International Health Insurance

International health insurance differs from domestic health insurance in three structural ways:

1. Geographic coverage — a single policy covers care across multiple countries, typically with worldwide-excluding-US, worldwide-including-US, or regional (Europe, Asia, etc.) tiers. The US tier is materially more expensive due to US healthcare cost levels.

2. Portability — the same policy follows the policyholder across moves. Domestic insurers (Spanish Sanitas, German TK, etc.) generally don't follow you to a new country; international insurers do.

3. Direct billing networks — international insurers maintain global networks of hospitals and clinics that bill the insurer directly, avoiding the upfront-cash-then-claim cycle that plagues lower-tier travel insurance.

Major IPMI providers and their typical positioning:

• Cigna Global — broad international network; competitive on price for non-US-inclusive plans; strong app-based claims processing.

• Allianz Care — formerly Allianz Worldwide Care; strong Europe and Africa networks; often the choice for European employers.

• Bupa Global — premium positioning; broad direct-pay network in Asia-Pacific; higher premiums.

• GeoBlue — for US citizens abroad, often pairs with US-based BCBS networks for return-to-US coverage.

• William Russell — UK-origin insurer, mid-market positioning, strong Africa/Middle East presence.

• IMG Global — wider mass-market range from short-term travel to long-term IPMI.

• April International, MSH International, Now Health — smaller players with regional strengths.

Key policy decisions:

• Pre-existing conditions — most IPMI policies exclude pre-existing conditions for the first 24 months; some have moratorium clauses that lift exclusions after 24 symptom-free months. Disclose all material medical history at application — non-disclosure is grounds for claim refusal.

• Maternity coverage — typically requires a 10-12 month waiting period before benefits become available. Add as a rider; coverage levels vary widely.

• US inclusion — adding US coverage to an IPMI plan often doubles the premium. For non-US-citizens with no US travel plans, exclude. For US citizens travelling regularly, include or pair with a US-domestic policy.

• Deductibles — IPMI policies typically have annual deductibles from $0 to $10,000+. Higher deductibles materially reduce premiums but require liquidity reserves.

• Direct billing vs reimbursement — confirm the insurer's direct-billing network in your country of residence. Mexico, Costa Rica, and parts of Africa have variable IPMI direct-pay networks.

For expats relocating to countries with strong public-healthcare systems (Portugal, Spain, France, Germany, UK), IPMI is often a transition tool used during the first 12 months until the holder is registered with the local national system, then dropped or downgraded to a top-up policy.