Group Health Insurance For International Organizations – How to save, select benefits, and more

Often an organization wants to take out just $5,000 or $10,000 term insurance on each field member. Generally, it is difficult to find a company that will provide such low levels of group term insurance for international staff working outside the USA. Now we have a company that is willing to do this. If your field staff has no term insurance and you want to provide “just” term insurance for all members and families, please contact us. The rates are also very reasonable.

Do you have your travel medical checklist ready? Some countries require that you be insured before you apply for a visa. In cases like this getting international medical insurance is not an option. You will not get a visa for your destination without proper health insurance.

Determine what special immunizations may also be needed for your target destination. Often you can find this information on the web; for example, at www.cdc.gov or www.who.int.

If you are suffering from a chronic or pre-existing condition, it would be good for you to have a short medical history on hand. If you can, keep prescriptions in original packaging. A letter from your doctor stating that you need certain medications would be a great help in getting through customs if you run into a problem. Did you know that nearly half of all visitors to developing countries get sick during their stays? So go prepared! I always take a small packet of first-aid items: salve for infections, aspirins, lozenges and band-aids. Divide your prescriptions between two bags so that you will always have some of your medications. Make sure you have adequate prescriptions for your trip, and also know the generic equivalent in case you need to purchase some while on your trip

In an effort to help non-profits find group insurance that is less expensive, several companies are offering “Tier Two” group plans with scaled back benefits. In order to do this one company increased their co-pays, lowered health-screening and annual physical examination benefits, limited outpatient mental and nervous disorder care and cut provision for home hospice health care.

Another company put a maximum of $600 per day for hospital room and board and $1,500 for an Intensive Care Unit. They cut the transplant benefit to $250,000 and put a cap of $6,000 on maternity coverage. Also they included a clause stating that no pre-existing conditions would be covered for the first 24 months a person was insured. The plan provides no wellness benefit.

Of course these plans are not as rich as the “Tier One” plans offered by these companies but it means that the rates are as much as 30% lower. In a time of budget crunch these plans enable a non-profit to still provide group health insurance to their overseas employees. Please contact us if you would like a group quote on either of these plans for your non-profit.

Some companies want an enrollment form from every employee signed by both husband and wife. Often they will ask for extra medical records on certain individuals. When your employees are spread all over the globe, it becomes a challenge to get the enrollment forms and medical information turned in. Companies usually provide a 30- or 60-day window in which all enrollment forms must be submitted. The final rates for the group health insurance won’t be determined until the underwriters have been able to evaluate the medical risk of every enrollee. Once in a while insurance companies will increase the rates for the whole group if they have discovered some unforeseen risk. And we have had experiences where an insurance company has declined coverage due to unforeseen risk.

There are other companies that only request a spreadsheet which can be filled out in the organization?s home-base office, and they don’t require signatures from any of the employees.

Once the group health insurance is in place, it is very easy to administer, and all new employees are automatically covered without going through underwriting.

One of the major problems career groups have is finding group coverage that will cover all pre-existing conditions. This is called a “complete takeover.”

Group rates go up like all insurance rates, and when they do, we like to look around for other options. The general problem is now your group has aged and have probably developed some medical problems, so now you need to find a company that will do a “take over,” thereby covering all of those existing medical problems. If your group is experiencing unbearable insurance premiums and you are interested in investigating lower rates with a company that will provide insurance with a “complete takeover,” please call us. In many cases we can help.

Often volunteer groups have a hard time setting up international group health insurance. This is usually due to the lack of finances (often individual members raise their own funds) and also the democratic nature of volunteer groups. One of the best and easiest solutions to this problem is to establish international group health coverage when the volunteer group is started. We have helped several volunteer organizations start their group coverage with a group of only two people. All new people who join the organization are then aware from the beginning that they will need to raise funds to pay for their group health insurance when they join the organization. All new workers are required to join the group coverage. Thus the group does not face a problem years later of trying to get the whole group to embrace group health insurance.

We have one company we work with that will insure a group of two and several that will insure a group of three. If your organization is small and you want to get started with international group insurance, please contact us.

TO CONTROL CLAIMS GET GROUP INSURANCE WITH COMPANIES THAT “POOL” SMALL GROUPS

There are two ways international health insurance companies handle claims for small groups (a small group is generally defined as from 2 to not more than 50 employees). Some companies ?pool? their small groups. When this is done, claims that come in on one of the groups are spread over the whole “pool” of groups. Thus a non-profit of three workers would be in a pool with 40 other non-profits; therefore, their claims would be spread over the 40 non-profits. The total employees in the pool might be 300 or 400. Obviously, a pool of groups like this helps keep rate increases reasonable if there is a major claim.

If the insurance company you are working with does not pool small groups, then that group will generally receive enormous rate increases if claims happen to be high on a given year. For example, if your non-profit consists of ten overseas workers, and you have claims for one year of $100,000, the rate increase due to large claims will be borne by your non-profit alone– that is by the ten overseas workers. We have seen premiums rated up by 45 percent on small groups like this. If that same non-profit was in a “pool” of non-profits, the rate increase might end up being 15 percent or 20 percent.

So, when buying group insurance, always ask if your non-profit will be in a pool with other small non-profits. We can help you sort out which international insurance companies have the best ?pooling? system for small non-profits.

Sometimes it is difficult for an international service organization to get all of their workers all over the world to agree on an international group health insurance plan. Now we have the option of insuring just one field of an international organization. For example, your organization may have workers in Mexico, France and Jordan. Most of the workers in Jordan and France don’t want a health insurance plan. But of the ten workers in Mexico, nine do want group health insurance. We can now write a group health insurance plan for the workers in Mexico. The group would be listed as XYZ NGO Mexican Team or something like that. So please keep in mind that even if your whole organization does not want group health insurance, if 80 percent of the workers in one country do want group insurance, it is possible to write a group insurance plan for them. Please contact us with any questions.

An adequate group health plan for a non-American non-profit can be a great benefit for the employees of the non-profit and also very cost-effective. If the organization has American and non-American workers, you could purchase two insurance plans–one for the Americans and another for the non-Americans. Why? Because the medical care in much of the world is very, very good, and non-Americans do not prefer to come to the USA for medical care, while some Americans insist on coming to the USA. By providing group insurance for non-Americans that does not include coverage in the USA, the rates can be lowered by 30-35 percent. And some special plans for non-Americans can be as much as 50 percent less expensive. One Asian non-profit is providing group insurance for their staff with the following rates: Single = $41; Couple = $85; Family = $126.

You may have non-American international staff serving all over the world. It is important to find them good, cost-effective group health insurance. We can help you do that.

Good Neighbor Insurance has companies who offer group insurance for two or more units, whether they be individuals, couples or families. Generally, organizations want to wait until they have four, five or more employees before providing group health insurance.

Here are several advantages in starting group health insurance with only two employees: (1) If you get group health insurance set up with two, all new employees will receive group health coverage despite their pre-existing conditions. If you wait and an employee is overweight and has diabetes, many international insurance companies will decline to quote. (2) If you wait until you have more workers, some of them may decline to enroll in the group insurance. You always need 80 percent participation. Thus one in four workers declining in a group plan could keep you from starting a group plan. (3) It does help in recruiting to inform candidate employees that your organization, even though small, provides international group health insurance. If the group is relatively young, the rates will be reasonable. (4) After a person has been on a group plan for 18 months they can receive a “Certificate of Creditable Coverage” which guarantees insurability if they return to the USA.

If Joe had been on group insurance, he would have received a “Certificate of Creditable Coverage.” On presenting this Certificate to any insurance company, they would be required by law to provide him with HIPAA (Health Insurance Portability and Accountability Act) coverage. These plans are more expensive, but at least he would have insurance.

If your group is interested in pursuing group insurance, call us at 480-813-9100.

One of the major frustrations in setting up group insurance for an NGO is to get all the employees on board. If workers are raising their own funds, they sometimes have low support and/or have a desire to buy into group health insurance. All international insurance companies demand 75-80 percent participation before they will provide a group health insurance quote. Getting that kind of participation, especially in a large NGO, is really difficult.

We are now working with a very reputable international health insurance company that will provide quotes without demanding a participation ratio. The one stipulation is that the NGOs have over 50 total employees in the USA and overseas. Third Country Nationals and local employees can also be counted.

If you are an NGO that has over 50 total employees, with 2 units or more that would like to be on a group insurance plan, please let us know. We will be glad to pursue a quote for you.

It depends! If you are 62 and all the other members of the group are under 30, group insurance will be less expensive for you. If you are under 30 and all the other members of the group are over 60, group insurance will be more expensive. The two major determinants of group insurance rates are the average age of the group and the general medical condition of the group. Thus a young group made up of several people with chronic conditions could be very expensive.

However, remember that there are other advantages with group insurance besides the premium. When a team has group insurance, new people entering the team that would be uninsurable on an individual plan can get full coverage. Most group insurance plans do not decline new enrollees or put riders on any medical conditions. If an overseas team decides against group insurance, they may be making it impossible for a good worker to get any health insurance.

Another advantage is that having group insurance makes it possible for a person who develops a chronic disease to come back to the USA and transfer to an individual domestic health plan under the HIPAA law. HIPAA requires all USA insurance companies to insure people, no matter what their condition, who are moving from a group plan to an individual plan. HIPAA is not applicable if moving from an international individual plan to a domestic individual health insurance plan.

If your group is interested in pursuing group insurance, call us at 480-813-9100.

So there are more advantages to group health insurance than “possible” lower rates.

By asking five key questions when choosing career health coverage, you will be able to narrow down your search for a long-term international health care plan. Here they are:

• First Question: “Do we want maternity coverage?”

  If you do, that will rule out all three-year plans. It will also affect the rates offered on career plans. In fact, one good career plan charges $2,500 a year extra for maternity.

• Second Question: “Will we be happy getting all of our health care outside the USA?”

  Certain countries provide excellent health care. If you say ?yes? to that question, then you can get a plan that excludes all coverage in the USA.

• Third Question: “Will we get most of our medical care outside the USA, but want coverage for furloughs and the option of getting some medical care in the USA?”

  If you answer ?yes? to this question, you may want to purchase an international plan that has limited coverage in the USA, but adequate coverage for all countries of the world.

• Fourth Question: “Will we get most of our medical care in the USA?”

  If you answer “yes,” you will want a plan that provides coverage comparable to what is charged by American medical facilities and practitioners.

• Fifth Question: “Do we want a plan that will provide permanent international and USA coverage?”

  This is possible for residents of most states of the USA. Of course, this is the best and most expensive of all of the career insurance options.

All individual insurance plans handle pre-existing conditions in one of the following ways:

1. Rider or exclude the condition from coverage
2. Rate-up the insurance plan because of the pre-existing condition
3. Postpone for a definite period, e.g., two years, and then cap any coverage for pre-existing conditions
4. Decline to provide any health insurance coverage for the person with the pre-existing condition

The advantages of “True Group” health insurance are that all pre-existing conditions are covered (sometimes after a short waiting period) and no one is declined coverage due to a pre-existing condition. If you have a large or small team of international workers, you want to make sure they all have health insurance for all contingencies, and it is very important to make sure that all of their pre-existing conditions are covered.

We can provide health insurance quotes for groups/teams as small as two or as large as several hundred. Please contact Good Neighbor Insurance if you are interested in a group health insurance quote.

Group insurance is not always less expensive or more expensive that individual long-term insurance. The rates/premiums are based on the average age of the group, the medical history of the group, and the benefits of the insurance plan. But whether more or less expensive than individual insurance, there are some definite benefits:

Workers on group insurance that leave the company can switch over to COBRA when they return to the USA, and can be on COBRA for up to 18 months. This is very important if an individual has medical issues that would keep them from getting individual insurance. COBRA is not available for people on individual plans!
Workers also have the option, after COBRA, of switching to HIPAA (Health Insurance Portability and Accountability Act). Every insurance company is required by federal law to insure a person on an individual plan if that person has been insured on a group plan. Again, this is a great benefit if a person has a chronic and/or terminal illness and cannot get individual insurance.
Group insurance makes it possible for workers who would be uninsurable on an individual plan to have health insurance. No one is declined for coverage or ?ridered? on group insurance plans. All pre-existing conditions are covered.
Finally, group insurance develops cohesion in the company. It is a sign of the employees caring for each other and of management working together with employees. It provides for team unity and team spirit.

Here are a few proven ways to save money on group health insurance:

1. Get new quotes every year. A good agent or broker will be able to get several comparable quotes for you from various international health insurance companies.
2. Require everyone over 65 relinquish coverage on the group plan. Help them get on Medicare, a Medicare Supplement plan, and an evacuation plan. Often this will also save them money.
3. Look at increasing the deductible on your present insurance or limiting some of the benefits.
4. Shop for a policy that rewards your employees for getting their medical care outside the USA.
5. Screen new candidates carefully. If you are accepting new employees with high- risk health problems, this will probably show up in your insurance rates in a few years.
6. Go back to your present carrier and ask for a rate-increase reduction. In most cases, they will give you a couple of points.
7. Consider getting individual medical evacuation coverage for your team. Sometimes group medical evacuation is more costly than individual medical evacuation plans.
8. If your staff has access to excellent medical care outside the USA, e.g., they work in Europe or near Singapore, you might want to consider a policy that excludes coverage in the USA. When they come to the USA for furlough, then they can take out a short-term plan that will cover their furlough time.

We know of one company that will provide self-funded insurance** for groups as small as 11 employees. Most insurance companies want to see at least 100 or 125 employees on a self-funded plan.

It is a misnomer to think that self-funded plans are always better or at least less expensive. That is not always the case. If the average age of your group is near 50 or even over 45, a self-funded plan is not a good idea. And some companies will not even consider providing self-funded quotes if the average age is near 50.

Of course, the advantage of a self-funded plan is that any surplus money from providing health insurance coverage “in-house” remains in the organization. If you are interested in looking at a self-funded plan, please contact us.

** See glossary for definition of self-funded insurance

It is a given fact that premiums for group insurance plans rise almost every year. The quote and rates you have now may have been fairly good when you purchased your group plan. But now, after three successive rate increases in the past three years, you are wondering if there is any way to cut costs? 

One way to cut costs is to raise the deductible on your group insurance plan. Sometimes that can make a sizeable difference in the premium. Companies generally allow you to go up to a higher deductible at renewal time.

Another way to lower costs is switching group coverage, or at least get quotes from other companies. Sometimes these quotes will not be as good as the rates you are presently paying. Yet knowing what other companies are charging helps you to better explain to your field staff the monthly premiums they are presently paying. And sometimes the rates offered by other companies are better. In that case, if the savings are significant, it would make sense to switch insurance companies.

Good Neighbor Insurance represents several international health insurance companies that provide group insurance. If you would like to research group rates for your organization, please let us know. We will be happy to help you in this matter.

You may be very satisfied with your present group insurance and also satisfied with the rate received from your present carrier. Yet there are at least two good reasons to get an insurance quote:

1. It helps you to keep abreast of what other companies are charging for group insurance
2. If you have volunteer workers who raise money to pay for their insurance, and if the rates from other carriers are higher, you can easily show them that the rates of your present group insurance are very competitive
3. If you discover that the premium charged by other insurers is running a bit less than you are presently paying, you can sometimes go back to your current insurance company and ask them for a discount. I have seen this happen several times

We are always happy to get group insurance quotes for groups as small as two people or in the hundreds. We work with six different insurance companies that provide group insurance. In order to get a quote for your organization we will need a “Census” and a “Request for a Group Quote.” If interested in us pursuing quotes for you from several companies, please contact us.

1. If you have been with a carrier more than five years. Carriers provide a “trend” increase every year, usually 10 percent. This could mean a 50-percent rate increase in five years. If you switch to another carrier, you can probably erase about 30 percent of that trend increase.
2. If you have had workers with chronic medical conditions leave the organization. Or if you have had any members who have received major medical care and are now deceased. Your present company will be calculating those past costs into your renewal rates. Your new carrier will be looking at your group afresh and not seeing those medical issues.
3. If you have had some younger people join your organization. Two or three couples in their twenties can lower the average age of the group. Your present carrier will not lower rates based on these new people, but new carriers will calculate their rates based on the average age at the time of quoting.

In 1996 the federal government in the USA passed the HIPAA (Health Insurance Portability and Accountability Act). In essence, this act says that if a person is insured by group insurance for at least 18 months and then goes on “COBRA” (state continuance insurance once you go off company insurance) for 18 months (if COBRA is available), they cannot be denied health insurance by any health insurance company in America.

Thus, long-term group insurance makes it possible for all of your workers to have guaranteed health insurance for the rest of their lives. How does this work? Here is an example: John and Mary work with your organization for 15 years. John develops a bad case of melanoma, a very serious form of skin cancer. He has international insurance, an individual plan, but now wants to return to live in the USA. Thus, he will drop his international insurance because he is not living outside the USA. His problem now is that no company in the USA will insure him with individual health insurance. His melanoma makes him an “automatic decline” as far as health insurance goes.

But if John and Mary are covered under “long-term group insurance” through your organization, once they come home they can immediately apply for COBRA insurance for the next 18 months; and, if they then immediately apply for HIPAA insurance, no insurance company in America can decline to cover them. The fact that they were on group insurance while overseas assures them of the option of lifelong individual health insurance coverage once they return to the USA.