Moving Abroad: Do I Need Private Medical Insurance?
Via AXA PPP International Expat PMI Experts
Some kind of public, universal healthcare may be available to you where you’re relocating to, but it’s well worth checking out what exactly you’ll be entitled to - and what’s not covered should you fall ill or have an accident. Often the public healthcare arrangements on offer in your new country will be more stringent than what we take for granted on the NHS, so let us guide you through some country-by-country facts on state healthcare and private medical insurance for expats.
Universal healthcare in Mexico is excellent, and its private care is amongst the most affordable in the West. Many doctors and dentists practising in Mexico trained in the USA, but medical professionals just as often come from the States to Mexico to complete their training too. Every medium-to-major city in the country has at least one excellent hospital, and Mexico is also considered a top medical tourism destination, especially for dentistry and plastic surgery.
Care under The Instituto Mexicano de Seguro Social (or the IMSS) is available to all Mexican nationals and expatriates who hold permits and jobs. A percentage of one’s annual salary is put towards this, and employers add to their employees’ contribution with a larger amount to top up and complete the premium. The retired and self-employed can also opt-in to the system by paying the annual fee.
IMSS affiliation entitles holders to doctors’ appointments, lab work and x-rays, medical procedures in hospital and prescriptions. Naturally, waiting lists are more of an issue than with private healthcare, so for many expats a private medical insurance policy is used as back up for situations where it would be preferable to skip the waiting list.
Italy's own NHS - Servizio Sanitario Nazionale or SSN - provides free or heavily subsidised care to those who pay social security. This automatically covers their dependents. Those entitled can attend GP visits, undergo hospital treatment and claim subsidised medical prescriptions. SSN also covers ambulance transport and other special assistance. Sometimes a contribution is charged to the patient – with prescriptions, for example – but the lion’s share of cover is paid by the government.
Like so many other countries, social health care in Italy is not a perfect system and some sectors – outpatient care, to name one - leave a lot to be desired by other Western European standards. Staff shortages and waiting lists are common complaints in Italian hospitals. Regional governments also control provincial health care services, so discrepancies exist between areas. The north of Italy and the central provinces are known for better standards than the south, for example. EU nationals can qualify for reciprocal health care with their home country, and other expats can register for the SSN by requesting a Health Card (Tessera Sanitaria) once they have an Italian Identity Card. These are only issued to permanent residents, however. Those staying in Italy with temporary documents will have to seek reciprocal arrangements if they’re from the EU, or arrange private medical cover.
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With what could be the best healthcare system in the world, Singapore has better life expectancy rates than the UK, and lower infant mortality rates too. A two-tier system that really works, most hospitals are state run in Singapore (29 state run versus 14 independent) but those under state care can pay as they go for extra services in state hospitals, or walk into private hospitals and pay out of pocket for treatment if desired.
Singapore’s state medical insurance scheme is called Medisave, and stretches to meet most treatments costs per patient. Medisave automatically covers dependents of those who qualify. Every working individual in the country is bound by law to contribute a portion of their earnings to this fund, including the self-employed. One big bonus here is that Medisave accounts are tax exempt, accrue interest and even form part of one’s estate on death. Participants in the scheme can only claim for approved medical procedures, care and treatments, however.
Top up plans like MediShield then exist for covering patients for treatment with major illnesses and chronic conditions, though patients will sometimes still need to make up the difference out of pocket. Medifund is a means-tested option for poorer residents, and Eldercare exists to cover treatment are care for chronic diseases linked to old age.
Dubai boasts world-class state healthcare thanks to high government spending in these sectors, but it’s only available to Emirati citizens. Expats arriving in Dubai without medical insurance should initially apply for a health card from the UAE’s Ministry of Health which will entitle you to care, if needed, at a public hospital. Emergency care will always be given regardless of nationality, but it’s much trickier for expats without insurance to receive scheduled care in public surgeries and hospitals. Expats without insurance run the risk of even being turned away from public facilities, but with insurance can be treated and seen at one of Dubai’s expanding network of private hospitals.
Check out your new contract and see whether PMI is included in your package if you’re relocating with work to Dubai. If not, seek your own medical cover – this is gradually becoming compulsory for expats, with access to the limited benefits of the health card likely to be withdrawn completely before long.
Those resident in Abu Dhabi, however, benefit from comprehensive health cover paid for jointly by the government and employers. You’ll either be granted local, international or both types of health insurance, with the onus being on you to then extend this cover to family if they’re not already covered as part of your package. Basic medical and dental cover is normally requisite, and cover for eye issues is normally an extra you’ll have to fork out for.
China and Hong Kong
Private medical insurance is highly advisable if moving to China or Hong Kong, but not normally mandatory for securing an entry visa. China, contrary to popular belief, does not offer a state-funded healthcare system of cradle-to-grave medical care, but rather a service that covers roughly half of the population for around half of their medical costs. The deficit is made up by the patients themselves out of pocket, or by health insurers. This supplementary type of medical insurance is the most popular type sought in China and Hong Kong.
Chinese state hospitals can be difficult to navigate and even more complicated if you don’t speak the language, as most staff will not speak English. Limited space and overstretched resources can often mean that healthcare services are difficult for expats to access at all, with even routine GP appointments taking place in hospital. For these reasons, most expats will take out private medical insurance and make use of the more comfortable, Western-style facilities available in the bigger cities like Hong Kong, Shanghai and Beijing.
Health care in South Africa is split between private and public, and the contrast is stark. One in five residents cannot afford private medical care, so the public sector is under resourced and crowded whilst private hospitals are some of the best equipped in the world. As an expat, the choice is probably clear if you want the security of Western-standard medical care in a country with more than its fair share of health risks: get private medical insurance.
Comprehensive cover will insure you for both GP visits and hospital treatment. Consider features such as air ambulance cover in your policy too, as this method of emergency travel is far more common in South Africa than it is in the UK.
For those relocating to Europe, healthcare provision can differ depending on where you’re heading for but the rule of thumb is that UK expats in EEA and Switzerland states can expect their healthcare costs to be covered by HM Treasury. One recent exception to this rule as recent as April this year states that those retiring early (under 65) to another EEA country outside the UK can no longer claim this benefit and should seek to take out adequate private medical insurance to tide them over until state retirement age.
Your EHIC (European Health Insurance Card) entitles you to state healthcare for free or at a reduced cost in all EEA states, as well as treatment for pre-existing conditions and routine maternity care as long as you haven’t come abroad specifically to give birth. In essence, you should expect to receive the same state healthcare as a local. Some countries charge a co-payment, or patient contribution, for things like dental check-ups and prescriptions. As of this summer, expats cannot claim these fees back from the Treasury.
It’s always worth chatting with expats in your new country for their experiences of public and private healthcare in the country you’re headed for. Ask your new employer for a few helpful contacts or look for community groups on social media sites. Plenty of internet forums exist for this sort of advice, and expat blogs are also great resources for general advice on new procedures and systems before you move. Finally, arm yourself with plenty of questions and speak to a few insurance providers before you make any decisions. Better to be safe than sorry, in our opinion!