Which plan is best for you?

“Strongest” and “weakest” is relative because it depends what you are looking for. If you consider a “strong” plan one that will cover you long-term overseas as well as in the USA, one that has co-pays, one that is direct pay (no cash involved), one that has no maternity waiting period, good wellness check-ups, a worldwide PPO, that kind of plan is now available. Obviously, the plan will be more expensive than regular international plans, but not more expensive than some standard USA plans. A couple in their mid-twenties on this plan with a $1000 deductible outside the USA would have a monthly premium of $266.

A so-called “weak” plan might be one that capped coverage for a CAT Scan or MRI at $600, provided up to $600 a day for hospital room and board, provided limited maternity coverage even with a 12-month waiting period, and did not provide permanent coverage in the USA beyond the allotted furlough time. A plan like this for a couple in their mid-twenties with a $1000 deductible would have a premium of $138 per month.

Many international workers opt for “middle-of-the-road” plans. They don?t like to pay $266 a month, but they also don?t like having “capped” coverage for MRIs, etc. Such plans require a 12-month waiting period for maternity, allow furlough coverage in the USA, provide some wellness check-ups, etc. These plans may put ?riders? on pre-existing conditions. A plan like this with a $1000 deductible for a couple in their mid-twenties will have a monthly premium of around $245.

The rates on most of the “weak” and “middle-of-the-road” plans can be lowered by five percent to ten percent by paying annually instead of monthly.

1. You want to make sure it is really “health insurance” and not a “caring” or “sharing” plan. These plans have worked for some, but many participants have been disillusioned.
2. Check out the A.A. Best Rating for the company that underwrites the plan. This is not hard to obtain. An A+ rating is good, but a B+ is often acceptable for health insurance companies.
3. Check out the company administering the plan. These companies are called “Third Party Administrators” (TPAs). Some TPAs that have been around for a while and have grown large give poor service, while younger and smaller TPAs give good service. So don’t turn a TPA down just
   because it is small.
4. Read the plan carefully to make sure the benefits match your needs, e.g., does the plan have maternity, medical evacuation, preventive care, etc? What is the policy regarding pre-existing conditions? Do they rider/waiver them or give limited coverage?
5. Have their annual price increases been reasonable? At the present time “reasonable” would be somewhere in the 8 percent to 15 percent range.
6. Do they offer the deductible you desire? Remember, the most cost-effective deductible is generally $1,000.
7. How do they handle co-insurance? Do you pay co-insurance overseas or only in the USA?
8. What is excluded from coverage? All insurance brochures have an “exclusion” section. Read that section carefully. Remember this key proverb when purchasing health insurance: THE LARGE PRINT GIVETH AND THE SMALL PRINT TAKETH AWAY!
9. How good is the company at paying claims? Ask your broker this question. If he has represented the company for a year, he will have a pretty good idea of the speed with which claims are paid. Remember, the bottom line is that insurance is only as good as the claims-paying ability of the company.
10. Finally, it is best to work through a broker who represents several companies. An agent technically represents just one company. If so, he only puts bread on his table if he sells you his product. A broker is different. He helps you search for a policy that will work for you, and is not dependent on selling you a specific plan. The good news is that Good Neighbor Insurance is a brokerage that represents seven major international health insurance companies. Thus we have a wide array of health plans from which you may chose.

How do people choose health plans? The Kaiser Family Foundation and Agency for Health Care Policy and Research did a telephone survey of 2,006 adults designed to find out what they are concerned with when it comes to health.

In choosing a health plan, people say quality of care is the biggest concern (42%), over low cost (18%), a wide choice of doctors (17%), and a range of benefits (14%). However, what most people say ultimately sways their decision is a personal recommendation from their doctors (59%) and family members and friends (57%).

Seven out of ten people regard their family and friends as “good” sources of information about health plans because they share common concerns. Employers, on the other hand, are seen less favorably. Nearly six out of ten say employers are not a good resource because they cannot be trusted to provide reliable information about the quality of different health plans “because the employer’s main concern is saving money on health benefits.”

This is an annual problem for those who have international health insurance. Let me give several suggestions:

1. Choose a high deductible of at least $1,000. A deductible of $2,500 or $5,000 is better yet if you have some reserve money in savings. This will have a definite impact on your insurance premium.
2. Choose a policy with “capped” coverages. Instead of guaranteeing an unlimited amount of money for a normal childbirth, they limit the coverage to $4,000. That is enough to cover the delivery of a baby almost anywhere in the world.
3. Choose a plan with less maximum coverage. Instead of getting $1,000,000 or $5,000,000 in coverage, settle for $500,000.
4. Select a short-term plan. Some short-term plans can be renewed up to three years.
5. Choose a career plan that will not cover you in the USA. Then, when coming on furlough, take out a short-term plan that will cover you during your visit.
6. If you need maternity, put your wife on a maternity plan and yourself and children on a non-maternity plan. This will often save $40 a month or more.

None of these are “ideal” solutions, but if you start with one of these and after a year your financial situation improves, you can then upgrade your insurance coverage. If you are putting out $200 a month now for insurance, in a couple of years bumping that up to $300 for a better plan will be easier than going from $0 for no insurance to $300 now.

Often we hear the question, “Why do young single women pay such high rates for health insurance?” Because they are paying for maternity coverage even though single! Finally–some companies are providing career health insurance plans for single women that do not include maternity. This means it is less expensive, cutting health insurance costs in some cases by as much as 35 percent.

If you are a single woman, you no longer need to buy career insurance that covers maternity. Now you can save a good deal of money and have the highest quality, long-term career medical insurance. Good Neighbor Insurance has a special page with international insurance plans for single women.

1. Plans that provide lifetime coverage overseas and in the USA. The coverage is seamless–you can leave and return to the USA at your leisure and always have insurance coverage.
2. Plans that put temporary or permanent riders on pre-existing conditions. Sometimes these exemptions for pre-existing conditions or the waiting period will be waived with a Certificate of Credible Coverage. In lieu of a Certificate (Since some companies are no longer issuing them) we can try submitting other forms of proof such as a certificate of issuance, medical I.D. cards proving current coverage, a Certificate showing the last day of coverage, etc.
   If the company puts temporary riders, e.g., two-, three-, or five-year riders on a condition, after that time period, pre-existing conditions will be covered. Sometimes the only way to get coverage anywhere is to accept a permanent rider.
3. Plans that put a waiting period on pre-existing conditions. Generally this waiting period is two years. Sometimes companies also will include permanent riders. Plans like this are acceptable if you are not concerned about the pre-existing conditions. (See above in regards to waiving the waiting period using a Certificate of Credible Coverage.)
4. Plans that exclude coverage in the USA or in the USA and Canada (And in some cases, select nations or cities in Asia). These plans are always less expensive than the plans above (No. 1) because they are excluding the location(s) of the most expensive medical care in the world. If you live in an area where the medical care is very good, you may prefer a plan like this. We heard recently that one individual had a heart transplant done in Germany for $25,000. The same operation would cost $250,000 in the USA.

Good Neighbor Insurance carries all of these types of plans. You can get a good overview of them at https://www.gninsurance.com/health/.

The least expensive international health insurance coverage is coverage that only covers a person outside the USA and Canada. The problem with this kind of coverage is that if you develop a chronic medical condition and want to return to the USA you will have no coverage. Yet the rates are excellent. For a couple in their early forties who do not want maternity coverage the annual rate for a $1000 deductible would be: $2,136 a year.

The most expensive coverage is a plan that guarantees lifetime coverage outside and inside the USA. This plan would provide on-going medical coverage in the USA if a person returned to the States with a chronic condition. The same couple as listed above would have to pay $7,272 a year for this kind of coverage.

The middle ground between those two options is a plan that will give limited coverage in the USA, at least six months and up to a year if the individual intends to return overseas. And the person would have coverage in the USA and Canada during furloughs. The annual premium in this case would be $2,848.

Good Neighbor Insurance also provides health plans limited just to the USA. The couple above, if they applied for a Blue Cross plan in Arizona with a $1,000 deductible, would have an annual premium of $5,712.

High deductible plans are more cost-effective, so they are a better option if you are a pretty healthy person, or younger. I am in my early 70s, and have not been in a hospital much over that time.

For short-term plans for a short-term missions trip or volunteer project of maybe two weeks or two months duration, the cost difference between a $250 deductible and a $500 deductible will not be very much. If you need to use the insurance overseas, I can almost guarantee you the policy will not be $250 more! It might only be $10 more. So check a couple different deductibles using the orange “Get a Quote” buttons that link to the plan you are interested in. You might also want to check a $0 deductible. Realize these out-of-pocket costs may need to be reimbursed if the carrier does not have a prior agreement in place to pay the hospital or doctor directly. We have plans that are better at this with more prior agreements in place. If that is a concern (paying up front and getting reimbursed), please call us for advice on which plans/carriers have better agreements in place in the area you are traveling to.

For long-term (over one year) plans, if the difference in the premium between a $500 and $5,000 deductible was only $100 (and usually it is more), a $5,000 deductible would have saved me $36,000 over that 30-year period. That money could have been put in a personal medical savings account in order to meet a deductible if I ever needed surgery: If surgery was not needed, I would have a substantial savings account. And this is only calculating the premium I would have saved on my own personal insurance. I have not calculated in the savings for my whole family. And you have the benefit of liquid capital as well as the interest income on $36,000. If surgery was needed, I would still have been protected from the cost of a major medical catastrophe, e.g., a major operation, and hopefully still have that money I saved to pay my high(er) deductible.

Deductibles run all the way from $100 to $10,000 depending on the plan. Usually the rates drop dramatically between $500 and $1,000. Thus we seldom encourage a person to take out a $500 deductible. I think the best buy is the $1,000 deductible.

Generally speaking, if we are pressed, we can find $1,000 to cover the deductible in a medical emergency. And the money saved in lower monthly premiums will in a very few months add up to that $1,000.

Co-insurance is another matter to keep in mind. Most companies run a 20/80 plan in the USA with no co-insurance when outside the USA. What does this mean? It means that if you have a medical situation in the USA, you will need to pay your deductible plus 20 percent of the next $5,000. In a worse case scenario, you will be out $2,000 ($1,000 for the deductible and 20 percent of $5,000 which is another $1,000). Overseas some companies waive the co-insurance and only require you to meet the deductible.

As little as possible? Everything? Neither answer is correct. If you don’t answer all the questions correctly and fail to give important details concerning the state of your health, the company holds the right to rescind your coverage. I know of a case where an individual failed to reveal a skeletal problem because he did not consider it significant. He was accepted for coverage, and later had an abdominal operation. Before paying the claims for the operation the insurance company discovered the failure to report the skeletal injury. They rescinded his coverage, and would not pay for the stomach surgery.

We have had several cases where the insurance company, after the fact, discovered medical conditions not revealed on the application. They rescinded coverage and returned all premiums. So you need to be forthright about your medical conditions.

But often applications will put a time limit on the questions, e.g., asking you to reveal medical conditions in the last five or ten years. If that is the case, don’t reveal what happened 15 years ago. And you do not need to reveal all minute details concerning your condition. If the insurance company feels they need more details, they will contact you for medical records.

Generally, if an applicant errs in this matter, he/she errs in not giving enough information. Remember, it is much better to give too much information. That way you won’t be shocked by a letter from the insurance company saying that the claims are not going to be paid and your insurance is rescinded (cancelled by the insurance company) just when you need it!

People generally choose a deductible based on their ability to meet that deductible. If you have no problem finding $5,000 to pay the deductible in the case of a major catastrophe, then a $5,000 deductible is a good option. If you think you could only find $1,000 in a crisis, then $1,000 would be a reasonable deductible.

Many folks think that going with a high deductible saves a lot of money. You do save, but sometimes not so much. Note the changes in annual premium for a 30-34 year old male based on various deductibles:

• $250 deductible = $1,275
• $500 deductible = $1,120
• $1,000 deductible = $871
• $1,000 deductible = $871
• $5,000 deductible = $632
• $10,000 deductible = $498

The largest saving of $249 comes between the $500 and $1,000 deductible. Going from $1,000 to $2,500 saves only $99, and from $2,500 to $5,000 only saves $140. In fact, going from $1,000 to $,5000 saves only $239 per year even though you have added $4,000 to the deductible. So increasing the deductible does not produce great savings. Up to the present time, with all companies, the $1,000 deductible seems to be the most cost-efficient.

Almost all international health insurance plans provide medical evacuation coverage. You can view a list of these plans on the medical evacuation insurance page.

How much medical evacuation coverage is necessary? This depends on the locale of your international workers. If Americans staff your agency and all are working in Mexico, $25,000 of medical evacuation coverage should be adequate. On the other hand, if you have workers in Central Africa or Papua New Guinea, it would be wise to have a plan that provides $100,000 in coverage.

On the average, international health insurance companies charge $12-$15 a month for medical evacuation coverage. Obviously, you will pay more for $100,000 than you would for $25,000. You can avoid over-insuring in this area by always considering the countries where your employees are working when purchasing medical evacuation coverage.

Often a major question is, “Will my pre-existing condition be covered?” Insurance companies handle this in basically four ways:

1. If the pre-existing condition is considered too large a risk, the company will decline to offer coverage.
2. One company we work with will cover acceptable pre-existing conditions, but with rate-ups of 20 to 40 percent. Coverage on their plan for a single male in his late twenties with a $1000 deductible would be $131 a month. A 20 percent rate-up would put the premium at $157 a month. The advantage here is that the pre-existing condition will be covered in full.
3. Some companies put a permanent rider on the condition. The monthly premium for a $1000 deductible on this plan for a single male in his late twenties would be $50.40 a month.
4. Another option would be to put a two- or three-year rider on the pre-existing condition. This means that the insurance company will not cover the pre-existing condition for the first three years of the policy. The annual premium for such a plan would be $901 ($75 a month) if paid up-front.
5. Finally, some plans say they will cover no pre-existing condition for the first 24 months of coverage; and then after that, cap coverage for pre-existing conditions at $5000 per year. The annual premium for plans like this for a single man in his late twenties with a $1000 deductible would be $868 ($72 a month) if paid up-front.

We generally like to have Dad and Mom and the kids all on the same health insurance policy. But sometimes you can save a lot of money by splitting the family up and putting different members on different policies. For example: A couple in their thirties with two children ages 10 and 12 would pay a monthly premium of $363 on an international policy that offered maternity. By putting dad and the two children on a non-maternity plan and leaving mom on a maternity plan, the total monthly premium would drop to $231. This would give a monthly saving of $132. There are variables involved here, e.g., deductibles and total coverage. And of course you will need insurance cards from two different companies. But the inconvenience would mean $132 extra every month in your pocket. That will add up to $1,584 in a year, and would easily pay for Christmas presents or some plane tickets!

Global Citizen is a very good international health insurance plan for individuals. Here are ten benefits that make the plan stand out:

• No exclusions for pre-existing conditions with six months of prior creditable coverage
• $5,000,000 medical limit and $100,000 medical evacuation benefit
• Deductible is waived for office visits
• Covers illness or injury due to acts of terrorism, up to the policy maximum; with no excluded countries
• Can be kept upon return to home country, up to age 84
• Administered using HIPAA guidelines
• No limit on the amount of time spent in any location, including the U.S.
• Freedom to visit any provider outside of the U.S. with a reduction of benefits
• No pre-certification penalty imposed for inpatient or outpatient medical treatment
• English-speaking providers in 180 countries bill HTH directly for inpatient and outpatient services when a member schedules services through HTH

This is true of insurance policies. The companies always list the benefits in large letters on their brochures and web sites. The astute buyer of insurance also checks the small print. It is especially important to note the small print on the ?Schedule of Benefits? page. And also read the ?Exclusion? section, as it is almost always written in very small print. Most of the things on the ?Exclusion? page are standard with various plans, e.g., no coverage for cosmetic surgery, suicide, etc. But read carefully because sometimes some key benefits you are interested in may be excluded from coverage.

Often the insured gets upset when he finds out that the company he is insured with will not cover a specific medical need. But usually the company has spelled out very carefully what it will not cover–in the small print! So read the small print very carefully!

More and more insured are asking for a high deductible when they purchase insurance, but “high” generally means $1000. It is true that the $1000 deductible is the most cost- effective. Just compare the following annual rates for a male between 35-39 on a good global plan: $250d = $1322; $500d = $1175; $1000d = $909; $2500d = $805; $5000d = $658; $10,000d = $517.

If a person goes from a $250d to $1000d, he can save $413 a year. If he does not have any major medical costs in two years, he will save $826, which is nearly enough to pay the $1000 deductible his third year on the plan. During my career overseas I was in the hospital one time in 30 years with Hepatitis. Thus with a deductible of $1000, I would have saved $12,390 over those 30 years. Similar savings would also be available for other members of the family.

You will notice, however, when you jump from a $1000d to a $2500d, the savings are minimal–only $104 a year–even though you are adding $1500 to the deductible. So the most cost-effective deductible at the present time is the $1000 deductible.

With soaring insurance costs everyone is looking for a way to control their health insurance premium. One way is to take out a long-term policy that only provides coverage outside the USA. Then, when you come on furlough, take out a short-term policy for furlough coverage. Here is a comparison of what rates look like when US coverage is excluded for a couple in their early thirties with two children under nine and a $1000 deductible: Including coverage in the USA = $2258 per year; Excluding coverage in the USA = $1694 per year. Thus rates excluding the USA are 25 percent lower. Of course, you would need furlough coverage which would be about $150-$200 per month during your furlough, depending on deductibles, etc.

1. Individuals usually want to receive medical care in their home country for serious illnesses
2. If you are in Europe or certain places in Asia or South Africa, you can get excellent medical care, plus there are excellent world-class hospitals in many other countries
3. Preexisting conditions are not covered on short-term plans

However, for those who are interested in cutting the cost of their insurance, excluding the USA in a policy is an option.

More and more, even in domestic insurance, people are looking for a high deductible. That simply means the amount of money the client pays before the insurance starts to cover medical costs. Many people used to ask for a $100 or $250 deductible. We are advising clients to consider a $1,000 deductible. That sounds unreasonably high to many people. Yet the premium savings are so significant that generally the money saved in one year from lower premiums (the higher the deductible the lower the premiums) will more than make up for the higher deductible if a person had to use insurance for hospitalization.

Most of us, in a crunch, could find $5,000. It is the $50,000 and $100,000 bill that scares us. We do have clients asking for $5,000 deductibles. And we do have plans that offer $10,000 and $20,000 deductibles. One way to look at this is to ask yourself, “How many years since I have been hospitalized or had a health insurance bill over $5,000?” If it has been a long time, and you are in relatively good health, maybe a $5,000 deductible would work for you.

The benefits are the first thing to look at. Lay the Benefits page side by side with the plan you are presently using or one that you want to compare it with. Are the deductibles the same? Is the plan deductible per incident or per calendar year? Is the co-insurance the same? What about co-insurance for overseas? Is it the same? What about the benefit period? Is there a six-month benefit period from the time of injury? Will the insurance reimburse for medical care received in the USA? What is the maximum coverage for the two plans? Is one providing $10,000 of maximum coverage and the other $100,000? What about medical evacuation? Is it included in the medical limit or a second benefit from the medical limit of the plan? Check the pre-existing condition policy. Is there a waiting period for pre-existing condition coverage? If so, how long?

Generally speaking, if the rates of one plan are 15 percent or more lower than another, there is a variance in the benefits. If companies are offering the same benefits, generally the premium is very close. You can get a good comparison of short-term plans at:

https://www.gninsurance.com/short_term.asp , and for career plans at: https://www.gninsurance.com/health/ .

Remember that one way insurance companies keep their rates down is by limiting coverage for pre-existing conditions. So if a company has strict pre-existing guidelines and/or really limit coverage for pre-existing conditions, they are doing so to keep their costs low. If you are healthy and have no pre-existing conditions that are of concern to you, then that is the time to take out such a policy. Since you have no pre-existing conditions everything will be covered.

Some companies will put a two- or three-year rider on a pre-existing condition. That is always better than long-term limited coverage for a pre-existing because you know that when that time period is past, your pre-existing condition will be covered. If your pre-existing is not giving you any problem and your doctor says that it should not bother you for a long time, then you might feel okay to take out a plan that would put a two- or three-year rider on that pre-existing condition.