International group medical plans typically cover either a short-term need or more permanent situations. Short-term needs consist of travel medical group plans and blanket travel medical plans. Long-term and more permanent situations require an employer-sponsored health plan that acts much like a U.S.-style group health plan. These plans typically cover pre-existing conditions, maternity, and wellness; most plans qualify as creditable coverage once an employee returns to the United States. Premiums come from the employer and can be paid monthly, quarterly, semi-annually or annually.

Who buys it?

International plans can help in a host of situations. Individual plans are commonly sold to families traveling abroad on vacation, church groups on mission trips, foreign exchange students in the United States, or business executives traveling abroad.  International group plans are bought by U.S.-based companies with employees abroad.

Long-term individual plans are sold to U.S. citizens residing outside of the country, non-U.S. citizens living in the United States who are not eligible for domestic insurance, and on occasion to local nationals living within a socialized medicine scheme who wish to opt out of that particular system.  Because these plans provide worldwide coverage, many Americans who live in the States part-time and have a house outside the country purchase international major medical plans that provide them coverage while they are in the States, as well when they are enjoying their home on the beach in Mexico, for example.

Most U.S. health insurance plans don't provide any coverage overseas. Those that do aren't equipped to deal with serious events such as emergency medical evacuations, language barriers, or the fact that many providers overseas demand payment up front. Additionally, it is important to note that Medicare does not provide coverage for medical costs or hospitalization outside of the United States.

How are international plans supported?

A limited number of companies provide international health plans. Plan designs are very simple and tend to be similar from company to company.

Many of the international benefit carriers are relatively young, with many of them popping up in the 1990s; they have grown up alongside the Internet. These companies have become very adept at selling insurance online and have some of the most user-friendly quoting and purchasing tools in the insurance industry. Most of the carriers provide brokers with online quoting and purchasing tools that can be hosted on a Web site or emailed to clients. These quoting links are embedded with a reference ID that notifies them that a particular broker has sold a policy; commissions are paid accordingly.

Many international carriers are eager to provide co-op marketing dollars and printed materials to insurance professionals.

Trends

One of the trends with international carriers is the development of international PPOs. Many international plans are reimbursement plans, with members expected to pay the provider up front and submit itemized bills for reimbursement. As you might imagine, at times this creates various issues depending on the severity of the event and potential costs. Providers are working to create worldwide networks and direct pay agreements globally. Some carriers have a solidified network, some are building their network, and some carriers have yet to begin building. It is fair to say these global PPOs are in an infancy stage.

To further limit member exposure, many carriers offer guarantees of payment depending on the event and are always wiling to verify benefits and accept direct bill from providers. Understand the carrier's policy and educate members accordingly.

In addition to building PPOs, carriers are now offering enhanced coverage options to draw in new members. These options include coverage for terrorism, natural disasters, political evacuation, hazardous sports coverage, wellness programs, dental and vision programs, as well as plans with no deductible and no co-insurance. Most carriers have reduced premiums over the past five years.

If your company sends personnel overseas, you owe it to those workers—and to your firm's bottom line—to investigate international coverage.