ITIC Global 2018 Review

International Travel & Health Insurance Conference

A full review of ITIC Global and the 2018 ITIJ Awards

ITIC GLOBAL 2018 | REVIEW

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ITIC GLOBAL 2018 | REVIEW

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ITIC GLOBAL 2018 | REVIEW

Contents Chairman’s message

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ITIC & ITIJ Awards sponsors

New Attendees Welcome Reception

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Welcome Reception

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ITIC Running Club

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Networking

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Sharp Selfie Campaign

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Charity Gala Concert

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Session reviews

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Educating the payers - cost and quality in medical transport services

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Underwriting updates

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Tools and methods being used to tackle industry fraud

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Air Ambulance & Medical Assistance Forum

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International students and their insurance and assistance needs

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Cross-cultural intelligence

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Health risks affecting international travellers

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High-value claims management

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Cyber risk and data protection

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Air ambulance industry trends

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Getting involved in a medical network

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EURAMI Members Meeting

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Cost containment in Mexico and the Caribbean

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Changing expatriate demographics

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Travel insurance challenges around the world

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Technology in travel and health insurance

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ITIJ Awards

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ITIC GLOBAL 2018 | REVIEW

Chairman’s message Thank you to everyone who joined us in Geneva for ITIC Global and the ITIJ Awards – I trust you had an enjoyable and productive week. It was great to see so many familiar faces and meet so many people who are new to the industry.

The speaker and panel sessions that took place throughout the conference provoked some lively debate, as always, with attendees sharing their opinions and insights on a broad range of pertinent topics. Many thanks to our speakers for their time and expertise, and to the conference committee for helping to shape yet another exciting and relevant agenda.

The social functions at ITIC are always a wonderful affair, and this year was no exception – from the New Attendees

Welcome Reception and the grand opening Welcome Reception, right through to the Finale Dinner and Awards ceremony, ITIC really does bring the industry closer together, and it’s a privilege to be a part of that.

It was a pleasure to co-host the ITIJ Awards – with the standard of entries this year more impressive than ever. Congratulations to all this year’s winners and finalists! And thank you to the Awards sponsors and indeed to all the ITIC Geneva sponsors – your input makes the event extra special.

I hope to see you all in Malta for ITIC Global 2019!

Ian Cameron Conference Chairman

Thanks to our ITIC Global 2018 Sponsors

Editor-in-chief:

Ian Cameron

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Published on behalf of Voyageur Publishing & Events Ltd Voyageur Buildings, 19 Lower Park Row, Bristol BS1 5BN, UK The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur & Events Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or firm mentioned, is hereby excluded.

Printed by Pensord Press Ltd Copyright Voyageur & Events Ltd 2018 Materials in this publication may not be reproduced in any form without permission.

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL ISSN 2055-1215

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ITIC GLOBAL 2018 | REVIEW

New Attendees Welcome Reception

Sponsored by

The ITIC Global New Attendees Welcome Reception, sponsored by AIG, was a great opportunity for those new to ITIC to meet the conference committee, the event organisers, members of the ITIJ editorial team, and each other in a relaxed setting over champagne and canapĂŠs. A thoroughly enjoyable evening was had by all, with guests welcomed into the flow of ITIC by those who really know the event and how to get the best out of it.

Robert E. Gallagher, Senior Vice President & COO, AIG Travel

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ITIC GLOBAL 2018 | REVIEW

ITIC GLOBAL Welcome Reception ITIC Global attendees were welcomed to Geneva in the style they have become accustomed to, thanks to this event’s sponsor, New Frontier Group. ITIJ spoke to Randall Condie, the company’s COO, to get his thoughts on this year’s Welcome Reception “It was with great anticipation that the New Frontier Group team arrived in Geneva, Switzerland in preparation of our sponsorship of the much awaited ITIC Welcome Reception, this year held at the wonderfully unique venue, Batiment Des Forces Motrices. Each year, the ITIC team works diligently in search of the perfect venue; two years ago in the beautifully modern AXICA building in Berlin, last year in Barcelona, the historically significant Casa Liotja de Mar. Each year, it is truly an honour for Gitte and I to work within these exciting settings, but the most enjoyable experience in sponsoring the Welcome Reception is reconnecting with old friends and partners, and also establishing new acquaintances in an exciting, but very warm and welcoming environment. Where else can you meet with people from all over the world, have a casual conversation or get reacquainted, while enjoying a glass of champagne and beautifully prepared canapés?

Cheers to you all and we will see all of you again next year in Malta.”

Gitte Bach, President & CEO, New Frontier Group

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ITIC GLOBAL 2018 | REVIEW ITIC Global brings together expert speakers and panellists for four days of knowledge-sharing and debate around key topics pertinent to the global travel and health insurance industry. Through speaker presentations, forums – namely the Air Ambulance & Medical Assistance Forum; the International Provider Network Forum; and the Medical Directors Forum – and case study analysis, ITIC Global attendees get to hear the latest thinking and share their insights on the issues that matter most. On the following pages, you’ll find a synopsis of each of the speaker and panel sessions that took place during ITIC Global, together with a review of what was covered in some of the Forum discussions.

Educating the payers - cost and quality in medical transport services

Andy Lee

Andy Lee of ER24 Global Assist gave a simple, overarching argument: communication between payee and operator is key. Payees need to be sure that who they are talking to is an operator not an intermediary, he asserted, and to avoid being dazzled by a broker’s website, payees should have better knowledge of the capabilities of aircraft – this can help to make missions more efficient and therefore less costly.

Andy posed questions to the gathered insurers that they should be asking operators in order to make sure they are getting the right deal. Although some seemed simple – such as what drugs or medical equipment they carry – these can make all the difference for mission costs.

Brokers will not be able to answer some of these questions, Andy asserted, while an operator will be ‘proud to show you its

Dr Bettina Vadera

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documentation or accreditation’.

During the questioning, Andy again stated that he believes that assistance companies should not be using air ambulance brokers, and instead should aim to deal directly with air ambulance operators. Julie added that although, for some, brokers offer an easier option, there are still cost implications involved in using one.

Dr Bettina Vadera, Chief Executive and Medical Director of Nairobi-based AMREF, showed the unique difficulties of air ambulance operations and keeping costs down in Africa. Good air ambulance operators are hard to find on the continent and expensive, she explained, despite the great need for them due to poor infrastructure. Add to these challenges limited air traffic control, navigation aids and weather information, combined with the lack of regulation for medevacs, and you can see why such services can differ

Julie Remmington

greatly. The quality of aircraft between operators can also fluctuate. While most simply ask whether an aircraft is single or twin engine, they fail to realise that some companies still operate old piston engines that are less safe. Twenty-fourhour capability is also limited due to a lack of serviceable airstrips. Dr Vadera echoed some of Andy’s recommendations, such as asking for the fleet list and flight crew information.

Medically, there are further challenges for operators. There are no aeromedicalspecialised training opportunities for staff in Africa, while cost-cutting can leave aircraft with no doctors onboard. Basic medical equipment and improvised stretcher systems only compound issues. To combat these challenges, Dr Vadera recommends

getting a list of medical crew details, with CVs and proof of registration, plus the specialties of the staff. A copy of indemnity insurance must also be obtained.

Finally, payers have to watch out for business ethics used by some African operators, and corruption can also cause certain services to be awarded contracts over better, more reliable operators. You get what you pay for, asserted Dr Vadera,

There are significant costs to the provider in terms of accreditation, which ultimately will be passed onto the payer and that means more reliable operators will be more expensive. Accreditation in Africa isn’t the full picture – auditing small providers personally creates a fuller picture.

Julie Remmington, as an insurer or payee – a term she asserted her dislike for – offered a counterpoint to the previous two presentations, offering to educate the providers on the other side’s needs.

Accreditation can help payees but has its issues, she said. The three main accreditors don’t share information, meaning a company could be struck off by one and be accredited by another. There are also significant costs to the provider in terms of accreditation, which ultimately will be passed onto the payer.

The relationship between insurers and assistance companies is different in every instance – but, Julie said, the insurer will always be the ultimate paymaster.

Communication was the key take-away for Julie, with both sides having to be open and honest, while being upfront when something goes wrong.

ITIC GLOBAL 2018 | REVIEW

Underwriting updates

Brad Dance

With overviews of the European/UK and Canadian marketplaces, this session offered some interesting insights into the challenges faced by underwriters in different jurisdictions, and the solutions they are finding. In the UK, for instance, Carl Carter, Managing Director of Voyager Insurance Services, believes that prices have to go up in order for underwriters to cater for all the macroeconomic pressures they are coming under. An increasing focus on data, he added, is resulting in a demand for dynamic granular loss ratio and modelling requirements from providers. More data means more detailed underwriting, with ratings by exact age, particular destination and even distribution channel.

Due to changing macroeconomic factors, distribution channels and hyper competition in the UK – where

Carl Carter

there are over 2,000 providers of travel insurance – travel insurance underwriting needs to become more complex, more frequent and more innovative in its make-up in order to remain profitable and competitive.

According to Brad Dance, Chief Customer Officer at TuGo, the Canadian market is a more relaxed affair than in the UK, with self-regulation taking precedence over draconian rules from government authority. Underwriters in Canada are reporting various trends, including a demand for increased – or no –limits on medical expenses, along with more demand for coverage for pre-existing medical conditions. Other issues affecting the underwriting of travel insurance policies, Brad continued, include terrorism cover, technology solutions such as instant cover with smart

notifications and updates, blockchain and – just recently – the legalisation

More data means more detailed underwriting, with ratings by age, destination and distribution channel of cannabis for recreational use. Most insurers, he said, are treating claims relating to cannabis in the same way they would a claim that involved alcohol – if a claim results from the use of abuse of cannabis, it won’t be paid, and if someone were to miss a flight from the US because they attempted to cross the Canada-US border with cannabis, then the cancellation of the holiday that would result wouldn’t be covered either.

Ian Cameron, moderator and Conference Chairman

Join us for the 9th annual ITIC Americas 2019

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ITIC GLOBAL 2018 | REVIEW

Tools and methods being used to tackle industry fraud Steve Knox, Lead Fraud Manager and ISIU Manager at Aetna, discussed how to mitigate member fraud and explained how his company tries to prevent it. There are two types of member fraud, Steve asserted: deliberate fraudsters and opportunistic fraudsters. Fraudulent activity includes doctored receipts, altered claim forms, images and medical reports taken from the internet (sometimes barely altered), collusion, non-declaration, dual claims, and the sharing of membership cards.

Internally, Aetna has an international investigation unit, helping to make fraud investigations more efficient. It logs all payments of over US$2,000, which allows for a better overview of trends.

The business also employs an ‘anti-fraud culture’, including having a ‘fraud champion’ in every office, which gives the unit better access to each local office. The unit also works with Aetna’s analytics department, meaning it is now able to give claims a numerical rating on how likely they are to be fraudulent. The unit is clearly successful; Steve revealed that it saved $2 million for Aetna in 2017, with the highest single fraudulent claim totalling $450,000. In his concluding remarks, Steve pointed out that genuine human error does creep in, and insurers need to be sensitive to this as well.

Phil Peart, General Manager of Travel Claims Investigations at MJM Corporate Risk Services, used his presentation to help identify the different kinds of fraud and where they are coming from. With an ever-expanding travel market, more and more fraud will start coming into the industry, Phil said. But how to tackle it?

Phil pointed towards pro-active strategies, such as data mining, fraud protection programmes and fraud training. One of

Steve Knox

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if a false claim gets approved, the public is likely to overstate the value of a claim. After much discussion, it was proposed that the public needs to be better educated on how these claims go on to affect their premiums.

Manjit Rana, as then CEO at Ingenin Ltd, explained the work insurtechs are doing to help with fraud detection. Artificial intelligence (AI) is one of the emerging technologies that insurers can harness for fraud detection, said Manjit. It can analyse vast volumes of data quickly and accurately to help find patterns within claims, spotting fraudulent behaviours. Currently, this technology is best utilised as an assistant to an already assembled insurance team. AI

the best way to negate fraud is by changing how insurance is sold to customers, to make customers feel like their product has value Manjit Rana

the biggest data silos that his company uses to help identify fraud is social media.

Reactive programmes are another method, including field investigations and bespoke video interviews.

Simple types of fraud, such as document doctoring, can be tackled with software or human intuition, but organised fraud can be more complicated, with more at risk.

Using case studies to illustrate his point, Phil opined that there is no ‘silver bullet’ for fraud investigating but using different methods can help find the missing link.

Phil also posed the question of what could be done to better dissuade the public from committing fraud in the first place. With only minor punishments and no obvious loser

can also be used for images, meaning that pictures can be examined for manipulation, location, and similar claims. In the UK, car, home and life insurers are pooling data together into insurance data ecosystems to help create larger systems that can be analysed, meaning trends and spikes can be picked up much faster.

At the end of the day, Manjit concluded, the best way to negate fraud is by changing how insurance is sold to customers, to make customers feel like their product has value – even if they don’t make a claim.

“Customers can’t get to the point where they think ‘I’ve paid all this money, but I didn’t get any value’ … If we change the way that product is sold in the first place, it will make it much less likely that a customer will try and rip an insurer off with a false claim.”

Phil Peart

ITIC GLOBAL 2018 | REVIEW

ITIC RUNNING CLUB sponsored by

ITIJ caught up with Chris Connor (left), President of Life Flight International Inc., to get the lowdown on ITIC’s most energetic social gathering Can you tell us how the ITIC Running Club started?

This was my second year sponsoring a casual group run at ITIC Global. A few people have asked me how I got to do that, and the short answer is that, originally, it was a joke between Andy Lee (International Business Executive at ER24 Global Assist) and myself on the ITIC message board. The conference manager, Kirsty, approached me the following year, after following our conversation, thinking it was a great idea and the sponsorship was born. The first year was successful and fun, so I did it again this year. It proved to be an even more successful run group this year, gaining momentum to approximately 60 runners this year from approximately 25 the first year.

Tell us more about the benefits of Running Club The ITIC Running Club can have a great social side, which is very important during this conference. You will gain friends often for life; you are meeting likeminded people who like to run and take care of themselves physically. There is plenty of time for professional meetings at ITIC, but for those of us who prefer more of a personal interaction with clients and colleagues, running is a perfect opportunity to meet the real person. Physically, the runs get your blood moving and oxygen flowing and prepare you for a fun-filled day of conference seminars and meetings!

So, can we look forward to Running Club next year?

The ITIC Running Club has been successful for the last two years and will continue to grow in numbers each year – it’s a great fit for the conference, which is truly shown by the attendance so far. We are all, in some way, part of the helping process for our worldwide citizens; if we cannot take care of ourselves first, how do we expect to help others? At Life Flight International Inc., we are all about health and wellness; a family-run business, 28 years and second-generation operated. Please, come run with us and all your colleagues next year at ITIC Malta!

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ITIC GLOBAL 2018 | REVIEW

Air Ambulance & Medical Assistance Forum Dr Bettina Vadera Chief Executive & Medical Director, AMREF

Patrick Schomaker Director of Sales & Marketing, European Air Ambulance

David Ewing Executive Vice-President, Global Markets, Skyservice Air Ambulance

Andrew Lee International Business Executive, ER24

This new forum for ITIC Global was brought together by the Air Ambulance Committee, whose forum at last year’s event was well attended by air ambulance operators.

This year, keen to garner more input from insurers and assistance companies, the forum organisers decided to rebrand as the Air Ambulance & Medical Assistance Forum and put a call out for air ambulance transport case studies from ITIC attendees.

Five case studies were chosen, and speakers from the companies involved presented details of their cases during the forum, followed by a discussion on each case.

“This year’s forum was very well attended, with extra seating needed due to the excellent response, and we still had people standing at the back of the room,” commented Forum moderator Andy Lee. “This was very encouraging, and the most satisfying fact was that the split was around 60/40 in in terms of insurer and assistance provider attending.”

Discussion on the case studies opened the door to wider issues that exist between all parties and promoted more understanding of one another’s potential challenges. “The drive behind this session was to build a better and stronger relationship between the payers and suppliers, to create safer and risk-free patient transfers,” said Lee.

Presentation: Dr Matt Kalina, Group Medical Director, Europ Assistance Dr Kalina reported on a particularly challenging case involving a medical evacuation from a cruise ship – the patient was removed from the cruise ship and left in a remote coastal town, where he was taken care of by Haiti Air Ambulance paramedics overnight in a hotel. A helicopter evacuation to Port au Prince took place the following morning, but there was no hospital with interventional cardiology capabilities available, so an evacuation to the US was required. The air ambulance provider that was supposed to take the job refused to do so, claiming that the patient was not stable enough; but in reality, asserted Dr Kalina, they were just worried about the liability issues inherent in transporting an unstable patient. The Europ Assistance medical director tried to speak to the air ambulance medical director, unsuccessfully, to discuss the case. After several hours’ delay, the air ambulance provider accepted the

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flight – but only after being provided with a discharge of responsibility.

Points of discussion raised by Dr Kalina included: • Cruise ship passengers should not be offloaded in a place where quality of care is lower than on the ship • Air ambulance providers must transport patients when the risk associated with care at the point of origin is higher than the risk of flying • So-called ‘letters of discharge’ are (to use a polite term!) hogwash – there is a true liability, said Dr Kalina, associated with non-assistance to persons in danger • Any discussion regarding how to achieve the evacuation safely in high-risk cases is a matter to be escalated to the medical directors on both sides • Emergency measure planning at the time of audits is of crucial importance to ensure smooth functioning when the real situationoccurs • Debrief of deficiencies with involved parties required after the event.

Discussion Concerns were raised by those in the audience about doctors on cruise ships not always being appropriately trained in the medicine they will be providing, nor in the equipment they are using. It was suggested that the assistance industry approach the American College of Emergency Physicians to discuss more appropriate qualifications for onboard doctors. When asked about the debrief with the involved parties, Dr Kalina said that there had been excellent discussions with the air ambulance provider, but these were less productive with the cruise company, who – potentially for liability reasons – was reluctant to admit that the patient shouldn’t have been offloaded in the first place.

Presentation: Melanie Veloso, Deputy Chief Operating Officer, MSH Americas Melanie’s presentation centred on the case of an expatriate who was hospitalised in remote Mongolia. The local clinic diagnosed flu and insisted there was no need for an evacuation as the patient was being managed in the facility. By day five, however, the treating medical officer urgently requested an evacuation, as there was no improvement in the patient’s condition.

Eva Kluge Director of Sales & Business Development, Air Alliance Medflight GmbH

The assistance company engaged an air ambulance provider to evacuate the patient to Beijing, but there was a two-day delay due to political red tape and clearance issues associated with getting a helicopter into the country. The patient was evacuated to South

Due to the patient’s diagnosis and deterioration, the decision was made to take off from Dubai without the Iraqi landing permit in place Korea instead. Points of discussion raised by Melanie included: • When is it appropriate for an assistance team to override the treating doctors?

• How can an assistance company be more proactive in knowing what flight requirements and clearances are required?

Discussion Audience members pointed out that the reasons why treating doctors hold on to patients vary – it can be ignorance of treating facilities elsewhere, or cultural pride, or even a considerable financial incentive to treat an insured patient. It can be difficult to intervene with treating doctors due to regulation, and cultural norms, according to one audience member.

There are workarounds, though, such as talking to the patient and their relatives, which allows the assistance company to make a more informed decision about the patient’s condition.

Presentation: Zack Bouhlel, Operations Manager Dubai Assistance Centre, RMSI AA Zack’s presentation focused on an evacuation from Baghdad to Dubai.

The patient was in rapidly deteriorating acute respiratory distress with suspected pneumonia; he required ventilation, intubation and sedation prior to the flight, which were initially performed by the treating doctor, but the facility in which the patient was being treated was not experienced in such procedures. Obtaining a landing permit for Iraq can be problematic – after hours, or during holidays, it can be especially challenging, said Zack. Due to the patient’s diagnosis and deterioration, the decision

ITIC GLOBAL 2018 | REVIEW

was made to take off from Dubai without the Iraqi landing permit in place, despite the fact that the patient was not stable.

Communication between the treating physician and flight doctor was maintained throughout the flight, which Zack pointed out was essential to keep the case moving forward, as the treating doctor was keen to keep the patient in situ.

Discussion The issue of the assistance company having a lot of faith and trust in the air ambulance company to perform the mission, allowing them to take off without the landing permit, was brought up. There was constant communication between the assistance company and air ambulance company medical director to agree that this was the best course of action for the patient.

Presentation: Yasir Ahmed, Network Manager, SOS First, part of SOS International Yasir’s case involved a severe injury to an employee in Kandahar, Afghanistan. There was an air ambulance already flying from Columbo (Sri Lanka) to Helsinki with a patient, and it was agreed that a co-transport would take place, picking up the second patient up in Kandahar en route. However, the first patient was then found not to be suitable for co-transport. Evacuation of

the second patient was becoming more urgent, but there was no provider ready to fly into Afghanistan to pick them up.

Another provider was found eventually, and the patient was repatriated onboard a Challenger air ambulance.

Discussion The major focus of the discussion following the presentation lay in the fact that the challenge for assistance companies is in finding air ambulance providers who

the challenge for assistance companies is in finding air ambulance providers who can fly into warzones can fly into warzones – such dangerous destinations are becoming more common, so the need for air ambulances to fly to them is greater. The issue of insurance was brought up, and Dr Bettina Vadera pointed out that providers may not be aware of the different types of war risk insurance that is available to them. The issue of co-transports was also raised – it is always a risk that one patient’s condition may adversely affect the other patient and the ability of the air ambulance company to perform both evacuations simultaneously.

Presentation: Dr Cai Glushak, International Medical Director, AXA Partners This case centred on the evacuation of a patient with a history of breast cancer who was on holiday in the Caribbean. Her preliminary diagnosis was cardiac failure due to chemotherapy; the patient had already arranged to be transferred by air ambulance to Toronto, but mid-flight, she suffered a ventricular fibrillation. The plane diverted to the Bahamas, but the patient was declared dead in the hospital there. The rest of the family, flying to Toronto via Chicago, were expecting to be updated on her condition on their layover in Chicago.

Discussion The discussion centred on what other assistance companies would do – when would they tell the husband, who was travelling with two young children, that his wife had passed away? A vote was held, and the majority of the audience said that they would have waited until the family reached Toronto. Cai said that AXA decided to inform the family while they were in Chicago, as it was thought that if they waited, at some point the question would be asked of ‘when did this happen, and you had the opportunity to tell me earlier, why didn’t you’? It was a difficult decision, said Cai, but one that had to be taken.

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ITIC GLOBAL 2018 | REVIEW

International students and their insurance and assistance needs This expert panel explained the ins and outs of the international student market and how to meet their insurance and assistance needs. Manny Soar, Insurance Manager at the International Association of Student Insurance Services, began the session, revealing that the international student market is bigger than business travel, with a market worth US$203 billion. Focusing purely on the higher education market, there are currently five million student travellers as of 2014, with the US and UK

With around one-quarter of all 18-to-24 year-olds suffering from mental health problems, this is a real issue in the student population the top destinations, and China, India and Germany sending the most students abroad.

“You might not be surprised to know that insurance is not the most difficult thing for students going abroad,” asserted Manny, who said that cultural and linguistic changes, as well as visa issues, are higher on the agenda. Insurance is also not the main cost for international students, with some policies available at only $500 – a small amount when compared to the $25k they have to spend on student fees alone.

Student insurance is too focused on ‘after the event’, said Manny, but trends

Manny Soar

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Elaine DelRossi

in insurtech point towards educating students and educating their educators.

Although many companies already have apps for customers, Manny said that, in his experience, many do not use these, and companies need to start finding better ways to engage with students.

Elaine DelRossi, Client Experience Officer at GeoBlue presented how her company helps US students navigate foreign healthcare systems. Elaine stated that mental health issues are the number one issue her company has to deal with. With around one-quarter of all 18-to-24 year-olds suffering from mental health problems, this is a real issue in the student population. Both students and parents are often unprepared for study abroad, and the need to assimilate quickly to a new culture can often be a shock. Health information should be given to students several times and in different forms to help with this assimilation.

Access to specific medications can be an issue for student travellers – especially if they are unable to get the medications they are usually prescribed in their destination.

GeoBlue offers a service that allows students to find out if their medicines are available in their destination and helps them to find alternatives. Prevention and education are key to GeoBlue’s approach and making sure both the students and parents understand medical protocols in their destination can help manage expectations.

GeoBlue also trains institution faculties and carries out site visits so that it is able to give more specific care advice. Insuring students studying abroad is a partnership, concluded

Elaine; without all parties working together, the student may not be able to fully take advantage of their experience.

Laurie Roberts, Vice-President of Sales Administration at GBG, began by explaining the two visa types for inbound students in the US: the J visa, a cultural exchange visa that has health insurance requirements set

by US Department of State, and the F-1 visa that is usually given to students and has no insurance requirements. Because of this, insurance was not as large a conversation for inbound and outbound students in the past; this has now changed.

Most universities now require international students to have insurance, and different institutions have different requirements for students. Navigating these complex requirements can be confusing for incoming students – especially if they opt out of the institution-sponsored insurance offering.

Outside influences also complicate matters, with even obvious hurdles like language barriers, non-familiarity with the US system and confusion over various compliance rules making navigating the process of gaining insurance a headache for an incoming student.

Laurie also touched on the US waiver market that has become popular to provide an alternative option to universitysponsored plans. GBG helps students to navigate these and check if they are up to university requirements. The benefits of good coverage for incoming students is obvious, but complicated guidelines create a challenge for incoming students to the US. Insurers, however, have the power to create systems to help students to navigate them, Laurie concluded.

Laurie Roberts

ITIC GLOBAL 2018 | REVIEW

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ITIC GLOBAL 2018 | REVIEW

Cross-cultural intelligence Irina Braun, Executive Partner, U-Coaching, offered attendees key insights into a complex topic, explaining the differences between various cultures and countries and pointing out that when two companies from varying cultures are brought together, this can in fact be very problematic, as approaches to business practices vary widely. In action-orientated cultures such as Anglo-Saxon countries, people tend to be driven to achieve, and act decisively and quickly. This is in contrast to processorientated countries such as those in Latin America, Eastern Europe and Russia, where decision making tends to be a more careful process, and discussion is valued over fast decisions. Northern Europe, meanwhile, tends to have more task-orientated cultures with direct styles of communication, a focus on rights and personal responsibility. Roleorientated cultures such as those of Arabic countries, Asia and Africa, are places in which people have a clear role in society, with indirect and formal communication styles, where quality and discipline count.

Irina concluded her presentation by showing a model of freedom methodology, showing where differences can be turned into advantages in business, if they are recognised and accommodated in the correct way.

in Latin America, Eastern Europe and Russia, decision making tends to be a more careful process, and discussion is valued over fast decisions

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Irina Braun

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Health risks affecting international travellers Dr Mark Parrish, Regional Director of Northern Europe for International SOS, began by asking the audience for their thoughts on the most typical illnesses from which travellers will suffer, and said that while there certainly are a high number of cases of gastroenteritis and trauma from road accidents, in fact, what International SOS is witnessing is an increase in calls for assistance related to anxiety and

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what International SOS is witnessing is an increase in calls for assistance related to anxiety and depression

Dr Mark Parrish

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depression. People who travel for more than two weeks a month are more likely to suffer from such mental health issues, said Dr Parrish. The second-most-likely health issue that will affect travellers, particularly business travellers, is an exacerbation of a pre-existing medical condition as a result of travel. Heart conditions, obesity, diabetes and high blood pressure are all examples of illnesses that can be worsened as a result of travel, because, for instance, people will rely on medication that runs out and either not replace it or replace it with local medication from a pharmacy selling counterfeit drugs.

ITIC GLOBAL 2018 | REVIEW

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ITIC GLOBAL 2018 | REVIEW

High-value claims management

James Walker

This session was kicked off by James Walker, Head of International Network at CEGA in the UK. As part of an assistance company, he sits right in the middle of three parties during high-value cases – the insurer, the medical facility and the patient.

All parties have varying needs, but all

successful cost containment needs both preparation and experience parties need to establish trust, he asserted.

Preparation is very important for dealing with claims. Establishing a local network, including medical providers and local cost containments experts prior to a claim can complement an in-house cost containment team and medical team, greatly improving case handling.

James used the analogy of training for a football match for how CEGA handles high-cost claims. The first stage is the preparation or training. An assistance company should fully review a case, gather all the evidence it needs and set targets for what it hopes to achieve. The next stage is the match itself, or the negation phase. An assistance company is then able to present all the evidence, make a proposal and then reach a settlement.

Finally, assistance companies need to analyse their processes, allowing teams to learn from experience and find out what changes they need to implement.

James concluded that successful cost containment needs both preparation and experience.

Gitte Bach, CEO and President of New Frontier Group, asserted that for her company, as a cost container, getting

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Gitte Bach

detailed information from the insurer is vital.

Detailed case notes allow case managers to be assigned and begin to predict the treatment needed. After these have been predicted, New Frontier then acquires quotes, meaning a baseline prediction for the cost of the entire course of treatment is established.

Case management teams will then be in constant contact to find out the status of the patient. Although the team has to find ‘soft savings’ during the care, not interfering too much in patient care is important. “No doctor wants to have another doctor tell them they’re doing things wrong,” she explained, so these changes to the treatment process have to be carefully handled.

Post-discharge care involves even further co-operation – especially when a client is not in their home country. Evacuation options are also considered, though; making sure the patient is able to travel far outweighs the savings, but cost containers

Dr Handan Umur

must constantly be looking for the best solution for all parties. Making sure both the patient and the patient’s family have a positive experience needs to be seriously considered alongside cost savings.

“Whether they spent $50 or $500 on a

detailed information from the insurer is vital policy, patients just want to be taken care of correctly,” she explained. With all parties properly co-operating and communicating, costs can be kept low and patients can have positive outcomes.

Marm’s Chief Medical Officer, Dr Handan Umur, added a medical angle into the subject of containing cost. She has found that the parties involved in claims – payer, patient, medical provider, and assistance provider – often blame one another for high costs, ‘turning claims into blaming games’.

This lack of trust and co-operation, she asserted, only serves to keep costs high.

All parties need to look at the wider picture, she explained, and better understand the patient journey.

The term ‘high cost’ is a relative one and companies need to determine what a high cost is for them and other parties, otherwise parties are left unhappy. Companies need to improve on their communication and negotiation, gaining a better medical network, getting better local know-how, improved repatriation evacuation skills, and medical expertise, Dr Umur explained; but for her, all cases will be smoother if case management is good. If every party involved is fully informed, there is no such thing as a high-value claim, because expectations are fully managed, and all parties leave happy. Companies should stop thinking about containing medical costs, but instead concentrate on cost effectiveness, she concluded.

ITIC GLOBAL 2018 | REVIEW

netWOrking The networking opportunities at ITIC Global are unparalleled in the global travel and health insurance industry. ITIC Global is the place to meet and do business, make new contacts, forge new friendships, and cement existing partnerships. Nowhere does networking quite like ITIC, with the Global conference bringing together insurers and suppliers from all areas of the industry, from all over the globe.

The Exhibition Area at ITIC Global is always a hive of activity, with over thirty exhibitors placing themselves at the centre of the conference space, maximising their exposure to the international attendees. Innovative booth designs, activities and give-aways were rife this year, setting a new standard for future events. Within the Exhibition Area, the Networking Lounge, sponsored by Commercial Medical Escorts and REVA, provided a dedicated meeting space for attendees to conduct business face-to-face in quieter surroundings.

Besides the social functions, the many networking coffee breaks and lunches, as well as a networking brunch, all provided ample opportunities to mingle with fellow ITIC attendees between conference sessions. In addition, pre-conference coffee and breakfast snacks were provided courtesy of sponsor Bangkok Dusit Medical Services on two of the days; with SA Medical Network offering Swiss delicacies for ITIC attendees on their exhibition stand on day two. For those looking for something to ease them into afternoon conference sessions, NAAMTA kindly sponsored wine with lunch on two of the conference days.

When it comes to keeping up to date with all things ITIC Global during the event, the ITIC App, sponsored this year by Atrium Health, places all the information attendees need in the palm of their hand. The ITIC App is attendees’ one-stop-shop for reaching out to ITIC Global’s broad audience and scheduling meetings with industry peers.

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ITIC GLOBAL 2018 | REVIEW

For the fourth year running, Sharp HealthCare ran the #LookingSharpITIC selfie competition at ITIC Global! From pictures within the conference area to snaps from around Geneva’s famous landmarks, the ITIC attendees truly pushed their creativity to the limit this year!

After a round of voting by ITIC attendees your winner was chosen …

Congratulations

to Yulia Sokur from Savita Group Ukraine for winning this year’s ITIC Global #LookingSharpITIC selfie competition by

Sharp HealthCare

SeLFIE

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ITIC GLOBAL 2018 | REVIEW

Thank you to everyone who took part, and especially our runners up who impressed the ITIC team immensely!

We look forward to more creative submissions next year in Malta!

Carl Carter Voyager Insurance Services

c. onnor tional In Chris C Interna t h g li F Life

Gregory Kyriakou Gamma Air Medical

SeLFIE Hamdi Inan Marm Assistance

Jane Hegeler Tangiers International

Svetlana Kotkova

Lahta Clinic & Hospital, St. Petersburg

astillo Pablo C Inc. k MedBric

Dana Soubar, Emrah Gultekin & Ersah Aksa - Orion Assistance

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Cyber risk and data protection This session focused primarily on the introduction of the EU-based General Data Protection Regulation (GDPR), which came into force in May 2018. Florian Thoma, Senior Director, Global Data Privacy for Accenture began by pointing out that while, previously, data privacy had been a topic that only compliance officers knew or

for regulators to alter the rule, though, and it can be adapted to reflect the reality of the marketplace. Going forward, said Mickael, data protection will occur by default, and systems will be designed in such a way that data is held securely, with procedures and practices being built in to businesses.

Jerome Pin, Project and Business

believes that air ambulance and assistance work is not compatible with GDPR due to the nature of needing to exchange data swiftly and is keen to engage the industry in discussions with the regulator to talk about potential exemption from GDPR regulation.

data protection will occur by default, and systems will be designed in such a way that data is held securely, with procedures and practices being built in to businesses cared about, it is now an issue that is at the forefront for business leaders, the media and regulators. Data ethics, said Florian, is now a key consideration.

Mickael Tome, Attorney with Barreaux de Luxembourg & de Paris, shared his insights into the challenges that faced companies before, during and after the implementation of GDPR, and was forthright in his assessment that ‘it is not possible to achieve full compliance’. There is still time

Development Manager and Data Protection Officer for Luxembourg Air Rescue Group, gave attendees information about how his company prepared for GDPR, with audits to identify gaps in data security, particularly with regards to medical data. There was a lot of work involved in changing contracts framework to ensure compliance although, in reality, compliance remains a work in progress from both a data protection and information security aspect. Jerome

(l-r) Jerome Pin, Mickael Tome and Florian Thoma

Air ambulance industry trends Dr Gert Muurling, Medical Director, Air Alliance Medflight GmbH, discussed how the development of new antibiotics came to a halt around 30 years ago, which has resulted in a proliferation in cases of drug resistant illnesses. There are resources available that can show which countries have cases of drug-resistant illnesses of various kinds, which can assist an air ambulance company in their decisionmaking process about which medications to take with them onboard the aircraft when collecting a patient. Dr Muurling also discussed the hygiene risks for the patient and crew when performing a transfer, as well as the risks posed by double stretcher transfers. He then showed how aircraft and crew disinfection is performed and checked.

Volker Lemke, CSO of FAI Air Ambulance,

Graham Williamson

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flight operations in conflict zones must be carefully considered and completed using comprehensive information and risk management

Volker Lemke

shared with the audience his company’s experience of flying into warzones and other high-risk countries, showing that while they can be high-risk operations, there are many steps taken and tactics employed to minimise and mitigate those risks to crew and aircraft. Performing for and on behalf of the United Nations means that FAI receives a lot of requests to fly into conflict regions and is, thus, experienced in ensuring that as much information as possible is gathered about real-time risks en route to the patient. Detailed risk assessments are carried out before the decision to fly is taken. Preparation, said Volker, is paramount for any air ambulance company considering carrying out high-risk missions, and flight operations in conflict zones must be carefully considered and completed using comprehensive information and risk management.

Graham Williamson, CEO of LIFESUPPORT Air Medical Services Inc., focused on the repatriation of critically ill – but

stable – patients onboard commercial airlines. He pointed out the benefits of such flights, including extra space for the crew and patient, and fewer fuel stops meaning faster flights with fewer take offs and landings. They aren’t suitable for all patients, though, and there are many cases where an air ambulance transfer would be more appropriate. Effective case management, said Graham, is key. Each case must be carefully co-ordinated, and every detail is essential. There must also be contingency plans in place for every eventuality. Engaged medical leadership from all stakeholders is, furthermore, absolutely essential.

Dr Gert Muurling

ITIC GLOBAL 2018 | REVIEW

Getting involved in a medical network This session saw a panel discus how medicals networks can be built. Rory O’Gara, Vice-President, Medical Provider Management Americas, Allianz Global Assistance USA said that stationing 94 people across the world to help to build and maintain relationships with medical providers is a vital part of Allianz’s medical network. Although the company has a large medical network, Rory stressed that it is the quality of the network that the company is most proud of. Hospitals have close relationships with Allianz, allowing for good preparation and consistent treatment of Allianz members.

Allianz has created its own evaluation form for hospitals, with 300 medical data fields that asses all aspects of patient care.

Although the data, held in the company’s Global Network Portal, is expensive to maintain, it gives members quick and efficient access to quality hospitals.

All constituents of a medical network need to be catered for in order for the network to work: the vendors, the patients, the providers and the payers. Patients want their policies to give them peace of mind, knowing that if something does go wrong, they can trust the other parts of the system to help them, Rory asserted.

Networks should aim to deliver quality care to patients; and the more complete the network, the better the outcomes.

Danny Quaeyhaegens, Head of the International Insurance Department at Bangkok Hospital Pattaya - BDMS asserted that although creating a network isn’t

Florian Zagel

difficult, keeping it constantly updated is. Even in BDMS’ 45-hospital network, keeping track of staff changes and company mergers is a constant, but

Rory O’Gara

Networks should aim to deliver quality care to patients; and the more complete the network, the better the outcomes important, task.

The importance of a good network is, however, obvious, said Danny. It enables assistance companies to make better medical and cost decisions. He conceded that while keeping track of all hospitals is near impossible, focusing on a certain number is greatly effective. Danny said that assistance companies should use their own network for most cases, and only bring in another company in complex cases, as although local assistance companies do offer greater local knowledge and access, they can be considerably more expensive. Looking to future network building solutions, Danny shared his dream of a dedicated medical network company that assistance companies could use to buy reliable network data from, or possibly even the ‘romantic’ notion of assistance companies sharing data.

When building a network, companies can use several methods to asses a hospital.

For speedy solutions, online research, a quick questionnaire or quick ground visit could suffice, but for better overview, a more in-depth questionnaire and longer site visits should be used. Hospitals should be

assessed regularly and, importantly, should be happy to be assessed. “I love when insurers come to our hospital because I can show them what exactly they’re paying for,” enthused Danny.

Florian Zagel, Managing Director, West African Rescue Association (WARA), tied the session up by explaining how insurers can build better relationships with medical providers. A huge part of his company’s role is managing expectations between insurers, policyholders and providers – balancing all of their separate interests is key, he said. Speaking as a provider, Florian said that one of the challenges his company faces is deciding when to delay treatment due to complicated coverage in order to get paid or risk loss of payment due to highly mobile business travellers or expatriates leaving the country before payment is received.

Some solutions that Florian put forward to improve the relationship between insurers and providers included educating clients to have realistic expectations and making payments in real time. Hospitals want agreed payment terms, rather than debating on discount fees as it means they can provide care faster, while he would also like to see assistance companies settle service invoices based on guarantees when due, not dependant on if they have been compensated by their insurers.

With both parties wanting the best for their clients, he believes that bettering the relationship between providers and payers will only help to achieve this goal.

Danny Quaeyhaegens

Join us for the 21st annual ITIC UK 2019

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ITIC GLOBAL 2018 | REVIEW

EURAMI Members Meeting ITIJ caught up with the European Aero-Medical Institute (EURAMI) to find out how it enjoyed ITIC Geneva and garner some insights into its Members Meeting. Here’s what the members had to say It was a banner few days for EURAMI at their exhibition booth during ITIC Global.

Dr Terry Martin (Chief Auditor) and Claudia Schmiedhuber (Interim Managing Director) proudly welcomed dedicated EURAMI members to discuss, debate and review the past year together. It was evident that accreditation and quality still hold a very prominent place in our industry and that reputable accreditation associations such as EURAMI e.V. are actively contributing to raising quality standards for patient transportation and aeromedical procedures. However, not just current members could be seen sitting at the EURAMI booth; many aeromedical providers are aware of the importance of standardised regulations and are looking to obtain EURAMI recognition to demonstrate quality, safety and responsibility to their insurance and assistance clients.

On 1 November, the 33rd EURAMI General Assembly was held to a packed room of members (most sacrificing their single free afternoon to attend to association business). The presentation, led by President Dr Laurent Taymans, reviewed the last year, including financial results, new accreditations and re-accreditations as well as the achievements and developments within EURAMI. It was a great sign of concern and trust that leadership is addressing the industry’s concerns, in part as indicated by the growing number of providers applying for EURAMI accreditation and that current members consistently continue to re-accredit.

This year also marked an election year for EURAMI, with three board positions up for election. Dr Taymans (President), Pascaline Wolfermann (Vice-President) and Franziska Hollenstein had completed their terms, whereas Dr Cai Glushak, Philipp Schneider (Treasurer) and Lisa Humphries continued their Board terms.

The Board candidates presented a great diversity and motivation for the upcoming terms, with each candidate outlining their targets and objectives for the upcoming years on the Board. Incumbent Franziska Hollenstein was re-elected and joined by new members Sergio Abril and Mark Chapman. With the former President and Vice-President having completed their terms, the newly elected Board also assigned the officer roles amongst its members. Dr Glushak was elected as the new President, Schneider as Vice-President and Mark Chapman took on the role of Treasurer.

The diverse EURAMI Board is composed

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of members from all sides of the industry: Dr Glushak is the International Medical Director and Chief Medical Officer of AXA Partners; Schneider is the Key Account Manager for Quick Air Ambulance in Cologne, Germany; re-elected Board member Franziska Hollenstein the founder of Prime Nursing Care, a global medical escort provider; and Humphries is the Director of Capital Air Ambulance in the UK. The newly elected Board member Sergio Abril holds the position of VP of Business Development at Airlink Air Ambulance and Treasurer Chapman is the Program Director at Medway Air Ambulance.

In his address to the members, Dr Glushak thanked Dr Taymans and Pascaline Wolfermann for their immense contribution, being integral to the re-organisation of association leadership and business structure, and their tireless efforts to advance the work of the industry. In particular, he noted that despite the intense pressures on this highly specialised medical services field, he applauded the Board he had worked with for the past two years on its objectivity and sole dedication to quality and safety. He assured members that he would ensure that individual commercial interests be put to the side in favor of pure attention to standards of quality care, patient safety and provider performance and reliability.

The newly elected President, Dr Glushak says that he intends to pursue the vision for EURAMI elaborated by Dr Taymans as well as specific targets during the upcoming term. These include: • Laying out a five-year plan to chart a course for advancement and sustainability of the organisation and contribution to the field of aeromedical services.

• Establishment of an Advisory Committee to incorporate additional experts and stakeholders of the industry that are key to EURAMI’s development

he applauded the Board he had worked with for the past two years on its objectivity and sole dedication to quality and safety and recognition.

• Completion and release of the EURAMI 6.0. standards spearheaded by Dr Terry Martin.

• Expansion of a highly qualified auditor pool to accelerate accreditation and assure objectivity.

• Obtain recognition of EURAMI accreditation by key agencies and government departments.

• Enlarge forums for member participation, communication and exchange.

• Add to the state of knowledge of the industry.

• Ensure consistency and responsiveness to members and the client community.

With the General Assembly successfully completed, the ITIC Finale Dinner and ITIJ Awards in the evening of 1 November marked another highlight for EURAMI, with all five of the aeromedical providers who were ITIJ Award finalists holding EURAMI accreditation. It is with great pride that EURAMI congratulates Air Ambulance Worldwide for winning the Marketing Campaign of the Year Award as well as CEGA for being named Assistance Company of the Year.

EURAMI is also delighted to announce that all the three finalists in the Air Ambulance Provider of the Year category are EURAMIaccredited members. Congratulations to SARPA and REVA for being among the three finalists and of course congratulations to Air Alliance for winning the award for the second year in a row.

The EURAMI team looks forward to reuniting with its members and the travel community in sunny Malta in 2019.

ITIC GLOBAL 2018 | REVIEW MEDFLIGHT

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Cost containment in Mexico and the Caribbean Many public medical centres in the Caribbean lack resources, especially when it comes to being able to treat complex medical cases, so private facilities are filling the gap. With international insurers taking several months to settle bills and with payer-provider relationships not very well established in the Caribbean, thirdparty administrators (TPAs) are stepping in to help medical providers get paid in a timelier fashion – especially for the smaller ones that lack the resources to do so themselves. However, as Charles Sealy, CEO of Doctors Hospital (Bahamas) Ltd, pointed out, every time you add a step between the hospital and the payer, there is more room for fraud and inflation.

Thus, international insurers are seeing bills that are massively inflated, and in

every time you add a step between the hospital and the payer, there is more room for fraud and inflation need to do, then, is identify certified medical providers that charge reasonably, ensure medical triage to promote real steerage, employ good case management, and ensure bill reviews and audits by doctors and administration staff. As Dr Anne Lepetit, Group Chief Medical Officer for Allianz Partners, explained, evacuation is also being used as a cost containment tool in the region, with patients being taken to Martinique instead of the US, as medical care at the University Hospital there is very good and there are many cost savings to be made.

Dr Anne Lepetit

Dr. Charles Sealy

Mexico, specifically, explained Jorge Rodriguez, Healthcare Risk Management Director, LATAM for Global Excel, billing for unnecessary procedures, duplicate charging, upcoding, fraudulent billing and patient steering for kickbacks are all rife.

Another issue that affects pricing in the region stems from the fact that a significant proportion of insured cases are denied, which leads to hospitals inflating their rates, which the collection agencies inflate further. Furthermore, said Charles, if insurers didn’t keep pushing for discounts, medical providers wouldn’t have to raise their fees for international patients in the first place in order to end up being paid a reasonable fee.

What insurance and assistance providers

Jorge Rodriguez

Changing expatriate demographics David Bowles, a consultant for market research firm Finaccord, presented a selection of new data from the company’s

ilk are probably the group in which insurers would be most interested, as they tend to be covered by employee assistance

according to Finaccord, the global expatriate population grew from approximately 52.8 million in 2013 to 66.2 million in 2017 latest research into expatriate behaviours, from their geographical movements to demographic shifts. While David noted that, being an inherently mobile group, expatriates are difficult to size, according to Finaccord the global expatriate population grew from approximately 52.8 million in 2013 to 66.2 million in 2017 (a compound annual growth rate of 5.8 per cent) and is expected to grow to 87.5 million in 2021 (CAGR of 7.2 per cent).

The research David presented also showed that while corporate transferees and their

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plans, they make up a comparatively small proportion of the overall expat population (only one per cent), with individual workers by far representing the largest proportion (71.1 per cent). Students (8.5 per cent) and retirees (5.2 per cent) were also notable demographics.

David also said that individual workers were likely to continue to be the fastest growing group up until 2012, while Gulf CoOperation Council countries will continue to be the fastest-growing destinations to which expatriates are heading.

David Bowles

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Travel insurance challenges around the world blockchain, chatbots and smart contracts affecting every part of the value chain.

However, travel insurers aren’t always quick to embrace new technology, due to lack of knowledge, the bureaucracy involved in being part of a larger group, and legacy IT systems, he said. Distribution models need to change, and senior management needs to be onboard with technological changes. Investment in insurtech is growing exponentially, so insurers should consider alliances with other insurers and startups to accelerate their use of technology and develop innovation ecosystems in-house.

quickly and easily, providing clear and easyto-understand products, and giving value for money. Cost containment challenges stem from rising medical costs, aligning data from suppliers, and travellers heading in low frequencies to new destinations.

Regulation and the forthcoming Brexit are very much current challenges; while distribution provides opportunities for growth, despite inherent challenges around cross-border distribution and protecting your brand value.

Robert E. Gallagher

Robert E. Gallagher, Senior Vice-President and COO of AIG Travel, began this session with a look at the internal and external challenges faced by travel insurers today.

Being part of a superstructure, he said, presents a multitude of challenges due to writing multiple lines of business, having a number of affiliated underwriters, thousands of employees, and offices around the world. For large insurers like this, navigating a global footprint is a considerable task: having language capabilities can be expensive, time zones need to be considered and skilled staff who understand cultural sensitivities and such issues as currencies are essential.

External challenges predominantly relate to regulatory issues, with the global energy in this arena at an all-time high.

Key partnerships and skilled international staffing resources are essential to address such challenges.

Rafael Senen, CEO at Coverontrip, then looked at how insurtech and innovation are impacting the travel insurance industry, with such entities as mHealth, GPS tracking, AI,

Bernard O’Sullivan

senior management needs to be onboard with technological changes Collaboration is the direction in which the world is moving.

Concluding this session, Bernard O’Sullivan, General Manager for World Nomads Group, looked at the opportunities and challenges faced by the industry.

Meeting customer expectations is vital, including solving customer problems

Rafael Senen

Join us for the 11th annual ITIC APAC 2019

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ITIC GLOBAL 2018 | REVIEW

Rowland Brothers International (RBI) hosted a Gala Concert in aid of London’s Royal Marsden Cancer Charity during ITIC Global. Starting life as a conversation between attendees in the bar during ITIC Global 2017 in Barcelona, the event came to fruition this year, delighting attendees with an evening of glorious vocal performances in the Hotel President Wilson’s Winter Garden. The musical programme was created by Carlos Alonso, Managing Medical Director of Evolo Medica, performed with the Ensemble Lycordia, four musicians based in Geneva who share his passion for great music.

“As always, everything that happens behind the scenes contributes to the success of an event. Ticket sales, JustGiving donations and cash donated at the concert amounted to £2,000. Thanks to everyone who contributed, especially Andy Lee and Bernadette Breton who rattled the buckets on the night!” said Rowland Brothers. “Thank you to everyone at ITIJ for their support, and of course to Carlos for his enthusiasm and commitment. As we prove every day, when we work together, anything is possible. If you’re coming to ITIC Malta, shall we do it again? Watch this space!”

RBI Managing Director Steve Rowland, Operations Director Fiona Greenwood and International Liaison Sue Ackerman visited the Royal Marsden Cancer Charity to hand over the proceeds from the inaugural Gala Concert in Geneva.

BROUGHT TO YOU BY

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ITIC GLOBAL 2018 | REVIEW

Technology in travel and health insurance offered by insurers to their clients. He described an online telemedicine process in which patients can quickly book an AI-based consultation from wherever they are, rather than travelling to see a real-life doctor. Pawell did stress that if a face-toface appointment was necessary, that’s what would be advised – although in 88 per cent of the consultations he described, a face-to-face meeting was not required.

Pawell listed some companies, such as Allianz, April and Docplanner Group, which are already making use of telemedicine.

The benefits he described were many: consultation times are shortened, there are no facility costs (and no travel costs for the patient), the number of ‘noshows’ is dramatically reduced, and for patients there is a much smaller gap between them becoming concerned and receiving advice.

A number of questions followed Pawell’s presentation, including the reliability of the artificial intelligence providing the

Ken Marke

This session was designed to showcase some of the technological advancements that are set to change the travel and health insurance landscape. Ken Marke, Chief Marketing Officer for B3i, began his presentation by saying that there is a lot of mystique around blockchain, but that his aim was to simplify it. He also likened blockchain technology to a Swiss Army knife – it incorporates various tools, but if you require a corkscrew, a corkscrew on its own may be sufficient, rather than a knife that incorporates one. Ergo, blockchain is not a magic bullet, as some have claimed it to be, although if used properly, the technology can provide growth, improve the quality and consistency of data (and optimise its utilisation) and make business processes more efficient.

Among the key features blockchain can offer the insurance industry, explained Ken, are smart contracts, cryptography (as the network is securely encrypted), consensus (as all parties in the chain have to agree on any changes that are made) and immutability (as once changes have been made, every subsequent link in the chain includes that information – it is also decentralised, so there is no risk of information being destroyed if a single computer is hit by hackers).

Ken concluded by giving a few useage examples, including a reinsurance case in which blockchain provided a 30-per-cent saving on administrative costs.

Telemedi.co CEO Pawell Sieczkiewicz gave an insight into the potential of telemedicine and how it can improve the medical service

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to this.

He went on to talk about two different chatbot projects that SPIXII undertook on behalf of Allianz and Zurich, including videos of the chatbots in action. A colourful, welcoming layout and a rolling visual style were found to both put customers at ease and make the exchange feel more like a conversation, even though from the insurer’s end, the responses were automated. Renaud said that his company

blockchain is not a magic bullet, as some have claimed it to be worked with underwriters and marketers to ensure that the tone of the bot’s responses was appropriate for the brand.

Making use of such bots, said Renaud, allows insurers to pinpoint customer ‘pain points’ where the relationship can potentially start to break down, and address them in order to maximise customer comfort while also increasing efficiency. Chatbots can potentially maximise performance, far outstripping traditional methods such as phone conversations (as customers cannot always get through) and web forms (which lack the conversational, free-flowing aspect that makes chatbots more accessible).

Renaud also mentioned some research from Gartner, which suggests that by 2020, 25 per cent of customer service operations will make use of virtual assistants such as these. Clearly, the ball is already rolling – will the insurance industry be quick to adopt?

Renaud Million

consultation – which, Pawell said, is learning all the time from every interaction – the cross-border implications of such technologies, and how this advancement can be applied to wellness.

Renaud Million, CEO of SPIXII, began his presentation by saying that as customer demographics change, it is important for the insurance-consumer relationship to shift from a monologue to a conversation.

Younger demographics, for example, have different attitudes, and the insurance industry needs to recognise and adapt

Pawell Sieczkiewicz

ITIC GLOBAL 2018 | REVIEW

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INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL

INDUSTRY AWARDS 2018

2018 ITIJ Awards Finalists

The 16th annual ITIJ Awards took place on the 1 November at the Finale Dinner of ITIC Global in Geneva, Switzerland. Hosted

by Ian Cameron, ITIC Chairman & Editor-in-Chief of ITIJ, and Sarah Watson, ITIJ Editor, the Awards recognise excellence and innovation across all sectors of the global travel and health insurance industry.

Ian Cameron said of the Awards: “The quality of entries we receive each year is testament to the importance of these Awards to the global travel and health insurance industry. Congratulations to all of this year’s winners, and to the finalists as well. Standards in this industry are high, and our winners and finalists are leaders in their field; setting the bar high when it comes to innovation and quality of service.”

Sincere thanks to each of the Awards sponsors, to nib for the entertainment during dinner, and Allianz Partners for the live stream.

Watch the 2018 ITIJ Awards on demand at itij.com/awards

ITIJ 2018 Awards sponsors

ITIC GLOBAL 2018 | REVIEW

ITIC GLOBAL 2018 | REVIEW

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ITIC GLOBAL 2018 | REVIEW

ITIJ MARKETING CAMPAIGN OF THE YEAR WINNER AIR AMBULANCE WORLDWIDE Air Ambulance Worldwide was founded in 2004 on the principle that every mission flown should provide uplifting care and outstanding support for our patients. Well into our second decade of operations, with thousands of patients safely transported, Air Ambulance Worldwide is a EURAMI-accredited provider that continues to grow while adhering to this founding principle. With a fleet of Lear 55 and Lear 35 jet aircraft, Air Ambulance Worldwide provides international air ambulance solutions for safety conscious clients requiring a partner with a spotless safety record and medical care that exceeds industry standards. Air Ambulance Worldwide: Uplifting Care and Outstanding Support.

“For as long as I have been in the industry, we have turned to the ITIJ to educate ourselves as well as inform our peers of developments that shape the world in which we work and live. To be recognised by the ITIJ is in itself an honour – to be recognised in a field of finalists as distinguished as this one makes the honour a very special one for us.”

(l-r) Amr Abass, CEO, 24/7 Clinic – Travel Medical Services; Mark Jones, President, Air Ambulance Worldwide

Sponsored by | 37

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

Albin International Repatriation committed to professionalism, dignity, care and respect

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specialists in repatriation since 1906

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ITIC GLOBAL 2018 | REVIEW

SPECIALIST SERVICE PROVIDER OF THE YEAR WINNER CAMBRIDGE GLOBAL PAYMENTS Cambridge is a leading provider of integrated cross-border payment services and risk management solutions. As a trusted partner for 25 years, Cambridge delivers innovative solutions designed to mitigate foreign exchange exposure and address unique business needs. Its award-winning and industry-leading technologies simplify the way businesses connect with the global marketplace. As one of the largest bank-independent providers globally, it has offices across North America, Europe, and Australia. On an annual basis, Cambridge processes over one million payments into over 150 different currencies, with over US$40 billion in foreign currency annual turnover.

(l-r) Emerson De Luca, Managing Director, Albin International; Jim Rosellini, Senior Manager, Enterprise Solutions, Cambridge Global Payments

Sponsored by | 39

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

LIFT OFF

SUN. 05:30

SUN. 08:30

Remote Russia. Patient faces grueling 12-hour drive to airport.

Likely won’t survive the trek; Gateway International EMS is called to help find a better way.

Turn and Burn. Medical crew flown to remote area; patient is loaded in helicopter.

ANCILLARY ASSISTANCE SERVICE PROVIDER OF THE YEAR

We achieved the impossible by turning a 12-hour drive into a 4-hour transport, ensuring the safety and comfort of the patient.

SUN. 06:30

SUN. 10:30

Solution Found. We coordinated ground ambulance and helicopter transportation.

Arrive at Airport. Within 4 hours, patient handed over to Air Ambulance company.

Our network of 3,000+ providers across the globe help close the gap when your patients need it most.

Worldwide EMS Solutions, Simplified™ | Call Us 24/7: +1-888-828-5258 | gateway-ems.com | operations@gateway-ems.com 40

ITIC GLOBAL 2018 | REVIEW

ANCILLARY ASSISTANCE SERVICE PROVIDER OF THE YEAR WINNER ALBIN INTERNATIONAL Albin International, formerly Kenyon Repatriation, has a history dating back to 1906 when its first recorded repatriation took place, which led to the creation of Kenyon Air Transportation in the 70s, dedicated exclusively to carrying out repatriations. In 2002, the company was restructured and Barry Albin (RIP) acquired 50 per cent of the shares.

Kenyon Repatriation was managed by FA Albin, a company with over 200 years of experience in the funeral business. In 2010, Barry Albin acquired the remainder of the company, which was renamed Albin International. Offices were transferred to new premises in Neptune Street during November 2011.

“All of our committed team who work hard and strive to provide a professional, high-quality and dignified service were extremely proud to have been nominated as one of the finalists. Albin International is a family business. It was the dream of our former owner Mr Barry Albin (RIP) to be recognised for the important work that the company carries out. To have received the award meant so much to everyone in the company who work day in and out to continue his dream and to provide a service of the highest quality.”

(l-r) Oliver Mueller, Managing Director, Gateway International & EMS LLC; Stephanie Dannet, Repatriation Executive, Albin International; Emerson De Luca, Managing Director, Albin International

Sponsored by | 41

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

Global Network Solutions Evidence-Based Medical Case Management Expertise • Experience • Excellence

24/7/365 Worldwide Assistance Medical Cost Containment & Claims Management

Visit our new website for the latest news!

Global Medical Management

GMMI, Inc. | 880 SW 145th Avenue, Suite 400, Pembroke Pines, FL 33027 (USA) +1 (954) 370-6404 | Toll-Free (in the U.S. & Canada) +1 (800) 682-6065 | www.gmmi.com | info@gmmi.com

MEDICAL PROVIDER OF THE YEAR

ITIC GLOBAL 2018 | REVIEW

WINNER ACIBADEM HEALTHCARE SERVICES Established 25 years ago, Acibadem is a success story that has evolved from a small district hospital into a powerful brand name that has taken its place on the international stage. Our vision and development of our business models have always driven us forward. Acibadem continues to build on its success – in 2012, we signed a partnership agreement with IHH Healthcare Berhad, one of the largest groups of the Far East. Our partnership has positioned IHH as the second largest healthcare chain in the world. Today we can confidently say: “Acibadem is now in the international league.”

“Winning the 2018 ITIJ Medical Provider of the Year Award is the biggest proof for Acibadem and for Turkey that we are on right path for the healthcare sector and Acıbadem; definitely in the international league.”

(l-r) Berna Gur, Coorporation Network Supervisor, Acibadem Healthcare Group; Sven Thorslund, Vice President of Sales & Product Strategy, GMMI; Melissa Gülagaci, International Insurances Specialist, Acibadem Healthcare Group

Sponsored by | 43

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

Discover more about our award winning products at passportcard.com

NEW OFFICES IN

Zurich - London - Munich Tel Aviv - Sydney

2014/2016 THE APAC EMMA’S

2016 MEDICI TOP 21 – INSURTECH STARTUPS AWARDS

2016 ITIJ AWARDS

The Most Innovative Emerging Company — General Catalyst Award for Travel Innovation

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PassportCard and TravelCard are a member of the White mountains Insurance Group (NYSE:WTM) and DavidShield Group

PassportCard's Australian Operation – TravelCard – Launched in 2018

ITIC GLOBAL 2018 | REVIEW

COST CONTAINMENT/CLAIMS MANAGEMENT COMPANY WINNER AXA PARTNERS AXA Partners, founded in 1959, was one of the first assistance companies to open its doors to travellers and those in need of healthcare and travel assistance services. AXA Partners US was created from the merger of several assistance companies in 1998. Within the AXA Group, AXA Partners US is the designated service provider for cost avoidance via medical case management and cost containment. As a recognised third-party claims administrator licensed in all 50 states, AXA Partners US has steadily advanced its capabilities to become one of the leading providers of cost containment solutions in the US.

(l-r) Geoffrey Nagle, Sales Director, AXA Assistance USA; Philippe De Dreuzy, Country Manager, AXA Assistance USA; Cai Glushack, International Medical Director, AXA Assistance USA; Yoel Amir, CEO, PassportCard

Sponsored by

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INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

World-class care. Here for you.

Our reputation for top quality health care and beautiful location on the Pacific Ocean attract patients from around the world. We offer multi-lingual concierge services to guide you on your journey, assisting you before your visit and during your treatment in San Diego, and coordinating follow-up with your doctor back home.

International patients benefit from our nationally ranked care in multiple medical and surgical specialties, including: >>

Cancer

>>

Neurology and neurosurgery

>>

Cardiology and heart surgery

>>

Orthopedics

>>

Geriatrics

>>

Pulmonology

UC San Diego Health is known for outstanding, culturally competent patient care. Patients’ families also enjoy the cultural and recreational attractions that make San Diego a popular tourist destination, famous for its year-round mild climate.

health.ucsd.edu/international 46

ITIC GLOBAL 2018 | REVIEW

AIR AMBULANCE PROVIDER OF THE YEAR WINNER AIR ALLIANCE MEDFLIGHT GMBH Air Alliance Medflight GmbH is an international air ambulance provider, utilising group owned and operated aircraft (AOC D-266), with headquarters in Germany and further branches in the UK and in Austria.

With a fleet of 14 owned air ambulance aircraft and 150 highly skilled staff in the entire Air Alliance Group, we are dedicated to supporting our clients in the most challenging situations. In 2017, we completed nearly 1,000 air ambulance missions worldwide, including remote and critical areas.

(l-r) Stacy Holberg, Director of International Operations, UC San Diego Health; Eva Kluge, Director of Sales & Business Development, Air Alliance Medflight; Dr Larry Friedman, Associate Dean of Clinical Affairs and CEO International Patient Program, UC San Diego Health

Sponsored by | 47

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

Access to Quality, Cost-effective Care in the U.S. With UnitedHealthcare Global, you’re not only working with a leader in U.S. cost containment and medical management solutions, you’re also working with a global health care innovator. By leveraging our foundational competencies of clinical insight, technology and information, our mission is to help people live healthier lives and help make the health system work better for everyone.

Discover what UnitedHealthcare Global can do for you.

Access to America’s Largest Health Care Network

Medical Management and Care Coordination

Comprehensive Administrative Services

Learn more at: uhcglobal.com or call +1.866.527.0549

©2018 UnitedHealth Group Incorporated. The service marks contained in this literature are owned by UnitedHealth Group Incorporated and its affiliated companies, many of which are registered and 48 pending service marks in the United States and in various countries worldwide. 11/18 UHCG_PUB-D-49776

ITIC GLOBAL 2018 | REVIEW

AGGREGATOR/BROKER/ AFFINITY PARTNER OF THE YEAR WINNER INSUREMYTRIP It’s simple. InsureMyTrip finds you the right travel insurance plan, every time. InsureMyTrip is the authority on travel insurance. We are committed to empowering travellers to make the best possible insurance decisions by leveraging our technology, data intelligence, and expertise.

“We are proud and honoured to receive this recognition. At InsureMyTrip, we are committed to empowering travellers to make the best possible insurance decisions by leveraging our technology, data intelligence, and expertise.”

(l-r) Louis Kacszack, Partnerships Director - Global Markets, UnitedHealthcare Global; James Miller, Sales Manager, ITIJ on behalf of InsureMyTrip

Sponsored by | 49

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

World-class care within reach.

At Atrium Health, one of the leading healthcare systems in the United States, we give patients the world’s best care – no matter where they call home.

Exceptional Medicine Leading-edge treatment for rare and complex cancers Award-winning children’s care Heart transplant and minimally invasive bypass surgery Nationally acclaimed orthopedic program

Personalized Service Dedicated patient navigator Medical appointment coordination Travel arrangements Language services and other cultural comforts

Charlotte, North Carolina, USA AtriumHealth.org/Global

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ITIC GLOBAL 2018 | REVIEW

INTERNATIONAL ASSISTANCE PROVIDER OF THE YEAR WINNER CEGA GROUP CEGA is one of the leading global providers of 24/7 medical and security assistance, travel risk and claims management services, with over 40 years’ experience delivering joined up emergency travel and medical assistance to many leading banks, insurance companies and other businesses. In 2015 we reached an exciting point in our history, marked first by a management buyout led by our new Group Chief Executive, Alistair Hardie. A year later, we were acquired by Charles Taylor plc, a leading provider of professional services to clients across the global insurance market.

“Thank you to the ITIJ community for hosting this prestigious award ceremony; it was a great evening and being recognised as International Assistance Company of the Year is a fantastic testament to the hard work and sheer dedication of everyone at CEGA. Time and time again, they go above and beyond to give customers the very best service. Importantly, this award also reflects our ongoing commitment to developing innovative new products and services for our clients and their customers.”

(l-r) Neil Heasman, Operations Director, CEGA Group; Lynne Piddington, Global Supply Chain Manager, CEGA Group; Liz Popwell, FACHE, PMP, Vice President – Strategy Executive, Atrium Health

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INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

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ITIC GLOBAL 2018 | REVIEW

INTERNATIONAL TRAVEL & HEALTH INSURER OF THE YEAR WINNER GENERALI GLOBAL HEALTH Generali Global Health (GGH) is a young division within the global Generali Group, launching just three years ago. We have been successful in rapidly growing the business, disrupting the IPMI market and providing some of the most flexible products and holistic services available to our brokers, clients and members. We provide international health insurance to globally mobile people looking for world-leading treatment outside their home country. We manage a global network of over a million doctors, hospitals and clinics. Almost all these providers are linked to via a direct billing arrangement. Our customer service division provides a 24/365 multilingual service.

(l-r) Gitte Bach, President & CEO, New Frontier Group; Richard Lonsdale, Head of Client Services, Generali Global Health

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INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW All good things must come to an end, but the ITIC Global Finale Dinner after-party was a superb way to round-off a thoroughly enjoyable evening and close the conference for another year. We very much look forward to welcoming you all again in Malta for ITIC Global 2019!

To see more photos from throughout the conference, please visit: flickr.com/photos/voyageurgroup 54

INTERNATIONAL TRAVEL & HEALTH INSURANCE JOURNAL INDUSTRY AWARDS 2018

ITIC GLOBAL 2018 | REVIEW

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ITIC GLOBAL 2018 | REVIEW

Getting all the pieces together for your members doesn’t have to be difficult.

Fill the gap with

Contact Global Excel at StandbyMDinfo@globalexcel.com or at +1 819 566 8833

HEALTHCARE RISK MANAGEMENT SOLUTIONS 56 globalexcel.com