Advice and warnings about expatriate health insurance

Destination country

What you should know before subscribing

  • Expat health insurance policies are not limited to medical emergencies
  • They can cover all types of care
  • You’ll need to complete a health questionnaire as part of your application
  • Check local regulations before subscribing

General rules for how it works

Context for subscription

Expat health insurance is recommended in the following situations:

  • Living abroad for more than one year
  • Retirement abroad
  • People living abroad for less than one year who want complete reimbursement of their medical expenses and other guaranteed insurance coverage.

Expat health insurance replaces a social security plan and traditional health insurance, but the rules are complex and need to be fully understood before subscribing to avoid disappointment or, worse, denial of coverage when making a claim.

The information below identifies issues that should be discussed with an advisor before you choose an insurance package. We also encourage you to carefully read the terms and conditions of each type of coverage or service before you subscribe.

Policy rules

Geographic area:
Expatriate health insurance covers you in your destination country, and possibly in other countries if they are part of the same premium area or a less expensive one. You are also covered worldwide for certain emergency expenses related to an accident or unexpected illness. Each insurer defines its own rules for coverage outside the destination country, so check the terms and conditions before subscribing. International insurers generally offer worldwide coverage, or worldwide coverage excluding the USA. Some may offer more targeted coverage for regions such as Asia, excluding Singapore and Hong Kong. French insurers tend to be more area-specific, which often results in lower rates. However, if you want to be able to choose to be treated in a country other than your destination country, you must include it in your rate area. Inform your International Santé advisor so that they can take it into account when reviewing your file.

Coverage in your home country:
If you have chosen a plan with worldwide coverage, or worldwide coverage except USA, you will be covered in your country of origin. If you have chosen a country that offers another coverage system, your coverage will depend on the premium area in your country of origin and your destination country. In any case, read the terms and conditions of your chosen plan carefully, to avoid any concerns about coverage. International Santé advisors can provide you with all the information you need on the subject upon request.

Annual renewal:
Most global health insurance policies are renewed automatically. This means that the insurer can’t decide to cancel the policy of an insured person because they consider it to be too expensive. The insurer also can’t decide to increase an insured person’s individual rate. This guarantees that the insured person will be covered, even if they have already begun medical treatment. But be careful: Some contracts may have an end date linked to age (for example, turning 65), or to changes in your status such as retirement. If you are planning to remain abroad for a long time, or if you are approaching these types of milestones, feel free to consult your advisor.

Rate increases:
Once you’ve subscribed, premiums may change based on 3 criteria:
- The annual indexing of health care expenses by geographic area (between 2% and 8% per year).
- The changes in each insurer’s technical performance. If an insurer’s performance has been good, they can implement a lower increase than the annual indexing, while if it is poor, they will clearly need to implement a higher increase.
- A change in the age bracket of the insured. Each insurer is free to define their own age brackets.

These premium increases depend on the insurer, and are not necessarily applied on the same dates. They may occur on the anniversary of the subscription date, on December 31, or on the insured's birthday. This means that your first rate increase may occur only a few weeks after the effective date, or more than a year later.

Presentation of rates:
In our tables, we list the price per month to provide you with a uniform basis for comparison. The price per month is calculated by dividing the annual fee by 12. Each insurer offers its own installment plans (semi-annual, quarterly or monthly) for which they may charge a fee. The rates presented in our tables do not include these fees, but they are generally listed in the detailed tables found under Fees and charges.

How coverage works

Waiting periods:
Most expat health insurance policies have waiting periods, also known as delayed coverage. During these periods coverage is not granted, or is limited to emergencies. They can vary depending on the type of care. For example, there may be no waiting period for routine care, 3 months for hospitalization, 6 months for dental and vision care and 10 months for maternity care. Check the terms and conditions. They may sometimes be removed if an equivalent insurance has been cancelled recently. If this is the case, you’ll need to provide a certificate of cancellation along with a detailed table of benefits.

In many expatriate health insurance policies, maternity expenses are an add-on option and are subject to a 10-month waiting period. The expenses covered under this option also vary from one insurer to another. If you are planning a pregnancy, please inform your advisor so that they can find you a suitable plan.

Even though global health insurance policies have a scope of coverage comparable to that of a Social Security system, they all have exclusions of coverage. The following is a non-exhaustive list of examples:
- Psychiatric or mental illness
- Plastic surgery, whether or not it is related to an accident or an illness
- Participation in certain sports
- Certain professional activities

All exclusions are specified in the Terms and Conditions of each policy, and an advisor can provide them to you upon request.

Certain medical care may require pre-authorization from the insurer. This may include hospitalizations, series of treatments such as physical therapy or speech therapy sessions, or even dental prostheses.

Direct payments and third party payments:
With the exception of the USA, there are no third-party payment systems equivalent to those offered in France by traditional health insurance companies. You pay for your health care expenses, and are reimbursed afterwards. However, for hospitalizations lasting more than 24 hours, the insurer pays the establishment directly.

Reimbursement management procedures:
To handle reimbursements, insurers may offer reimbursement options by email, through an online customer service center or via smartphone apps. In some cases, insurers require you to mail them your original receipts (for invoices over €1000, for example) along with a reimbursement request document that can be download from their website. If you live in an area where the postal service is unreliable, talk to an advisor so that this can be taken into account when considering insurance packages.

Repatriation assistance:
Repatriation assistance is offered as an add-on. Prices vary from one insurer to another. It covers medical transportation to a quality establishment, either in your host country, a neighboring country, or your country of origin. It is essential if you live or will be traveling in areas where the provision of healthcare is limited. It often includes many services designed to make your life easier in the event of a health problem: medical advice, addresses of health care centers, delivery of medication, etc.


The health questionnaire

Do I have to fill out a health questionnaire?

All expatriate health insurance policies include health questionnaires that must be completed as part of your application.

If you are undergoing or planning to undergo treatment, or if you have had health issues in the past, you will have to declare them. The insurer may then decide to offer you regular coverage, coverage at a higher rate, or coverage that excludes certain health expenses. They may also decide to refuse your application completely.

If you have a history of health problems, talk to an advisor. They can help you find an insurer who is more likely to accept your application.

Please note: International Santé advisors are bound by strict professional confidentiality agreements, but aren't subject to medical confidentiality. In order to benefit from medical confidentiality, please send your application directly to the insurer's Medical Advisor in an envelope clearly marked "Confidential Medical Information." Advisors can provide you with envelopes for this purpose upon request.

How to complete the questionnaire correctly

All insured adults must complete the questionnaire themselves and sign it. A parent may complete the questionnaire for a child under 18. However, a parent subscribing on behalf of their child who is a student abroad cannot fill out the questionnaire for their child.

You must tell the insurer everything

You have to answer truthfully and completely. However, each insurer asks different questions, and you should only answer the questions that are asked.

If you answer yes to a question, you will need to include information such as dates and details on how the situation is progressing in your answer. If you did receive any further monitoring or follow-up after a treatment, be sure to include that information.

For example: right ankle sprained in 2017, 10 days of anti-inflammatories and 10 sessions of physical therapy, no follow-up or aftercare.

In the questionnaires, we often find the terms "condition," "disease" and "symptom" and those insured may always know which term to choose. The easiest answer is to say, "It’s what you tell your physician when you explain the reason for your visit."

If you’re still sure, to avoid any problems, just answer yes to the question and explain your situation in detail. It is better to say too much than enough.

The consequences of an incomplete declaration can be far-reaching!

As soon as you submit a reimbursement claim for the limb or condition in question, your insurer will probably receive the information created by the physician. If they consider a health declaration to be incomplete or inaccurate, they will not bother to ask you for an explanation. Depending on the seriousness of the case, the insurer may:

-Refuse to reimburse you
-Decide to exclude a specific pathology, body part or medical specialty
-Cancel your subscription outright while keeping any payments already made.

Saying that it isn't the same back pain or ENT problem as the one mentioned in the physician’s report will work either, because they can’t redo your whole medical history for every claim.

The concept of a false declaration applies here in a broader sense. If an insured person hasn't declared a medical condition and the insurer finds out, the insurer can decide that the insured made a false declaration, even if the insured hasn’t filed any claims for their undeclared condition. This is because, on the one hand, the insurer wasn't able to assess the insured's overall state of health at the time of application and, on the other hand, there is nothing to prevent the insured from filing claims for this undeclared condition later.

Picto vidéo

Health questionnaires rely on the principle of confidentiality


Local regulations

Obtaining expatriate health insurance does not exempt you from any possible obligation you may have to sign up for local health insurance plans, or the payment of any applicable local taxes on the insurance policies you purchase.

We strongly advise you to contact the appropriate local authorities for more information.

Some of the countries concerned are: the United Arab Emirates, Germany, Switzerland, the USA, Singapore and Thailand. Requirements may vary depending on the type of visa you have, your professional activity and the date on which you take out your policy. The International Santé advisors can provide more information about these requirements. Feel free to contact them.

Optional coverage

Apart from health expenses, there are other types of coverage that are important for your financial security:

Medical leave of absence and disability:
This guarantees you a replacement income if you are temporarily or permanently unable to work. This is essential coverage because it is almost never provided by the social systems in host countries. In the event of an accident or long illness, you could find yourself without any income for several months, several years, or even for life.

Civil liability:
This covers you against material, immaterial or physical damage that you may cause to third parties. It generally includes legal assistance, which can be very useful abroad.

Kidnapping and ransom insurance:
These are useful in certain high-risk countries or for people who are in particular danger.

We strongly encourage you to ask our advisors about all these optional coverage possibilities.

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