Tomorrow, the eagerly-awaited – if not entirely controversy-free – Olympic Games in Brazil are due to get under way. As the athletes complete their final training sessions and prepare for the opening ceremonies, International Investment looks at what insurers and other experts say expatriates, international business travelers and the financial advisers and insurance brokers who look after them need to know about Zika – the terrifying new virus that has become associated with this South American country, after it struck with heartbreaking force last year.
It was beginning to seem as though international business travellers were getting as relaxed about their pending trips, and even postings, to once exotic locations as they were to their visits to rather more prosaic destinations in Europe or the American Midwest. Manila? Ho Chi Minh City? Bangkok?
“Like Chicago or Minneapolis, maybe with a few more palm trees”…or so it seemed.
Not any more.
Towards the end of last year, the world was horrified to learn of an apparently new, mosquito-borne virus known as Zika that, it soon emerged, was causing a horrific type of birth defect in the children of infected pregnant women, known as microcephaly.
Children whose mothers contracted the virus were being born with abnormally small skulls and other serious brain abnormalities. At least at first, most of the reported cases were turning up in Brazil.
Thus far, more than 1,400 cases of microcephaly have now been diagnosed in the country.
At one point there was a call, by some 200 public health experts, to move or postpone the Rio games, on grounds that it would be “unethical” for them to go ahead, but this was soundly rejected by the World Health Organisation in May.
The event would “not significantly alter” the spread of the virus, the WHO said, as it was already present in almost 60 countries around the world.
In July, that observation by the WHO was underscored, when a number of people in the southern US state of Florida were discovered to have been infected after being bitten by local mosquitoes. On Monday, the US-based Centers for Disease Control and Prevention advised pregnant women and their partners to avoid certain areas north of downtown Miami, in what was described as an “unprecedented” travel warning, as it was the first the CDC had ever issued which involved warning people to avoid a an American neighborhood for fear of catching an infectious disease.
What to do?
For international business travellers who spend time in the kinds of tropical countries most at risk of harbouring the mosquito-borne Zika virus, the obvious question about necessary precautions arises – not only as to which precautions they should take for themselves, but on behalf of their families and, in the case of pregnant women, their unborn foetuses.
The question is particularly agonising for those who have brought their families with them to places like Brazil, Guyana, Central America and the Caribbean, (see WHO map, left), which are seen as the closest to the centre of the initial outbreak.
Wealth managers and financial advisers with clients in this international space, meanwhile, are also wondering what they should be advising such clients to do.
The short (and not really surprising) answer, say insurance company experts – apart from urging them to avoiding mosquitoes wherever possible – is to tell them that they need to ensure that they have sufficient medical insurance, either personally or through their employer.
April International’s Joe Thomas says all of his company’s international private health policies fully cover Zika virus infections.
Because it is unlikely that an individual will know they have the virus without being checked out first, he adds, “we would expect clients to follow the normal steps of contacting our assistance provider, and then going to see a GP, who [would] provide the initial diagnosis.
“As such, the process is no different from any other illness requiring medical attention.
“Where Zika differs is in its potential to harm new babies. If a mother is unlucky enough to have a child born with microcephaly, we do offer support under our Executive Plus policy, which has congenital and birth defect cover, where these are diagnosed within one year of birth.”
Echoing other insurance industry experts interviewed, Thomas added that because of the medical establishment’s still-limited knowledge about Zika and how it needs to be treated over the longer term, “it is not possible at this stage to say how a case would be treated after the initial cover had been used”.
Common sense prescribed
For those heading to affected areas – and that’s not only Brazil but 60 countries altogether (see www.who.int) – Andrew Apps, of global insurance specialists Bellwood Prestbury, said experts prescribe a large dose of common sense, taken early.
For instance, “practice safe sex; if you are pregnant or planning to be, then perhaps don’t go to affected countries”.
Most insurers say that if the UK’s Foreign & Commonwealth Office advises against travel to a destination (which it thus far hasn’t done for Zika-affected areas), exclusions would begin to apply to certain conditions, Apps noted, which makes a case for keeping an eye on the FCO’s recommendations, as well as for staying in touch with one’s insurance company.
“I think the Zika outbreak, and indeed past outbreaks of viruses abroad, only go to show that if you are working abroad, medical insurance is essential,” Apps added.
The pregnant woman’s dilemma
One thing that insurance company representatives and other experts seem to agree on is that there could be some big questions about a policyholder’s insurance coverage over the long term if a Zika infection were to lead to something permanent and significantly disabling – such as a brain-damaged baby.
Claudine Audin, international PMI sales and account manager at Aviva, said that there is no specific treatment available for dealing with Zika infections, even if they’re officially diagnosed, “other than rest, drinking plenty of fluids and taking recommended medication to ease any symptoms of pain and fever”.
“We would look to consider benefit for the medical practitioner costs and the blood tests, [and] in the unlikely event of an International PMI customer being referred to a consultant, this would [aso] be covered under the terms of the policy.”
But if the policyholder was pregnant at the time of infection, and gave birth to a baby afflicted with microcephaly, there would be a limit on how much the child was covered for, Audin said.
Any acute care needed at birth would be covered, she noted, but “once the acute phase of care has been dealt with, no further benefit [would be] available”.
Added Tammie Peters, senior vice president of products and compliance at medical insurer International Medical Group commented: “If a baby is born to a IMG policyholder, and they are enrolled in line with the terms and conditions of the policy, the baby would be covered, up to the maximum limit available for congenital conditions.”
Expacare’s Beverly Cook said her company would “cover any necessary treatment or tests required and for pregnant members’ investigations into the risk of microcephaly”, if Zika were suspected.
“Additionally, we have a newborn benefit that will assist with claims within the first 30 days of birth for any congenital abnormalities.”
Jorien Jansen of Expat Assure added: “The majority of insurance companies will allow you to add your baby to your cover without a medical questionnaire as long as the request is made with 30 days of the birth. This means that, in theory, all pre-existing conditions are covered following the limits of the policy.
“However, here is the tricky point: even the baby is added without medical questionnaire, microcephaly is seen as a congenital condition, and most insurance companies will apply a lifetime limit on this benefit.”
For companies, meanwhile, the business of sending employees into regions where they may be exposed to potentially dangerous diseases isn’t new. Malaria, for example, remains a concern in many places, as does HIV/AIDS. Ebola seems to be all but wiped out, at least for now, in Guinea, Liberia and Sierra Leone, but health experts aren’t saying it won’t ever come back.
Still, the unique awfulness of the risk of having a seriously brain-damaged and deformed infant seems to be giving at least some employers pause, at least with respect to women who are or who might become pregnant.
Sarah Dennis, head of international at The Health Insurance Group, said that until there is a cure for the Zika virus “or more control” over its spread, “employers will look more seriously at where sending their employees, to ensure they are not being put at risk, as they have a duty of care”.
Like April International’s Thomas, Adam Harding, of insurance brokers Jelf, stressed the importance of ensuring that one’s private health insurance covers Zika-related conditions.
“Insurers will in general cover Zika, but it depends on the terms of the policy – I do know of a couple of products which don’t,” he said.
“Most policies will cover congenital birth defects, but there can be a policy limit of, say, £150,000 – and that’s a lifetime limit.”
What’s more, he added, if an employee, or their employer, were to look to switch insurers, there could be a potential problem if the insured individual had been infected with Zika while covered by the first insurer, “but didn’t know, [and] later wanted to claim for birth defects caused by the [initially-] undetected virus.
“That’s because it would count as a pre-existing condition, even if you didn’t know you had it.”
While Zika might be troubling to some of those contemplating travel to infested areas, specifically Brazil, at least one long-time British expat living close to its Brazilian epicentre sees it as less of a worry than other concerns.
John Fleming, the founder and principal of the Rio de Janeiro-based Global Index International advisory firm, has spent the past 14 years in Brazil, and first came to South America more than 20 years ago.
He said: “The president is facing impeachment, and the vice president has already had two ministers resign since May. Frankly, no one in Brazil is talking about the Olympics, and they certainly aren’t giving any thought to Zika.
“They have other things to worry about.”
What is Zika?
* Discovered in a monkey in Uganda in 1947
* Native mainly to tropical Africa, it first appeared in Brazil in 2014
* Transmitted by the Aedes aegypti mosquito
* May be transmitted sexually
* Symptoms of Zika are: mild fever, rash, joint pain, and red eyes; they usually last less than a week
* No vaccine against Zika has yet been developed
* Experts say people living or visiting a Zika-infected area should wear long-sleeved garments and trousers, and use mosquito repellent
Other famous viral viruses
Ebola: First detected in 1976. Outbreak in West Africa 2014-2016; more than 28,000 cases
SARS (Severe acute respiratory syndrome) Between 2002-3 more than 8,000 cases in China
Bird flu: First human case in 1997. Since 2003 700 plus cases in China and Far East
Feeling ill? Tropical diseases to watch out for
Malaria: More than 214m cases worldwide in 2015 – and 430,000 deaths. Spread by mosquitoes
Cholera: Endemic in many countries; 129,000 cases worldwide in 2013. Spread by contaminated water
Dengue fever: Around 2.4m cases annually. Spread by mosquito. Nine epidemics since 1970; endemic in parts of Asia and Latin America
Yellow fever: Mosquito-borne virus. Endemic in Africa, Central and South America. 170,000 serious cases in 2013
Rabies: Endemic on all continents, bar Antarctica; 95% cases in Asia and Africa. Usually spread by dog bites. Around 59,000 deaths a year
Schistosomiasis: Caused by parasitical worms present in infected water. Rise in eco-tourism and ‘off the beaten track” travel means more tourists are being infected, says the World Health Organisation. More than 60 million people received treatment for it in 2013, mainly in Africa.