International Health Insurance for U.S. Citizen Living Abroad

Factual Questions
1

Hello!

I am going to be graduating from college this June, and will be moving to Sri Lanka in August to work for a non-profit for roughly 9 months. I am currently a U.S. citizen and resident of the state of Indiana. The minute I graduate, I am kicked off of my parent’s health insurance plan, and so I need to find some form of insurance. In addition, the non-profit I’m going to work for is in the start-up phase, so there is nothing established as far as benefits go.

I have been researching “International Health Insurance” plans (mainly marketed to ex-pats i think) and would appreciate advice. Basically, I need something to cover me in case of accident i.e. hit by a bus, but I don’t need the whole nine-yards as far as dental, eye, prescription, etc …

After doing some preliminary looking, it seems as if there is a class of insurance policies you can take out that cover you both inside and out of the U.S. for an entire year, provided you live out of the country for at least 6 months of the year. This would be ideal for me.

I have been looking into policies online from providers like

  1. HealthCare International
  2. International Health Insurance
  3. HTH Worldwide
  4. Seven Corners
  5. International Medical Group (IMG)

but I really have no experience with any of these companies, and would appreciate any info you all had on them, or in International Health Insurance in particular.

Thank you!

2

First, let me say that I’m about eight years out of date on this, so I can’t comment on the specific companies. I did used to help companies figure out what to do for expatriates being sent to remote locations, and how to get medical coverate. So, I can offer some suggestions about how to pick a company and a policy. There are two concerns with “international” health care: access and payment.

Access: You get sick in Small Town, Undeveloped Country, and you need to find a doctor or hospital for treatment. You want one that meets U.S./international standards for cleanliness, sterilization, modern treatment, reasonable equipment, etc. So, the first problem is possibly even finding one. This isn’t so much of a problem if you’re in Belgium, say, but it is if you’re in Kenya.

Now, in emergencies, like if you’re hit by a car, you may not even be conscious, so you’re going to get what you get. But if you’re talking about (say) an intense abdominal pain, you want to select where you get treated. Be sure that the insurance you get has some sort of toll-free international dial-up number, so that you can call them and say, “I’m here in Scrubsville, Nigeria, and I need a doctor. Here’s my ID number,” and they’ll tell you to go to Dr Wossname and give you her phone and address, and they’ve vetted Dr Wossname meets Western standards for medicine and speaks English. They’ll provide access, in other words: that’s one of the considerations you’ll use in selecting which company to use.

Part of access is convincing the medical institution (doctor, hospital, whatever) that you can pay. If the doctor is registered with the insurance you use, that’s not a problem. Otherwise, it can be: you need an insurance that is recognized in whatever country (or countries) you’re going to be in. You check in to the hospital, the administrator will ask how you’re going to pay, and you need to give them some sort of ID that they will accept. Alternately, you may need to give them a toll-free number to call to verify that there are funds standing behind you. So, in selecting an insurer, be sure that they can provide that service.

Payment: This is usually the easy part. However, depending on where you are and what the policy says, payment might be reimbursement – that is, you have to pay directly and then your insurance will pay you back. That can be a headache. So, this will be another area for you to investigate.

Finally, there’s the question of medical evacuation. If you’re in the Bangladesh and need any serious treatment, you’re not going to trust a local hospital. You want to be medically evacuated to the nearest western-standard hospital (like, Hong Kong.) That’s expensive, and you want to select an insurance that will not only cover the costs, but will arrange for everything for you.

Hope that’s helpful.

3

Regarding medical evacuation, I highly highly highly recommend MEDEX Assistance, www.medexassist.com. We have had three occasions to call on them over the last ten years and in all three they have been simply stellar - full of good information (which was mostly what we needed) and they paid bills without giving us any run-around.

Another thing you need to look at is cost of medical care in Sri Lanka and any surrounding countries you might end up in for the next level up in medical care. You should weigh the cost of the insurance vs. the cost of actual treatment. I’m not saying “don’t insure yourself” but do look at all the options. You’re young and healthy, right? So unless you get very unlucky (and that’s possible - car accidents are the leading cause of death for Americans abroad) you will probably only have limited expenses. You might want to look at a less expensive plan with a high deductible that could save you money while offering some protection against disaster.

4

These should all be fine IF you have absolutely NO pre-existing conditions, otherwise you will find it very difficult indeed to get insurance (I have a pre-existing condition and was turned down by some of the above). This applies really for their longer term stuff… t is easy to get short-term (under 1 yr) but it won’t cover any preexisting stuff.

You may also look at getting a plan from BUPA which is based in the UK.

I have used Seven Corners for short term insurance for trips to the US.

5

Note that the closest top-notch hospital is probably Bumungrad Hospital in Bangkok (about 3 hours flying time from Colombo).

We have used this hospital after getting “jungle fever” :wink: in Cambodia. Very highly recommended (the hospital, not the jungle fever).

Medical care in Bangkok is by far the best in the region. Also, if you get a chance, take a side trip to the Maldives for a quick holiday.

6

Thank you so much. Great information.

7

CairoCarol (and all)

Thank you very much for the advice! Following up on your post about Medex, did you use their TravelMed Choice or TravelMed International Plan? Also did you have U.S. Health Insurance at the same time, or was this the only insurance you had?

8

I would recommend BUPA.

Allow me to be the voice of dissent over Bumrungrad Hospital in Bangkok. It sucks! I and others have had some very bad experiences there, and it’s WAY overpriced. BNH and Samitivej hospitals are just as good and cheaper, plus they actually give a damn if you’re unhappy with the service, unlike Bumrungrad.

9

This is the insurance my husband has (he works out of Shanghai). I’m currently COBRAing it because I’m pregnant and didn’t want to futz with changing my insurance right now. BUPA is administered by United Healthcare in the States FYI.

10

BUPA info is here. And BUPA hospital info for Sri Lanka is here.