Why is employee engagement key to mitigating rising international PMI costs? Stuart Birch comments

08 April 2015

Stuart Birch, Senior Health Management Consultant, recently made comment in an Employee Benefits article written by Clare Bettelley on how cost control is driving new trends in international PMI.

Many employers have traditionally accepted the relatively high cost of international private medical insurance (IPMI), labouring under the misapprehension that its cost is incredibly difficult, if not impossible, to contain.

This is, in part, due to the fact that the cost of IPMI has been increasing. Richard Saunders, sales director at Healix Health Services, says: “The cost of IPMI is really going up. There are a lot more providers in the marketplace, but [there is still] exposure [for employers with] repatriation and possible claims for high-value items.”

A US-based food-poisoning-related claim worth in excess of $2m (£1.3m) last year is a case in point, he adds.

But times are changing. A number of employers are beginning to realise that they can better manage their IPMI costs and are starting to do just that.

John Kaye, director of client management, Europe and Middle East, at Cigna International Expatriate Benefits, says: “In the last four or five years, employers have been looking much more at the sustainability of their expatriate programmes.  They look at themselves first, [in terms of] making sure they’ve got all the expats they need, and then they’re looking at how long assignments are and making sure [that their IPMI] provider can provide the appropriate cost.”

Healthcare providers have a role to play, too. “As much as employers still want rich benefits for expats, it’s more and more important that providers don’t just write cheques to hospitals at rack rates, and that we maximise network agreements and manage high-cost cases effectively.” adds Kaye.

More appropriate hospital choices for employee treatment can also help to contain employers’ costs. Stuart Birch, senior health management consultant at Capita Employee Benefits says: “There is a role for employers to play in learning from people on the ground about how to provide a directed care pathway and position it as a positive to their employees.”

Directed care pathway

A directed care pathway would detail the medical facilities that expats and their families can visit for support and treatment.

Greater involvement in their IPMI strategies may also enable employers to tackle issues such as alleged market fraud. According to Capita’s Birch, some hospitals perform unnecessary procedures, such as MRI scans, on employees who do not need them, particularly in the Gulf, Singapore and Hong Kong.

The consequences of employers continuing to take a passive approach to their IPMI strategies could be huge. Birch says: “If an employee has cancer here, domestically, yes, it’s life changing and very difficult, but there are also tools to help support them, and they can stay at home and get back into the workforce in a staged manner.

If they are overseas, they have got to come home, so the employer has failed deployment and all the difficulty around that.”

Regulation may be the only way to help drive market growth, as in Dubai. From October 2014, the Dubai Health Authority has required employers with more than 1,000 employees to provide workplace health insurance.

Although IPMI product development has been slow in recent years, a number of providers are starting to respond to employers’ increasing scrutiny of their IPMI arrangements with expanded product and services offerings.

For example, Aviva International has invested in its Everyday Healthcare module to offer expats prescription medication, vaccinations and eyecare, as well as expanding access to its Gulf products into Bahrain and Jordan.

Meanwhile, Cigna International Expatriate Benefits is focusing on Europe this year, with plans to expand access to its life and accident and disability insurance, which it currently sells in the UK, Belgium and the Netherlands, elsewhere in Europe as part of a rolling programme.

Evolution of the IPMI market has been slow, but it is coming and employers need to prepare.

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