For many industries, global travel for work is no longer a rarity. And employees who travel for work without proper insurance coverage leave themselves and their employers vulnerable to paying high out-of-pocket costs if they fall ill or are involved in an accident.
This also presents a legal risk to employers that have a duty of care to a globally mobile workforce.
Over the past 20 years, the definition of a global traveller has broadly expanded from expatriates to include inpatriates, third-country nationals, rotational workers, key local nationals, business travellers and contractors.
And there has been an increase in short-term assignments of two years or less, in all industries and regions.
To address these complexities, the global insurance market has designed sophisticated international private medical insurance (IPMI) plans for employees working outside of their home country for more than 180 days per year and for those on business trips.
These plans offer robust worldwide coverage that includes high-risk countries and occupations, alongside a strong focus on global compliance to ensure there are no issues obtaining work visas.
These plans also do not require membership to a government health-care scheme if one is not available. This is important as employees who have moved to a new country may lose government-provided care in their home country, while simultaneously not being eligible for a similar scheme in their new host country.
And, given that dependants often remain in their home country, the plans will cover trailing dependants wherever they reside.
But IPMI plans must include a variety of features to provide an adequate duty of care:
Occupational coverage: Worker compensation programs are often not portable (or only available for short periods of time) and local programs are often not accessible or robust enough. An IPMI should not exclude occupational injury or illness unless the employer has taken out another policy to respond in these circumstances.
Preventive health and wellness programs: Annual checkups, health assessments and wellness tools should be available to a global workforce. Many employees on international assignments lose out on some of the health and wellness initiatives their colleagues receive. IPMI plans can bridge this gap by including these services in their core products.
Pre-existing condition coverage: If pre-employment medicals are not completed or employees are sent on international assignments with ongoing health problems, it is important to include coverage for pre-existing conditions. Otherwise, an employee could be required to pay out of pocket for care that cannot be serviced through insurance or a government program.
Medical evacuation coverage: IPMI contracts usually have an option to add a rider that covers travel assistance and evacuation for medical emergencies. Unfortunately, similar coverage for security or natural disasters usually requires a separate travel assistance contract.
International employee assistance program (IEAP): Part of a good wellness strategy is access to on-demand counselling for personal issues for employees and their families. Stress and mental health-related issues are a big driver of failed expatriate assignments, so mitigation is important. These plans seek to provide telephonic or face-to-face multilingual counselling wherever employees are located.
International platform for service delivery: This provides for the direct settlement of medical expenses or one-time guarantees of payment to avoid out-of-pocket expenses. Specialists help employers to understand the needs of a global employee and the countries in which they are working.
A common question is whether an out-of-country provision under a domestic group medical program can be used. This may not be an ideal solution for the following reasons:
• Trip limits: It is common for there to be 60- or 90-day trips limits on domestic programs. This limits their usefulness for global assignments.
• Emergency-only coverage: Employees who are posted in foreign locations expect to be covered for simple preventive tasks such as doctors’ visits or specialist exams, not just unforeseen medical emergencies.
• Stability clauses: This may exclude important coverage and can be quite restrictive.
• Termination age: It is common to see very senior employees take foreign assignments into their 70s.
• High-risk countries: They may be excluded.
It is important for employers to understand the employee population and to have a strong global benefit strategy.
If they are benchmarking to the domestic plan, they should make sure to compare all the benefits and provisions so there are no gaps that could result in large out-of-pocket costs.
And they should make sure the plan design is applicable, compliant and cost-effective.
Costs can be justified once the risks are identified and the resulting outcome is a positive experience for global employees and their families.
Janice Ogilvie is an international benefits consultant at financial services firm Penmore in Calgary. She can be reached at firstname.lastname@example.org or (403) 202-5953 or (866) 229-2212 x280.