How to choose an international medical insurance
How to choose an international medical insurance
When you decide to become an expatriate, you will most likely start looking for a new medical insurance provider. Depending on the country you decide to settle in, the choices to make can be very different. I had to go through this myself and I have prepared a comparison between 4 providers ( but 3 are relevant if you aren’t French so I will not dwell on this last one on the English version of this article): April international, MSH international, Allianz and CFE (French overseas funds).
A big medical issue can bring personal bankruptcy and when you are an expat, you are already living (to a certain extend) with no safety net. You can get fired, have visa issues, sometimes one salary for a whole family and most often do not get support from the country of residence as you don’t have the nationality (but still pay the highest taxes ! ). If you come from a country where social welfare is poor or not provided by the company; juggling through offers might come easier for you. But I am French and the concept of paying such an expensive premium for medical insurance was a difficult mentality shift to make. ( and the realization, that I would gladly pay my French taxes and get a good hospital than the more expensive private insurance for the same service… a debate for another time).
If you aren’t French – I would qualify 2 types of options:
- You want an international medical insurance marketed for expats with all the great coverage and more flexibility of the where you can get treatments.
- Or you a happy with the infrastructure and services available in your country of residence and need a good quality local medical insurance.
If you are working for very local Asian company (not multinationals or large local companies) most times they provide the legal minimum or just something above, which doesn’t necessarily give access to English speaking care.
Criteria and preliminary information to compare international medical insurance
First, whenever I went all the way to the get a quotation. We are a healthy couple with no pre-existing conditions, no drinking, no smoking and no major health issues in our early 30’s. I have glasses, but my glasses cost usually about 200/300 euros when I have to do new ones every few years. We have good dental health. So, pricing would reflect these needs. Any pricing would be done for a zone which includes Indonesia, where we live at the moment.
What we wanted: to have access to an English-speaking healthcare professional in a hospital that doesn’t look like a madhouse, which is clean and where queuing is not too long. Preferably close to our home. We wanted to be covered on any accidents and also have the option to be repatriated to our home country for delicate treatment or receive treatment in a neighboring country with better facility. (Middle class and wealthy Indonesian’s go to Penang’s hospitals in Malaysia for example).
Quick presentation of the international medical insurance’s companies mentioned in this article
April international
I have been using April international on my first two years in Malaysia. I never had a big health issue but I must say for all outpatient needs I had (dental checkup, glasses change or gynecologist visit etc…), all was refunded. I did have to send the paperwork hardcopies by mail after submitting the claim online and refund did take some times for out-patient needs. For in-patient no cash advance unless you go into their list of approved partners*. It was mainly for planned hospitalization that pre-approval was needed.
The company is part of group which are broker of insurances across the globe. They do have a fair network for direct billing (where you don’t need to cash advance) in Asia. And some local Asian insurance packages as well.
Download the long-term expat insurance brochure
Download the a-la-carte expat insurance brochure
MSH International
We got to know about MSH through their corporate offer which is called Previnter. Previnter is the name of the product that companies can buy to insure their employee and my husband got us both on this plan for 4 years in Thailand through his employer. I must say, the plan was comprehensive, we never got to think twice when we needed to get a checkup, a knee issue with x-ray or MRI or any of our medical needs during this time. We could go to the most expensive hospital in Bangkok and be covered. I had some medical issue while on holiday in Hua Hin and also absolutely no problem at all at the local hospital. That was a good peace of mind. Apart from the MRI, that required a pre-approval (very quick) and for us to send the original copies, claims are done online and paid back pretty quickly.
We did like this insurance, so we subscribed as private individuals for the last 2 years while in Indonesia to their similar coverage, but then for individuals it’s called MSH International.
MSH is a subsidiary of SIACI Saint honore, which is a European leader in insurance brokerage. They have offices across the globe, which is easier for customer service. For Asia it’s Shanghai.
Download their insurance brochure for expat
Allianz
I am sure that I don’t have to present this world-famous insurance provider. They do have a strong footprint globally in what I would qualify as local medical insurance. Many of my local colleagues would have an insurance from Allianz or even a life insurance there. Because of it, we also looked at them when we had to buy our new medical insurance. They also have an expat marketed product but we didn’t go as far as asking for a quotation.
If you are not looking at an expat marketed insurance, a very good quality local one can be excellent value/money. Allianz seemed to be a solid option then. Although to be fair, it’s not really comparing potato with potato, as in the end even if Indonesian’s themselves don’t trust their own hospitals, we wouldn’t have gone with a pure local insurance, we needed the insurance (pun intended) that we could go back home or to another better country for treatment would “shit hit the fan”. It will mainly depend on your budget!
Since I didn’t get as far as asking for a price, I will not compare Allianz product in tables like with April & Previnter. But I did get all the brochures – so I am adding them here to download for your information.
Download their international insurance brochure
I think the most relevant would be for you to search “Allianz health insurance COUNTRY NAME” to get to know the local products available.
CFE – Caisse des Francais de l’Etranger – translated into: French abroad fund
For the sake of general information. We, French people, have the option to continue subscribing to our social welfare system. It’s divided into 3 types of funds you can pay to:
- Retirement: to keep accruing benefit, that’s only good if you are just on a short time expat abroad. It’s super expensive because you have to pay the employer AND the employee part. The contribution is proportional to your revenue.
- Social benefit: such as unemployment support, children support, various subsidies etc…
- Medical coverage: all medical expenses to be refunded at the same level as if you were in France.
Do you spot the issue? Most medical hospitals with English speaking staff abroad are private and bloody expensive, much more than our pretty good public hospitals in France. Therefore, this will not cover all your needs at all. It must be supplemented by some especially designed insurance products for French citizens. Whereas every claim goes first to the public system and the insurance would refund the balance. It can be a good & affordable option for short term stay abroad and if you just need to be covered in your country of residence and in France. It’s also super easy to get back the “carte vitale” and be back into the French system as you would never have left it! We love paperwork, when you have been abroad for too long getting back into the system in France can be really tricky!
And to find out the list of available services which can offer the additional coverage – here is a list to start your search
International medical insurance: The core services and offers of the expat marketed ones
Understanding the zones
Some plans are available only for specific countries – for example if you live in the US, by default your only option is often the most expensive offer. Ensuring that your insurance has interesting countries within the same zone of coverage is important. For example, it’s a good bonus for me that France and Indonesia are often in the same zone, so I can be refunded for any treatment received in the two countries!
When you are traveling a lot for leisure, you could be fully covered would you get injured and receive treatment in your country of travel thanks to these zones. The repatriation options can be very good replacement to travel insurance too. Plus, they often even contain delayed luggage, missed connection refunds or, if an airline practices overbooking and you get stranded, the hotel price!
Major differences in zone boundaries
April international
Zones are from 0 to 5, the zone 0 being the most expensive countries. What is quite good with April is that if you purchase an insurance for a country in zone 3, then you will have access to zone 3,4 and 5 countries to receive care.
However, if you live in an expensive country like the US, you can’t choose a cheaper package (and therefore acknowledge that you will have a less than ideal coverage).
MSH international
They recommend packages based on zones, which are decided on the average cost of care. From reasonable cost countries - like Algeria, India – intermediate countries - like Chile, France or Malaysia – high expenses countries such as Taiwan or Australia and the very high expenses countries such as the US or China.
These are recommendations only; you are free to purchase any package that you like. You are however covered only for the countries within the same zones.
If you purchase a high expenses country package, you will only have access to care in these countries but not on a reasonable cost country for example.
Let’s dive in.
Comparing April International and MSH International medical insurance
It’s not easy to re-group and compare as they have different categories and thresholds of refunds. So I have tried to combine them into main comparable groups.
We will compare here the all-inclusive packaged offers. Because April has an a la carte kind of offer and I will talk about it later.
Each insurance has 4 plans so for the sake of not having overly complicated tables. I will compare them side by side and I will compare, entry level, mid-tier and high. The super high which is basically unlimited, you can have a look at them in the brochures ( download link above )
April international products are, from cheaper to expensive:
International, International +, Executive, Executive +
MSH international products are, from cheaper to expensive:
Quartz, Pearl, Sapphire, Diamond
Comparison of International vs Quartz
| April International | MSH | |
| Long term International Health Plan | First Expat | |
| International | Quartz | |
| Overall limit | USD 2 millions | USD 500,000 |
| Inpatient treatment and hospitalization (1) (2) | Covered 100% | Semi private room (limit of 125 USD/day) |
| Post hosp. treatment | Limited to 1,000 USD |
Covered and limited for external prostheses / palliative care Physiotherapy is limited to 1250 USD Rehabilitation post injuries: 100% for maximum 20 days |
| Medical aids | USD 500 | Excl. medical expenses for organ transplant |
| Mental health | Excluded | Excluded |
| Home hospitalization | Excluded | Excluded |
| Outpatient | Excluding: General practitioner / X-ray/ Physiotherapy/ Chiropractor/ Osteopath | 100% (limits on number of sessions for Physio,chiro and Osteo therapy) |
| Medical evacuation | Covered | Covered (Europassistance) |
| Medical assistance | Excluded | Covered (Europassistance) |
| Well-being care (2) & Routine healthcare (3) | Vaccination only | 19,000 USD limit for routine healthcare / vaccines only |
| Worth noting | AIDS/Chronic Conditions is out of area cover | Emergency dental and vision are not covered |
| Added services | WorldAware/Bloodcare fundation/Second opinion | 3rd party liability insurance & Legal Assistance |
| Dental & vision | Not covered | Extra & optional. |
| Maternity | Not covered | Extra & optional. |
| Repatriation/Burial | Max USD 15,000 | Optional |
| Life / Disability insurance | Excluded | Optional |
PRICE QUOTED |
1,307 Euro / person |
2,258 Euro / person(incl. Repatriation, dental and vision options) |
Conclusions
At the entry level coverage, April seems to be a better in-patient coverage when problems really happen. Their maximum coverage is high. But I find that for out-patient care, which let’s hope is really what you will use the most, it’s lacking: The General practitioner is not included! MSH on the other hands covers better out-patient care and seems to try to provide a wider coverage but with a lower maximum amount covered, which might be a good plan if your country of residence average care cost is low.
On the plus side, MSH also includes legal support and third-party insurance.
Price wise, even if we removed the options of MSH, April remains a pretty good value/money.
Comparison of International + vs Pearl
Note: we have the MSH Pearl coverage now ourselves.
| April International | MSH | |
| Long term International Health Plan | First Expat | |
| International + | Pearl | |
| Overall limit | USD 2 millions | USD 1 million |
| Inpatient treatment and hospitalization (1) (2) | Covered 100% | Private (limit of 190 USD /day) |
| Post hosp. treatment | 100% |
Limited For external prostheses / palliative care. |
| Medical aids | USD 1,000 | Included |
| Mental health | Excluded | 100% with a limit |
| Home hospitalization | Excluded | 100% with a limit |
| Outpatient | 100% | 100% (limits on number of sessions for Physio,chiro and Osteo therapy) |
| Medical evacuation | Covered | Covered (Europassistance) |
| Medical assistance | Excluded | Covered (Europassistance) |
| Well-being care (2) & Routine healthcare (3) | Vaccination only | Up to USD 38,000 / Excl. dietitian |
| Worth noting | AIDS/Chronic Conditions is out of area cover | Emergency dental and vision are not covered |
| Added services | WorldAware/Bloodcare fundation/Second opinion | 3rd party liability insurance & Legal Assistance |
| Dental & vision | Dental is covered | Extra & optional. |
| Maternity | Not covered | Extra & optional. |
| Repatriation/Burial | Max USD 15,000 | Optional |
| Life / Disability insurance | Excluded | Optional |
PRICE QUOTED |
1,859 Euro / person |
3,070 Euro / person(incl. Repatriation, dental and vision options) 2,350 Euro/person(incl. Repatriation) |
Conclusion
April still has a higher overall expense coverage, double the one from MSH. In this comparison, it’s noteworthy that April covers dental expenses, it’s only optional with a surcharge for MSH. I do however think that the routine checks up covered by MSH are quite comprehensive on the outpatient offer and the max expenses possible would be more than enough for physiotherapy or more serious injuries. Same as for the entry level, MSH offers legal advices and third-party insurance as basic offer.
I think that the price gap between the two offers is reduced for this category – which makes MSH stand out more for this category, as the added value insurances & legal assistance make it worth the difference. (without the dental & vision options). Unless dental is very important to you – then April is the better proposition.
Comparison of Executive vs Sapphire
| April International | MSH | |
| Long term International Health Plan | First Expat | |
| Executive | Sapphire | |
| Overall limit | USD 2 millions | USD 2 millions |
| Inpatient treatment and hospitalization (1) (2) | Covered 100% | Private ( limit of 310 USD /day) |
| Post hosp. treatment | 100% |
Limited For external prostheses / palliative care Physiotherapy: max USD 6,250 Reconstructive surgery 100% / Rehabilitation post treatment: 100% / 30 days |
| Medical aids | USD 1,500 | Covered |
| Mental health | Excluded | 100% but limited |
| Home hospitalization | Excluded | 100% / 20 days |
| Outpatient | Excluding: General practitioner / X-ray/ Physiotherapy/ Chiropractor/ Osteopath | 100% (limits on number of sessions for Physio,chiro and Osteo therapy) |
| Medical evacuation | Covered | Covered (Europassistance) |
| Medical assistance | Excluded | Covered (Europassistance) |
| Well-being care (2) & Routine healthcare (3) | Incl. Medical check up | 100% up to USD 62,000 |
| Worth noting | AIDS/Chronic Conditions is out of area cover | Emergency dental and vision are not covered |
| Added services | WorldAware/Bloodcare fundation/Second opinion | 3rd party liability insurance & Legal Assistance |
| Dental & vision | dental is covered | Extra & optional. |
| Maternity | Not covered | Extra & optional. |
| Repatriation/Burial | Max USD 20,000 | Optional |
| Life / Disability insurance | Excluded | Optional |
PRICE QUOTED |
3,002 Euro / person |
3,554 Euro / person(incl. Repatriation, dental and vision options) |
Conclusion
Considering the price quoted, I believe that the higher package you get, the more MSH is competitive. A difference of 552 euros for all the added value services (third party, legal support) and no franchise system (like in April) so you get truly 100% refunded within the limits allowed, on the longer run makes it a much better value.
Extra notes
Comment 1: April covers cancer. MSH does not specify.
Comment 2: for MSH
Incl. room, outpatient hosp. ER (incl. for short trip in another coverage zone), intensive care, surgery, consultations, lab tests/MRI/X-ray/Scans/Tomography, drugs, dialysis, oncology, AIDS, protheses, palliative care, transplant, physiotherapy, psychatric, newborn care
Comment 3: For MSH
Incl. GP/Specialist, ER dental/vision w/o hosp., orthoptics, physio w and w/o prescription, alternative medicines, tests, drugs (incl. chronic diseases, psychiatry, med. Equi.)
Comment 4: For MSH
Incl. vaccinations, routine exam (every 3 years), prevention package (cancer - cervical, breast and prostate over 45 y.o., oral (every 5 years), skin (every 5 years), colon over 50 (every 5 years), fecal occult blood, bone density over 45 (every 5 years )), dietitian, nicotine replacement
April a-la-carte offer
It exists an a-la-carte medical insurance products which is French based from April.
You can download the brochure here (in English). We didn’t pursue it further because after doing some online research on insurance website comparison, it was more expensive than the package ones from UK and as or more expensive than MSH ! So “a-la-carte” for same types of coverage as the package was not interesting at all.
It is only interesting if your company provides a good in or out patient and you need something to fill the gaps – or you need really barebone medical insurance.
Comments on Allianz and good quality local medical insurances
If your new country of residence has satisfactory level of healthcare and infrastructures, you may not need to go for an expat marketed medical insurance product. It’s also good to look at real local insurance companies (sometimes you may have never heard the names before! ( ask your colleagues or company) These companies may have much better direct billing services network with the countries’ hospitals. Indeed, their computer systems might be linked and approval for an expense can come very quickly. So, it’s really worth checking it out. In Indonesia, I am also covered with one of these companies thanks to work and for something as simple as an “A/C flu” or the usual gastro-enteritis – I am happy to seek a healthcare professional with so-so English in a mid-range local hospital. For these kinds of small and commons problems that’s absolutely fine and I have been really well cared for so far – just popping in, providing the card to the registration desk - and not having to explain that unknown foreign insurance is to someone at the counter desk with so-so English, it’s quite convenient too.
Price can go much much lower and can provide a great level of coverage.
Our PERSONAL opinion and what drove our choice to MSH International (for now)
I want to emphasize that these are our personal preferences and choices, I am not an expert and you should still do your due diligence before choosing a medical insurance!
As mentioned earlier in the article, we needed to be able to receive treatment in another country, as we didn’t trust the quality and availability of specialists in Indonesia. So we had already ruled out Allianz for that reason. But again, we can afford the expensive product marketed for expat! Allianz is not a bad choice, and there are good hospitals in Indonesia as well! It come down to personal specifics – we can also come back to France as we have our family there. Many people have no more reasons or roots left to their home country, so it’s less of a relevant criterion for them.
Even though April international had better zones ( if you pay for a high cost country, then you can access the “below” zone countries), as we would have in the same zone: Malaysia, Thailand, Indonesia and France – those being suitable regional and personal choices for good quality healthcare. MSH International was good enough, as we had France, Malaysia and Indonesia in the same zone.
We also appreciated the legal and third-party insurance that came by default in all of MSH International plans. The repatriation option added a lot of benefit (and not just the burial cost in case of death) for delayed flights and casual travel related support. This was also quite interesting as we do a lot of small regional holidays. Even though my company covers me well for business trips in the region, it’s an added cover for those instances too.
Finally, what drove us to choose MSH over April or Allianz, is that MSH International has a good call center in the same time zone in Shanghai and truly refunds 100%. With April international, there was always a couple of euro there and there that was franchise or some penalties if you don’t get pre-approval or submit the claims on time. It’s not really much but, you know, it’s not exactly 100% either. Read the fine print and you will see – we found that even though the price seems cheaper at the beginning, if you had a weak knee / small sport injury and needed 10 sessions of physiotherapy, then with the franchise system, I think you would pay the difference in the end with the initial cost of MSH International. We though that MSH International was more transparent on what we had to pay and what was covered.
Both MSH and April provided fast answers and quotation as well as a call to explain the products.
For April, the “package” product marketed for expats are also UK based product, with UK law and stuff – with Brexit (we might be totally wrong about this!) we just didn’t feel like it was a safe choice. So we would stick with a service provider offering an insurance product that we could understand & from a country (France) whose law in case of issue we could easily access and we could relate to.
It’s worth noting, that while we are with MSH International, we paid less the second year than the first for the same zone and product.
Navigating through all these offers was long and tedious. There is no real best insurance out there, there is the one that works for you (and your budget). I can’t emphasize enough that you should take a deep breath: list a few names, start downloading the brochures and create a table / excel file to compare benefits. Once you have found one that works, there isn’t a real need to change unless your personal circumstances do and you just keep on renewing it!
Photo credits:
Office workers: by Scott Graham on Unsplash
Ombrellas: by Ulises Baga on Unsplash
