NEWS IN REVIEW: Volume 2, Issue 23

Am I covered abroad? Educating employees on the limits of their health insurance

By Simon Stirzaker

linkedin.com – Very few people think in much detail about their health when they go abroad, often failing to acknowledge that a visit to a doctor or hospital could be required. The fact is, chances of requiring medical treatment increase when travelling.

Without adequate insurance, such episodes can be very expensive. But few employees are fully aware of what their health insurance covers when it comes to foreign travel. Human Resources departments can play a valuable role in this respect, making sure employees are educated on the key terms of their medical insurance.

So let’s look at the most important questions an employee should ask when planning a trip abroad.

 

Six key insurance questions when travelling abroad

Insurance is all about predicting future risk. There are some things we can never know but there is much we can be aware of to help limit our exposure to medical mishap and financial loss. Most health insurance policies offer at least some coverage for travel but the specifics can vary a great deal. Getting your workers to ask the following questions will help them identify what level of travel insurance they need, what to take with them, and how to respond in case of an emergency. 

  1. What about existing medical conditions? A pre-existing medical condition is the most common reason for requiring medical treatment while travelling abroad. By 2020, the number of people from the Middle East travelling to another country each year is set to reach 57 million, with around 77% going to another Gulf state, 11% to Europe, 6% to Africa and 5% to Asia. With conditions such as diabetes or high blood pressure common in the UAE, many of those travellers will need to carry some kind of medication. Therefore, it’s very important to know what medications may and may not be taken into their destination country.

Any employee of yours with an existing medical condition needs to know the answer to three questions:

  • Are my prescription medicines legal in the country I’m going to?
  • What are the rules when entering with medication?
  • Does the medication have a different brand name in that country?

When entering Saudi Arabia, for example, drugs for personal use will be cleared only if accompanied by a medical report or prescription less than six months old, and provided this document contains specific details like patient name, diagnosis, dosage and condition. There are additional regulations if the medication is administered by injection. Contrast this with the UK, which is more interested in restricting ‘controlled drugs’, that is drugs that can be used for medical purposes or can be misused – such as morphine.

Travelling to certain countries specifically for the purposes of getting medical treatment for a pre-existing condition overseas presents a different scenario and will likely need pre-authorisation from your insurance company. In these situations, it is always best to check with your broker or insurer in advance.

  1. Is a particular destination covered by the policy? The first question an employee should ask about their insurance policy is, ‘Does it include the country I’m going to?’ Different policies have different inclusions and exclusions. All but the most basic will usually provide cover in the Middle East and Africa, where healthcare is of a similar cost. Other policies typically offer ‘worldwide cover, excluding the USA’, while the most comprehensive offer ‘universal cover’ or ‘worldwide plus the USA’. In cases where there are geographical exclusions, the policy will often cover emergencies in the case of an accident.
  2. Are family members covered? With only one third of overseas trips being carried out for business, the chances are that your employees will be taking members of their family with them when they travel. In fact, a study produced for the European Travel Commission shows that 60% of Middle Eastern travellers do so in groups of three to five people. Employees need to be clear about whether their health insurance covers these travelling companions too. It should if they’re family, but it’s best to make sure.

If extended family members are coming – such as cousins or nephews – your employees should check with them to make sure that they have appropriate cover. In an emergency, it’s often family members who end up out of pocket. 

  1. What exactly is covered? If an employee does have an emergency, what are they entitled to claim for? Medical evacuation is one very important aspect. Let’s say the worker is involved in a car crash in Cambodia but there is no medical facility there equipped to provide the treatment they need. They will need to be evacuated to a hospital that can treat them – even if it’s in another country or continent. The question is whether they are covered for such an eventuality.

Similarly, if the insured person is pregnant and requires maternity care while abroad, will that be covered? Check the policy carefully because some will only reimburse a proportion of the fee for maternity care, and that could leave a fair chunk of money for your employee yet to find.

Some policies may also have “reasonable & customary” cost limitations for treatments taken overseas and this is something to look out for, particularly if travelling to more expensive countries, as you may be left paying the excess charges out of your own pocket.  

  1. What isn’t covered? Just as important as knowing what is covered is knowing what isn’t, especially if the planned holiday involves high risk activities, like skiing or trekking to high altitudes. Medical treatment for accidents resulting from risky activities like these is often excluded, so watch out for them in the policy under the heading ‘standard exclusions’. Where they are excluded, your employee can top up their cover with a travel insurance product that specifies insurance cover for the particular activities they wish to undertake.

Make sure, too, that your employees are aware that insurance providers are quite specific about when they expect to be contacted in the event of a claim. For example, if a person has to access non-emergency outpatient care, the insurer may well ask to be contacted for approval first, otherwise the claim will be rejected. For in-patient emergency care, providers often expect to be contacted within 24 hours. 

  1. What should your staff do in a medical emergency? Finally, your employees should know what to do if there is an emergency. They should make sure they pack their medical insurance card and take the following information with them:
  • Emergency contact details of insurer or Third Party Administrator (TPA – normally on the back of the insurance card)
  • Closest hospital to their accommodation
  • A prescription showing the brand and generic name of their medication

If your company uses a third party administrator (TPA) to handle claims, the employee should be aware of this. TPAs offer many benefits; for example, they can often arrange medical facility discounts for insurers and administer the claims in these facilities on behalf of the insurer. No TPA has global coverage, so insurers will often partner with multiple TPAs around the world. This ensures that treatment is available wherever required.

Give your workforce a break

When, in 2014, UAE nationals were asked in a poll, ‘What do you truly love?’ the top three answers were family, hobbies and travel. You can easily argue that holidays cover all three, so it’s essential that you help your employees to make sure some of the most memorable moments in their lives don’t turn sour. People can get injured anywhere, but accidents don’t have to injure us financially.

In your role of taking care of the workforce, one of the most valuable services you can provide, in addition to seeing that they are adequately insured while at work, is to make sure they are aware of the extent of their medical insurance coverage and what is expected of them should it be called upon.

So when they go away to recharge their batteries, they will know they can truly relax.

Please visit the Al Futtaim Willis website at www.willis.ae.

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Health systems see returns on risk-based reimbursement

By Alex Kacik  

modernhealthcare.com – Despite a broad push to pay for value over volume, health systems are still largely reliant on the fee-for-service model as they gradually take on more financial risk through new payment methods. But systems that have the resources, infrastructure and appetite to delve more deeply into value-based payment reform are starting to see a return on their investments.

In this year’s Modern Healthcare Hospital Systems Survey, only nine out of 60 respondents said they derived 10% or more of their net patient revenue in 2016 from risk-based contracts, which was largely in line with last year’s survey. Three-quarters of the respondents estimated that risk-based contracts generated 4% or less of their net patient revenue, but most indicated their share of risk-based contracts would slightly increase in 2017.

To view the original article in its entirety, click here.

 

Opioid prescriptions dropped but remain high, CDC says

By Debra Goldschmidt and Nadia Kounang, CNN

CNN.com – Opioids continue to be prescribed at high rates, a report from the Centers for Disease Control and Prevention finds. Opioid prescriptions overall decreased 18% from 2010 to 2015.

To view the original article in its entirety, click here.

 

When it comes to healthcare, U.S. once again ranks last in quality of care compared to other wealthy nations

by Ilene MacDonald

fiercehealthcare.com – The United States spends more on healthcare than other wealthy nations, yet ranks dead last on equity, access, efficiency, care delivery and healthcare costs.

Despite progress made in providing coverage to previously uninsured Americans via the Affordable Care Act, the latest report from The Commonwealth Fund finds that the United States offers its citizens the least financial protection among the 11 high-income countries surveyed. It is also the only one without universal health insurance coverage.

 

To view the original article in its entirety, click here.

 

 

Texas legislators take aim at high maternal mortality rates

by Paige Minemyer

fiercehealthcare.com – Maternal death rates are on the rise in some regions, pushing leaders in several states to investigate the trend and putting hospitals on alert.

Maternal deaths have been trending up since the late 1980s, according to data from the Centers for Disease Control and Prevention. In 1987, there were 7.2 deaths per 100,000 births, rising to a peak of 17.8 deaths per 100,000 births in 2009 and 2011. In 2013, the most recent year recorded by the CDC, the rate was 17.3 deaths per 100,000 births.

To view the original article in its entirety, click here.

  

Mysterious Zika transmission confounds researchers

By Stephanie Soucheray

 cidrap.umn.edu – The source of infection for a Utah man who became ill with Zika virus after caring for another patient last summer remains a mystery, but person-to-person transmission is the most likely culprit. New details surrounding the patient’s case from investigators at the Centers for Disease Control and Prevention and their partners in Utah appear in latest issue of Emerging Infectious Diseases.

To view the original article in its entirety, please click here.

 

Pricey prescription drugs could soon come with a money-back guarantee

omaha.com – Warranties and money-back guarantees, long used to entice buyers of products such as hand tools and kitchen gadgets, are now being used to sell something more crucial: pricey new-generation drugs for diseases such as rheumatoid arthritis and cancer.

To view the original article in its entirety, click here.

 

Jerome Adams, Indiana doctor, is new surgeon general

by  Joanne Finnegan

fiercehealthcare.com – The U.S. Senate yesterday approved Jerome Adams, M.D., to be the country’s next surgeon general.

Adams was confirmed, along with three other nominees for positions in the Department of Health and Human Services. The confirmations were not unexpected as all of the nominees won approval from a Senate committee earlier this week and were sent to the full Senate for confirmation.

To view the original article in its entirety, please click here.

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