Medical Conditions and Cover – Watch Out for Policy Exclusions!

When you have an accident or fall ill you’ll want to know that you will have the full backing of your international private medical insurance (IPMI) plan to get you back on your feet as soon as possible. In most circumstances your policy will do just that but it’s important to think ahead when buying your policy to make sure you maximise your cover within the budget you have available.

The process of choosing your expat health insurance isn’t straightforward. There are many different insurers all offering a wide range of plans with different options. The cover permutations and combinations are almost endless. Insurers will provide the option of excluding certain benefit categories in exchange for lower premiums. Pregnancy is a good example that is usually clear cut – after all, if you are a man in your 40s looking for an individual insurance plan, you are not going to want pregnancy cover. Dental is another example, although we all have teeth so it’s a little trickier to decide if you really need that benefit!

In fact, international private medical insurance usually comes with clear choices to omit maternity, dental and even out-patient as options.

As a rule of thumb, buy the most comprehensive cover you can afford. That way you’ll limit your exposure if something unexpected does happen.

Cover limits

Of course, it’s not just about what is excluded from your policy, it’s also about how limited your cover is. One plan, for example, might have an overall annual payment limit of US$7,000,000 whereas a seemingly comparable plan may limit this to only US$3,000,000. Another may have a limited scope to pay out for prescription drugs compared to one that refunds this benefit in full. And a third plan may offer comprehensive cover for dental compared to one that’s severely limited.
Understanding when a policy won’t pay for a certain condition when buying your insurance is relatively easy. Understanding whether the policy you are considering is limited in the areas that are important to you can be very difficult when looking to compare plans yourself.

Time-based exclusions

Insurers may exclude cover on the basis of pre-existing conditions. If you request a policy and already have (or have had) a condition, the insurer may deny cover. What an insurer will decide to do is complicated and based on many factors. If you are in a large group plan, you may not be denied cover at all. If you have an individual policy and your condition is permanent, however, it may be very difficult for you to ever secure the insurance protection you need. Conditions from which you have recovered should be covered but there may be a time-lapse; the insurer may offer you that benefit but only after a set number of months have passed.

Exclusions through excesses

Excesses are important to. In a sense these are self-imposed cover limitations. If you take out a plan with a high excess – say US$500 per claim – you are effectively making it more difficult for you to make a claim; because you know you’ll be paying the first US$500 out of your own pocket. Of course, excesses give you the advantage of lower premiums. It’s often worthwhile for those on tight budgets to think of their cover in terms of insurance for major events. A policy with a very high excess, say thousands of US dollars, will mean that you have to pay for minor treatment but if a major event occurs, that will cost you hundreds of thousands, you’ll be covered.

Buying the right IPMI policy can be essential to your well-being. Buy the wrong cover and you could be very exposed. The trick is to pay a competitive premium for a policy that provides you with the precise benefits you need but not the cover you don’t. If this logic sounds as sensible to you as it does to us, jump onto My Matchmaker’s Selector tool and you might find it really helps.

David Eline

David Eline

Founder Rivier Expat

After experiencing the frustrations of expat healthcare firsthand, David built what was missing: a truly independent advisory service backed by a proprietary comparison engine that prioritizes quality over commissions.

His approach is refreshingly straightforward: diagnose your exact coverage needs, design a modular solution with genuine portability and deliver transparent advice without hidden agendas

Whether you’re a digital nomad bouncing between borders or a corporate executive relocating your family, David eliminates the administrative headaches and coverage gaps that plague international professionals.

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