Wellness in Expatland: why iPMI is increasingly about prevention rather than just cure

Wellness in Expatland: why iPMI is increasingly about prevention rather than just cure

Using old methods and new technology to promote fitness among one’s insurance plan members keeps claims down – and premiums lower – insurance companies say. Many have been introducing and expanding wellness programmes in their home markets for this  reason. Here, Charlotte Beugge looks at how this trend is increasingly being embraced as well in the international health insurance space. 

“Wellness”, at least as defined by insurance companies in 2017, might run something like this: “The business of making active choices in one’s lifestyle designed to ensure and promote one’s health – not just by preventing illness, such as by getting flu shots, but by looking at one’s complete physical, mental and social well-being, and then taking steps to improve it, such as through exercise, diet, and lifestyle.”

Wellness is a word that is increasingly being used by international private medical insurers, as well as by their home-market counterparts, because it is seen as one way of keeping the number and cost of claims down, at a time when insurance costs generally are rising rapidly, putting pressure on profitability and membership numbers.

It’s also part of a shift in attitude that’s been brewing in the past few years, as the role of medical insurers as being simply there to help plan members when they fall ill or become injured has changed, to one which engages the policyholders as partners in helping to prevent their becoming unwell in the first place.

Explains Alison Massey, group marketing director of Now Health International: “We’re seeing a fundamental shift in the way customers perceive international health insurance. Expats are increasingly looking for more than just a health insurer that pays claims fast, [and instead, for] a ‘true health partner’ that can support their overall well-being.”

Decade in coming

According to Joe Thomas, April International UK’s business development director, the move towards introducing the wellness concept into the iPMI marketplace has been growing over the past decade, as insurers increasingly saw evidence that prevention was better than cure. April International is the international arm of  the Paris-based April Group insurance company, which evolved out of UK-based MediCare International after April acquired it in 2012.

Thomas notes that wellness can be a particularly relevant issue for expatriates, since, depending on where they happen to be posted, living abroad can often mean poorer medical facilities than they would be accustomed to back home, as well, in many cases, as presenting language barriers, which can make it difficult to obtain treatment while overseas.

Another problem, Thomas points out, is that something as simple as the way an individual goes about accessing healthcare can be very different abroad than is the norm back home. Arranging a visit to one’s local GP if you happen to be living in the Far East, for example, he explains, would in many places be considered unusual; instead, he says, you’d probably go straight to a specialist for your condition.

Mental and social issues, meanwhile, are likely to be magnified for policyholders when they’re living in an unfamiliar environment, he notes.

If insurers can help sort such issues before they develop – whether from pre-trip medical examinations to online health advice for policyholders – then it helps promote wellness, and keeps claims down, Thomas says.

Wellness programmes included 

Aetna International, the expatriate-focused arm of US health insurer Aetna, has wellness programmes included within its international private medical insurance packages, company officials say.  These range from health assessments and  biometric screening to online wellness and coaching programmes, and are largely the domain of the company’s corporate iPMI offerings. However, its individual plans for expatriates have wellness programmes too, such as health assessments, so possible medical issues are identified early, Aetna International says.

That pre-empting problems by introducing such pro-good health practices works is something Aetna discovered when it introduced them for its own staff, according to Damian Lenihan, Aetna International’s executive director – distribution (pictured left).

Several years ago, “we identified that our own employees with the highest levels of stress were costing us US$2,000 more each year than less stressed co-workers”, he says. This, he explains, led the company to set up programmes to promote yoga and meditation, which were found to result in better heart rates, increased workplace productivity, and to cut employee health benefits costs by 7% the next year.

Benefit for employers seen too

Individuals and their insurance companies aren’t the only beneficiaries of wellness programmes, experts point out: these individuals’ employers also stand to benefit when wellness is embraced, even if it means the employees spend fewer hours per week at their desks. This, they add, can translate into a financial positive, even as the insurer also gains.

“If we can improve the health of our insured populations, this means healthier [scheme] members and improved productivity levels for our corporate customers as well as a lower claims experience,” says Stuart Leatherby, chief commercial officer at Generali Global Health.

Andy Seale, global head of sales and distribution at Allianz Partners, as it has been officially known since last week (until which time it was Allianz Worldwide Care), says he and his Allianz colleagues have also been seeing employers increasingly placing an emphasis on the well-being of their expat staff  “by encouraging them to manage proactively their health and that of their families in order to prevent illness”, as well as by supporting them “on a personal level as they go through the process of moving abroad”.

“Highlighting the importance of fitness is central to that work,” he adds.

He notes that recent studies have suggested that a healthy, stress-free and well-motivated workforce can result in better retention rates, lower levels of sickness, and higher levels of employee performance.  This, he notes, is driving organisations – both large and small – in the direction of prioritising the health and wellbeing of their employees, “so they can have not only a happier and healthier workforce, but also hopefully a more productive one”.

To help employers (And their employees) in this regard, he notes, Allianz has posted wellness guides on its website. 

Wearable fitness technology 

David Hilton, senior international account manager at Jelf, the Bristol-based insurance broker, believes the next stage for the iPMI sector in the move towards embracing the wellness trend could be wearable fitness technology. This is already being offered to plan members on some UK plans, such as Vitality, which urges scheme members to “earn Vitality activity points…by linking an eligible activity tracking device or app to your online Vitality profile”.

A variation on this, in the “Internet of Things” or IOT department, is where healthcare data is collected from a person without involving wearables: say, data from a heart monitor is transferred to a computer.

“Integrating devices and the IOT into a member’s health ecosystem is key in supporting and motivating members to stay fit and achieve their goals, as well as ultimately linking back to a reduced risk, and therefore lower premium,” explains Jamie Marshall, chief technical officer for Generali Global Health.

But technology only goes so far.  And when it comes to effectively promoting wellness, some experts say it can sometimes be as simple a matter as just rewarding good behaviour by passing on the savings that result.

Tony Ratliff, executive chairman at Expacare, explains that individuals can cut up to 25% off their premium, depending on their answers to six questions asking for details of their height; weight; smoking habits; alcohol consumption; amount of exercise taken and how many sick days they’ve taken in the past year.

“The questions are asked again at the renewal of the policy, in order to encourage members to get healthier during the course of the year,” he adds.

Bupa Global also uses simple ways of encouraging wellness: newsletters and magazines focussing on fitness and wellbeing, for example, are being sent out, Bupa executives say. Some of its plans also include, as standard, health assessments, whereby policyholders would be offered wellness advice.

Whether it’s advice being delivered online or via magazines, to users wearing Fitbits or other devices, the aim, according to executives from all the iPMI companies interviewed, is the same: a well, balanced policyholder, who is less likely to need treatment than might have been the case without all the “wellness” incentives – which, ultimately, is good news for their insurers’ premiums, the insurer’s bottom line, as well as the individual’s employer and, last but not least, the employees themselves.


Is it the original “expat wellness programme”, or, as some jokingly call it, “a drinking club with a running problem”? Read about the 79-year-old, globally-active  expat running group known as the Hash House Harriers by clicking here.