Understanding international health insurance

An international health insurance contract defines a geographic coverage zone (for example: worldwide, worldwide excluding the United States, or a specific region). Benefits, caps and price vary widely depending on this zone, because the cost of care varies enormously from one country to another. A contract covering the United States is structurally more expensive than one that excludes it, since American medical fees are among the highest in the world.

Checking the exact coverage zone, not just its marketing label, is the first step before comparing two contracts: “worldwide” can mean different things from one insurer to another.

See the full guide: how to choose your coverage zone and avoid the most common pitfalls.

Two mechanisms coexist depending on the contract and the care provider. With reimbursement, the insured pays the cost upfront and is then reimbursed on presentation of receipts. With direct billing (sometimes called international cashless care), the insurer pays the care provider directly within its partner network, with no upfront cost for the insured — a mechanism that is particularly useful for hospitalisation, where amounts can be very high.

The extent of the partner care network (clinics and hospitals with which the insurer has a direct-billing agreement) varies widely from one insurer to another and is worth checking for your specific destination country, not just in general.

A deductible is an amount that is always left to the insured before the guarantee kicks in, per claim or per period depending on the contract. A coverage cap is the maximum amount reimbursed over a given period, per benefit category (hospitalisation, routine care, dental, etc.) or overall. A cheaper contract often comes with a higher deductible or lower caps: comparing a price without these two elements tells you nothing about the real level of protection.

Most contracts require a health questionnaire at the time of application. A condition declared as part of your medical history may be subject to an exclusion from cover, a surcharge, or be covered only after a waiting period — the exact terms depend on each insurer and should be read before signing, not discovered at the time of a claim.

A waiting period generally applies to certain benefits (maternity in particular), even without a health questionnaire.

Many international health insurance contracts include a base layer of assistance (24/7 medical guidance, organising a medical repatriation) — worth checking item by item rather than assuming it matches a separate stand-alone guarantee. See repatriation and assistance.