Your health insurance questions answered

Thank you to everyone who submitted a question to Simon Ashworth (Group Head – Healthcare). Simon has taken the time to review the most pertinent questions, including what are the key factors to consider when buying health insurance and why do premiums rise each year, and has answered them in an open and transparent manner.

Simon Ashworth - Your PMI questions answered

What are the key factors to consider when looking for the right health cover?

For most people being in good health is a top priority. When it comes to your health you can’t predict what’s around the corner – but you can make sure you have the right plan in place. There are lots of health plans to choose from and all aim to give you:

• Prompt access to medical treatment
• Reassurance that treatment costs will be met
• Access to high quality private medical facilities
• Choice of doctor, hospital and time of appointment
• Support navigating the healthcare system

At JW Seagon we offer a full range of international health insurance plans. We will guide you through all the options and address the following areas:

In which countries do you want to be treated?
Are you comfortable with the medical facilities in the country you live in? Whilst you might be for routine treatment, if you needed to treat something more serious, would you want the option to travel to access superior facilities and expertise within Africa, in Europe or in the USA? The wider the area of cover you choose the higher the premium you will pay.

What do you want treated?
Do you simply want to know that the treatment of the big, serious illnesses is covered, or do you want to have cover for everyday routine treatments as well? Health plans give you the option to cover in-patient treatment, in-patient + out-patient treatment, or in-patient + out-patient + wellness, optical, and dental benefits.

Whichever combination is right for you, we would recommend that you make sure your health plan includes evacuation cover (with some policies it is an option). When the right facilities aren’t available locally, evacuation cover meets the cost of transporting you to another hospital where you can get appropriate treatment. This might be in a nearby town or city, or a completely different country.

Whilst most health plans will not cover any medical conditions you currently have or have had in the past (often referred to as ‘pre-existing conditions’), there are a few that may do so. Africa Wellness Solutions is such a plan. We know how important it is to cover you for the things that matter most, so instead of excluding pre-existing conditions, we look to cover them where we can, sometimes for an additional premium to cover the increased risk.

What is your budget?
For most people getting the right health cover in place is a balancing act between the extent of cover and what they can afford. Your choice of which countries to have cover for and what you want to have treated will affect the plan price. But there are other ways to manage the price and make your plan affordable. For example, with most policies you can take an annual deductible, which means you pay all claims up to the deductible amount in return for a lower premium. On Africa Wellness Solutions, for example, a 55 year old selecting a $720 deductible would see their premium reduce by $852, or 12%.

Why are you not offering discounts for good health?

In the UK, Vitality Health offers health insurance that rewards customers for being healthy. As well as protecting them when things go wrong, it encourages them to lead a healthier life and rewards them for doing so. The reward for 12,500 steps in a day twice a week, for example is a Starbucks drink and a cinema ticket.

However, this is not something that international health insurers currently offer. There are policies that offer preventative wellness benefits such as health screens (it’s much better to catch something untoward early rather than later) but there is no discount or reward for using the benefit.

The starting position for Africa Wellness Solutions is that most people are in good health. As part of the application process we capture information about pre-existing conditions, body mass index (BMI), smoking and alcohol consumption and where necessary will load the premium to reflect any significant increase in risk.

There’s more that can be done to encourage and reward good health on international plans. And it’s certainly something the JWS team will be discussing further with insurers.

How much do big operations typically cost?

How much do big operations typically cost?

Why do premiums go up each year?

One reason is that your age is one of the key determinants of your health plan price. As our bodies get older we are more likely to need medical treatment of some sort. So as you move to the next age band your premium will go up.

One reason is that your age is one of the key determinants of your health plan price. As our bodies get older we are more likely to need medical treatment of some sort. So as you move to the next age band your premium will go up. The other key reason is what is referred to as medical inflation. The cost of medical care continues to rise across the globe and whilst the trend has slowed in some countries, it is still mostly above inflation*.

Medical inflation is being driven by:

  • The cost of life saving, or life extending, medical innovations – new drugs, new technology, new equipment. On a more positive level, whilst driving cost it does also mean that people have never had a better chance at surviving serious illnesses such as heart disease and cancer!
  • The increased use of medical services. High blood pressure, obesity, diabetes, are all linked to lifestyle choices and are on the increase; they are the top reported conditions giving rise to adverse claims experience around the world.

Overall medical inflation in Kenya continues to increase and is even higher in Nairobi, where increases can be 15% to 20%. Traditionally, medical inflation has been about 5% above general inflation

*Source: Willis Towers Watson: 2017 Global Medical Trends Survey Report

Quick fire questions!

Would you be covered if you went travelling to a random place like the Galapagos and e.g. cut your foot on coral and had to have an operation there to sort it out?
Yes. Africa & India plans would cover under emergency out-of-area. Worldwide (excluding the USA) plans would cover this as standard.

What happens when you do something that you know is silly like running with the bulls in Pamplona and you get injured?
Certain insurers may possibly exclude under ‘hazardous / extreme sports’, but generally this would be covered. Africa Wellness Solutions has no exclusion for extreme sports, whilst Aetna specifies certain activities, such as off-piste skiing, potholing, caving…but not running away from bulls!

If you develop a long term illness after you’ve bought health insurance are you still covered?
Certain insurers have exclusions relating to ‘chronic conditions’ so you’d need to ensure you buy a plan that covered ‘routine management of chronic conditions’.

Is evacuation included in all international plans or do you have to specify that you want it?
Typically covered as standard – Bupa Lifeline, Company or WWHO are the exception.

Jargon buster

  • Area of cover: the countries where you can have treatment (NB travel costs are not covered).Deductible or excess: choose to pay a specified amount of the claim value; the bigger the deductible the lower the premium.In patient treatment: treatment requiring an admission to hospital.
  • Out patient treatment: treatment not requiring an admission to hospital + visits to a doctor, consultations with a specialist, tests to find out what is wrong, as well as prescribed drugs and medicines.
  • Pre-existing conditions: medical conditions you have, or have had, before buying a health plan.
  • Provider network: insurance companies have networks of medical providers (hospitals, clinics, doctors etc.)  Typically:
    • If you use a network provider the cost of treatment will be settled directly by the insurer
    • If you don’t use a network provider you have to pay for treatment and submit a claim for reimbursement.