iPMI Magazine Expat Health Insurance Round Table: Managing The Lifecycle Of An Expatriate

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INTERNATIONAL HEALTH INSURERS FORUM Made with Love by iPMIM

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ROUNDTABLE SESSIONS 2012

MANAGING THE LIFE CYCLE OF AN EXPATRIATE EXCLUSIVE C-SUITE IPMI EXECUTIVE COMMENTARY FROM ALC HEALTH - HTH WORLDWIDE - IMG EUROPE - INTEGRA GLOBAL - MORGAN PRICE - MEDIBROKER - NOW HEALTH - VALENTE ROCHA

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Exclusive Roundtable: Managing The Life Cycle Of The Expatriate

Expatriation tends to involve posting highly specialized and highly paid employees the ball rolling�. How will you evolve your health care service offerings to cater to th

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INTERNATIONAL HEALTH INSURERS FORUM In a Closed Door Exclusive Round Table Business Forum 2012, iPMI Magazine Spoke with Industry Leaders from the Private Medical Insurance Market.

Get the Inside Track on Expat Health Insurance from the Experts.

Moving a business into new uncharted waters where your native tongue may not be the local language is a daunting affair.

Speak to any CFO, HR Director or Expatriate or simply consider the stress put on ones shoulders when operating in a foreign and sometimes hazardous environment. For the unseasoned traveller on distant shores even simple tasks like shopping can be a strain.

So imagine being in a life threatening situation, miles from home and family, seeking professional medical services and attention, in a foreign language and without the correct insurance coverage.

Roundtable

s to international locations, in small teams, to “get he growing demands of the expatriate?

iPMIM >> International Health and Medical Insurance | Expatriate Health Care

we have you covered

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iPMIM >> International Health and Medical Insurance | Expatriate Health Care

HTH WORLDWIDE

IMG EUROPE

INTEGRA GLOBAL

ANDREW APPS

ANGELO MASCIANTONIO

CARL CARTER

PHILIP CATTERTON

MEDIBROKER

MORGAN PRICE

NOW HEALTH

YOU ARE GLOBAL

STEVE NELSON

JON CARPENTER

ALISON MASSEY

ADRIANO VALENTE ROCHA

A BIG THANK YOU TO ALL OUR SPONSORS ESPECIALLY INTEGRA GLOBAL WHO MADE THIS FORUM POSSIBLE. ACCESS TO HEALTHCARE AT HOME FOR EXPATRIATES

MEDICAL EVACUATION OPTIONS

TECHNOLOGY, ONLINE PORTALS AND APPS

8Expatriates like to head home for major health care treatment.

Does your expat insurance plan support global portability?

8 In case of civil unrest or demonstrations, will your insurance policy cover for medical and nonmedical emergency evacuation?

8Look for value and insurers that accelerate the customer experience through the power of technology with tools like ZapTag.

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ALC HEALTH

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iPMIM

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FRONT COVER PORTABILITY AND ONGOING USABILITY OF PRODUCT

CULTURAL DIFFERENCES TRAINING AND SUPPORT

EMPLOYEE ASSISTANCE PROGRAMS AND WELLNESS

An expatriate far away from home protects himself from a unexpected rain storm.

LEGAL 8Will your expat insurance policy offer coverage in your home country when your assignment ends? The best laid plans can go wrong and you need to prepare for every eventuality. The ongoing usability of the product is critical.

8Working in a different country comes with challenges. Understanding local custom and culture is key to living abroad. Superficial symbols like a handshake, food, languages and basic etiquette are important to master when living abroad.

8Living away from home can be stressful, especially during times of ill health. EAPs are intended to help employees deal with personal problems that might adversely impact their work performance, health, and well-being.

© 2009 - 2013 All rights reserved. All editorial content and graphics in iPMI Magazine are protected by copyright, international treaties and other applicable copyright laws and may not be copied without the express written permission of iPMIM.

Sometimes it’s good to have a lot on your plate.

With a wide range of international health plans providing coverage for expats, travelers, students, missionaries and more; GeoBlue keeps your plate full of options.

Our network of elite physicians in over 180 countries extends an all-access pass to an exclusive level of care worldwide. And because each GeoBlue policy is U.S. licensed and offers the most complete set of benefits and services in the industry, you can feel confident that your clients expectations will be exceeded.

For more information: Visit: www.geobluetravelinsurance.com Call: 1 (855) 481-6647 or 1 (610) 254-5850 Email: sales@geo-blue.com

Š2014 GeoBlue. All Rights Reserved. GeoBlue is a trade name of Worldwide Insurance Services, LLC, an independent licensee of the Blue Cross and Blue Shield Association.

iPMIM >> International Health and Medical Insurance | Expatriate Health Care 11

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8 PLEASE INTRODUCE YOURSELF, YOUR BUSINESS AND BACKGROUND IN THE INTERNATIONAL EXPAT, TRAVEL AND HEALTH INSURANCE INDUSTRY:

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of Omaha, Wand AG and Aetna (Goodhealth) before joining ALC Health in December 2009. As a seasoned traveller and former expatriate having worked extensively in Russia, the Republic of Georgia and Germany, I understand what it is like to be living overseas in an unfamiliar country, but also the importance of being able to access high quality medical care both at home and abroad. ALC Health has for more than a decade been providing international medical and travel insurance protection to private clients, companies and organisations worldwide and we continue to grow and develop on a philosophy of ensuring that every policyholder whether as a private individual or a member of a corporate group is assured of the highest level of personal service and support.

Jon Carpenter: I’m Jon Carpenter, an ACII Chartered Insurance Broker. I own two companies in the expatriate insurance business: Morgan Price International Health Care Ltd, an MGU/Product provider, and Expatriate Insurance Services Ltd; a broker involved in international and domestic Private Medical Insurance since 1990.

MPIH is a founder member of the Association of International Medical Insurance Providers, and EIS is a member of BIBA and the Association of Medical Insurance Intermediaries. Both MPIH and EIS are looking at the domestic UK private medical insurance market in 2012.

Angelo Masciantonio: My name is Angelo Masciantonio, and I’m cofounder and CEO of HTH Worldwide. HTH is my third successful start up. Prior to HTH, I was the CEO and cofounder of Workers Comp Advantage, Aetna U.S. Health care’s managed workers comp company and founder and CEO of Managed Health Care Services, a managed care development and data services affiliate of The Traveller’s Insurance Company, which developed doctor and hospital networks in over sixty U.S. Cities and provided data analyses services to state commissions which set hospital rates. Together, these ventures have prepared me to build a data-driven business focused on the needs and expectations of U.S. expats and other global travellers. The team I have assembled at HTH has a detailed understanding of global health care and the health care experience Americans expect – both at home and overseas.

Alison Massey: I’m Alison Massey, marketing and ecommerce director of Now Health International. I’ve been a financial services marketer for over 20 years; the previous seven within International Private Medical Insurance with Goodhealth Worldwide, Aetna Global Benefits and most recently Now Health.

Adriano Valente Rocha: I am Adriano Valente Rocha, Director of ValenteRocha Consultora e Corretora de Seguros, an insurance brokerage firm founded in 2004.l

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hilip Catterton: I’m Philip Catterton, an American with 25 years of experience both in the capacity of working and living, as an expatriate since 1989. I am a founding member of Integra Global which was established in 1999. I have personally steered the company strategy and pioneered technical advancements, including Integra Global being the first provider to offer online enrolment and the full scale implementation of Zaptag personal health care records. As an American firmly grounded in Europe for over two decades, I have a unique perspective on not only what a comprehensive health care plan should include, but also to embody the unique aspects of what North American and globally, what expatriates are looking for in a quality plan.

Steve Nelson: Steve Nelson, Sales Manager, Medibroker.

We are a dedicated online expatriate medical insurance broker and have specialised in iPMI since our inception in 1998.

Carl Carter: I am Managing Director of IMG Europe, the European subsidiary of International Medical Group (IMG). I have approaching 15 years experience in the international medical insurance business at senior management and Board level.

Andrew Apps: With over 30 years senior sales and marketing experience across the medical insurance industry, the past 22 within the international sector, I have held a range of management roles with a number of industry leading players including BUPA, Mutual

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8 CROSS BORDER HEALTH CARE IS COMPLEX. WHAT DO YOUR CLIENTS DEMAND, AND WHAT DO THEY RECEIVE?

hilip Catterton: Integra Global’s clients our “Members” choose our plans if they are looking for comprehensive coverage at an affordable price.

Our clients are typically families and professionals that plan to live abroad for longer periods of time.

They receive excellent coverage including – superior wellness benefits, maternity, and inclusive emergency evacuation; easy accessibility to providers through our extensive direct bill networks globally, seamless online applications, billing and personalized customer service.

Moreover, we are one of the few international health care providers that do not have specific limitations on chronic conditions, prescription drugs or outpatient treatments.

Carl Carter: In such a competitive and truly global marketplace, clients demand the best in terms of product coverage, service delivery and of course competitive pricing. We know that our clients and brokers have a wide choice of providers on both a regional and international basis, so we always strive to deliver innovative and highly competitive health insurance products and services.

We always aim to go the extra mile in terms of both service delivery from offering a fast and efficient claims turn around right through to our innovative use of online customer service technology - as well as providing many unique coverages that go far beyond traditional old school expat medical insurances.

Alison Massey: The market has historically suffered from a poor service reputation. The days of customers’ hand-writing a claim form, having it signed off by a GP and waiting weeks for even the smallest claims to be paid are over, or should be.

Clients are now very demanding and rightly expect the best cover and extremely fast service from what

is, after all, a premium product. Our Steve Nelson: No two clients are service is underpinned by a set of the same and so clients demands service promises that guarantee differ greatly. What we have to do how fast we’ll complete important is ensure that our level of service tasks and a unique state-of-the-art meets our client’s requirements IT platform that delivers full online whatever that maybe. To this end plan management to our customers we have a team of dedicated experts – these are the new hygiene factors in iPMI who offer fast and impartial in this business. advice from nearly 30 different Angelo Masciantonio: Our clients, providers so that we can find the whether individual or group members, right plan for our clients. are looking for U.S. style group plan Jon Carpenter: Clients demand first benefits and services. class service, from knowledgeable They also want the convenience staff, coupled with value for money of reliable medical information and products that do what they say on assistance services delivered on the tin. This is what they get from mobile devices. both companies.

Employers want to empower their Adriano Valente Rocha: As a leading employees with the knowledge to health insurance broker in Brazil, we handle a medical event while providing provide health insurance plans from them with the extra level of care leading worldwide providers like that HTH provides.

Integra Global, Cigna, and Now HTH continues to provide updates Health. and information to manage their As a gateway into Spanish speaking expectations. Members gain access health insurance markets, our clients to our fully profiled, contracted want to insure they are covered for doctor and hospital network in more any eventuality. Our clients want than 185 countries. options and choice, backed up by Clients also know that on-going the best administration, customer insurability is very important once service and claims management. they return home. Our plans allow They demand the most up-to-date for seamless coverage back home i n f o r m at i o n o n n e w p l a ns because we offer U.S.-admitted, and providers. credible insurance coverage.

It is often that clients demand Andrew Apps: This industry is as some sort of travel insurance plan much as about the service that we as international private medical deliver as it is about the products insurance is quite unknown among that we offer, and the ability of ALC major Brazilian companies and Health to deliver a market leading consumers. As we understand Brazil client experience is about the day is passing through a unique phase to day interaction we have with in terms of economic and social our clients. improvement, and a lot of Brazilians From the purchase decision and have realized they can afford to go enrolment through to making a abroad; either to work, or study for claim, our aim is to provide our clients extended periods of time. with a simple, straight forward and As a result, more and more clients stress free experience. are now demanding iPMI plans in As a specialist provider we have Brazil, to cover medical, travel and only one chance, so we make sure potential air ambulance medical that we deliver the service and evacuation costs, for expatriates, support that our clients expect and business executives, leisure travellers demand every time. and of course the family. l

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8 OVER THE NEXT 5 YEARS, WHICH GEOGRAPHIC MARKETS AND INDUSTRIES WILL REPRESENT YOUR CORE STRATEGIC FOCUS, AND WHY?

hilip Catterton: We approach markets individually, rather than following others. Often insurers concentrate on demographics rather than markets where they know they can make a difference. Historically, Integra Global has focused its efforts on expatriates in key areas around the world including Europe, Asia and the Middle East. The global trends for expatriates point towards the BRIC countries, which do remain of interest, however other regions such as Africa and Central /Eastern Europe currently remain under served. Moving forwards, the South East Asian market is an area where we have direct support and this will be a near term focus in our expansion strategy. Our goal is to grow in areas where we are can build relationships with brokers, intermediaries and employee benefit firms, that have the best interest of the customer in mind.

Alison Massey: We’re already wellestablished in Europe, the Middle East and in some areas of Asia. Our next major market is Mainland China where we will be looking to target local nationals as well as expats.

There’s been a dramatic rise in income amongst many Chinese citizens who are becoming more aware of health care choices outside of China – and an IPMI policy is the perfect vehicle to allow them to exercise those choices.

Andrew Apps: With the demand for international Private Medical Insurance continuing to grow, as more and more governments are transferring the responsibility of health care onto the shoulders of the expatriate, the focus for our business is squarely on the new and emerging regions rather than the traditional countries of the Middle East, Continental Europe and North America, which are showing signs of market saturation. Central Asia, South East Asia, Africa and Eastern

Europe will be ALC Health’s key focus over the next few years as we continue to develop regional products and services to meet local Private Medical Insurance demand.

Angelo Masciantonio: We will continue to see expansion in the high-tech, medical and educational markets. We are keeping an eye on the U.S. regulatory environment, which may shape the domestic health insurance market over the next few years. A recent study projects that because of health care reform, 30% of U.S. employers are going to drop group health coverage in the years following 2014 when the Affordable Care Act takes effect.

That sets the stage for the individual market to expand, and we will be there to ser ve the needs of individual expatriates. Geographically speaking, HTH will continue to partner and provide services in other global territories. Through our GeoBlue expat insurance programs, we expect to have a significant expansion in blue cross and blue shield branded programs in other opportunistic markets.

Jon Carpenter: The BRIC countries are going to dominate the world recovery coupled with the traditionally rich oil nations of the Middle East.

These are the countries we will be focussing on going forward, as this is where the demand for expatriate workers will be, and hence for our health insurance products.

Adriano Valente Rocha: Brazil and Latin America represent our core strategic commercial focus. There is a big increase in the demand for iPMI solutions for travellers and expatriates coming (and leaving) to Brazil. Groups and Individuals have realized that public health systems may not be relied on for a suitable standard of care. As Brazil flourishes economically, we forecast more growth and development in numbers.

Carl Carter: We are already an award

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winning and a leading global provider in the international expatriate and international medical insurance marketplace and our core strategic focus is to maintain that position through investment in people and technology, but by also working closely with our insurance brokers and their clients worldwide.

We will also continue to develop new and unique product solutions for an increasing number of niche international markets in addition to our existing marine crew, student groups, teachers and even missionary groups – these all require cover that is designed for their distinct needs rather than ‘bending’ an existing product to try and fit. In addition to increasing our range of short term expatriate and international travel medical insurance plans, we are also focusing on providing regionalised products for certain geographic or regulatory environments and markets, to give both our global and regional brokers some of the very best ‘world class’ products available locally. This will support their business and the needs of their regional clients, countering against the ‘local’ home-grown products, being offered to expats in-country.

Steve Nelson: As an online virtual broker our geographic reach is Worldwide – we can usually find a plan for an expat no matter where in the World they are. However, iPMI is geared up towards the professional expat and so the areas that will attract them will be of interest to us. The Middle-East and Far-East countries continue to attract expats but of course we need to focus on the newer expat destinations such as China, Russia and India. Some of the other ‘less popular’ Far East countries such as Thailand seem to be attracting younger professional expats too. Some South American countries such as Brazil can also provide a good source of expats. l

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8 THE PRIVATE MEDICAL INSURANCE MARKET IS HIGHLY COMPETITIVE. HOW WILL YOU ACHIEVE SUCCESS IN YOUR STRATEGIC VISION?

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hilip Catterton: Our focus has been on building a streamlined billing process by accessing local direct bill network providers that have the expertise to handle claims and to provide the needed infrastructure to properly support our members. In areas where language and cultural differences are barriers we find this as a welcomed service to our members in accessing health care providers when needed.

Alison Massey: Like any strong business we have a clear plan and firmly entrenched values – customers first, value people, deliver promises and think ahead. These are serving us well so far and, unless there are good business reasons to make changes, sticking with them will ultimately enable us to achieve our strategic vision.

Steve Nelson: As an online business we will rely on SEO work to find us the right clients in the right areas. With a track record of approaching 14 years we also find that the good old fashioned recommendation from an existing client very welcome. This is testament to the hard working, dedicated staff at Medibroker.

Angelo Masciantonio: Innovation and service have always been the key to the HTH Worldwide strategy. We have a patented online appointment scheduling process, and we were the first international health care provider to offer downloadable apps for finding and accessing care abroad.

In February, we launched a social TV program- On the Map- on Facebook to reach our targeted markets. By continuing to innovate, we plan to achieve our goals.

Jon Carpenter: Hard work, focus, and most importantly by recruiting and retaining personnel who have a like mind and vision.

Adriano Valente Rocha: We have a number of key advantages that helps us achieve our success in the business plan. In the last 24 months we have seen an increase in business from the inbound travel market to Brazil. As a dedicated and local insurance broker we know and understand local culture and business practices in Brazil, but also in Spanish and Portuguese speaking countries. We provide the best choice in international health insurance solutions, in

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terms of medical coverage. Brazilians rely on us as a local team that can understand what may be provided on a global scale, and from a host of health insurance providers.

We speak Portuguese and explain the nuances of International Private Medical Insurance products in their own language, with marketing materials available in Portuguese or English.

Andrew Apps: Our industry has proved remarkably resilient during the global economic downturn, due in part to the demand by expatriates across the globe for high quality health care while working overseas. For many, iPMI continues to be seen as an ‘essential’ rather than a ‘luxury’ and is highly valued by those on overseas assignments. We believe that our future success will be reliant on our continuing ability to create a long term emotional bond between our clients and the company through brand loyalty, the longevity of our business proposition and the profitability of our portfolio.

The iPMI market is seeing an increasing demand from those looking to purchase iPMI through the internet, a vehicle which is fast becoming the expatriates’ primary route for obtaining information about international private medical insurance.

Client service excellence is not simply about process change, more importantly it is about transforming mind-sets and behaviours; the day to day interaction of ALC Health at each of the touch points with its clients. It requires an understanding of the journey clients take from the first instance they become aware of ALC Health as a brand, the purchase decision, the initial inception experience, making a claim, the interaction with treatment providers and through to renewal and leaving.

Carl Carter: By keeping a very close eye on the market, continually developing new coverage and service solutions to complement our existing product range.

We will continue to invest heavily in both people and technology whilst working very closely with our global and regional brokers and by investing in and providing first class sales, technology, training and marketing support to our brokers. l

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8 HEALTH, TRAVEL AND EXPAT INSURANCE BUYERS DEMAND VALUE. HOW DO YOU DELIVER VALUE TO YOUR CLIENTS?

hilip Catterton: Insurance is a given in 2013 and an underrated component in offering value to a member is the personal service provided.

Delivering value is core to our philosophy and as a hands-on company, we take a minute-byminute interest in the welfare of our plan members. This ethos is also present in the way in which we recruit and manage our broker/ intermediary network. For us it is crucial that distribution partners share the same vision and dedication to the customer, in order to live up to customer service expectations and benchmarks set. This way we ensure value delivery at each step of the customer experience.

Technology is another area. For example, our expat health plans come loaded with an Electronic Health Records Account powered

by Zaptag. The system enables members to build a complete health picture online, which can then be shared safely and securely with trusted health partners, providers and payors. As we know the right patient info at the right time is critical, and the convenience of having insurance documents and health records stored in one place, at one time, can save a life in an emergency.

As testament we are on target for 55-60% growth in 2013. That is due to member plan satisfaction and how confident our brokers are in our plans delivering.

Angelo Masciantonio: We deliver value by offering innovative and critically important medical assistance services. We provide all of our members with the same level of care abroad as they expect in the U.S. We strive to provide exceptional service, convenience and quality.

For example, through formal contracts with providers, we ensure that members avoid expensive balance billing hassles and that the

providers are following guidelines for usual, customary and reasonable fees. Members can avoid paying up front and out of pocket when they schedule appointments through HTH Worldwide. Our mobile tools and 24/7 concierge style assistance services provide peace of mind to our members.

Alison Massey: We have a very comprehensive set of plans for clients.

They do allow for differing budgets but we have been very careful to ensure we have some of the highest levels of cover across all of our policies.

We have a ‘claims paying’ approach to business and, as such, our clients can be assured we’ll be there to help them when they need it most. We sort out cover quickly and pay claims quickly, which is how we like to do business.

Steve Nelson: We offer value to our clients with the wealth of experience and knowledge we have in our field – in our small sales team alone we have more than 24 years combined experience and our product knowledge is vast. This gives us the ability to always offer best, impartial advice to our clients.

Jon Carpenter: As an MGU, Morgan Price is able to constantly review its products and service offerings and where they do not work, change them. As a small flexible company we don’t have huge layers of bureaucracy and so decision making is quite easy.

On the other hand we don’t have the resources of our larger competitors so we have to ensure value at all levels of the supply chain. This comes through to the clients who get a product offering combining good cover with excellent service delivery at a very cost effective premium.

In Jan 2012 our premiums rose by only 6% compared to the market average, which is much higher, so I would say we are delivering on our promises. With EIS as a broker we

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can simply drop a provider who is not delivering on the service and product mix that we demand for our clients. If a product is cheap but takes weeks to get the documentation or more importantly to pay a claim, then we won’t use them, simple as that.

Andrew Apps: Direct clients and Intermediaries need to have absolute confidence that the International Private Medical Insurance provider and the plan that they recommend to their client will provide the cover expected and will deliver top quality service when needed.

An iPMI policy which fails to respond when an expatriate is facing a medical emergency is useless. If a provider is offering big discounts and their plans are priced well below the market norm, you need to take great care to understand how the cost savings are being achieved so as not to compromise policyholders’ expectations.

ALC Health is about service, delivery and matching the expectation of our clients, and it is ALC Health’s ability to deliver a market leading client experience that is one of the critical determinants in sustaining competitive advantage and differentiating in our sales proposition.

Adriano Valente Rocha: That’s a hard question to answer. As Brazil had been closed to new businesses, including new insurance products either due to Government protective acts or economic challenges, iPMI solutions were rare to be part of a medium-Brazilian customer purchasing plan. As the economy was concentrated on national issues, most enterprises, families and individuals were not used to going abroad for studying and/or working, as it has been seen lately. So, Brazilian culture, economic barriers, frequency of overseas travelling and language barriers were things that slowed iPMI adoption in Brazil.

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Carl Carter: So as to maintain our competitive advantages, we constantly keep a close watch on both global and regional developments in terms of both expanding client needs and

also changes in the marketplace, in terms of both coverage, service delivery and pricing.

We know how our products place in the marketplace and that our

products continue to offer an outstanding opportunity for our brokers and outstanding value in terms of pricing, coverage and service to our mutual clients. l

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8 OVER THE LAST YEAR, WHAT IS THE BIGGEST AND MOST IMPORTANT ACHIEVEMENT OF YOUR COMPANY?

hilip Catterton: Integra Global is constantly seeking ways to be innovative and flexible not only with our members but with our distribution partners. We help them directly to deliver a product that best meets the wants and specific needs of their clients. As example our representatives were expanding into the Middle East and stressed the importance of a provider that could offer a direct bill network in the UAE. Continuing our efforts to support streamlined outpatient treatment we added direct bill access, adding a UAE network this year with our local direct bill network partner providing the ability to extend coverage to other areas in the Middle East.

Andrew Apps: The past 12 months has seen ALC Health continue to expand and develop our presence across our key markets, and the launch of a more interactive web presence has dramatically improved online traffic to both our main and sister sites. An exciting new underwriting partnership launched in December 2011, has enabled us to expand our

product offering, introduce new member services and simplify the experience of making a claim with improved response times.

Steve Nelson: Being able to grow our turnover significantly despite a highly uncertain global economic position.

Carl Carter: The highly successful launch of our new ground breaking GlobalFusion product that helped maintain our continued rapid increase in terms of product sales and global distribution channels - within an increasingly competitive global environment, especially when considering the difficult global economic climate. Some established global product lines continue to grow at 50%+ against a marketplace of 20+ competitors. These results and on-going global support from our brokers confirm we are delivering great products, at great prices that are backed by world class service to our insured, our groups and our insurance brokers and intermediaries.

Alison Massey: Ultimately, everything we do is aimed at delivering the best possible service to our customers

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whenever they need it. Since we pride ourselves on delivering our service promises, each and every time this happens it is our most important achievement.

Jon Carpenter: For MPIH it is the launch of our admitted product in the UAE. For EIS it is achieving FSA authorisation in its own right – previously it was an AR. This gives us a huge amount of flexibility to develop the business going forward.

Adriano Valente Rocha: Last year was a very important period for ValenteRocha as it was the year when our new specific insurance brokerage was founded – You are Global.

We believe that being a pioneer in International Private Medical Insurance in Brazil, having both government and non-government enterprises as clients, You are Global is set as a reliable platform for clients and independent insurance agents around the world.

Angelo Masciantonio: We were able to significantly increase our budget for research and development to make sure we maintain our position as a market leader and innovator. l

GMMI – ISO 9001:2008 Certified Continuously improving service and increasing client satisfaction.

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8 HOW WILL THE COST OF EXPATRIATE HEALTH CARE AND EXPAT INSURANCE RISE IN THE COMING YEAR AND WHY?

hilip Catterton: Increasing pressures on medical inflation are beyond our direct control and have reached double digit levels. Integra Global has however incorporated a well designed policy and network utilization to contain costs and to limit our overall price increases to a minimum.

As a testament to plan design and our approach we have a track record of keeping price increases to single digit figures for the past 5 years despite the overall rise of medical inflation being higher.

Carl Carter: Unless International Private Medical Insurance providers or their partners are able to capitalize on in-house cost containment, large case management, global buying power and global network management and negotiations, then due to the continued impact of medical inflation, average premiums in the market will be forced to continue to rise in line with medical inflation.

This is further compounded with the increasing impact of medical research and development costs coupled with highly priced ‘new’ drugs, treatments, medical technology and procedures as they become available and demanded by the insured expat consumer.

Innovations in product design, no and low claims discounts, underwriting methods and of course cost containment and anti-fraud measures have allowed IMG Europe to actually launch products such as GlobalFusion, that offers comprehensive cover but at significantly lower new business costs compared to many traditional products available in the general iPMI and expat medical market place.

Jon Carpenter: Costs will continue to rise, as they always have done. Inflationary impacts in most countries will contribute a big percentage.

However, if normal economics were to be applied, with pay rises for staff being capped or nonexistent, and suppliers in all industries under pressure to deliver at no increase in cost, then the impact should be less.

That said we all know that normal economics do not really apply to medical treatment delivery. In terms of

claims utilisation, the other big factor in premium increases, we expect to see this continuing to rise as people in danger of redundancy try to get things covered before they leave, and companies with fewer staff needing them at the tops of their game – so needing to get those little issues sorted. In short we would expect to see increase in the same region as this year.

Steve Nelson: This is something that is becoming a real problem. The cost will continue to go up and insurers will continue to blame hospitals and doctors for increasing costs. However, the insurance industry has to somehow come together and collectively do something about this, but it does need ALL insurers to participate. Do hospitals increase their costs because an insurer is footing the bill? I’m sure the answer is yes so the insurance industry has to stand up and be counted.

Double digit percentage increases cannot keep happening year after year.

Angelo Masciantonio: The rate of inflation is particularly high in areas like China. Trends indicate that demand for medical care from physicians and hospitals delivering western-style medicine is outpacing the supply. We feel that we will continue to see strong demand for access to private facilities in emerging markets. As a result, we anticipate continued acceleration of medical costs in those areas.

Andrew Apps: Medical inflation and the cost of health care in general is one of the overriding concerns of the industry. No one likes premium increases and at ALC health we continually strive to keep these costs down to a minimum by not only monitoring claim charges but looking at ways to reduce our own operational costs. Our members demand premium stability and over the years we have had great success in keeping costs reasonable and affordable.

Adriano Valente Rocha: The costs of expat insurance will rise in future years due to medical inflation and critical illness care. This said we have had great success in keeping costs reasonable and affordable.

This is because there are so many developments in worldwide medicine that people can have some updated treatment as never seen before. There are a lot of new protocols and treatment for illnesses and diseases that benefits clients, but, sooner or later, are going to result in general International Private Medical Insurance rise.

Alison Massey: Medical inflation is a perennial problem that affects the whole industry - and it’s largely outside of the control of all providers. However, we can control our costs. We’re set up to be lean and efficient and this, at least in part, allows us to bring a degree of stability to the premiums we can offer customers.l

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Q8

8 HOW CAN CORPORATIONS IMPROVE AND MANAGE THE LIFE CYCLE OF THEIR EXPATRIATE WORKFORCE?

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hilip Catterton: Comprehensive think about incorporating and cover should be looked at not promoting healthier lifestyles’ only as a necessity but as a for their employees with perhaps perk. Quality health care gym membership. insurance benefits are an important Jon Carpenter: Companies element in ones life, but to an expatriate need to consider the value of and their family it has added value. their medical programs when Having the ability to seek treatment they look at cost cutting. Often in one’s home country is something benefits like PMI or IPMI are the of significance to an expatriate. easiest to cut or pass back to Domestic employee or even Human the staff for self provision. This Resource professional may not is short sighted. In addition, comprehend the difficulties an expatriate companies should look at staff may face in communication, cultural differences and welfare programs – maybe introducing things like stress general standards of facilities. counselling and/or health checks to ensure their staff Having the ability to go “home” for health care remain fighting fit and able to cope with/deliver in this treatment should be a standard consideration of very challenging world economy. expatriates and their families if the employer is interested Andrew Apps: Being an expatriate has changed in the long term commitment of the employee to the dramatically over the past few years and the generous assignment abroad. Given the special circumstances expat packages have long disappeared, so it is important employers face when hiring expatriates including the that companies think carefully about what they do and cost of initial transportation and accommodation for don’t provide. the interview, moving abroad and perhaps paying At first sight cutting iPMI is seen as an easy means housing, relocation expense, schools, local housing etc, to reduce costs, but this can be short sighted and will healthcare insurance is a reasonable expenditure invariably end up with the company having to foot a considering the overall expense of hiring. large and unexpected bill somewhere along the line.

As a perk this component to the overall compensation The scope of cover offered is important but so too is strategy can increase the longevity of the expats career, the support that is given to the expatriate, whether it but for the human resource professional it can also be in the form of a stress free claiming experience to result in savings should the expatriate leave. The costs providing the tools that can make life just that little be incurred in finding a replacement may include, for easier. As any expat will tell you, knowing that there is example, recruitment costs, down time, training and someone on the other end of the line that cares can additional relocation expenses. All things considered make all the difference. From the employer’s point of considering health care insurance is normally an essential view too, being able to speak to someone who really element of the employee agreement - it does not cost understands the market, the quirks of living overseas that much more to offer a high quality comprehensive and even being an expat themselves can help ensure insurance plan, not only for the expatriate but their that the unexpected is avoided and life returns to family as well, especially if it leads to increased employee normal as quickly as possible. At ALC Health we satisfaction, higher moral and dedication to the understand that no two individuals or organisations assignment and company as a whole. are the same, which is why we take a more personal Angelo Masciantonio: Corporations can better manage approach for each and every one of our clients. the life cycle of their expatriate workforce by assisting Alison Massey: Becoming an expat can be a difficult with a more comfortable cultural integration, maintaining time, especially when experienced for the first time. a strong employee assistance program, and offering A combination of some of the most stressful events in accessible and affordable mental health services. a person’s life are happening at the same time - a new Steve Nelson: A good comprehensive medical insurance job, often uprooting of a family, a new country, a new plan can be worth it’s weight in gold. Giving your culture, leaving extended family members behind and employees the best possible medical care rather than so on. Companies need to empathise with this and the cheapest will ensure that your employees have offer support if they want to get the best out of their shorter absences through illness and so be more overseas workforce. There are many services available productive for the corporation. A plan that includes but it’s key to ensure the employee has a good IPMI wellness benefits can be of real value. They should plan so health care is not a concern. www.ipmimagazine.com International Health and Medical Insurance and Assistance News Magazine

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Roundtable

Carl Carter: There is much that can be done by an employing corporation to manage the life cycle of their expatriate workforce and much of this will depend upon the profile and location of their expatriate employees themselves. The first step is to work with an appropriately trained and experienced expatriate broker. Then in addition to relocation assistance and employee assistance programmes offering well-being and cultural support in the early stages of a new expat placement to both the employee and their family they should offer a quality and dependable expatriate medical insurance plan. These are key factors that should be utilized by the

corporation. An added advantage is selecting a product such as GlobalSelect that can provide treatment not only in the expat location, but in fact in any medical facility within the complete area of cover being that another country or even back in the comfort and security of treatment back in the home country. Additionally by selecting medical insurance products that include an element of international support and employee assistance as well as annual well-being health checks these can be major supporting factors in helping the expatriate employee life cycle and in delivering a successful outcome for both the employer and employee.

Adriano Valente Rocha: It is important that corporations start to understand the role of an international project that demands an international employee.

Once that is understood, those who manage international HR must understand (or rely on specific consulting firms) that each country features specific guidelines for international employees. Added to that, it is also important that international management get to understand that public health services in foreign countries (especially emerging-economy countries) are from bad to worse and can’t provide the desired services in case of medical services overseas. l

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iPMIM >> International Health Insurance | Expatriate Health Care

Q9

8 HOW DO YOU THINK INTERNATIONAL HEALTH CARE WILL BE DEFINED IN THE FUTURE?

Roundtable

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on Carpenter: More and becoming not just more common more IPMI will be a must have but are also staying out longer if not benefit. The health systems on a permanent basis. As this trend in countries where they even becomes more prevalent I think you exist, cannot cope with their own will find that there will be more of a populations by and large, let alone demand for more comprehensive any expatriate workers adding to quality cover. The emphasis in the the pressure. We have already seen future I think will be more on value, compulsory schemes for expats in especially as it concerns the long-term the Middle East and I would expect value of quality health cover. these to spread out to other parts Angelo Masciantonio: International of the developed and developing lifestyles will continue to expand and world. I think the insurers will become evolve -- raising expectations that even more disenchanted with the access to health care services and health providers and you will see insurance benefits will be seamless the larger ones start to own their globally and convenient and appropriate own hospitals and clinics in an to any destination, including your at tempt to arrest the of ten home country. uncontrollable increases in claims Steve Nelson: With the way premiums costs. have increased over the last five years Carl Carter: There is a continued there is a danger that it will be defined increase in the number of expatriates as too expensive! On a positive, we and international companies, as well have seen more and more providers as increased mobility of labour being able to cover some pre-existing internationally. This is coupled with medical conditions, something which a wider geographic spread of global was practically unheard of five years hospital networks and medical or so ago. Therefore if clients are infrastructure. We will see an improved having to pay higher premiums, they standard of health care available to are going to expect more from their expats worldwide, but will also see plans, and I do think that more and continued increases in the cost of more providers will have to consider quality medical treatment available pre-existing condition cover. to expatriates. Whilst there will be an Andrew Apps: Buyers are becoming improvement in base medical care, more demanding and iPMI is no longer there will also be an increasing gap about just insurance but about the in the treatments available between ‘whole package’. No longer will providers t h e i n s u r e d a n d u n i n s u r e d be able to stand behind their brand expatriates overseas. and expect policyholders to put up Alison Massey: The market will with sub-standard service or inappropriate continue to be defined by customer products. The expatriate market is choice. In a number of countries, growing and as it continues to do so, health insurance is compulsory and so will the need for iPMI providers to this is likely to increase over the next step up to the challenge. Whilst price few years. In these instances, there’s is important so too is the ‘package’ always a choice between local and and what it encompasses. international plans often for local Adriano Valente Rocha: International nationals as well as expats. Both types health care is very important to are looking to appeal over and above understand for expatriate individuals the other and this competitive factor and families, as a way of preparing will have an influence over mid-market themselves for future risks. I think it product design as we move forward. will be a mandatory subject for all Philip Catterton: Expatriates are citizens in the future. l www.ipmimagazine.com International Health and Medical Insurance and Assistance News Magazine

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iPMIM >> International Health Insurance | Expatriate Health Care

Q10

Roundtable

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8 A READER RECENTLY SUGGESTED “THERE IS A HUGE GAP BETWEEN UNDERWRITING AND CLAIMS AND EVERYONE NEEDS TO START TALKING THE SAME LANGUAGE.” WHAT DO YOU THINK?

hilip Catterton: It is important to be up front and transparent when it comes to underwriting.

I think this is where the misunderstandings come in on the claims side. Too often there is ambiguity of accepting an application and then later applying the terms.

Customers often do not read or understand the fine print especially when it comes to insurance. And I don’t think we should expect them to. Our approach is to have a completely transparent process from the beginning. And this is best done if Full Medical Underwriting is done at the time of application. In this way, everyone know the terms and conditions from the start and therefore there is little room for misunderstandings at times of claims.

Carl Carter: I think this depends upon the organisation itself and how it chooses to structure its business model. In many cases smaller iPMI providers have no choice but to outsource both their international claims handling and also their assistance services externally to Third Party Providers, and in some cases they also have to externalise their Underwriting of certain types of plans or groups back to their carrier.

Unless fully integrated, this fragmented business model can only lead to a gap in information and understanding between all sections.

This gap will also increase if the provider has overseas offices that are not working off the same systems.

Some companies, such as IMG Europe benefit from the fact that we provide all our key services such as Underwriting, Claims, Cost Containment and Assistance services in-house and even when shared between two offices everything including data is kept real time in sync.

Angelo Masciantonio: Some carriers approve almost all applicants; however, a lot of the underwriting is done on the back end at a time

when it can damage a member financially. HTH Worldwide prefers to do full medical underwriting up front to avoid future claims problems and misunderstandings.

Additionally, if an applicant has prior credible coverage, we will waive the pre-existing condition waiting period so that there is a smooth transition from a domestic health plan to an expatriate health plan.

Steve Nelson: This is something that insurers can comment on – as a broker we sometimes wonder whether underwriters live on the same planet as the rest of us but I am sure underwriters think the same of brokers!!

Jon Carpenter: I agree. As someone who has done pretty much all the different jobs in health insurance from marketing and sales to operational management, claims processing underwriting etc.

I think there has always been a detachment between the different functions – which is not helpful. My view is that there should be more cross functional training and working.

In a small company like ours where everyone has to get involved in everything it is less pronounced, but in the larger companies you will very often have claims people talking to a client about treatment delivery when they have never been out of the office, or an underwriter talking about a risk in a country they know nothing about.

The sales people also need to understand that a company needs to make a profit, and the underwriters are there to protect that margin.

Alison Massey: This issue does present a challenge – some providers take a full medical underwriting approach, others moratorium, some experience rate and some community rate. Quite rightly, this is a purely commercial decision. The differences between the combinations of approaches clearly present a

www.ipmimagazine.com International Health and Medical Insurance and Assistance News Magazine

knowledge gap for customers. While there continue to be so many different ways of underwriting, the challenge lies in keeping the customer informed so they understand the relationship between their chosen provider’s underwriting approach and how it impacts on the claims process and the on-going pricing of their plan.

For customers, it comes down to making an informed choice, and in particular, which provider offers the approach that best suits their circumstances.

Andrew Apps: Absolutely and it is the responsibility of the iPMI providers to start thinking about the ‘bigger picture’ rather than segmenting the various products components.

Underwriting, Claims, Marketing, Sales and Finance needs to be more integrated and this is perhaps one of the major strengths of the smaller iPMI providers such as ALC Health, where both communication between departments and real ‘hands on’ experience is making a difference to the final product proposition.

The direct personal experience and on the ground knowledge that is the DNA of many of the smaller iPMI companies is something that can help to shape the industry going forward.

Adriano Valente Rocha: There is, for sure, a gap between these two departments and they are the heart of a good service and the ultimate barrier that turns a client/an insured into a long-term customer or not.

It has to be said as well, that as there are different medical/health protocols worldwide, this can be a (bad) opportunity for fraud.

In my opinion, as there are tables and refs for underwriting, there should be a reference of medical/ health claims for each part of the world.

That could straighten the gap between the underwriting and claims departments. l

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Roundtable

Q11

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8 AND FINALLY, WHAT ROLE DOES TECHNOLOGY PLAY IN YOUR DAY-TO-DAY OPERATIONS AND WITHIN YOUR HEALTH, EXPAT OR TRAVEL INSURANCE PLANS?

ndrew Apps: For many expatriates, technology is without doubt an important part of their lives. After all it is often their window back to home and friends and they are far more ‘savvy’ than most when it comes to managing their lives online.

The International Private Medical Insurance industry is already moving quickly in this respect and over the next few years, online policy and claims management will become the norm. It is however, also very important that we don’t lose touch with the ‘personal touch’. This is an industry that is all about ‘people’, so let’s not forget that.

Philip Catterton: At Integra Global we take the attitude that human touch is at the forefront of quality customer service and technology is in the background supporting the process. It remains a vital component to better servicing and supporting our members, and as mentioned previously Integra Global was the first provider to offer online enrolment and the full scale implementation of Zaptag personal health care records.

Our investment in technology serves to support and enhance our personal touch not to replace the human interaction which is imperative in our approach. As the need for medical attention can be at any time technology plays a huge role as we deal with expats around the globe. It is important that our systems are available 24/7 365 days a year. Web based systems – incorporate with direct bill networks and administrative offices globally – our network partner in China, UAE and the USA have all the customers plans loaded on their system and administered locally providing a seamless infrastructure.

Yet this technology works in combination with the

human touch – technology is there to service our customer better but not to replace the human element.

Alison Massey: Technology is key for us and we’ve invested heavily in it. Our business model has been developed such that many day-to-day issues are taken care of by technology – including buying online, accessing plan documents, tracking the status of claims payments and adding new members. This means our customerfacing staff spends less time taking phone calls from customers chasing their claims reimbursements and more time providing first-rate personal service when it’s really needed.

Angelo Masciantonio: Technology is an absolutely crucial part of all health plan operations and services.

From selling, to underwriting to assisting members, the plans destined for long-term success will be technology leaders. As the leader in global technologically based services for global travellers, our success will depend on our ability to continue to innovate and add value through the deployment of our innovations.

Adriano Valente Rocha: As our clients don’t see any barriers while considering living, working or studying abroad, paperwork is part of the past. Technology, nowadays is so important, once our clients can read about the solutions we provide, can reach us anything, from anywhere, can purchase and manage their policies on-line, wherever they are. Technology at You are Global is taking our businesses to another level.

Steve Nelson: Technology is the key to our company.

We started out back in 1998 as an online medical insurance broker and this is what we remain today. We were pioneers of the worldwide web era and get 98% or our leads from our online marketing. Communications via e-mail, telephone. Skype etc are essential to our business and allows us to be a truly global broker.

Carl Carter: Being a global organisation with over 25,000 independent brokers worldwide, we, our brokers and our insureds all benefit from the investment in the advanced IMG systems available to them. Whether it is the ability for a broker to 24/7 instantly quote worldwide and receive applications online via a co-branded sales link on their website; a customer seeking a medical provider in a remote location or checking the status of a claim online, our in-house technology plays an integral part in maintaining our competitive advantage and is a key factor in our continued success and expansion.

Jon Carpenter: Technology is important in an industry where the clients are all over the world. We would be lost without our computers, phones and the internet.

However, health insurance is a personal and emotive business and the technology can only ever be an aid to us delivering a people to people service. l

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