Quick Finder
Expatriate health insurance: Requirements by country
It is impractical to provide comprehensive detail on the requirements for international and expatriate health insurance in every country. In addition, rules and requirements often differ by nationality too. Private Healthcare UK only covers the requirements for UK citizens.
- Countries may have rules on allowing you in as a long stay visitor, depending on whether you are working temporarily, have moved there permanently, are a student, or retired there.
- In some countries, rules apply to " workers " so the position of retirees is unclear.
- Some countries will now only allow you a visa if you can prove you have health insurance.
- Theory and practice, particularly in non-EU countries can differ. Corruption is not unknown; in some countries you are expected to " pay " certain officials, while in other countries you will be thrown in jail if you try to.
- In some countries you have to buy local insurance.
- In some countries you can buy international health insurance, but only if the insurer is authorised in that country.
The basic rule in most countries is that a UK citizen resident in that country is subject to the same laws and rules as all other residents. There is no excuse for not doing your research on what health provision there is for foreign citizens, rules on what health insurance you must have, or require, before you go abroad.
Most international health insurance policies will cover the countries mentioned below. Links to company and policy information are ONLY included when there are country specific policies.
Europe | Outside Europe |
Health insurance for Europe
Cyprus
Specific health insurance for Cyprus is provided by:
France
All residents need to be protected by the French Healthcare System which means expatriates must register with a local GP/Family Doctor. Many people buy top-up insurance to protect them against the substantial difference in what the state pays, and what the health system charges individuals.
Specific health insurance for France is provided by:
From October 2007 any expatriate living in France who is not working and/or is below the French retirement age is no longer eligible for free healthcare from the state.
The French state system only pays for 70% of healthcare costs, the indivbidal is responsible for the balance.
To become a permanent resident in France and to obtain a residence permit (carte de sejour) the individual must prove that they have health insurance that either provides partial or total reimbursement of their medical expenses.
Britons who are retired and under pensionable age are not covered by the national Franch system.
Any Britons over the UK's state retirement age, 65 for men and 60 for women, are covered by getting a form E121, which means their fees are paid by the UK government under a reciprocal agreement.
Expats can also get cover for the first two years they are living in France by obtaining a form E106 from the Department of Health before leaving the UK, and anyone who has lived in the country for at least five years is entitled to care as a resident of France.
For those who are healthy, it is possible to get an international plan to cover the three years between the expiry of your E106 and the five-year residency qualification period.
International plans are generally more expensive than UK plans but they will also cover you wherever you travel in Europe as well as in France.
The first rule is not to give up a healthcare plan in the UK if you have one until you have checked out exactly where you stand. Cancelling a policy over here would be a disastrous mistake because many insurers will let you change from a UK plan to an international plan that covers Europe, while keeping you on the same underwriting terms.
If you want to relocate to France and know you are going to need some treatment in the future, the current situation is that you will have to pay for your own care once your two years E106 benefit runs out.
Ireland
It is not compulsory to have private health insurance in Ireland but as private health insurance is very common –is a good idea.
Health insurance is used to pay for private care in hospitals or from various health professionals in hospitals or in their practices.
If you are a UK expat in Ireland, there are two schools of thought on international health insurance, and until the question is tested in this country where legal arguments between insurers and the state has become a way of life, no one is sure which is correct.
Version one says that you can buy and use an international health insurance plan.
Version two says that as the state heavily regulates health insurance and licences insurers under strict rules, it is a technical illegality for any insurer in any country to compete with the three authorised insurers
There are now 3 insurance providers currently in Ireland: -
The Voluntary Health Insurance Board (VHI) is the largest provider of voluntary private health insurance. It is a semi-state body whose board is appointed by the Minister for Health and Children. It is subsidised by competitors (a very long story!) Against its will it is being reformed and privatised in 2008.
Quinn Healthcare, which took over BUPA Ireland in 2007 after BUPA withdrew in protest about having to pay huge sums of money to VHI.
The third, and most innovative, is Vivas Health
Ireland has a reputation of being expensive for healthcare - but Any EU national or a person "ordinarily resident" in Ireland is entitled to the following for free:
a) All in-patient public hospital services in public wards, including consultant services, subject to certain charges. There is a daily charge of €60 for public hospital accommodation, up to a maximum limit of €450 in any consecutive 12 months.
b) All other outpatient hospital services, including consultants.
Accident and Emergency department treatment. If your doctor refers you, there is no charge. Otherwise it costs €60 per visit.
c) Maternity and Infant care services including the services of a GP during pregnancy and for up to six weeks after the birth. FREE
A visit to a GP will cost you around 30 to 45 euro - and some insurance schemes will refund some of this fee - you would have to be pretty sick to make enough visits to a GP to make it worthwhile taking out insurance for all the family.
Malta
Specific health insurance for Malta is provided by:
Netherlands
If you are a UK expat in the Netherlands, or thinking of working there, then you need to keep up to date with the compulsory private medical covers which apply to expats as well as Dutch citizens.
As of 1 January 2006 the two-tier public-private healthcare system was replaced by basisverzekering, or a base level health insurance, for everyone (Zorgverzekeringswet). It is obligatory for all residents of the Netherlands to have one of the basic health insurance plans. All resident children under the age of 18 are insured as part of their parent insurance policies for free
You are free to choose one of any number of health insurers (zorgverzeraars) who all offer a basic coverage package, as well as a dizzying array of extras, like supplementary coverage for: dental, after-pregnancy care, extra physiotherapy, etc.
The government has opted to have private insurance companies provide the coverage to use market forces to cut healthcare costs. In addition, the insurers are not permitted to refuse anyone the basic package regardless of age, employment status or general health, but may refuse anyone for supplementary insurance (aanvullende verzekering).
The cost has risen 10 percent for 2007, with more increases expected in 2008.
The Dutch government continues to change the coverage of the basic insurance package. For example, in 2008 the birth control pill will be included once again, as will a yearly check-up with the dentist. However, pre-natal screening for women under the age of 36 has been removed. So it is essential if you have specific health insurance needs that you check your policy carefully.
For expats there is a lack of clear information and you are quite likely to get several different answers to the same question. Whatever the local officials may say, the facts are that if you are from the UK, unless you have a residence permit based on study, you are legally required to have the minimum, basic insurance. Your residence may be at risk if you do not get insured within 4 months of officially residing in the Netherlands.
If you are here on a temporary stay/ holiday, or are a student, you are not eligible to have the basic, Dutch health insurance, but will be required to have a health insurance, either international, or from your country of residence.
If you are applying for residency international health insurance is only considered acceptable for the period until you receive your residency, once you are officially a resident you will be required to have Dutch health insurance.
Do you need your residence permit before you apply for health insurance, or do you need health insurance before you apply for your residency permit? Unfortunately it’s apparently both, depending on who you speak to on any given day. Our advice: Follow what you are told when you register.
Your eligibility for resident status is partially dependent on having sufficient health care coverage.
The government has estimated the cost of the nominal premium for basic insurance this year will be about EUR 1,115 – 1,250 annually, or EUR 92 - 105 per month.
Until January of 2008, under a no-claims regulation, you can receive a deduction (maximum EUR 255) on your premium. Doctor's appointments won't be counted under the no-claims system. You can also opt for a higher personal liability (EUR 100 to EUR 500 per year) to help reduce the premium.
After January of 2008 the no-claims regulation will disappear and a personal liability will be in place for everyone.
You may wish to take out supplementary insurance (aanvullende verzekering) to cover elective treatments, as well as dentistry and physiotherapy and other treatments the government considers to relate to be the individual's 'own responsibility'. This is also where the real differences in policies show up – from no frills and basic to private hospitals.
No one who qualifies for the basic insurance package may be refused for that package, however, insurers are allowed to impose conditions and determine the pricing for supplementary insurance, and may refuse anyone supplementary insurance coverage. You can choose to switch your basic coverage to another provider once a year.
An essential part of the new system is that insurers can offer a choice of basic policies: healthcare in kind (the insurer organises everything and pays the medical bills); a policy under which you arrange and pay for the treatment and the insurer reimburses you; or a mixture of the two. Hospitals are encouraged to compete with each other and between insurers, who will seek to make deals with specific health bodies and hospitals in order to provide their clients with the most attractive treatment prices. The government hopes this will lead to hospitals specialising in particular areas of medicine.
The down side for patients can be longer travel times to the appropriate hospital. Also, be warned, insurance companies are only required to reimburse you for what is considered ‘reasonable costs’ Therefore always check with your insurer before you have expensive treatment done or you could be in for a shock.
For those UK expats working in the Netherlands, you may get misleading advice from international health insurers and brokers. They may tell you that an international health policy can be bought instead of using the official system- this is wrong. They may tell you that you can have an international health policy as well as the official cover. Those insurers who have studied it are agreed on one thing, the legal situation is confusing, but on balance it is felt that it is legal to have a top up international health policy, but may be illegal to have a full policy as well as an authorised local one. On the other hand, some insurers have suggested that such possession is only a technicality. We are not so sure,
If you are a UK citizen who works or wants to work in the Netherlands, you have to comply with local law. Failure to comply can mean the loss of your residence permit. Local officials do seem to have the capacity for interpreting the law how they each think it works, so our advice is to play it safe and buy cover locally.
Portugal
Specific health insurance for Portugal is provided by:
Spain
A third of hospitals in Spain are independent. The state system has some of the longest waits in Europe for treatment. Many people buy private health insurance.
Specific health insurance for Spain is provided by:
Newly arrived UK expats have to report within three months with their passport to a "Foreigners' Office" (Oficina de Extranjeros) in their province of residence or a designated police station. They will get a certificate stating name, address and nationality, identity number and date of registration. Those under UK pensionable age (65 for men and 60 for women) have no automatic right of access to free extended healthcare.
UK expats who are retired, employed or registered self-employed in Spain can expect the same treatment as a Spanish citizen. If you have not reached UK pensionable age, are not getting a disability pension, and are not working, you are only entitled to emergency treatment.
Switzerland
All residents including expats and temporary workers must take out insurance, which is offered on a price competition only basis by a range of local insurers; details vary by canton. Alternatively, expatriates may opt out if they can produce a current certificate of health insurance from an insurer.
Outside Europe
Bahrain
Bahrain is introducing compulsory private health insurance for all expatriates. 2008 will see compulsory insurance for expats working at large companies with over 500 employees. The following years will see this extended to those with over 50 employees, then over 10 employees, then all expats except domestic helpers, and finally, all domestic helpers. By 2013 all expats will have to have cover.
Meanwhile, even small businesses will have to pay increased fees and levies to the state, for every expatriate worker. Individuals and companies will be expected to buy international health insurance from the insurance market.
Canada
Medical insurance premiums in Canada are supplementary (top-up) plans, as there is no official acknowledgement of the existence of a private health insurance. Recent Court rulings are changing this, but only in some states. The state system is struggling, with many Canadians seeking treatment in the USA.
China
The language barrier and cultural differences, makes it hard for expatriates to obtain medical services and insurance coverage in China. Expatriates often choose to travel to Hong Kong for surgery or crucial medical advice. Medical costs in China and Hong Kong are the highest in the world after the USA.
All healthcare policies are underwritten by a registered insurer in China. As medical policies currently issued by insurers in China do not cover treatment outside the Mainland, virtually no expatriates staying in China take up a local medical plan.
The first ever insurance product for expats in China has been launched. International health insurance provider, Goodhealth Worldwide's office in Shanghai has launched its first healthcare product for the expatriate market in China in a partnership with China Life Insurance Company Limited.
The product - The China Life Goodhealth International Healthcare Plan (IHP) - is the first international healthcare product with a pan-China license.
The IHP will be issued by China Life but fully managed and backed by Goodhealth.IHP policyholders will gain the benefit of access to much-sought-after private clinics and private hospital wards in China.
Details from enquiries-sh@goodhealthchina.cn- there is no active website.
BUPA set up an office in China in 2006. Over the next couple of years, it will be carrying out consumer research into the Chinese insurance industry and hospitals. Together with the Chinese government, it hopes to eventualy provide consumers with a health insurance solution - but does not currently offer cover.
Abu Dhabi
Any UK expatriate, whether employed or self employed, working or planning to work in the UEA, needs to take steps to ensure they comply with the law. No insurance= no visa.
Employees and their dependents, including their spouse and up to three children under the age of 18 years, must be provided with private health insurance by their employer.
The Abu Dhabi government aims to provide its citizens with the highest standard of living, including the provision of world-class healthcare services for residents and nationals alike
Since January 2007, all companies must ensure their staff are covered by health insurance and will be personally liable to cover costs of staff who lack an authorised health insurance policy as approved by the relevant UEA insurance authority.
The Health Insurance Policy replaces the existing health card and will have to be obtained prior to renewal of visas.
As yet, the laws so not seem to apply to self employed individuals.But the government aims to ensure all local and expat individuals have medical insurance
Local officials may interpret the law to mean that all self- employed individuals must have insurance too , and no insurance will mean no visa
Anyone working in this country is wise to have insurance.
The new rules mean that the insurer and any broker the cover it is bought from , must both be specifically registered in the country for the insurance to be accepted.Valid insurance bought from an a broker or insurer not locally registered, will mean that a visa will be refused- this has already happened.Not all UK insurers or brokers selling expat cover will know this.It takes years to get authorised in the country, so only international insurers and brokers will be authorised.
Companies authorised locally include;
Dubai
Dubai has announced plans to require all the 1.2 million expats to have international health insurance, bought via a locally authorised insurer and/ or broker.
By 2008, a federal law on health insurance will be enacted to provide expat residents with health services in return for a health insurance premium.
Saudi Arabia
The Kingdom of Saudi Arabia has made health insurance compulsory for expatriate workers in KSA. The law aims to ease the financial burden on the government, which offers free medical services to some 22 million people, including about 6 million foreigners.
An international health insurance policy from an approved cooperative health insurer will be a requirement in the granting of Iqamas and work permit renewals.
The law has started to be implemented in phases. Companies with more than 500 expatriate workers need to have medical insurance for its employees by June 2006.This will be extended in 2007 to companies having 100 workers and more and in 2008 to all workers including domestic servants. Medical insurance will eventually be made mandatory for Saudi citizens.
If you are going to live or work in Saudi Arabia, buying an international health insurance now is recommended.
Thailand
Specific health insurance for Thailand is provided by:
United Arab Emirates /UEA
The United Arab Emirates (UAE) is a federation of seven states.Although each state - Abu Dhabi, Dubai, Ajman, Fujairah, Ras al Khaimah, Sharjah and Umm al Qaiwain - maintains a large degree of independence, the UAE is governed by a Supreme Council of Rulers made up of the seven emirs, who appoint the prime minister and the cabinet.
Most people expect the other five states to follow and make international health insurance compulsory for expatriates , bought via locally authorised companies.
USA
The costs of medical treatment in the USA are very high and increasing every year. If you go to work or live in the USA without buying health insurance, you are taking an enormous financial gamble.
 |
Get a quote
For costs on expatriate and international medical insurance, visit one of our Featured Providers, or, complete the enquiry form.
|
Featured providers
Private Healthcare UK features the following insurance providers who offer online quotes or immediate quotes over the telephone.
Medibroker Limited
Medibroker is a fully independent international medical, health and travel insurance broker offering a free quote service with advice, globally across the Internet. Our service is available to people of any nationality, anywhere, living or working in another country not shown on their passports (expatriates).
Norwich Union Global Care
Global Care is designed for expatriates living and working in another country. It is not available to non-UK nationals residing in their home country, or UK nationals who spend 6 months or more per year in the UK. Terms and Conditions apply.
Last updated: 26 February 2008