British expats are fuelling overseas healthcare growth because many states are clamping down on immigrant entitlements. James Sullivan reports

?Despite the best efforts of brokers and insurers to breathe new life into the domestic private health insurance market, take-up rates have failed to improve significantly in recent years.

And while governments continue to shy away from any reform of the NHS, it seems that, at least for the private individual, the commercial healthcare market is likely to experience moderate growth at most.

Look overseas, however, and the situation changes. For British expats, obtaining private health insurance is not some sort of expensive luxury but often a necessity. And with more Brits seeking to find that wonderful place in the sun and take advantage of the strength of the pound by buying property abroad, the expatriate health insurance market seems more buoyant than ever.

Across the Channel our neighbour France has decided to adopt a very different approach to expatriate healthcare.

While it would be logical to have reciprocal healthcare agreements between France and the UK. the European health insurance card, formerly the E111, is only for short-to-medium term visitors.

Long-term resident expats formerly had access to the state system, but this is about to change in France and some other European countries.

According to Foreign Office figures for last year, there are 202,000 British passport holders resident in France.

Under the change in the rules, which is due to take effect on 30 September, anyone under British retirement age and not working will lose their right to French state healthcare once they have lived in the country for two years.

Larry Fulton is chief executive of healthcare intermediary Exclusive Healthcare, which specialises in providing cover for the ‘

‘ British expat community in France. He says: “The background to this is that the state has overdone it and given too much provision, leading to healthcare becoming unaffordable .

“Buying a policy where emergency evacuation cover is provided may be great for the Congo, but not so good for the streets of Paris

Sam Bengree, Interglobal

“All these arrangements were set up following the Treaty of Rome and have been issued on behalf of the EU by member states, so that for every European health insurance card issued to UK citizens in France the UK is paying something like €4.000 (£2,732) per year.”

He adds that the real reason that expats are now being singled out by the Sarkozy government is recent legislative reform.

On 1 January 2000, the ‘couverture maladie universelle’ (health cover for all) came into being. This gave all residents of mainland France and its overseas departments the right to state healthcare at a relatively low cost, with the poorer sections of the community getting it free.
Unfortunately, it seems, the cost of this provision is now being seen as too high. Fulton says: “People have been calling us and saying: ‘we’ve been refused healthcare, what can we do?’.”

For those who specialise in this area, the answer is clear. Private medical insurance can step in to plug the gaps which are now opening up in Europe.

Sam Bengree is a broker consultant at InterGlobal, the former agency which became an insurer after backing from venture capital.

“Obviously it’s a great opportunity for international medical insurance,” he says. “Previously France was a closed country for expats, where you had to top up the state provision of 75% of costs. It seems like it wants to move to a more Australian-style system.”

He stresses, however, that expats need to be careful about the type of cover they purchase. “You need a bespoke product to get the best out of a country like France. So buying a policy where emergency evacuation cover is provided may be great for the Congo, but not so good for the streets of Paris.”

Yet while France is currently in the headlines, it’s not the only country which is adopting a stricter approach to expatriate healthcare.

In Spain, new rules this year mean that EU citizens under pensionable age have no automatic right to medical help beyond emergencies. Also, Greece does not give free healthcare to retired people moving there from other European countries.

According to David Pryor, senior executive director at Medicare International, even without such changes the sensible expat should always consider private healthcare insurance.

“With more Brits seeking to find that wonderful place in the sun, it seems the market for expatriate health insurance is more buoyant than ever

“In EEA countries there is a reciprocal agreement for certain healthcare provision, but in a state hospital the facilities aren’t likely to be as comfortable as a private hospital. So we offer different levels of cover ranging from hospitalisation cover, through to cover that includes GP visits, and cover for both in-patient and out-patient care, and routine dental work.

“Our plans are bought by business people of all nationalities. And if you are a British subject you can have treatment in the UK, but generally within the territorial scope you can have treatment where you want it.”

He adds that this is very much a growth sector at the moment.

“I started off in 1983 when it was all very niche. Today there’s much more choice. It’s grown considerably for us.

“When we started out our book was British expats. Now they constitute only 20% of our book. International health insurance has grown rapidly in recent years, much more quickly than the domestic side.

“In the UK we have one of the highest percentages of long-term migrants leaving the country. Now I don’t know what that says, but it’s good for international health insurance.”

And, he adds, the opportunities are definitely there for intermediaries. “This is very much sold through the broker channel. We will accept individual business but we prefer to deal with brokers.”

Now, where was that property brochure?”