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When expats move overseas, they are often concerned about health insurance. For some, your company will cover this cost.  Other expats need to buy themselves.  This article will review some of the most popular expat insurances and answer frequency asked questions (FAQs).

Before we begin with the reviews and FAQs, perhaps I should answer a very important question at the get go; how much health insurance do you need as an expat?  

As health insurance is dead money if nothing happens, you need the most covered for the least cost.  As most smaller costs are cheap to get fixed directly, moreover, it often makes sense to get basic industry that covers emergency and serious conditions that can cost a fortune. 

Or let’s put this another way.  Why worry about getting a $30 procedure covered, when paying off to pocket makes sense, and you should worry about the serious things?

This article is long. It will cover;

1. Insurer specific reviews 
2. Industry specific questions, such as oil & gas and international school teachers 
3. Should you mix insurance and investments 
4. Frequently asked questions 

For anybody who doesn’t have the time to read this article, you can email me at [email protected], or [email protected], if you want a quote or for me to review your current insurance situation.

I can’t promise you anything, but I may be able to save you money.  I have negotiated discounts with a few of the providers listed below, compared to their online prices.

Expat insurers reviews 

This section will briefly review some of the most commonly sold expat plans.

William Russell Review

An insurance company from the UK, William Russell have a quick and efficient online system. They can accept monthly options, unlike some other providers, and they aren’t the most expensive option in the market.  

The negatives are that they are expensive relative to the quality of coverage, and they don’t always accept people with pre-existing conditions.

I would only consider this option if you want monthly premiums and can’t afford to pay for annual payments.

AXA Global Elite Review 

Good value premiums, relative to the quality. Automatic acceptance and renewal until age 80. Great payout rates. The main issue is that the paperwork in year 1 is awful, especially with AXA Hong Kong, and they can only accept yearly premiums. They also can’t accept American expats, unless they `fly and buy` in Hong Kong. For expats outside of Hong Kong, you can only buy through a trust system. 

As opposed to Global Elite, Reviews of AXA PPP are mixed, although the online processes and high deductibles make it a reasonable option.  

Aetna Review/InterGlobal Review 

Very popular amongst American expats and for expats in Dubai, due to some specific product offerings, such as the Pioneer Dubai 4000 option. Aetna isn’t the cheapest option in the market. Renewal premiums have been known to increase a lot.  This is an option that should only be considered if your company is paying for the premium.

Allianz Review 

Definitely a top-class option. They have individual, family and corporate plans.  99% of claims are paid out within 24-72 hours. The biggest negative is how much it costs, and it isn’t available in all parts of the world.  Like Aetna, it is usually chosen if companies are funding the premium.

Now Health Review 

With offices in Beijing and Dubai, Now Health have been in the expat market for a long time now. Not a bad option, but they are a bit more expensive than other insurance options, for similar levels of coverage.

Cigna Review

There are good things about Cigna. For example, they continue to cover individuals even after they leave their company. However, they aren’t the cheapest, claims can take 10-20 days to pay out and their premiums have been known to jump 10%-30% on a yearly basis. 

Aviva Health Insurance Review 

A UK company, Aviva are relatively new to the expat market. They do offer the highest coverage for maternity leave ($16,000), but are expensive for what they provide and the claims forms can’t be updated onto an application.  Therefore, not a convenient or cheap option.

Regency for Expats Review 

Good value premiums, efficient online system and a 98% payout rate makes Regency for Expats an excellent option. They also accept people who have pre-existing conditions, but exclude those conditions. 

In other ways, if you have a heart problem, they will accept you for coverage, but exclude the heart condition. This might not sound great, but many providers refuse to accept any applications from plan participants who have pre-existing conditions. Another positive is that they also accept American expats.

The main negative is that they can’t accept new applications for people above 70. 

Generali Group Health Review 

Generali do offer expat health insurance in certain locations, and their plans used to be popular in China and a few other locations. Generali in China is a joint venture between Italian insurance company Assicurazioni Generali and China National Petroleum Corporation. Not a bad option, and the plans are fully compliant in China, but also not the cheapest option in the market relative to quality.

Bupa Asia Review 

Bupa Asia is one of the best health insurances for people with a big budget, like Allianz. The best things about Bupa is guaranteed lifetime renewal, and direct billing with hospitals.

AIG’s PROHealth (Singapore) review 

Typically, AIG, MetLife and similar firms are focusing on volume and the local markets. In other words, they aren’t focused on tailored options, even though they have different packages available. 

Many expats will want better coverage than these plans offer. The coverage is quite low. In Singapore, the maximum coverage is up to S$300,000 per year on the lower packages.

AIA expat health insurance review

AIG in China, Myanmar/Burma, Cambodia, Laos and beyond offer similar plans to AIG.  Often not really expat policies, they are typically `local +`. Often not sufficient for expat needs, although some top packages exist. Usually best avoided unless you just want something very basic;

Pacific Cross Insurance Review 

They do offer both Thai and English options online. Staff are typically bilingual. The biggest positive is that they have no age restrictions. Their premiums are competitive as opposed to fantastic.

A Plus International Healthcare Review 

They used to be one of the cheapest options in SE Asia, but premium increases have changed that. Their  Easy Care health plans are excellent value for very basic coverage, however. One of the best options at the very lowest end of the market. 

Some Frequently Asked Questions.

Expat health insurance – how much does it cost?

It depends on how old you are and the quality of coverage you need. For younger people under 35, it can cost hundreds of dollars a year, often $500-$950, for the basic packages.  The cost rise above $1,000, $2,000 and $3,000 as people age.  There are big increases in premiums for people above 70 and 75.  A 65-year-old paying $3,500 per year may find himself or herself paying $6,500 barley 10 years later.

Do expat health insurance cover pre-existing conditions?

Typically, not. A few cover basics, like AXA Global Elite covers a small amount of pre-existing conditions. If you get the pre-existing conditions after you begin coverage, meaning you didn’t have the conditions upon acceptance, then you can usually get reinsured, but the cheaper options often don’t have automatic renewal. 

One of the only ways to get your pre-existing conditions covered is from group expat health insurance, typically covered by your employer.  This often means that a big 10-20-person group is covered, and an average price is paid by the employer.

Why is automatic renewal important?

If you get cancer or a heart attack in 6 months, it is best if your existing insurer will reinsure you, without putting up the premium by 5x! This is what automatic renewal means; the insurer is legally obligated to reinsure you. 

Should you move insurances if you are paying a lot?

As insurance is dead money, changing insurances can make sense, but it does depend on your circumstances 

Can I get health insurance if I am a digital nomad?

Yes.  And most digital nomads are young, although that is changing, so the insurance options are affordable.

Do retirees in Thailand need health insurance?

Yes, and the authorities are starting to enforce this policy regarding visas and insurance. 

Do retirees in Spain, Italy, Portugal, France and other EU nations need health insurance?

It depends.  Until now, EU rights exists.  The Brexit process is making the issue less clear, however.  Some countries in the EU, do enforce the EU law on sickness insurance.

Health insurance for American expats

The same fundamentals exist for American expats, as other nationalities.  However, due to the FATCA laws, many providers can’t accept Americans. For example, AXA Hong Kong stopped taking Americans in 2014-2015.

Health insurance for British expats

The same fundamentals exist for British expats, as other nationalities.  However, Brexit has meant that many British expats in Spain and beyond are worried about losing their benefits. 

How about expat life insurance? 

Expats with kids, or those planning to have kids, might want to consider life insurance.  As a generalization, term insurance is better than whole of life.  Some of the most frequently sold polices in the expat market include;

• Friends Provident International International Protector (Level or Decreasing International Term Assurance)
• RL360 LifePlan
• Zurich International Futura
• Zurich International International Term Assurance 
• Atlas Life

How about expat critical illness or disability insurance? 

Insurance is dead money, but spending 5%-10% of your income on protecting your health, life and income can make sense. Critical illness and life insurance can often be cheaper than health insurance for older people – so it can be worth it.

Should expat combine insurance with investments?

Many expat insurance plans combine investments and insurance in one package, especially life insurance policies.  As a generalization, it is better to have insurance and investments separate. 

What does co-pay and deductible mean?

A co-pay or deductible is how much you need to pay out of your pocket, before your insurer will pay.  For example, if you have a $10,000 procedure and your co-pay or deductible is $2,000, you will pay $2,000 and the insurance will pay $8,000. If you have savings, having a high co-pay makes sense to lower the premiums.

What does direct billing mean?

It means the insurance company will settle the bill with the hospital directly.

Country-specific questions 

You can need expat insurance in every country. The list below covers some of the main countries I have been asked about. As a generalization, there is a gap between being an expat in a high-income country and a developing one. 

Expats in developing markets need health insurance even more than those in developed markets.  In most developed markets, health coverage is mandatory or free, and facilities are free or heavily subsidized. In several emerging markets, health facilities are poor. Having insurance is therefore a must.

Expat insurance in the European Union (EU)

It is a misconception that residents of the EU are automatically entitled to 100% free coverage. Many EU states, even high-tax ones like Sweden, have co-pay systems.  

Expat health insurance in Spain

A few years ago, it would have been a clear-cut case; expat health insurance isn’t always needed.  It is cheap for younger people, but can cost $4,000-$7,000 yearly for people above 70; that was an unneeded cost.  Given the current situation with Brexit, it might make sense to reconsider that opinion.

Expat health insurance in India 

The top hospitals and doctors are world class in India, like in Thailand, but expat health insurance is definitely a must in India. Most of the main providers can accept expats based in India. Expats working in India might have insurance provided by their employer, but coverage may be basic and limited – for instance only covering certain hospitals. 

Expat insurance in Malaysia

There is no national health system in Malaysia, and they don’t have reciprocal agreements in place with other countries to fund healthcare for expats. So, health insurance is a must, if your employer doesn’t provide it. The tropical climate also increases the chances of getting certain diseases. 

Expat health insurance in Switzerland

Healthcare in Switzerland is administered by local health authorities, not nationally. Expats can get subsidized Swiss healthcare once they become residents. It is best to join a Swiss health insurance scheme, rather than an international one.

Expat health insurance in South Korea

Like in Japan, expats in South Korea live under a co-pay system. Private medical care isn’t always needed for expats, assuming they can get onto the national system.

Expat health insurance in South Africa

Public hospitals aren’t great in South Africa, so private coverage is often needed. Many of the cheaper options, such as Liberty, aren’t suitable for most expats.  The situation is typically similar in Ghana, Ivory Coast, Nigeria, Egypt, Kenya, Angola, Algeria, Morocco, Ethiopia and other African countries.

Expat health insurance in the United Kingdom 

Expats living in London are entitled to access to the National Health Service (NHS) if they are legally a resident, but the waiting lists are long.  Private health insurance isn’t needed in the UK, like Switzerland and Japan, but is a bonus.

Expat insurance in Indonesia and Bali

For expats that want to to get an extended license to work (IMTA), they need good quality health insurance from their employer, or from their own accord. Tropical diseases and awful traffic also make health coverage a must.

Expat insurance in Japan.

Japan expat health insurance is a tricky subject. The Japan National Health Insurance is compulsory.  It covers dental and medical. You pay 30% of the cost and the government pays 70%. 

If you are only going to be in Japan for 2-3 years, before going onto your next expat destination, having separate expat coverage probably makes sense. This is because if you pick up pre-existing conditions in Japan, you won’t be able to get good coverage in your next expat destination.

If you are going to stay in Japan, having separate private expat health insurance isn’t needed, considering you are already paying for the national system through your taxes, and the system is excellent.

Many years ago, expats could get away with not paying their national insurance contributions if they had local coverage, but these days such expats are being asked to pay back payments.

Expat health insurance in the Philippines

Many Filipino companies offer limited protection for minimal cost. This protection, however, tends to only cover the basics, such as accidents. Expat health insurance is there needed.

Expat health insurance in Cambodia 

Like in the Philippines, many local Cambodia insurance companies offer limited protection for minimal cost. This protection, however, tends to only cover the basics, such as accidents. Again, private health insurance is a must.

Expat health insurance in Vietnam 

Health services in Vietnam are generally better than Cambodia.  Vietnam is currently working on developing a universal healthcare system for its citizens, but expats need quality expat coverage.

Expat health insurance in Singapore 

Most expats are on packages in Singapore.  For those that aren’t, the same fundamentals exist, although local coverage can be considered in Singapore, given the excellent facilities.   

Expat health insurance in Hong Kong 

Hong Kong has more expats who are permanent residents than most other Asian countries. If that is the case, the hong kong healthcare system is well suited for most expats. For expats who are new, and therefore not permanent residents, private health insurance is often needed.

Expat health insurance in China 

I lived in China for 4.5 years. Facilities are getting better. Expat health insurance is ideal and preferable, and many company health insurances are basic.

Expat health insurance in Dubai and UAE

Expat health insurance in Dubai and Abu Dhabi is required to secure health insurance in order for their visa to be issued or renewed. Many firms will help with this, otherwise you need your own coverage.

Expat health insurance in Russia.

Health coverage is free for residents under the obligatory medical insurance system (OMI) that covers basic treatments.  However, the Russian healthcare system isn’t the best, especially outside of Moscow and St Petersburg. Therefore, most expats elect to have additional coverage.

Expat health insurance in Holland.

Expat health insurance in the Netherlands is mandatory. Expats who arrive outside the EU must get health insurance within 4 months of arriving in the country.  Due to this situation, a local Dutch solution is usually the best.

Expat health insurance in Belgium

Health insurance is mandatory in Belgium. Health insurance is linked to social security, whereby the employer pays some contributors and the employee also contributes. So additional coverage isn’t usually needed, although unemployed expats can get coverage in their home country. 

Expat health insurance in Germany

If you are resident in Germany, it is compulsory to register with either a statutory German health insurance scheme or a private insurance scheme. This usually depends on your employment situation. In general, local German insurances are enough, as opposed to expat coverage.

Expat health insurance in Brazil 

The vast majority of expats have private medial care in Brazil, due to the potentially massive cost of getting treated privately.

Expat health insurance in Canada 

Whether your own private coverage typically depends on how long you stay for. Short-term expats usually do not qualify for the medicare system. Long-term workers are edible for it by applying for a state medical card on arrival or online.

Expat health insurance in Australia 

Short-term visitors and expats often get limited healthcare.  For example, under the reciprocal healthcare arrangements, British people traveling or on short-term expat assignments are entitled to subsidized, but limited, health services from Medicare. How much health coverage you are entitled to depends on what kind of visa you hold. 

The Overseas Visitors Health Cover (OVHC) is designed for expats who are not covered under the Medicare policy. Specific expat insurance, similar to those described at the start of this article, are typically not needed, as OVHC is usually cheaper.

Expat health insurance in New Zealand 

Tourists are entitled to free healthcare in New Zealand.  The public healthcare system in New Zealand gives residents access to free or subsidized hospital care, meaning you don’t need your own coverage.

Expat health insurance in Qatar 

Health insurance is a must for expats in Qatar. Similar to Saudi Arabia, Oman, Bahrain, Kuwait and other gulf states, usually employers give expats coverage as part of the package, or you need your own coverage.

Occupation specific insurance 

FAQs related to specific industries

Does expat insurance for oil and gas industry exist?

Yes.  Ultimately, the fundamentals of insurance are the same in all industries for private coverage, although industry-specific insurances are often provided by employers. 

Many oil and gas workers are sent to some countries which have geopolitical instability, or have questionable medical facilities unless you pay top dollar for private clinics. Examples include Iraq, Iran, Libya, Kazakstan, Uganda, Ecuador, Mexico and Uzbekistan.  

If you are working in high-income countries like Norway, health coverage is usually better than in low- and mid-income countries. 

But if you are in a dangerous job, you should make sure you are covered for industry-specific risks.  

Does expat insurance for international school teachers exist?

Usually this isn’t needed.  Most schools will cover your insurance needs, but you should check the coverage is sufficient, as some international schools will not provide good coverage.  

Further reading 

Expat financial plans review.

Expat savings plans and portfolio bonds reviews: Zurich Vista + RL360 Quantum/PIMS + Friends Provident + Old Mutual executive/redemption bonds

I was listening to an interesting interview with Elon Musk a few days ago.  He said that most people are too risk adverse even when they have nothing to lose in their 20s.

It reminded me of something I was reading online a few days after.  Many older people were answering the simple question; what do you wish you would have known at 20? Many answered they wish they had taken more risks.  

It got me thinking.  Most of the people I know who are 25, 28 or 32 who are doing very well took risks.  

A typical example is 2-3 recruiters I know.  They got a job with a low basic salary at 21-22 after graduation.  Then after 2-3 years of getting good at it, went to commission only or started their own company.

At 26-30, they were earning great money, with a better work-life balance than most people at the top consulting or law firms.

Most people would have been petrified to take such a risk, but what’s the worst that could have happened? My friend would have lost some money.

At 25-27, he could have applied for other jobs, and some interviewers would have been impressed, I am sure, about how proactive he was.

Let’s go further. Let’s say he would have lost $5,000 by failing as a commission only recruiter, as he lost his touch and still needed to pay his bills. He was only 23-25. He can make that money back; and besides most people waste much more than $5,000 on pointless consumption anyway.

Moreover, you can’t take away a client relationship vert easily. A salary can be taken away at any moment, especially in the private sector, but a client relationship built over time, can’t be taken away so easily. 

The same thing in investing.  Ironically, I have met many 25 year olds with only $5,000 to their name, who are more adverse to declines than 60 year olds.

This makes no sense.  There is very little chance markets will be down over a 40-50 year period; and besides, a 10% decline on $5,000 is only $500.  You probably spend that in daily life without even thinking. 

The keys to having a more balance view on risk are often:

1. To distinguish between volatility and stability – too many people think something that is volatile is more risky. The opposite is true.  The person who is self-employed, and has 2-3 incomes, has a more volatile income. However, that person’s income is less likely to go to zero, compared to the person relying on 1 `non-volatile` income. Likewise, assets that are more volatile, like markets, have always outperform cash and bonds long-term. People make this mistake all the time. They speak about China having a `stable government` as opposed to a `low volatility government`, or `stock markets being unstable now`, when they really mean `highly volatile`. 
2. Remember also that taking no risks is impossible.  
3. There is no such thing as a free lunch. That job paying a non volatile income, especially if the income is high, will have 1000 candidates per 1 job. You will get told what to do all day, unless you are lucky. If you have a non volatile investment portfolio, you will end up poorer, you will just never see big declines.
4. Doing nothing, taking no action, is usually more risky than doing something long-term. 
5. A decline and a loss isn’t the same.  $10,000 invested in the S&P in 1941 would be worth $52 million today but there has been so many 50% declines along the way.
6. Taking immediate action is one fo the best ways to overcome procrastination. Top performers get in the habit of taking immediate action.
7. You will never get 100% information.  As soon as you have 80%, you have actionable information. Take the decision. In investing all you need to know is; a). What is the long-term performance of the funds; b). What is the cost; c). What’s the process.  Maybe 1-2 other things, but you get the point.  Half the questions people ask, or are worried about, are irrelevant.    
8. If you are going to have loss aversion about anything, make it about time. Think about it. If you are paid $100 an hour, and you complain for 1 hour about some $5 fee your credit card company has levied, you are losing $95 even if you get it reimbursed. If you spend 5 hours a month, or 60 hours a year, checking your stock portfolio, you are losing time.

Extra reading:

1. DIY Investors – why do they tend to fail?
2. How to become rich by investing 
3. Negotiation and wealth 

In today’s Youtube video I review Interactive Brokers – https://www.youtube.com/watch?v=zCr_rFPatNc

One of the best pieces of business advice I was given a few years ago was about firing clients and defining an ideal client.

When people are new to an industry, they often want any clients. We all have to live, and put food on the table, after all. 

I was the same. I wasn’t picky before. And that is fine for the first few years, but over time, it makes sense to become more selective. 

Some of the most successful businesses in the world, after all, reject certain clients.  Some of the best nightclubs refuse to enter people with certain dress codes. 

Many companies are not flexible on price, for example, lawyers and the fees they charge. 

Some companies actually fire clients. They cause too many problems, break too many rules and abuse a previously trusting relationship. They take up too much of your time, for little reward and payoff. 

Beyond that, going into business in any industry, a company, and individual needs to picture their ideal client and be brave enough to say no to those that don’t fit that ideal.

For me, who are my ideal clients? Here is a list of what I look for in clients. If clients don’t meet these criteria, I refuse the business, as they will cause too many problems:

1. They are focused on the long-term. They aren’t short-term investors.  At least 5-year horizons.  10 years+ is ideal.  A very long-term relationship lasting decades is most preferred. 
2. They have at least $500 a month or $35,000 as a lump sum to invest – soon to be raised to $40,000.
3. They are not cynics. This excludes many lawyers, journalists and several others who assume the world is a dangerous place, full of scams! It is human nature to like people who are more like yourself.  I don’t assume the worst.  I don’t read every piece of small print.   Just a few weeks ago, I got my laptop fixed in Seoul. The person with me commented on how trusting I am because I didn’t close my computer down when the IT engineer was looking at it.
4. Following on from number 3,  being trusting is simply realistic. Research has shown that if you lend money to a complete stranger, there is an 80%-90% chance they will pay back. The average person assumes the chance is only 50%. Crime is falling in most countries, but most people assume otherwise.  The point is, the very worst cases like scams are 1% of total cases.  People who assume otherwise before they are in, just cause more problems when they are clients.
5. They understand the value of doing things online. Most face-to-face meetings are a waste of time and money. Things can be done cheaply and more efficient online. 
6. They realize the location isn’t important. This is linked to points 3 and 4. Somebody who is overly cynical likes to deal with somebody they know – maybe at the expat bar or another location – even if they deep down know better options may exist. This is better safe than sorry idea. My ideal client understands the value of saving them time and money, by doing things online 
7. They realize how you dress isn’t important. Pointless meetings, ties and business cards should have been discarded in the 1990s. 
8. They realize the importance of time – they are proactive. They realize, in the words of both Dale Carnegie and Sir Alex Ferguson, that if a decision is to be made, it should be made quickly. As soon as they have enough information to make a decision, they make it decisively, just like I do. They don’t procrastinate and think about things for weeks – also known as analysis paralysis. 

How about you and your industry, who are your ideal clients? Who causes 80% of your problems?

Being selective about these problem clients by refusing to take new ones in the first place, will solve many of your business problems.