, mountain rescue at ski resorts, or lost and stolen property. It should therefore be used to complement a good travel insurance policy.

It should be noted that a UK-issued EHIC card cannot be used to access healthcare by anyone who has moved “permanently” to an EEA country, or Switzerland.

While it may be well known that over 55s need to have cover, what level is enough? What are the key healthcare and planning topics intermediaries should be covering with their retiree clients?

The Foreign and Commonwealth Office (FCO) recommends the medical cover of your travel insurance policy should be a minimum of £1m for Europe and £2m for the rest of the world.

A client over 55 is likely to have pre-existing medical conditions, unless they have been very lucky. It is therefore vitally important that the implications of underwriting are discussed with the client, as pre-existing medical conditions may be excluded permanently, or temporarily, depending on the method of underwriting. A plan which covers the individual for repatriation including burial at home and abroad should be considered.

The affordability of premiums as a member increases in age should also be discussed, to ensure a client can afford the policy in future years.

While PMI clients tend to have visions of emergency evacuations, air ambulances and near death experiences in reality assistance usually comes in far less a dramatic form. What are the main reasons people use their PMI?

As well as cover for medical emergencies and curative treatment many international private medical insurers provide a ‘Wellness Benefit’ that pays for treatments that help to maintain clients health, for example cancer screening, cardiovascular or neurological examinations, well child tests, vital signs tests or vaccinations.

In addition to obvious example of wellness, many plans include benefits that can contribute to day to day wellbeing, either by paying for treatment that helps to maintain a certain level of health or by encouraging individuals to seek treatment for non-emergency medical conditions. The benefits on offer aim to provide peace of mind and protection for individuals in unfamiliar surroundings.

Customer service – when something goes wrong abroad what standard of service and treatment can a client expect from their provider?

InterGlobal’s service levels should remain the same regardless of the individual receiving treatment at home or abroad. Close links with assistance companies and medical providers in order to ensure individuals receive a consistent level of service. A client should expect to be able to pick up the phone 24-hours-a-day, 365 days-a-year to an insurer’s multilingual helpline. The helpline staff will offer advice on how to claim, arrange for planned treatment to be pre-authorised and to arrange for medical evacuation/repatriation in conjunction with the treating doctor.

We have entered into a unique and exclusive partnership with security experts red24 in order to provide 24/7 security services and solutions to ensure that insured persons are prepared for the unexpected. These services are essential for those travelling to countries where there is a risk of political instability.

red24 not only offer practical assistance to protect insured persons when they unexpectedly find themselves at risk in a violent situation, they can also provide insured persons with preventative and proactive advice to minimise their exposure to such situations. The insured persons can be provided with up to date security information and advice on a particular country either online or via a security helpline as well as on the ground support - including security evacuation if required.

What sort of intermediary should consider selling international PMI and how profitable is it an area of business?

In addition to specialist healthcare intermediaries, an increasing number of Independent Financial Advisers (IFAs) are advising clients on IPMI. InterGlobal plans can be sold to expatriate clients and to high-net-worth individuals looking for a policy with a higher specification of benefits than you would normally find in a domestic PMI policy. Popular benefits include cover for private GP fees, chronic medical conditions, routine maternity and the flexibility to claim for planned treatment received abroad.

Building a portfolio of international PMI clients will establish a useful additional revenue stream to an intermediary’s core business. Due to the nature of the product, premiums will be higher than those of domestic PMI plan but with attractive commissions of up to 20% for individual business. Both initial and renewal commission are now indemnity based and offer an attractive package to provide the intermediary with a steady income.

Considering it’s cheap, popular and easily accessible it is little wonder so many people rely on travel insurance instead of a PMI policy. But when should advisers recommend to their clients to opt for the extra coverage and peace of mind?

Although travel insurance is a popular and accessible form of insurance for individuals travelling abroad it does not offer the level of cover or benefits that an international private medical insurance policy can provide. Travel insurance should therefore be considered for short trips of no more than two weeks, for example a family vacation or business trip. Travel insurance is designed to pay out for unforeseen events, such as medical emergencies. The longer you stay away from your home country, the more likely it is that a person will require non-emergency medical treatment. Many multi-trip travel insurance policies restrict the maximum travel time to 90 days per trip. An adviser should recommend a client seriously considers an international PMI plan if the client travels abroad frequently for long periods, or is looking to reside abroad.

What should international PMI intermediaries be telling their clients about the potential impact of pandemics?

An IPMI intermediary should be able to advise its clients of exactly how their insurer would deal with a potential pandemic. The terms and conditions of the policy should be checked to ensure that the insurer will pay out in the event of a pandemic.

What impact do advances in medicines and medical procedures have on international PMI policies?

Advances in medicines and medical procedures have a similar impact on both domestic and international policies as these advances tend to spread worldwide creating a cost implication, especially in countries like the USA where medical treatment already carries a high price. Investment in new technologies and medicines often means that IPMI and domestic providers see a rise in their costs per claim as these changes filter down. As time progresses a wider number of medicines and procedures  become available to policyholders, which inevitably has an impact on the premiums payable but also provides better quality treatment for clients which in turn helps to aid a speedier recovery.

British people who spend more than three months living outside the UK are no longer automatically entitled to free NHS hospital treatment in England. Are there solutions in place that will pay for medical treatment when they are both home and abroad?

InterGlobal plans provide cover for members in their home country providing their home country is within their chosen geographic area of cover and taking into account any restrictions there may be within their home country. By choosing the right cover members can still benefit from treatment both home and abroad.

With several countries implementing new legislation, how important is it that intermediaries keep up to date with the rules in the countries in which their clients are operating? And how do they stay informed?

It is extremely important that intermediaries keep in touch with events in the market place to ensure that they provide accurate and up to date information for their clients. Intermediaries should make contact with an international insurer’s compliance department, which should be able to give advice on current and planned legislation. Regularly seeking information from websites such as the World Health Organisation (WHO)and the Foreign and Commonwealth Office is advisable for up to date information.

How easy is it to get cover in so-called danger zones?

Cover in so-called danger zones is not easy to obtain. However, InterGlobal will consider cover within so-called danger zones such as Iraq subject to certain benefit exclusions or premium loading due to increased risk.

Technology is vital in the international PMI arena. How well are brokers geared up to the needs of their clients and business partners?

The internet and e-mail are ideally suited to the IPMI arena, as documentation can be sent in soft copy around the world instantaneously. Brokers can e-mail claim and pre-authorisation forms to their clients on request. Scheme administrators can e-mail details of changes to their schemes to the insurer, via their broker. Increasingly, intermediaries are offering to act as scheme administrator for their clients, using the insurer’s online services facility to make membership changes etc. Management information reports can be e-mailed by brokers to their overseas clients.

How much of a threat to international private medical insurers are local providers? What should customers be wary of?

There are a wide variety of plans in the market place by local providers which offer varying levels of cover and benefits. It is essential that clients ensure that the cover they purchase meets their needs and demands/expectations. Repatriation of mortal remains can be an expensive exercise if the bereaved is left to pay instead of the IPMI provider. Individuals should also be aware that local plans may not cover individuals and their family for treatment in their home country. A local PMI plan is likely to have benefits tailored to the local market, but may not necessarily meet the needs of an expatriate client.  Evacuation and repatriation cover is unlikely to be included and the geographic area of coverage will be limited. As a result, a member will not be able to seek medical treatment in his or her home country, or anywhere outside the restrictive area of cover. The terms and conditions of the plan should also be checked carefully, as they may differ from what is deemed customary in international private medical insurance plans.

What facilities are there in place for brokers to reassure their clients that their policies will get them access to the best quality medical care while abroad?

International insurers will often have robust provider networks in place all over the world to provide quality medical treatment and services. Other insurers will allow the client choice of provider. If the latter is the case, a system of pre-authorisation of treatment allows the insurer to steer the insured member to another facility if the one chosen was deemed to be inappropriate for their requirements, thus ensuring the best quality medical care.