1 / Know your needs… and budget 

Choosing the right international health cover means you know what you need! So ask yourself the right questions…! What will happen if tomorrow you are sick or injured abroad or in your country of nationality? Are you alone or with your loved ones? Do you have a project of motherhood? Do you need a « personnal accident » cover or you want to cover expenses in case of hospitalization?

As we consider that not more than 30% of a monthly budget should be spent on housing,  a maximum of 10% should be dedicated to the health, welfare and retirement protection. This will allow everyone to set a reasonable budget. Finally, there are usually solutions to every situation at every stage of life!

2 / The scope of cover

All contracts are built the same way : a basic warranty that supports expenses in case of hospitalization (« in patient »). Most international health contracts support 100% of actual costs, with generally high and sufficient limits (it is to check in some countries such as USA, Singapore … in which care is extremely expensive). However, some limits will remain insufficient if you like luxury (if for example the « single room » in case of hospitalization is supported with a maximum of 200 euros / day, you will need to complete to get to the American Hospital of Paris!).

In option, you can cover routine medical expenses (« out patient »), dental, optical, maternity and of course evacuation (or repatriation) plan. Again, for each item, check the « annual benefit limits »: be reasonable and think that you do not sign a health insurance plan to change your glasses every year… Finally, some items are more important than others!

3 / The territoriality

Most companies offer three options: worldwide, worldwide except USA, Africa alone. Segmentation can sometimes be thiner, hence the need to compare! If for example your formula is « world except USA », you can not be hospitalized in the USA. You will however be covered in the States for emergency cases in case of accident or sudden illness.

4 / « Lifetime warranty » or « short term insurance »?

If you are going abroad for a long time (over 12 months), it is recommended to sign a « tacit agreement plan » with a « lifetime warranty ». This means that once your application is accepted, the insurer may not cancel the contract even if you have long disease conditions. This is the guarantee to be covered until the end of your life.

A « short term » contract (from a few weeks to a maximum of… seven years in some countries !) is much less expensive, but its renewal is at the discretion of the insurer. In other words, if you cost the insurance company more than you pay, he is not obliged to extend its guarantee! This can be very problematic in case of  a serious long-term illness.

5 / Are pre-existing conditions covered?

Before granting the guarantee and confirm an annual premium, the insurer (who’s purpose is, it’s important to remind, to offer competitive products to its customers, delivering a promise… and make a bit of profit) will ensure that the potential insured is not subscribing by opportunism! Risk selection is the basis of the job and the future client needs to complete a « medical form. » Weight, height, alcohol or cigarettes, past illnesses, accident injuries, treatment or ongoing family history will be examined by doctors from the insurer who can refuse or accept a file without having to justify it. « Non-standard » health profiles may be subject to a premium increase or specific exclusions may be offered.

Some companies (British in general) have a different approach and accept pre-existing conditions after a two years « moratorium ». It is important to understand the logic of health insurance. In the same way that everyone understands that it is too late to buy a car insurance plan after the crash…

6 / What about deductibles and waiting periods?

Premium proposed by the insurer will also depends on « deductibles »: the amount that the client accepts to take in charges… from his own pocket. For example, to reduce your annual premium, you can choose to be reimburse up to 80% or 90% for the « current medicine. » This deductible (also known as coinsurance) is generally appreciated by the insurer because it « moralizes » consumption. Another point to be considered: starting date? Guarantees are generally immediate for accidents and deseases. Only some items will be granted after a waiting period: maternity (usually 10 months), dental or psychiatry…

7 / Services offered by the insurer and mistakes to avoid

Each insurer is committed to excellence in service and provides 365/365 help line. This healthy competition allows consumers to benefit from greater security of mind and the best services in case of an emergency or simple consultation with a general practitioner, anywhere in the world. In fact, difficulties often come from non-compliance by the client of the procedures established by the insurer : they must be strictly followed, whether to ask for a support in case of hospitalization or subsequent refund in current medicine.

Some insurers are now distinguished in service offering the ability to scan documents and send them by email: a major step forward when we know how internet makes life easier for expatriates, even at the end of the world! Most companies also offer (free or not) to split the premium: in all cases don’t forget to pay (credit card or bank transfers) because in case of failure to pay on time, your contract will be cancelled and the consequences could be severe.

8 / The annual premium

Finally, the cheapest contract is not necessarily the one to choose… neither the opposite! So, be careful at a rate that can be misleading … because misunderstood! You can, however, identify significant differences in rates (30 to 50%) since each insurer has its target and segmentation. It is therefore worthwhile to compare, especially when your situation changes (geographic, family, needs to be covered …).

Despite all, be philosopher: it is likely that the price of your contract will increase every year. Inflation of medical care on the planet and longer life (including yours!): you will statistically  « consume » more care in the futur, more expensive care ! However, some companies offer discounts if you do not use you plan: an encouragement to virtue ! Before changing insurer, make sure to respect contractual periods of and the acceptance by the new insurance comapny.

9 / Understanding « medical evacuation » or « repatriation plan » 

Most international health plans include (it can be optional) a 24/24 worldwide sanitary evcuation plan, also called « medical evacuation » or « repatriation plan ». It offers medical evacuation (to the nearest suitable place) or « repatriation » (to the country of origin when possible), when local treatment is not possible. It is true that in case of an emergency, the insured as his family generally prefer to return « home ». But don’t forget that the purpose of the guarantee is first to save a life so trust professionals in charge!

In all cases, two doctors will organise the evacuation: the one locally in charge of the patient and the one of the assistance provider. Therefore, the insured chooses neither the time nor the conditions for intervention! This, once decided, will be on regular scheduled flight (usually in business class and with a doctor detached for travel) or air ambulance if necessary. It is imperative to respect insurer procedures and not decide anything or finance anything without having his consent. All plans include repatriation plan of the body in case of death and sometimes the return of the insured in case of illness or death of a loved one at home.

10 / …and the French overseas: CFE or not CFE?

Voluntarily join the Caisse des Français de l’Étranger is an individual choice that should be reflected. In this reflection, you should take into account the limits of the CFE, which pays on the basis of the French Social Security, approximately 60% of expenditures to date, which can be very insufficient abroad. It is therefore advisable to purchase a top-up plan to CFE including a « repatriation » guarantee.

Premiums at CFE are for a « family » and automatically include maternity option: it is a particularly judicious approach for large families. Contributions are based on the activity, income and age of people. If you have more than 35 years and not insured at SS ou CFE in the past months, you will have to pay two years of « penalty » (plus the coming year) and you will have a two months waiting period. This waiting period goes from 7 months for people who have more than 45 years old. Undeniable advantage : pre-existing conditions will be covered easily by the CFE and in case of total and permanent disability, you will continue to be covered until the end of your life without contributing.

Beyond the « citizen choice » that could be the motivation of the recipient (national solidarity organized for health and retirement), the financial aspect is often the determining factor to make a choice.

Abroad, many expatriates or binationals will then prefer a « private » insurer (PMI), for their medical costs to be supported up to 100%  everywhere in the world : it is called insurance « at 1st euro » (or 1st dollar, 1st pound…). For singles or couples up to two children, this formula is often cheapper than CFE + top-up plan. Pre-existing conditions may be subject to a premium increase or specific exclusions.

Depending on your situation, you will be more or less interested (financially speaking) in choosing one or the other options available to you. Knowing that at the end, the level of benefits of a  « CFE + top-up » plan  or « 1 euro plan » are identical