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ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS JUNE 2009 ISSUE 101 Page 24 Page 22 Page 30 Page 32 Insurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody, successfully used guns and a fire hose to beat off an attack by pirates off the east coast of Africa, according to captain commander Ciro Pinto. Mandy Aitchison follows the latest attack The ship, which was carrying its full capacity of 1,500 passengers and crew, was slightly damaged during the attack from gunshots issued by the pirates. The ship was 200 miles north of the Seychelles and 600 miles from Somalia when the pirates launched their offensive. Pinto described how the attack was carried out, saying that the pirates had at first hit the ship with a barrage of gunfire, at which point the decision was taken to equip security crewmembers with pistols. Pinto continued: “They [the pirates] tried to put up a ladder with hooks. They were climbing up, so we reacted, we started firing. When they saw us firing – we even sprayed them with water with the fire hose – they gave up and went off.” Although deterred, the pirates then followed the MSC Melody for a further 30 minutes firing their weapons. “The passengers, meanwhile, were inside the cabin,” said Pinto, “There are no injuries, only two people with scrapes; someone slipped and fell.” Although the cruise ship successfully avoided capture by the pirates, the actions taken by the captain and crew have been criticised by the East African Sea Farers Assistance Program (EASFAP). Andrew Mwangura, a spokesman for the organisation, told Reuters: “Having weapons on a passenger or merchant ship is dangerous. They should have used other means to shake off the pirates, like a loud acoustic device.” AXA has issued a warning to thrill seeking holidaymakers to check their travel insurance, following new trends in activity and experienced- based holidays. Sarah Watson has the details Adventurous activities, such as zorbing – rolling down a slope inside a giant inflatable ball – are becoming increasingly popular with vacationers, but AXA warns that those taking part in such pursuits should get their insurance checked before rolling away as not all insurance providers will cover such extreme activities. John Dacey, the company’s lifestyle claims manager, advised travellers: “Whatever activities you’re planning on your holiday, make sure you tell your insurer. Many will be included on a standard policy, but it’s always worth checking.” Although AXA has re-written its insurance polices to ensure people are covered against new activity trends like zorbing, holidaymakers could be putting themselves at a costly risk if they fail to take out the correct level of insurance for their trip, with the average cost of a UK medical insurance claim coming in at £744, according to AXA data. Dacey concluded: “Buying travel insurance should be as essential as checking they’ve tied the bungee rope to your foot before you jump.” Britons who took an insurance gamble by failing to check their European Health Insurance Card (EHIC) are suffering the costly repercussions, after a survey by Sainsbury’s Travel Insurance found that the EHIC did not cover the expenses of over half of Britons needing medical assistance abroad. Vicky McPhie reports According to Sainsbury’s, cardholders paid an average of £386 to settle their medical bills, with 51 per cent not being able to claim any of this back when they returned to the UK. Other results showed that 10 per cent of the 1,011 adults polled had received medical treatment through their EHIC card and eight per cent who held an EHIC card failed to take out any other form of insurance as they thought they were fully covered. Sam Marrs, Sainsbury’s travel insurance manager, said: “Many people wrongly overlook travel insurance because they think their EHIC will cover them when they are abroad. But it will not cover you for private medical care, nor will it pay for you to be … repatriated to the UK.” He added: “By not having travel insurance, many people are taking on a great risk when they travel in Europe.” Criticism of the EHIC has continued in the British press, with figures from the Department of Health showing that only one in ten Britons has remembered to renew their EHIC. The reason for the low renewal rate is that it is not well known that the cards each carry an expiry date of five years after the date of issue, and the government does not notify holders of the cards when their renewal dates are looming. Steve Williams, head of travel insurance at aggregator site Confused.com, said that yet again, the importance of having comprehensive travel insurance in place had been emphasised, and added: “Travellers should ensure they not only have the right travel insurance for their circumstances, but they have read the policy in detail – especially when claiming medical expenses. They might find that if they do not follow the procedures in their policy, their claim could be rejected.”
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Page 1: Insurance gamble doesn’t payInsurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody,

ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS JUNE 2009 • ISSUE 101

Page 24

Page 22

Page 30

Page 32

Insurance gamble doesn’t pay

Holiday activity trends call for insurance checks

Italian cruise ship outruns piratesAn Italian cruise ship, the MSC Melody, successfully used guns and a fi re hose to beat off an attack by pirates off the east coast of Africa, according to captain commander Ciro Pinto. Mandy Aitchison follows the latest attack

The ship, which was carrying its full capacity of 1,500 passengers and crew, was slightly damaged during the attack from gunshots issued by the pirates. The ship was 200 miles north of the Seychelles and 600 miles from Somalia when the pirates launched their offensive. Pinto described how the attack was carried out, saying that the pirates had at fi rst hit the ship with a barrage of gunfi re, at which point the decision was taken to equip security crewmembers with pistols. Pinto continued: “They [the pirates] tried to put up a ladder with hooks. They were climbing up, so we reacted, we started fi ring. When they saw us fi ring – we even sprayed them with water with the fi re hose – they gave up and went off.” Although deterred, the pirates then followed the MSC Melody for a further 30 minutes fi ring their weapons. “The passengers, meanwhile, were inside the cabin,” said Pinto, “There are no injuries, only two people with scrapes; someone slipped and fell.”Although the cruise ship successfully avoided capture by the pirates, the actions taken by the captain and crew have been criticised by the East African Sea Farers Assistance Program (EASFAP). Andrew Mwangura, a spokesman for the organisation, told Reuters: “Having weapons on a passenger or merchant ship is dangerous. They should have used other means to shake off the pirates, like a loud acoustic device.”

AXA has issued a warning to thrill seeking holidaymakers to check their travel insurance, following new trends in activity and experienced-based holidays. Sarah Watson has the details

Adventurous activities, such as zorbing – rolling down a slope inside a giant infl atable ball – are becoming increasingly popular with vacationers, but AXA warns

that those taking part in such pursuits should get their insurance checked before rolling away as not all insurance providers will cover such extreme activities.John Dacey, the company’s lifestyle claims manager, advised travellers: “Whatever activities you’re planning on your holiday, make sure you tell your insurer. Many will be included on a standard policy, but it’s always worth checking.” Although AXA has re-written its insurance

polices to ensure people are covered against new activity trends like zorbing, holidaymakers could be putting themselves at a costly risk if they fail to take out the correct level of insurance for their trip, with the average cost of a UK medical insurance claim coming in at £744, according to AXA data. Dacey concluded: “Buying travel insurance should be as essential as checking they’ve tied the bungee rope to your foot before you jump.”

Britons who took an insurance gamble by failing to check their European Health Insurance Card (EHIC) are suffering the costly repercussions, after a survey by Sainsbury’s Travel Insurance found that the EHIC did not cover the expenses of over half of Britons needing medical assistance abroad. Vicky McPhie reports

According to Sainsbury’s, cardholders paid an average of £386 to settle their medical bills, with 51 per cent not being able to claim any of this back when they returned to the UK. Other results showed that 10 per cent of the 1,011 adults polled had received medical treatment

through their EHIC card and eight per cent who held an EHIC card failed to take out any other form of insurance as they thought they were fully covered.Sam Marrs, Sainsbury’s travel insurance manager, said: “Many people wrongly overlook travel insurance because they think their EHIC will cover them when they are abroad. But it will not cover you for private medical care, nor will it pay for you to be … repatriated to the UK.” He added: “By not having travel insurance, many people are taking on a great risk when they travel in Europe.” Criticism of the EHIC has continued in the British press, with fi gures from the Department of Health showing that only one in ten Britons has remembered to renew

their EHIC. The reason for the low renewal rate is that it is not well known that the cards each carry an expiry date of fi ve years after the date of issue, and the government does not notify holders of the cards when their renewal dates are looming. Steve Williams, head of travel insurance at aggregator site Confused.com, said that yet again, the importance of having comprehensive travel insurance in place had been emphasised, and added: “Travellers should ensure they not only have the right travel insurance for their circumstances, but they have read the policy in detail – especially when claiming medical expenses. They might fi nd that if they do not follow the procedures in their policy, their claim could be rejected.”

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IN THIS ISSUE

REGULARS

News continued 6Company brief 11Insurance matters 12Editorial comment 12Health matters 17Travel matters 18Air ambulance news 20IPMI News 37Service directory 40Grapevine 46Diary dates 46On the move 47

FEATURES

News analysis: Mexican swine flu: A test of confidence? 22The outbreak of swine flu in countries around the world has asked several questions about the preparedness of the insurance industry to cope with a pandemic

The ITIC Review 24Offering a round-up of the speakers, panel sessions and gossip that took place in Oxford

Feature: Legal adventures 30The dangers of adventure holidays are often mentioned, but what protection is in place for the tour operator?

World markets: Hungary 32A country as diverse in its healthcare offerings as it is beautiful, Hungary’s standard of care is put under the spotlight

Profile: Dr Sutuspun Kajornboon, Bangkok Hospital Medical Center 36

Milan Korcok is an award-winning freelance health policy and economics writer who covers travel insurance, public health, and medical education issues in Canada and the US. He has been writing about health fi nancing and policy issues in these countries since the 1960s and is a frequent contributor to leading North Ameri-can professional journals and consumer media. He lives in Fort Lauderdale, Florida.

Jose Quesada is the director of fi nance and operations for UHealth International. He received his medical degree from Carabobo University, and a masters in business admin-istration from IESA in Venezuela. He has held several positions with healthcare providers in the US, Latin America and the Middle East. He has extensive experience in hospital opera-tions, revenue cycle management and fi nancial planning.

ITIJ CONTRIBUTORS

4

Published on behalf of Voyageur Publishing & Events Ltd, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or fi rm mentioned is hereby excluded.

Printed by Pensord Press, South Wales, United Kingdom

Copyright © Voyageur Publishing 2009. Materials in this publication may not be reproduced in any form without permission INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522

Editor-in-chief: Ian CameronEditor: Sarah WatsonAssistant editor: Mandy AitchisonCopy editor: James WallisStaff writer: Vicky McPhieDesigners: Eli Butler Steve AnnetteUS correspondent: Milan KorcokConference manager: Denise ClementsProduction: Helen Watts

Kirsty DiclaudioAdvertising sales: David Fitzpatrick James MillerFinance: Louise Goddard

Elspeth ReidIllustrations: Chris Duggan

ITIJVoyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK

Telephone: +44 (0)117 922 6600 editorial dept: Ext. 3 advertising dept: Ext. 1

editorial fax: +44 (0)117 925 2040 advertising fax: +44 (0)117 929 2023 email: [email protected] web: www.itij.co.uk design: V Creative Design

WOULD YOU LIKE TO SUBSCRIBE? VISIT www.itij.co.uk

International Travel Insurance Journal ■ www.itij.co.uk

ITIJ TEAM

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International Travel Insurance Journal

6 NEWS

Rise in Aussie arrests causes concernThe recent arrest of an Australian woman in Phuket, Thailand, has brought back into the limelight the issue of how ignorant of local laws travellers are becoming. Annice Smoel has since been set free after stealing a AU$60 bar mat from a bar in Phuket, but her ordeal has served as a reminder to travellers that ignorance of local law is not an excuse.The most recent figures made available by the Australian Department of Foreign Affairs and Trade (DFAT) show that in 2008 and so far this year, 970 Australians were arrested abroad, 507 of whom are serving time in foreign jails. In the first five months of 2009 alone, there were 790 arrests of Australians abroad, despite a warning on the DFAT website that states: “Every country has the sovereign right to determine its laws and penalties. When in another country, you are required to respect and abide by that country’s laws just as foreigners are required to respect and abide by Australian laws when in Australia.” It continues: “Australians are advised to learn as much as they can about the laws of the countries they visit. If they are arrested or jailed, the Australian Government will do what it can to help, but can’t get Australians out of trouble or out of jail.”As former Foreign Affairs Minister Alexander Downer pointed out: “Australian embassies are not travel agencies, nor is it their job to provide free travel insurance.” Whether or not a travel insurance policy would be any use if a policyholder were arrested is down to the individual policy, but many would not offer cover if the insured had performed a criminal act. Regarding Australians following advice offered to them, though, Downer said that thousands of Australians had ignored warnings about travel to Lebanon in 2006, and when the fighting began between Israel and Lebanon, the Australian Embassy had to repatriate 6,500 citizens at a cost of over AU$32 million.

Health checks could cause problemsA plan is afoot by the British Government to offer free health checks to people over 40 years of age, but concerns over the plan have been voiced by one travel insurer, who believes that people who are diagnosed with a medical condition could then find themselves underinsured when abroad. The government has estimated that more than two million people will see a doctor for a free health assessment each year, and insurer All Clear is concerned that this could lead to thousands of people heading off on holiday without coverage for their pre-existing medical conditions. Of course, those ‘in the know’ about insurance policies will go home following their diagnosis and check their policy wording to make sure they are still covered – but how many will not, and simply assume their current insurance is still valid?Chris Blackman, head of product development at All Clear, is worried that the new health checks, which are for everyone aged between 40 and 74 in England, will especially cause problems for people over 65 years of age: “Whilst there are some companies who specialise in covering the over-65s, and others who will cover some medical conditions, there are only a small number that provide cover for people of any age and virtually any medical condition,” he added. He also predicted that travel insurers will soon be receiving more calls from the public who want to ensure that the insurance they have is still suitable. “Whereas on the one hand this might be viewed as a nice problem to have, travel insurers will need to be prepared to cope with the extra demand, and in a position to inform customers correctly.”

Last-minute BritsAccording to figures from AA Travel Insurance, more than 50 per cent of European single-trip travel insurance policies sold in the UK are bought within three days of the traveller’s departure, often just hours before boarding a ferry or aeroplane. Christian Young, director of AA Travel Insurance, has voiced his concern that ‘last-minute Brits’ are indicative of a wider problem: “People who leave things to the last minute are inevitably going to have less time to be well organised, and insurance tends to be back of mind until it’s too late. They are even turning up at the travel terminal without their passports.”The insurer also published figures demonstrating that the most common claim it receives is for medical expenses, and Young reiterated the vital cover that travel insurance offers, saying: “Local doctors and hospitals will sort you out, but won’t send you home. Many will also charge for treatment, even if you have remembered a European Health Insurance Card, which should never be considered a substitute for travel insurance.”

Thailand to insure touristsThe Thai authorities have approved the provision of five billion baht in loans to help the country’s ailing tourism industry, and has launched a special insurance scheme that will cover travellers to Thailand. The travel insurance scheme started on 1 May, and will run for six months. Cover is provided for accidents and travel delays, including any costs that are incurred by political unrest, up to US$10,000 per person.Deputy finance minister Pradit Phataraprasit spoke to a local paper about the scheme, and explained that it had been dreamt up as a direct result of foreign travel insurance companies not covering claims related to the political unrest that has been seen in the last few months in Thailand. Phataraprasit continued: “Although we believe there will be no more unrest in the country, we must have an insurance system, since foreign travel agencies no longer guarantee the safety of tourists here. As a result, the government has to find an insurance company to cover foreign tourists.” The budget for the scheme is reported to be around 200 billion baht, which the government claims would insure about five million tourists. The Ministry of Finance was appointed to the task of finding an insurance company.

Fraudulent claims on the riseFigures from the Association of British Insurers (ABI) have found that the number of fraudulent insurance

claims has risen to a record level, with 2,000 such claims identified across all sectors each week. Last year, 4,300 sham travel insurance claims were detected, worth roughly £5 million. The research points out that 20 per cent of people are willing to cheat on claims for

products such as holiday insurance, despite the risk of getting caught. Nick Starling from the ABI warned: “Cheating on your insurance really does not pay – you will get caught, future insurance will be more expensive and, along with credit, harder to obtain.” He added: “The only thing you are likely to get is a criminal record.” One of the most prominent cases of fraud highlighted by ABI was a ‘recovery expenses’ claim by a man, following an illness

in West Africa, which actually turned out to be

‘services’ at a local brothel.

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International Travel Insurance Journal

8 NEWS

International Passenger Protection Ltd (IPP) has predicted that financial failure protection will become an essential component of travel insurance policies during the course of this year, following continuous record losses within the airline industry. Insurers like IPP are pushing travellers to review their travel insurance policies to ensure they include financial failure protection, which will cover them in the event of an airline collapse, such as the high profile failure of XL Airways in 2008. Scheduled Airline Failure, which will cover pre-paid sums in the event of insolvency, including lost money and the cost of a return ticket home; and End Supplier Failure, which will extend this cover to include end suppliers of holidays, such as hotels and car hire companies, are sections that travellers

should consider if they are to be protected against the potential liquidation of an airline, according to IPP director Paul McLean.He stated: “There are huge chunks of the travel market which do not have government protection. Although there is credit card cover under section 75 of the Consumer Protection Act, this will not usually extend to include additional costs to get home following a collapse.” McLean believes that travellers are often ‘confused’ with the type of protection they have in place when purchasing travel insurance and said: “[Travellers] need to check with the retailer of their travel tickets to see what protection is in place and ensure it meets their needs.”

Sainsbury’s Finance has released a report that has found that around 500,000 Britons with medical conditions travelled abroad in the last year without valid travel insurance – most of whom failed to inform their insurer about their pre-existing medical condition. A survey performed by the company estimates that around 267,000 people with a heart problem failed to tell their insurer about their medical situation, while around 206,000 did not inform the company of their respiratory conditions.The main reasons for the non-disclosure were cited as the fear of being refused cover all together if a person was to make full disclosure of their condition, and the need to find a cheaper policy in the economic downturn. Also, some of those surveyed said they were embarrassed to discuss pre-existing conditions with an insurance representative. Sam Marrs, travel insurance manager for Sainsbury’s Finance, told consumers that they were doing themselves no favours in the long run: “Withholding key information such as any medical conditions could mean your cover may be invalidated and in the worst of cases, this could mean facing large hospital bills or arranging your own repatriation.”Recent research by travel insurer AllClear has blamed the credit crunch for British holidaymakers withholding information about their pre-existing

conditions – increasing pressure on household finances has prompted some consumers to try and contain their insurance costs by not making a full declaration. Chris Blackman, head of product development at AllClear, noted: “Some travellers do not understand the potential consequences of their pre-existing medical conditions. And yet if they fall ill abroad and need to be repatriated, they could find themselves paying an enormous bill.”The insurers’ conclusions were drawn from a survey that showed 57 per cent of consumers bought the cheapest insurance policy they could find, while 22 per cent said they were looking for value for money. As Blackman warned consumers, though: “Travel insurers share common issues with motor insurers. Cheaper products often mean less cover, and policyholders only discover they are not covered at the point that a claim is made.”AllClear recently analysed its claim statistics over the past year, finding that some initially simple claims were costing far more than originally thought. The claims data also showed that the insurer is paying out more frequently to repatriate its customers once they have undergone treatment abroad. One case in particular that was highlighted was a traveller who broke their ankle in Menorca and needed treating and taking back to the UK – the bill for the claim came to £28,000.

Vacationers forced into holidaying more locally or having a ‘staycation’, due to the biting recession, could be overpaying on their travel insurance, according to a report by data provider Defaqto. The report found that UK holidaymakers will commit themselves to just one holiday this summer, with ‘the number of overseas trips showing a decline for the first time in two decades’, said author of the Defaqto report Brian Brown. He explained that travellers may be better off purchasing single-trip insurance, as opposed to paying extra for annual cover, and stated: “Purchasing a single-trip policy makes more sense.” Figures from Moneysupermarket.com seem to support Defaqto’s analysis and reveal that a single-trip policy costs just £4.11, a massive decrease from a purchase of annual cover, which starts at

approximately £25. Maxine Barker, travel insurance manager at moneysupermarket.com, added that while costs will be a priority when searching for cover, it is worth sticking to certain minima, which include at least £2 million for medical expenses, £1 million for personal liability, £3,000 for cancellation, £1,500 for baggage and £250 for cash.Findings from the report have also called for a review of packaged accounts, which many people have bought due to a deal for free annual travel insurance. Michael Taylor, money mentor with moneystatistics.co.uk, noted: “If you are paying £12.50 a month or more for an account like this for the free annual travel insurance, it may have seemed a reasonable offer. Once you can meet your travel insurance needs for as little as £5, the scandalous over-charging becomes more obvious.”

Pre-existing problems continue

Overpaying for travel insurance

Effective fraud solutionsA fraud detection system developed by CEGA Group Services has saved its clients in the travel insurance industry more than £2 million during the first year of its operation, according to the company. Sussex-based CEGA, which handled over 200,000 travel insurance claims in 2008, investigates hundreds of potentially fraudulent claims each month through its Special Investigations Unit using a cognitive interviewing process as one of its techniques. CEGA’s special investigations manager Simon Cook commented on the company’s methods: “Being office-based, our cognitive interviewing process offers an economical solution for a high volume of low value travel claims. It is complemented by assessments from our in-house medical staff, on site investigators and close communication with our claims management teams.” The company investigates claims on behalf of many household insurers and has cracked numerous fraudulent claims, including a staged car crash and a case of gold bullion that went missing from luggage. Despite figures from the Association of British Insurers indicating travel insurance fraud to be up 80 per cent at the end of summer 2008, systems such as that used by CEGA are helping the travel insurance industry to save significant amounts of money.

Airline collapses call for correct protection

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www.itij.co.uk

NEWS 9

Jersey launches new travel policyFollowing the demise of the UK’s Reciprocal Health Agreement with the Channel Islands (see ITIJ 100, Insurance needed for Channel Islands), Jersey Tourism has launched a travel insurance policy for independent visitors to the island. The tourist board has collaborated with Rossboroughs, States Insurers and PJ Hayman to secure a policy that will provide cover for all who travel to the island. According to David de Carteret, Jersey Tourism director, there were growing concerns about the lack of insurance companies able to provide cover for visitors to the Channel Islands. He said: “A high proportion of companies define Jersey as part of the UK. Therefore, when the policy is used for travel outside of the UK, the Channel Islands are effectively excluded.”

Prime Travel Protection shut down in ColoradoPrime Travel Protection Inc., a company run by Jerry and Christine Watson, has been ordered to close down by the authorities in Colorado, US. Cameron Lewis, a spokeswoman for the Colorado Division of Insurance, said around 200 people had purchased travel insurance from the company, and complaints about the service and cover they received have come from as far away as Florida. As such, the company has been issued with a ‘cease and desist’ order from the authority. Marcy Morrison, Colorado’s Commissioner of Insurance, said of the issue: “Travel insurance companies must prove they have adequate financial reserves to cover claims, for example. Licensed companies must answer to the Division of

Insurance if we receive documented complaints about their practices.”In Colorado, the company has also been known as Vacation Protection Services, Inc., Traveler Protection Services, Inc. and Universal Assurance Ltd. Colorado is the latest state to take action against a company run or owned by the Watsons. See ITIJ 98, Prime Travel Protection out of business; and ITIJ 99, America uncovered, for a full history of the company’s cease and desist orders.

Recession hits insuranceAmerican Express Insurance Services has released a survey showing that as the recession continues to make its impact felt, the number of people considering stopping their insurance payments is rising. The survey shows that 52 per cent of Britons who usually make regular insurance product payments are thinking about stopping doing so in order to free up some money. When the same survey was performed in 2008, the number of people considering halting such payments was 48 per cent.American Express broke down the results of its survey into different types of insurance products, including identity theft protection, health insurance and travel. ID protection saw the biggest increase in the number of people considering stopping paying for the product, followed by health insurance with a nine-per-cent increase, and then travel insurance, which six per cent more people say they would consider travelling without. Chris Rolland, head of American Express Insurance Services, commented on the findings of the survey: “It is particularly worrying, with the summer holidays approaching, that the number of people who are thinking about cutting their travel insurance policies has increased. We strongly urge people to consider the financial implications should something go wrong while on holiday and to rest assured that money can be saved on travel insurance prices by shopping online.”Similar statistics from insurance provider LV have revealed that an alarming five million Britons plan to cut back on insurance policies this year, with as many as 22 per cent intent on giving up travel insurance. The company’s figures show that 69 per cent of vacationers holidaying within the UK could fail to take out any form of holiday insurance for their trip, which raises cause for concern since research accompanying the statistics indicates that Brits holidaying in 2009 are likely to save around £3 billion by exchanging overseas holidays for UK breaks. Emma Holyer, spokesperson for LV, advised: “It is important people remember that even though they are staying in this country, travel insurance is still important.”

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International Travel Insurance Journal

10 NEWS

Jet2, a low-cost airline based in the UK, hit the headlines recently after it attempted to charge one of its passengers for the cost of a medical diversion.Clare and John O’Brien were on their way back to the UK from a holiday in Tenerife when John was taken ill and collapsed during the flight. The flight attendants gave him oxygen and found a doctor who happened to be onboard, who prescribed aspirin. The pilot then emerged and discussed the situation with the doctor, telling the doctor that the plane was in a suitable position to divert to a nearby airport if he deemed it necessary. John, by this time, felt a great deal better and insisted he was fine to continue with the flight. However, as the doctor was unable to guarantee that John’s condition would not deteriorate further, the decision was taken to divert the plane.The couple’s travel insurance policy covered the cost of the medical bills incurred in Spain and the price of the new flights home, but once they had returned to

the UK, the O’Briens then received a letter from the airline, together with an invoice for £4,365 for ‘costs directly associated with medical diversion of flight’. The couple’s travel insurer has insisted the airline can recover the loss from its own insurance company.A consumer television programme in the UK picked up the story, and asked an aviation lawyer what he thought of the situation and demand from Jet2. James Healy-Pratt responded: “I think it’s wrong morally, wrong legally and wrong commercially for Jet2 to seek to get four and half thousand pounds from the O’Briens for a decision that Jet2 made. Where there is a medical diversion, the airline bears the cost or the airline’s insurance bears the cost.” Upon being contacted by the programme, the airline quickly backed down and made a statement to the media: “Firstly, Jet2.com would like to make an unreserved apology to Mr and Mrs O’Brien. It was never our intention that they should personally settle these costs as we believed they should have been covered by their insurance.” It continued: “We do appreciate the distress that this situation has caused them and we have taken the decision to cover the O’Briens’ costs ourselves. We have reviewed our policy in this regard to ensure that all similar expenses are covered by us now and in the future.”

Diversion cost passed on to customer

Freedom Direct falls victim to the crunchUK-based online travel agent Freedom Direct has ceased trading, having failed to renew its Air Travel Organisers’ Licence (ATOL) in April. The Civil Aviation Authority (CAA) estimated that around 200 Freedom Direct customers were abroad when the announcement was made that the company had stopped trading, and there are around 9,000 further holidays booked. The company’s previous ATOL bond covered the company for £750,000, although it has been estimated that the total cost to the CAA’s Air Travel Fund could be up to £2 million. A spokesman for the CAA noted that the case had become more complex due to the fact that the company had continued to trade for three weeks after its ATOL licence had expired, meaning there are customers who purchased a holiday during this period who are not

protected by the bond.CEO of Freedom Direct Martin Jones said on the website: “We would like to

apologise for any inconvenience caused to our

customers and to thank

the many people who have booked holidays with us over the last 12

years.”

£90 million of holiday mishaps not coveredInsureandGo has estimated that Britons suffered approximately £90 million worth of uninsured holiday mishaps in 2008, a 38-per-cent increase on 2007. The company has revealed that medical problems accounted for the bulk of these missed claims opportunities at roughly 92,000, with 62,000 incidents of lost/stolen baggage and over 39,000 flight cancellations. Lost/stolen money and travel delays were also common amongst the estimated 236,000 incidents that could have been claimed for last year, had the victims been insured.Although millions of British travellers managed to minimise unnecessary costs by having adequate travel insurance, around 14 per cent ventured abroad without insurance. Perry Wilson, founder of InsureandGo, noted: “Thankfully, most people get adequate insurance before they go on holiday, but there are still a significant proportion of us going abroad without being insured. Issues like medical problems and lost baggage affect so many holidaymakers nowadays – and with average claims values rocketing they can be very costly.” Wilson is also urging travellers to prioritise medical cover above all other types of protection, and maintains it should be ‘the biggest point of call’ for anyone taking out travel insurance. He advised: “The main crux of it is

medical problems. People don’t understand that when they go abroad, especially Europe, they’ll patch you up but you won’t get a free ticket home.”

Insurance as a talismanA new academic study undertaken in Canada has found that on some level, people think insurance policies can act as talismans that can protect them from harm. As the study authors say, for many people, refusing to buy insurance is a way of tempting fate.Eric Dolansky, a professor at Brock University in Ontario and one of the study authors, noted: “Based on how superstitious someone is, they’re more or less likely to connect having insurance to being protected against the (negative) event, rather than the financial loss associated with the event.”The research was carried out by conducting experiments with 243 people that examined the degree to which insuring a precious ornament would be seen as a talisman against breakage during a shipping process. The results of the experiments showed that participants consistently believed that if they did not insure the ornament, it would be more likely to break.The researchers indicated that such beliefs could be the reason behind the rise in uptake of travel insurance that has been seen in Canada in recent years. Vincent Beretta, CEO of insurer Walkaway Canada, noted that many people consider travel insurance that includes cover for redundancy – in today’s uncertain climate, many would see this cover as reassuring. Beretta continued: “Consumer debt has risen and it leaves us in a situation where we can’t even handle a minor adjustment in our income, let alone a major one.”

Refunds offered for Mexican tripsSainsbury’s Travel Insurance has announced that it is to grant refunds to its customers who were scheduled to travel to Mexico between the 28 April and 6 May, in light of the outbreak of swine flu. The supermarket has, however, advised its customers that they should first try and seek compensation from their travel agents, who may also offer a refund or an alternative holiday.

However, if the travel agent refuses to offer either a refund or an alternative holiday, Sainsbury’s customers can ring the insurer, which is dealing with claims arising from the swine flu outbreak on a case-by-case basis.For more details on the effects that swine flu has had on the travel insurance industry, please see our news analysis on p. 22.

ABI urges double checkingMalcolm Tarling, a spokesman for the Association of British Insurers (ABI), has warned British tourists that they should ensure they know exactly what their travel insurance policy covers them for before they agree to purchase the cover. The details of cover contained in the small print are vital, said Tarling, for consumers to truly understand the exclusions applied to their particular policy. He continued: “[Customers] should actually understand what they are covered for. The essentials – what you would like to be covered for when you go abroad – are medical expenses and loss of baggage and possessions.”

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COMPANYBRIEF 11

New ticket protectionTravel Insured International has launched a new online Airline Ticket Protector plan with strengthened features for leisure travellers and business travellers alike. The new online plan covers airline tickets as priority, but includes trip delay and baggage loss as standard. It also offers new value-added options for travellers in need of more comprehensive coverage such as cancel for any reason, a combined emergency medical option, a flight accident option and a car rental collision damage waiver.The plan is designed to be a more cost-effective option for travellers, with affordable base prices starting as low as $16 per passenger, and has increased available coverage on trip cancellation or trip interruption, which now cover up to $3,500 instead of just $1,000. Additional new benefits are a maximum $500 missed connection cover and $1,000 for lost baggage and personal effects.

Improved Canada productCanadian travel insurance provider Travel Insurance Coordinators Ltd (TIC) has unveiled its newly improved Visitors to Canada product, designed to ease the process of understanding, selling and purchasing travel insurance for people visiting the country. TIC has introduced the product as a response to the sheer number of people that venture to Canada each year, including tourists and new immigrants, with the intention of meeting the specific needs of these visitors. Craig Spencer, director of product and underwriting for TIC, explained: “We’ve really listened to the marketplace … to capture the needs of both our partners and consumers. Just a few of the exciting new enhancements to our Visitors to Canada product are: clarified eligibility criteria, simplified policy language, more competitive rates, and three follow-up visits to emergency care.”Results from the Canadian Tourist Commission revealed that tourist spending in Canada reached $70.8 billion in 2007, and foreign residents made 17.8 million trips in the same year. Although the figures for 2009 are slightly lower, Devanand Prashad, claims manager for TIC, said that this doesn’t change the fact that vast quantities of people are still visiting the country that need to be covered in case of medical emergency. He said: “Every year we see a number of visitors to Canada who end up needing emergency medical care during their stay. Some of the more routine occurrences are the cases of minor food poisonings, broken bones due to common accidents, and unexpected heart attacks or strokes.” The new product will also cover seniors up to the age of 69, will have no maximum number of family members in the family coverage plan, and will be especially beneficial to those visitors staying in Canada for longer than the average tourist. One such British mother’s three-month plan from TIC covered her $12,289 medical expenses when she had to undergo emergency bowel surgery whilst staying with her daughter for a few months in Ontario.

New Dubai assistance officeCONNEX Assistance Middle East has announced the launch of a new branch office in the commercial area of Al-Qusais in Dubai. The business unit has been developed as a response to the company’s growing demands by clients to handle larger volumes of cases in the UAE and will act as a regional hub for all activity in the Gulf. Lara Helmi, international network director, explained: “It is of strategic importance for us to gain a solid foothold in the Gulf, and the expansion of our Dubai team and facilities is critical to ensuring the highest standard of service is continued in all our activities.” She added: “Having a team on the ground with over a decade of experience will allow us to fill the gap for full-service assistance that is highly responsive, efficient and cost effective.” The new centre will accommodate a state-of-the-art alarm centre, company executives and medical consultants.

FirstAssist wins ONE

Access America enhances cover

Following in the footsteps of several other travel insurance providers, Access America has announced changes to its Cancel Anytime policy, raising reimbursement for trip cancellation due to job loss from 80 per cent to 100 per cent of the cost

of the trip. By increasing the reimbursement rate, the company says it is allowing customers to book their trips with more confidence that they won’t find themselves in debt should they lose their job.Mark Cipolletti, vice-president of communications at the insurer, noted: “With the improvements to Cancel Anytime’s coverage for job loss, Access America continues its tradition of providing coverage that’s relevant to the American traveller. It’s understandable that even financially secure families and individuals might fear the unexpected in this economic environment, but with Cancel Anytime, there’s little reason to postpone booking a vacation.”The cover requires that the insured must have at least one year of continuous employment with the same employer and that the termination must be due to the economic situation. Other unforeseen cancellations will be reimbursed at a rate of 80 per cent cash back, including job loss insurance for those who have not yet been in their current position for a year.

MSC agree with EA GroupMSC Cruises and the Europ Assistance (EA) Group have signed a global agreement to design and launch a personalised worldwide international travel assistance and insurance programme. The agreement, which is being managed and centralised by the EA Group, will allow MSC Cruises to offer the complete range of products to its customers in 16 different countries. The policies have been designed specifically on behalf of MSC Cruises and are tailored to its needs and requirements.

Passenger protectionFollowing the 2008 success of International Passenger Protection’s website ProtectMyHoliday.com, which enables travellers to directly purchase financial failure insurance against the end suppliers of their holiday, an affiliation programme has been launched that gives travel organisations the ability to link their site to protectmyholiday.com and earn a commission on each policy sold. The programme is designed to earn affiliates revenue while providing an important product to their customers, and will help cater for the expected collapse of airlines this year, following the demise of 30 airlines in 2008.The insurance policies are underwritten by a selection of insurers with a combined net worth of more than €100 billion and cover will protect travellers against the liquidation of un-bonded end suppliers, allowing lost money to be refunded if failure occurs prior to travel, or cover the cost of a return ticket if failure occurs during the trip. It is said to be a simple and cost-effective method of adding the protection missing from many travel insurance retail products. Paul Mclean, director of International Passenger Protection, explained: “As more and more people continue to make their own holiday arrangements and book direct with airlines, there is usually no cover in place for insolvency of the airline, for example, and therefore travellers are urged to check for cover with their travel company or on their travel insurance policy.” Mclean said that only some 10 per cent of travel insurance policies included cover during the XL collapse, but now it is expected that 70 per cent of all travel insurance polices sold in 2009 will include cover. He concluded: “Consumer protection has always been unclear … and many people take for granted that they are automatically covered. The fact is if someone books a holiday independent of a package … they could face a lack of financial protection for the elements of their holiday financially collapsing, such as the airline.”

FirstAssist Insurance Services has won the contract to provide ONE Underwriting, part of the ONE Group, with travel insurance products and underwriting, including their insurewithease and OUL Direct brands. Travel is a core part of the FirstAssist business and its comprehensive range of covers includes online medical screening, independent traveller, impaired life cover and scheduled airline failure insurance (SAFI). Chief executive officer of the ONE Group Paul Byrne

rated FirstAssist’s ability to tailor a flexible solution to meet his company’s needs as ‘second to none’. Alistair Hardie, managing director of speciality insurance at FirstAssist, commented: “We are delighted to have been chosen to support ONE Underwriting, and we look forward to building a highly successful partnership with them. This contract is a big win for us and … further strengthens our position in this key sector.”

WTH alters coverUS-based World Travel Holdings (WTH) has announced it is to enhance its travel insurance policies so that consumers booking various types of travel can cancel their holiday for reasons including job loss or furlough with a full refund. The addition to the policies was made after the company saw a positive response to the February launch of Cruise Assurance, a job loss cancellation policy rolled out by CruiseOne and Cruises Inc, WTH’s cruise division.

Brad Tolkin, co-chairman and co-CEO of WTH, said: “It is imperative that travel providers continue revamping their insurance programmes so that as we ride out this economic storm, consumers can enjoy their right to book a vacation with peace of mind. After rolling out Cruise Assurance, we saw an immediate uptick in consumer confidence, realising bookings from those who were on the fence.”

Brad Tolkin WTH

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channels is part of a move to combat the economic situation, adding: “Since last year, Fortis has marketed its Real Life Cover via Asda, Bright Grey has launched new products via The Idol and now Friends Provident has struck a deal with Tesco. Insurers are clearly trying to improve distribution in challenging market conditions.”Trevor Matthews noted that the sea change in the way the industry views such ventures has given the sector new and exciting opportunities: “A few years ago, out intermediaries would have recoiled in horror at this move. But this deal gives us critical mass and an opportunity to increase our platform; it’s very significant.”

June is an exciting month here at Voyageur, as it marks the first International Travel Insurance Conference (ITIC) Pacific event. This will take place in Thailand from 16th to 18th June, and promises to be an essential conference for anyone involved or potentially involved in working in this part of the world – whether in the realm of insurance, assistance or healthcare. With an array of speakers from local business, as well as international representatives with experience of operating in this market, the panel and speaker sessions promise to deliver enlightening presentations and spark interesting debate for those with an interest in the APAC region.Meanwhile, this issue of ITIJ brings you the latest developments in the global travel insurance arena, with features on topics including swine flu and Hungarian healthcare reform. We also have a comprehensive review of the recent ITIC event in Oxford, UK, and, in our news sections, analysis of the latest trends affecting the international travel insurance market.

I hope you enjoy this issue.

European insurers face tough yearLeading insurers across Europe have predicted that the next nine months will be challenging for the industry as a whole, and have said that in order to offset large writedowns and depressed investment income, they will be concentrating more on their basic, ‘bread and butter’ business. It seems, though, that 2009 could bring better news than did 2008 – Swiss Re has recently posted better-than-expected first quarter earnings, showing it was making progress in disposing of risky assets that made investors very nervous. The company said that it has cut the number of risky corporate bonds and complex structured finance products it holds by Swiss F6.5 billion in the first three months of this year. Stefan Lippe, CEO of the reinsurer, noted that it could take ‘some time to reduce the asset risk’ in the company’s overall portfolio. Michael Huttner, an analyst for JP Morgan, said the signs of recovery boded well for Swiss Re: “They are on track in reducing their exposures. You feel confident that things are stabilising.”Elsewhere in Europe, feelings are mixed. Henri de Castries, chairman of AXA, announced a two-per-cent fall in first quarter revenue compared to last year, adding: “We expect the environment to remain difficult throughout 2009.” Both AXA and Zurich Financial Services Group, though, have said they are confident that their business strategies would allow

them to ride the rollercoaster and land safely on the other side of the recession.In related news, the European parliament has approved a deal with affected governments that should see Solvency II rolled out across the European Union by 2012. Approval was given to the plan that states one supervisor from an insurer’s home nation will lead oversight of that company, replacing the current system whereby each of the company’s subsidiaries must deal separately with regulators in each country. Jose Manual Barrose, EU Commission president, said the new rules would restore confidence in the market as well as shielding Europe’s economy from ‘a repeat of the disastrous excessive risk taking by financial institutions, including certain insurance operators, that has contributed to the global crisis’. The deal, which was agreed at the end of April, did compromise on one point, scrapping a proposal for ‘group support’ – it would have meant insurers setting aside enough money to cover risk across their entire business. Now, however, the capital requirements will remain as they are currently – set separately by each nation where the insurer wishes to do business. Charlie McCreevy, an EU financial services official, was disappointed that this had not been altered, but said that he hoped it would be introduced at a later date, as it is ‘a key element for modernising insurance supervision’.

Friendly deal with TescoUK insurer Friends Provident recently announced an upturn in its fortunes through a new and exclusive deal with high street giant Tesco, while at the same time announcing first-quarter results that fell well short of expectations. The company’s management team announced figures that show new business sales dropped by 40 per cent compared to last year to £148 million – analysts had been predicting a figure of over £200 million. Blame for such results was placed in the usual areas – a tough economic environment and falling investment income.Friends Provident’s deal with Tesco, under which the supermarket chain will only sell Friends’ insurance products, will not bring in any revenue until the end of the year, according to chief executive Trevor Matthews. The deal agreed between the insurer and the supermarket involves term assurance cover, which is already mostly sold through intermediaries, and will be marketed directly to consumers through Tesco’s personal finance website and through its thousands of stores.Industry experts say the latest deal between and insurer and supermarket is just another sign of the times – insurers need new markets to penetrate and the huge volume of shoppers that Tesco can accommodate brings the companies a much higher level of visibility on the high street. Friends Provident has joined the list of other companies, such as Norwich Union and AXA, that ‘white label’ their insurance products and sell them through outlets that are more accessible to the public.Ben Heffer, principal consultant with Defaqto, said insurers expanding their distribution

Insurers use more predictive softwareAccording to the president and CEO of Arbitration Forums Inc., a US-based arbitration service, insurers are increasingly using predictive analytics to identify subrogation claims, and turning to arbitration as a means of settling disputes. Russ Smith, speaking at a National Association of Subrogation Professionals (NASP) conference, told delegates that 60 per cent of subrogation professionals are making good use of such software. He then claimed that the company is making a big difference to the industry by saving the property and casualty industry more than $700 million a year in litigation costs through programmes that resolved around 498,000 claims in 2008.Disputes leading to arbitration typically arise when insurance or self-insured companies believe their insureds are not at fault or due to disagreements over the percentage of liability or the amount of damages.

Sarah WatsonEditor

[email protected]

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Figures from the ISO and the Property Casualty Insurers Association of America (PCI) have shown that property and casualty (P&C) insurers operating in the country remained profitable last year, despite the challenges facing the industry. P&C insurance companies collectively earned $2.4 billion in net income after taxes in 2008, even as catastrophe losses, the recession and government bailouts caused chaos across the financial services sector. The figure is far below those of recent years and a long way off the $62.5 billion that was seen in 2007.The PCI said of the declines: “Insurers suffered $21.2 billion in net losses on underwriting in 2008 – a

$40.5-billion adverse swing from insurers’ $19.3 billion in net gains in 2007. The combined ratio – a key measure of losses and other underwriting expenses per dollar of premium – worsened to 105.1 per cent last year from 95.5 per cent in 2007.” In spite of the significant fall in net income, the PIC remains convinced that the industry ‘remains well capitalised’.Michael Murray, ISO’s assistant vice-president for financial analysis, commented on the figures: “The ‘perfect storm’ that beset the industry in third-quarter 2008 continued unabated in the fourth quarter, as the downturn in the economy gathered momentum and financial markets tumbled. Yet, aside

from some problems in the mortgage and financial guaranty sector, the P&C insurance industry emerged intact.” Intact, maybe, but not unscathed, as Murray continued: “Insurers’ net income in 2008 would have been the lowest in more than two decades if not for the net loss the industry suffered in 2001 when terrorists destroyed the World Trade Centre. Insurers’ 0.5-per-cent rate of return for 2008 was their second-lowest full-year rate of return since the start of ISO’s annual data in 1959 and 8.7 percentage points below insurers’ 9.2-per-cent average rate of return during the past 50 years.”David Sampson, president and CEO of PCI, was full

of praise for the industry as a whole and its ability to cope with financial crises such as the one currently being faced. He said of the figures: “That P&C insurers remained profitable in 2008 and finished the year with more than a trillion dollars available to pay claims is a remarkable testament to their risk management and conservative approach. Unlike the banks and Wall Street icons brought down by the financial crisis, and unlike some once mighty industrial giants that have had to turn to Washington for financial aid, P&C insures have thus far been able to continue servicing policyholders without skipping a beat and without burdening taxpayers.”

GIC India to share profitThe national reinsurance company of India, General Insurance Corporation (GIC), has introduced a profit sharing scheme with other general insurers in order to encourage more prudent underwriting across the industry. The Hindu Business Line has reported that the scheme will become operational only if the reinsurance treaty proves to be profitable. The profit is to be calculated on an agreed formula, with allowances made for any expenses incurred by the reinsurers, and then a percentage of the profit paid to the insurers. The profit offered to the insurance companies would be in addition to the ceding commission that reinsurers already pay to insurance companies.GIC chairman and managing director Yogesh Lohiya told The Hindu Business Line: “We are ready to cede 10 to 20 per cent of the profits as long as the companies underwrite the risks properly. We have taken some strict measures to bring discipline to the market – we have reduced the ceding commissions by five and 10 per cent, as companies offer deep discounts, which in turn brings down their profitability.”In other news, a report by the Financial Sector Assessment Committee has found that the insurance industry in India is facing a severe shortage of skilled professionals in areas such as actuarial science and treasury management. Following the publication of the report, the body has urged the Insurance Regulatory and Development Authority (IRDA) to act fast if it is to enhance the current set of skills as well as retain those staff that are already trained. It recommends: “IRDA should put in place systems to ensure effective group-wide supervision by formalising the relationship through a memorandum of understanding with both home and foreign regulators.”

P&C insurers well capitalised despite troubles

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Increased risk for expats highlightedClement International, a provider of insurance to expatriates around the world, has said that the kidnapping of an American ship captain by Somali pirates is a stark reminder that international organisations are increasingly at risk of kidnapping, ransom and extortion. Yan Bui, a commercial insurance executive with the company, said: “Kidnapping occurs more often than most realise. There’s intense focus now on Africa and the Gulf of Aden since Richard Phillips, captain of US cargo ship Maersk Alabama, was taken hostage and then freed by the US military; but this is certainly not a new problem, and international organisations and expatriates face other very real risks in the form of kidnapping, ransom demands and extortion threats.” Figures from the International Maritime Bureau have shown that Somali pirates, in 2008, managed to seize over 800 crewmembers.Although Clements International noted that piracy is a very particular threat to the shipping industry (although it would appear that cruise lines are also becoming targets), Bui said other threats to international organisations should not be

underestimated. According to the company, the incidence of kidnapping has increased in Afghanistan, Mexico, Pakistan, the Philippines and Venezuela in recent years, while most occur in Latin America. Statistics from Clayton Consultants Inc., meanwhile, show that at least 172 foreigners were kidnapped in Nigeria in 2007. It is estimated that only 10 per cent of kidnap incidents

are reported in the international press, as in most cases the ransom is paid and the victim released in a swift recovery. Bui warned international companies that kidnapping is a threat they cannot simply ignore: “Organisations cannot afford to deny the threat that kidnap and ransom poses to their operations and employees. It is vital to ensure mechanisms are in place to safeguard against these risks.”

NEWSWIREFortis Insurance UK has announced strong 2008 performance, with non-life profit before tax and interest increasing to £76 million. The company is also in a strong capital position of £246 million.

China Life Insurance and other insurers are set for a bigger healthcare insurance market, following the unveiling of the central government’s ¥850-billion healthcare reform package.

PICC Property & Casualty Co, China’s largest non-life insurer, has reported a 98-per-cent fall in net income for 2008, a year during which it saw heavy catastrophe losses and the effects of the credit crunch.

Hiscox has announced that due to its recent expansion in the US, the Group structure has been reorganised along geographic lines and the US management team has been strengthened. Richard Watson will now manage all US business.

China Reinsurance has announced that it made a profit of ¥1.58 billion in the first three months of the year – a turnaround from last year’s results, which saw a ¥3.14-billion loss.

Lloyd’s has said it will repurchase the local currency equivalent of £102 million of its outstanding debt securities, following its invitation to holders to submit offers to sell their holdings. It has offered to purchase up to £100 million of the securities.

Sompo Japan Insurance has said it expects a bigger loss for the financial year ended 31 March, from ¥52 billion to ¥66.5 billion.

Aon’s first quarter revenue fell by three per cent to $1.9 billion, due to a 10-per-cent decline from foreign currency translation and a 44-per-cent decline in investment income. The decline in revenue was partially offset by a seven-per-cent increase in acquisitions.

Mondial Assistance has been given ‘A’ and ‘AA-’ ratings from AM Best and Standard & Poor’s confirming the strength of its outlook over the next 18 months.

India’s four government-run non-life insurers have forecast that the industry will grow by around seven or eight per cent in the 2009-2010 financial year.

The Investment and Financial Services Association of Australia is urging its citizens to ensure they have adequate levels of life insurance to protect themselves from financial hardship.

The life insurance industry in India saw new business premiums fall by six per cent in the 2008-09 fiscal year, according to the Insurance Regulatory and Development Authority. It is the sector’s first decline since it was liberalised.

Staff recruitment by insurers in Australia has increased over the last year, despite the financial turmoil that has affected the investment earnings of the industry.

Japanese insurers should buy more foreign government debt, according to a report that cites the country’s largest brokerage firm, Nomura Securities.

Lloyd’s of London broker Cooper Gay is said to be considering up to 12 potential acquisitions as it seeks to add to previous deals.

Local ratings possible in MalaysiaThe senior vice-president and head of business development of the Malaysian Rating Corporation, Roza Shahnaz Omar, has told a local newspaper that both local and foreign insurance companies that operate in Malaysia should be rated separately to their international parents. Citing the current economic situation as her main reason for pushing the local ratings, Omar said that by rating insurers

locally, there would be an independent assessment of their abilities to meet the needs of local policyholders.Unlike banks in the region, insurers do not currently have to be rated – it is a voluntary scheme run by the Malaysian Rating Corp. Omar said the local ratings system would be similar to those seen internationally, with the range spanning ‘AAA’ down to ‘D’ for the lowest rated companies.

Profits plunge in ChinaChina Life Insurance, Ping An Insurance and China Pacific Insurance, the three largest insurers in China, have all recently announced a serious fall in profits, indicating that although the country’s economy is protected, it is not immune from outside influences. China Life announced a 45-per-cent drop in profits in 2008 from 2007, blaming lower investment returns and foreign exchange losses. Total premiums, though, rose by nearly 17 per cent on 2007 to 121.6 billion yuan. Yang Chao, chairman of the company, said in a statement to the press: “This company’s operating and development environment has become very challenging,” adding that 2009 ‘is expected to be a more difficult year full of uncertainties’ as economic conditions elsewhere make sales more difficult.Ping An Insurance, meanwhile, has announced that its annual profit fell in 2008 – the first time it has done so since 2004, when losses from Fortis and a slump in the local stock market had a similar effect on profit. Net income for Ping An fell by 98 per cent to 268 million yuan in 2008 from 18.7 billion yuan in 2007. Again, Dutch group Fortis has been at least partly to blame for the recent figures – Ping An had to write off 22.8 billion yuan last year on its stake in Fortis. China Pacific Insurance also saw a steep drop in profits – the company saw its net profit fall by 81 per cent in 2008 when compared to 2007, in spite of the fact that premium income rose by over 25 per cent to over 94 billion yuan.In other signs that the industry is in need of a boost, the Chinese financial authorities have just introduced uniform pre-tax deductions for charges and commissions. The new policy, launched by the Ministry of Finance and the State Administration of Taxation, sets a ceiling on insurers’ pre-tax deduction. For property insurers, the ceiling has been set at 15 per cent of the value of insurance premiums for the current year, less refunded premiums. For life insurers, the ceiling has been lowered to 10 per cent.China’s Finance Ministry has also shown it is not afraid to take direct action to try and minimise the effects of the recession – it has ordered pay cuts for all the top executives of state-owned insurance and financial services firms, arguing that excessive remuneration has been paid in the past.

Maersk Alabama

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Swine flu calls for business reviewsAs a result of the recent outbreaks of swine flu, the New York-based Risk and Insurance Management Society (RIMS) has issued recommendations to businesses that call for them to review their insurance programmes, risk management systems and action plans in the event of a pandemic. Cases of swine flu recently spread from Mexico to several other countries, including the US, Europe, and Asia, which raised fresh concerns that businesses may lapse under pressures that could arise as a result of the rapid spread of a virus. RIMS is advising that companies should consider their insurance offerings to see whether or not restrictions apply in cases of infection, with workers compensation and employee life/health policies at the forefront of the

matter. Other general concerns include: the absence of employees due to illness, disruptions in the delivery of goods/services, and the inability to perform business operations in flu-affected areas.RIMS advised: “If you have not already devised and rehearsed a business continuity plan, keep in mind the key elements of your daily operations that are most likely to impacted by a widespread swine flu outbreak.” RIMS also recommended that firms should keep up-to-date with news on the ever-changing outbreak situation as well as maintain regular communication inside their own organisation. Although the current outbreak is subsiding, concerns still exist that a more virulent outbreak will emerge in the Autumn.

Business increase for PT PrudentialThe Indonesian subsidiary of UK-based Prudential, PT Prudential Life Assurance, has experienced healthy growth through its takaful business, with takaful premiums reaching IDR844 billion (US$79.4 million) last year. The robust increase comes from a boost in takaful demand and an expansion of its market distribution, which saw IDR821 billion of last year’s total takaful premiums come from new business. PT Prudential has also reported a 27.5-per-cent overall rise in total premiums to IDR7.02 trillion, as well as a 15.8-per-cent leap in new business premiums to IDR4.14 trillion in 2008. The company, which offers regular and single premium investment-linked products that feature three Shariah-based underlying investment funds, intends to focus on developing health and crisis cover riders as well as long-term regular premium protection products, including conventional and Shariah unit-linked product ranges. When launched in 2007,

takaful business was responsible for 25 per cent of PT Prudential’s total business in Indonesia (based on annualised premium); it now accounts for roughly 20 per cent of the company’s new business premiums.

Takaful operator numbers upAccording to the World Islamic Insurance Directory, the number of operators in the Islamic insurance and takaful market has increased to 165 from 138 last year, an increase of over 19 per cent. The directory, which is only in its third year of publication, is collated by Takaful Re and Middle East Insurance Review, incorporating figures from Global Takaful Group. The directory shows that total contributions to the market reached US$7.2 billion 2007, up from $5.9 billion in 2006, and the predictions are that 2008 will show further increases, despite the global economic situation.Chakib Adouzaid, CEO of Takaful Re, said at the release of the information: “We are confident that the directory will serve as a useful source of information and contacts in daily operations and will enjoy a

prominent position on the desk of every professional involved in the booming global takaful market.”The directory has been put together through input from Islamic insurance, takaful and retakaful operators around the world, stemming from 23 countries. From a geographical standpoint, the Gulf Cooperation Council (GCC) represents just over 35 per cent of income for the takaful business, the Far East 12 per cent and Africa nearly four per cent. The GCC is clearly shown to be the hotbed for companies interested in starting takaful operations, as the figures show that Iran alone accounts for nearly 50 per cent of the market and the number of players involved in the GCC market has risen from 39 to 72 in just over a year.

Tanzania passes Insurance Act 2009The National Assembly of Tanzania has passed a new Bill for The Insurance Act of 2009, which, among other stipulations, sets out a time frame in which insurance companies must settle customers’ claims. Before the recent amendment, insurers were allowed 90 days to pay out on claims, but the updated Act only allows companies 45 days. In addition, the Act states that the Commissioner of Insurance has powers to examine circumstances in which an insurer has failed to keep to the new deadline and allow it further time to pay.Omary Yusuf Mzee, deputy minister for finance and economic affairs, presented the Bill to Parliament and explained how the legislation would allow the regulator to impose a penalty on insurers that do not comply with the latest legislation. The Act, which replaces the Insurance Act Cap 394, 1996, has included provisions that deal with loopholes left in the first Act – the old law did not protect clients and did not give any power to the Insurance Board that would enable proper supervision of the industry. The new Act also states that any foreign insurer wishing to begin operations in Tanzania must ensure that at least one-third of its shares are owned by Tanzanians. Other sections of the Insurance Act 2009 make provisions for an Insurance Appeals Tribunal, which will be responsible for handling appeals made by insurers and agents against decisions made by the Commissioner of Insurance – under the old law, such appeals were made directly to the finance minister. The Commissioner of Insurance has also been granted new powers and is now able to assess and audit the financial and income statements of insurers in order to safeguard the interest of its clients; the financial statements will also be made available to the public.

Top ten risks identified

Generali wins UAE licence

Italy’s Assicurazioni Generali has successfully obtained a licence to sell life insurance in the United Arab Emirates (UAE). In 2008, the insurance market in the region rose by 30 per cent to US$4.7 billion of premiums, and Generali believes there is still plenty of potential left in the region, as chief executive Sergio Balbinot said: “With a number of high-earning expatriates from Europe, the US and Asia, who represent 80 per cent of the population and who have expanded 20 per cent in recent years, this market certainly still has potential to grow.” He added that Generali is currently seeking to develop its Islamic insurance product offering through the introduction of takaful products that cater to locals.

Sergio Balbinot

Aon Corporation has announced the findings of its 2009 Global Risk Management Survey, which was collated from the responses of over 500 organisations in 40 countries.Steve McGill, chairman and CEO of Aon Risk Services, said of the report: “This survey helps our clients stay abreast of emerging issues and learn how peers and competitors are managing risks, overcoming challenges and capturing opportunities in order to achieve sustainable growth, continuity and profitability. One of the benefits of having an unmatched global network is the ability to leverage Aon’s size and scope to create the industry’s most comprehensive data reports and better serve our clients.”According to the results of the survey, the top ten global risks facing the industry in 2009 are, in order: the economic slowdown; regulatory challenges; business interruption; increasing competition; commodity price risk; damage to reputation; cash

flow; distribution or supply chain failure; third-party liability and a failure to attract or retain top talent.Aon has noted that compared to the findings from the same survey in 2008, most organisations have acted to increase their overall risk preparedness, yet less than half are tracking and managing the total cost of their insurable risk. The insurer also highlighted that for three of the top ten risks – economic slowdown, damage to reputation and regulatory challenges – less than two thirds of respondents had formally reviewed the risk or plan they already have in place.Analysing the results of its survey, Aon noted: “While reputation risk has fallen from its top position in the firm’s 2007 survey, the importance of this threat is not diminished. Reputation risks impact the public’s perception of the quality, integrity and intention of an organisation, influence a partner or customer’s decision to do business with a firm and may affect a government or regulator’s decision to allow a company’s actions.”

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HEALTHMATTERS 17

Dengue threatThe UK’s Foreign and Commonwealth Office (FCO) has warned that the northern Argentine provinces that border Paraguay (notably Chaco, Corrientes, Misiones, Formosa, Salta and Jujuy) and Bolivia are the areas most affected by an outbreak of dengue fever. The FCO states that travellers could, however, be at risk in any part of the countries, as fatalities from dengue fever have been reported in Paraguay, and there is no vaccination or immunisation from the disease.

Meningitis hits IndiaSince the beginning of this year, local health officials in India have reported over 230 deaths and 2,000 possible cases of meningitis in the northeastern states of Tripura, Meghalaya and Mizoram – all of which are in the part of India bordered by Bangladesh to the west and Burma to the east, indicating that spreading of the disease is highly likely. The US Centers for Disease Control and Prevention (CDC) has advised travellers heading to these parts of India to have a meningococcal vaccine at least 10 days before travelling.The bacteria that causes meningitis are spread by close, direct or prolonged contact with an infected person through saliva, or respiratory or threat secretions. In order to prevent secondary

cases, the CDC has recommended that preventive antibiotics should be used by people who have been in close contact with someone known to have the infection. Such antibiotics include rifampin, ciprofloxacin and ceftriazone, the latter of which can be taken by pregnant women.

Lassa fever diagnosed in LondonA case of Lassa haemorrhagic fever has been diagnosed in London in the case of an individual who died shortly after returning from Mali. The young British male, aged 24, was a volunteer with an NGO working in a rural area of the country, some 35 kilometres northeast of Manankoro, which nears the border with the Ivory Coast. After being evacuated in February from Mali to Bamako and subsequently repatriated to London for further treatment, the man died. This is the first symptomatic human case of infection by the Lassa virus caught in Mali to be diagnosed.

Increased pertussis cases in Australia

Reports of an increase in the number of cases of pertussis (or ‘whooping cough’) in several areas of Australia has led to a call for all international travellers to be up-to-date on routine vaccinations that can easily prevent the effects of the illness. From early 2009 till April, more than 7,000 cases of pertussis have been reported across the country, with New South Wales accounting for more than 5,000 of these cases. It is believed that disease rates are higher in areas where vaccination coverage is low. Pertussis, which circulates worldwide, is a highly contagious respiratory infection caused by bacteria that is spread through coughing and sneezing, and its symptoms are often mistaken with those of the common cold. Although the disease is most severe amongst infants, two combination vaccinations – DTaP (acellular pertussis with diphtheria and tetanus toxoids) and Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis) – will protect against it.

Yellow fever expands in BrazilThe Rio Grande do Sul and São Paolo states of Brazil have been designated expanded areas of risk following confirmation of new human cases of yellow fever within their boundaries. The outbreak demonstrates the intensity of the virus in the southern part of the country, with an expansion of the virus’s transmission being recorded since the beginning of this year. Six sufferers of the 13 confirmed cases of yellow fever died as a result of the viral disease in Rio Grande do Sul and nine deaths have occurred from the 22 cases reported in São Paolo since February 2009. Presently, Brazil does not require yellow fever

vaccination for entrance to the country, although the increasing intensity of its spread calls for vaccination as a precautionary measure before entering the country

in all areas of Acre, Amapá, Amazonas, Distrito Federal, Goiás, Maranhão, Mato Grosso do Sul, MinasGerais, Pará, Rondônia, Roraima, Tocantins and designated areas of Bahia, Paraná Piauí, Santa Catarina Rio Grande do Sul and São Paolo.The disease, named because of the

jaundice-like symptoms that affect some patients, is spread by the bite of an infected mosquito so travellers should also be reminded to take steps to prevent being bitten.

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International Travel Insurance Journal

18 TRAVELMATTERS

Zimbabwe seeks lost touristsZimbabwe’s new coalition government may be viewed with some suspicion by many in the international community, but since President Robert Mugabe and Prime Minister Morgan Tsvangirai formed the unity government, hopes have been

heightened that recovery for a country currently on its knees cannot be far away. Income from tourism, a key currency earner in the country, dropped off sharply when violence dominated the national elections and economic turmoil saw inflation rise beyond control.Joyce Mujuru, vice president of the unity government, said at a recent tourism meeting in Harare that western

governments should lift the travel advisories they have in place at the moment regarding travel to Zimbabwe in order to encourage tourists back there. She added that it was time for all Zimbabweans ‘to take serious introspection to see to it that whatever we say and do does not contribute to the negative perceptions’ surrounding the country. “We are here now, through our inclusive voice, asking the international community to please remove the travel warnings,” she continued. What Zimbabwe needs, she said, is more international flights, upgrading of public utilities and improvements in telephone and Internet systems that are hardly working at all at the moment. “Our visitors do not need to go through the stress of failing to catch a bath in the morning or narrowly missing accidents on the roads … lest we forget, potential tourists have alternative holiday destinations.”

Iraqi tourism beginsIn the latest indication that security is improving in Iraq, the first Western tourists have now visited the country, courtesy of a British adventure travel agent.Eight foreigners, including Britons and Americans, took part in the first officially sanctioned tour of the country outside the semiautonomous northern Kurdish region since the US-led coalition invasion in March 2003. One of the tourists, Tina Townsend Greaves, told The Associated Press: “Sadly, we did not have the chance to see the museum or any of the monuments, because they’ve been shut.”Although the group did not experience any major violence, it did have some difficulties navigating and passing through the many checkpoints that still exist in and around Baghdad. The group visited such areas as the International Zone in the heart of the capital, as well as Ctesiphon Arch, a Persian ruin near Salman Pak – once one of the country’s most dangerous towns. However, as Greaves pointed out, although Iraq might seem a good deal safer for tourists, a major influx is unlikely in the near future: “I think maybe a few more of the sites need to be open to tourists, because if tourists are going to come to Iraq, there has got to be things for them to see when they get here.”

The ‘AIG effect’ takes holdHoteliers have dubbed it ‘the AIG effect’ – the swift cuts that companies have made to corporate travel allowances as a result of negative public perception following trips made to conferences by AIG executives. Starting back in September of last year, hotel organisations around the world are still seeing the negative effects that public outrage about AIG spending brought to the fore. In Las Vegas, the Mandalay Bay Resort and Casino has seen around $131 million worth of cancellations since the beginning of 2009, while the Four Seasons in Los Angeles has seen its meetings business drop off by around 15 per cent. A knock-on effect of curtailed corporate travel are the job losses in the hotel industry – according to the US Department of Labour, up to 200,000 travel industry jobs were cut in 2008, and it is predicting a further 247,000 will be lost throughout the course of 2009.Some hotel chains are doing their best to tempt corporate customers back through their doors through schemes that offer to give a certain percentage of the cost of the conference to charity, trying to show that not all corporations care solely about profit. Hoteliers that are still receiving bookings for conferences or meetings are saying that the cost of such events is falling thanks to the fact that conference organisers are trying to put on events more cheaply – a chicken main course, rather than duck, for instance. Laurence Geller, president of the firm that owns the Ritz-Carlton Laguna Niguel and Hotel Del Coronado in San Diego, has noted that some firms are even asking that the company name is

not placed on signs in the lobby directing delegates.The US Travel Association has estimated that the hotel industry has, since the beginning of the year, lost nearly $1 billion through the cancellation of corporate meetings and conferences. The Association has thus lobbied both Congress and the White

House to ask them to relax rules on travel for those companies that received government cash in the bailout. The argument is that face-to-face meetings bring better business results, while also showing that the fall in travel is affecting lower wage earners, such as cleaners and waiting staff. Roger Dow, president of the Association, said: “Our message is ‘Hey, let’s tone down the rhetoric. If you want to lose a million more jobs, just keep talking’.”

Australians undeterredAustralian travel insurer AAMI has reported that the global economic downturn does not seem to be enough to stop plenty of Aussies from packing their bags and heading off on an overseas holiday. Research by the insurer has shown that instead of not travelling at all,

holidaymakers from

Australia are looking for

ways to make

their holidays more affordable. When asked,

73 per cent of those surveyed

said they were searching for good travel deals on the Internet, while 72 per cent also said they were travelling during off-peak seasons when hotels, flights and tours are all cheaper. James Merchant, AAMI operational services executive manager, noted that it would need more than an economic crisis to quell the Australian passion for travel – but that holidaymakers are seeking ways to cut costs before and during their vacation. The survey showed some reassuring results that contradict what several other questionnaires have said – 95 per cent of those surveyed said they would still be purchasing travel insurance before they head off on their trips. As Merchant said: “Peace of mind goes a long way when holidaying. Travel insurance is the only way to ensure you’re covered for unexpected events when travelling overseas.”

Baltic tourism set to sufferNadejda Popova, travel and tourism industry analyst for Euromonitor International, has voiced the concern from the Baltic tourism sector that the fledging tourism industry in the region could suffer serious blows as a result of the global economic crisis. Already, in terms of infrastructure development, behind its close neighbours in Europe such as Turkey, countries like Latvia, Lithuania and Estonia have few differentiating tourism niches and a poor quality of accommodation thanks to their Soviet history. Coupled with a general wish among tourists to spend less but get more from their holidays, and the Baltic region is in for a tough time in terms of winning foreign visitors.However, all is not lost, according to Popova: “Increasingly budget-conscious holidaymakers in the region are changing their preferences from long to short-haul holidays and a further decrease from short-haul holidays abroad to domestic holidays. This in turn has had a significant positive effect on domestic tourism.”Euromonitor’s figures show that for the past five years, tourism has been one of the strongest growth

sectors in the Baltic region – Estonia has been the top choice for Finnish holidaymakers since 1999, partly because the journey is so easy. It is a simple 90-minute ferry trip from Helsinki to the capital of Estonia, Tallinn. Since February this year, though, Estonia has seen its international visitor numbers drop by four per cent compared to the same period in 2008, as even countries like Finland reign back consumer spending. Hotels in Latvia have reported a nine-per-cent drop in the number of guests compared to last year – the majority of the fall came due to fewer numbers of international visitors.In order to try and tempt more international visitors back to the Baltic region, development projects to upgrade the region’s transportation system are already underway and the international airport in Latvia is to receive a €300-million upgrade. Despite the plans for improvements, Popova warned: “The lack of financial resources in the Baltic region, slowing foreign investments, increasing unemployment rates and political tension will all have a negative impact on tourism growth throughout 2009.”

Business travellers bewareThe British Foreign and Commonwealth Office (FCO) has warned on its website of new dangers that have become apparent for business travellers heading to China. The organisation has cited recent incidents of British nationals being detained against their will by workers or hired gangs for the specific purpose of extorting money or intimidating for other gains. The warning states: “Typically, the British national is threatened with violence and detained at a factory, hotel or private residence until payment is negotiated and delivered.” Although it goes on to say that violence occurs only rarely, it is nonetheless a concern. It also noted: “The police may be reluctant to act unless they have specific evidence of an actual assault taking place.”Making reference to problems that have already occurred, the FCO added: “[Foreign] nationals doing business in China should be aware that if they become involved in a business and/or civil dispute, and the case actually goes to court, the Chinese government may prohibit them from leaving China until the matter is resolved. There are some cases of British nationals being prevented from leaving China for months while their civil cases are resolved.”

Islamic travel demand remainsAccording to the CEO of Dubai-based hospitality firm Almulla Group, the Islamic hospitality industry now represents 10 per cent of the world’s tourism market, and demand for Sharia-compliant accommodation continues to rise. Abdulla Almulla, speaking to Arabian Business, pointed out: “UAE travellers alone spend more than $4.9 million on travel annually and the Islamic hotel product will be in high demand, certainly reaching 10 per cent in the short term.” The Almulla Group, which last year launched the world’s first Sharia-compliant hotel portfolio, says it aims to have 30 additional properties up and running by the end of this year, with target destinations such as Saudi Arabia, Jordan and Egypt.The World Tourism Organisation (WTO) found last year that travellers emanating from the Gulf region spend over $12 billion a year on leisure travel, with those from Saudi Arabia alone contributing

$6.7 billion to the total. The WTO’s research showed that on average, each traveller from the UAE spends $1,700 per holiday – a significantly higher sum than the average amount spent by a European traveller.

It is not just the Almulla Group that has seen the potential of offering Islamic travellers Sharia-compliant hotels – other companies involved in similar projects include the Rezidor Hotel Group, Shaza Hotels and Rotana Hotels. Sellim El Zyr, president and CEO of Rotana Hotels, said of the future of the industry: “In this ever-changing world, individuality of choice is important to the traveller and some guests

seek to reflect the values they hold in the accommodation they choose. We have introduced the Rayhaan brand to Rotana’s hotel and resort portfolio after considering the diverse needs of our guests.” The Rayhaan brand caters specifically to Islamic

travellers.

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International Travel Insurance Journal

20 AIRAMBULANCENEWS

Challenger offers three-stretcher capacityJet Executive has announced that its company-owned Challenger 600, D-BUSY, is now available in a triple-stretcher configuration for worldwide medevacs.The aircraft can be set-up in various configurations. In single-stretcher mode, with a full intensive care unit (ICU) medcrew onboard, it can accommodate up to eight further passengers. With two stretchers installed, five seats are available for accompanying passengers. When using the full capacity of three stretchers, the remaining four seats can either be used for an extended medical team or for accommodating up to two relatives of the patients.A company press release said that the aircraft’s

capacities make for a cost-effective solution, with the Challenger’s pricing being approximately 1.75 times the price of a Learjet 35. Therefore, said the company, with two or three patients onboard, this will result in a cost saving for customers.

Aeromedical boost for AustraliaPhillip Dowler, general manager of Australian emergency rescue service RACQ-CQ Rescue, has started up a new fixed-wing air ambulance service in the country that aims to complement the work done by the Royal Flying Doctors Service. The service, called Australian Aeromedical, will be based in Mackay, Queensland, and will be staffed by a team of 10 intensive care nurses from the Mackay Mater Hospital. Dowler said the air ambulance service had been designed in order to help free up hospital beds as well as to transfer critical patients in a faster, more efficient way – the company’s Beechcraft 1900D can transport up to three stretcher patients and five ambulatory patients at a time, along with three medical crew members. Dowler also noted that he is currently negotiating with the Queensland

government to discuss funding for inter-hospital transfers, adding: “The fixed-wing plane would be cheaper to operate than CQ Rescue’s Bell 412 helicopter and would save CQ money by conducting inter-hospital transfers.”The fixed-wing aircraft is on loan from Vincent Aviation, a New Zealand-based firm that has entered the marketplace in order to diversify its business. Vincent Aviation has fitted out the aircraft with the necessary medical equipment and is also responsible for providing the pilots and maintenance.

CAMTS accreditation for Asia baseAirMed International has announced that its Hong Kong-based subsidiary, AirMed Asia, has received accreditation from the Commission of Accreditation of Medical Transport Systems (CAMTS). AirMed Asia is only the fourth international programme to receive this recognition, joining Ornge and STARS in Canada and SOS Air Rescue Africa, South Africa.AirMed Asia began operations in Hong Kong in March 2008 with a US-registered Raytheon Hawker 800. The service provides specialty care

and a ‘seamless’ transport package to its customers in the region. Jeffrey Tolbert, president and CEO of AirMed International, said the accreditation reflected the quality of the company’s staff and programme in Hong Kong, adding : “We remain committed to excellence no matter where we are on the globe.”AirMed’s headquarters in Birmingham and its subsidiary in Honolulu, AirMed Hawaii, are also CAMTS accredited.

Air ambulance closes runwayA Westwind II twin-jet air ambulance plane belonging to Guam-based CareJet caused chaos in the Philippines recently, after its left landing gear caught fire as it was approaching the take-off runway of Ninoy Aquino International Airport. The airport management was forced to close the main runway, which resulted in the diversion of 14 flights to a different nearby airport.The incident occurred just as the jet was being lined up for take off – as it powered up to gain speed, it was noted that smoke was emanating from the left wheel and brake assembly. The flight crew, Captain Charles Cooper and Captain Toshihiro Shimo, immediately brought the aircraft to a complete stop, jumped out and started to put out the fire with extinguishers. Emergency workers from the airport quickly arrived to help them smother the flames. Both flight and medical crew were unharmed.Terry Habeck, president and CEO of Aviation Concepts, parent of CareJet, explained what happened: “The aircraft had a long taxi and was cleared for takeoff when smoke was observed emanating from the left wheel and brake assembly. A small flame broke out in this area while still sitting in the takeoff position. The crew, upon seeing the smoke and flames, exited the aircraft with a fire extinguisher and put out what remained of the flames, which was minimal at this point.”Recovery from the accident was hampered as the airport staff lacked the necessary equipment to lift the aircraft from its position on the runway, combined with the fact that the left brake on the plane had seized, making it impractical to taxi the aircraft off the runway. Octavio Lina, assistant general manager for operations at the airport, noted that there are some recovery tools available, but only for aircraft

that are regularly used in the region – a Westwind II is not one of them. He pointed out the aircraft, which had been modified for medical transfers, has an extremely low profile for easy egress and ingress, which has rendered the airport’s normal equipment useless. Pneumatic lifting bags, which are usually placed underneath the wing and then inflated to raise the plane, were too big for the Westwind II. A special axle jack was also too big for the aircraft and was unable to fit underneath the wheels to be lifted. Finally, the problem was solved by borrowing a forklift truck from a nearby hangar – the forklift was used to lift the plane, place it on skates and tow it gently to the maintenance hangar. Following the calamity, a local paper reported that an airport official has recommended that authorities purchase more aircraft recovery tools to lessen the time it takes workers to dismantle and remove the debris of a disabled plane.Habeck has confirmed that: “There was no patient onboard at the time, as the medical portion of the flight had been accomplished. There were no injuries or additional damage sustained on the aircraft. CareJet has brokered flights to other operators in the region during this interim period.” The aircraft was flying again on 5 May.

New repat pact for high-risk areasEuropean Air Ambulance (EAA) and Remote Medical Solutions International (RMSI) have announced the start of a new co-operation agreement that the organisations say will make use of the best of each service to provide more efficient mission handling and less overall risk for customers. The intention of the agreement is that both EAA and RMSI will promote the quality and reliability of each other’s product to the customer in order to highlight the advantages of co-operation in terms of improved communication and established operational and medical processes between both parties. In particular, the agreement will apply to repatriation from Afghanistan and Iraq – high-risk areas in which RMSI provides medical evacuation. Under the agreement, RMSI will fly the patient to Dubai, where wing-to-wing transfer will take place with an EAA aircraft already in position. EAA will then fly the patient back to the final

destination. The entire operation will be handled by EAA’s Missions Control Centre (MCC), which is available around the clock. EAA is promising too that customers will receive a quotation from its MCC within one hour for repatriation from Afghanistan or Iraq. Once the quotation is approved, EAA and RMSI will immediately move into action, with the MCC co-ordinators choosing the appropriate physician from a pool of anaesthetists, neonatologists, gynaecologists and other specialists.EAA, formed from founding members Deutsche Rettungsflugwacht (DRF) and Luxembourg Air Rescue (LAR), has a fleet of five Learjet 35As and one Beechcraft KingAir 200. RMSI specialises in emergency medical response, support and retrieval solutions for governments, non-governmental organisations and companies working in remote and/or hazardous environments, using Hawker 800 jet air ambulances.

A view of Hong Kong taken from the Kawloon peninsula Pauliyas

N911GU, the aircraft involved in the incident CareJet

Jet Executive

Waypoint airshow and conference postponed until 2010Voyageur Publishing and Events has announced that the Waypoint AirMed and Rescue airshow has been postponed to 2010. The inaugural event, which will combine conference sessions, an indoor exhibition area and both static and live aircraft displays, will now take place next year. The date and location are yet

to be confirmed. Voyageur managing director and Waypoint editor-in-chief Ian Cameron explained the postponement: “There has been a large amount of interest in the show; however, because of the current economic climate, we felt that the show would be better served by postponing it until 2010”

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AIRAMBULANCENEWS 21

ITIJ asks AirMed International why bigger is often seen to be better when it comes to air ambulance aircraft

Alabama-based AirMed International started out with large, long-range jets. In 1989, with CEO Jeffrey Tolbert as captain, the company’s Lockheed JetStar circumnavigated the globe, performing the world’s longest transport of a ventilator-dependent patient from New York, US, to Manila in the Phillipines. The firm also flew the longest balloon pump (artificial heart) transport from Osaka, Japan, to Houston, Texas, US, in 1990, also in a JetStar.AirMed’s current flagship aircraft is the Raytheon Hawker 800. “Even though it cost more to

purchase and to operate this larger jet, we chose the Hawker because this aircraft provides optimum patient care for long, over-water flights,” said Tolbert. “It is also capable of carrying two critically ill patients, and the stand-up cabin is crucial for true, quality patient care, especially in the event of a patient code or performing intubation or chest compressions.” Though the company has had many types of aircraft, both large and small, throughout its history,

its fleet now includes three Hawker 800 aircraft – two in the US and one based in Hong Kong – as well as three Beechjet 400s, a Citation II, and four propeller jet King Air C-90s. These short-range King Air jets are used at the company’s Hawaii base for inter-island transports involving short distances when a larger jet is not a practical solution.AirMed International’s aircraft were also the first civilian medical aircraft in the US to be equipped with a medical liquid oxygen system. “The liquid oxygen system that we have custom built allows for longer flights without having to replenish oxygen during the trip. Simply put, using the larger aircraft allows us to carry more O2,” said the company’s executive vice-president Denise Treadwell, herself a seasoned air transport nurse.

A question of powerAnother advantage that larger jets have is their ability to house an Auxiliary Power Unit (APU) onboard. This creates total self-sufficiency for the medical team and their care of the patient. “We’ve landed in some areas of the world with no ground power supply to be found anywhere. Without our onboard APU, we would be unable to control the temperature in the aircraft or power the medical equipment during technical/fuel stops or even while on the runway,” said Treadwell. From a pilot’s perspective, the APU is also crucial to a successful mission, because it provides power to the avionics, meaning no interruption to the navigation and communication system during tech/fuel stops. “By keeping the aircraft powered up and the temperature constant, the APU helps reduce the length of tech stops and therefore reduces the amount of time the patient is on the aircraft,” said Darby Wix, AirMed chief of operations, “Larger jets also have a more comfortable flight deck, which helps reduce flight crew fatigue and adds to all-around safety and quality of service.” It is not only international flights that benefit from the use of larger jets. Even a longer distance cross-country transport benefits from the comforts a larger cabin affords, such as the closed-door lavatory and the ability to move about the cabin freely. Larger jets, such as the Hawker, would also normally have extra seating for a family member of the patient and space for small carry-on baggage, something smaller aircraft cannot offer. “For these and many other reasons, we’ve found that our customers and large insurers in particular take serious note of the benefits of larger jets over small. A large jet may not be at the lowest price point, but it is the quality of care and service they seek for their transports,” concluded Treadwell.

Size matters RFDS expands Broken Hill baseThe South Eastern section of the Royal Flying Doctor Service has recently unveiled its brand new base and visitors centre in Broken Hill, which was officially opened by the governor of New South Wales, her Excellency Professor Marie Bashir AC, CVO. Casting a watchful eye over the entrance to the centre is a four-metre high sculpture, designed by renowned artist Ron Gombok, called The Guardian.The RFDS has said that it is only through the generosity of supporters of the charity service that the base’s expansion was possible. A local philanthropist, Sir Michael Bishop CBE, gave $600,000; the figure was then matched by the Federal Government. The new medical centre is in fact named after Sir Michael Bishop’s father, Clive Bishop, while the visitors’ centre commemorates Bruce Langford.The RFDS has had a base in Broken Hill since 1938, and for the past 22 years the service has operated from a converted airport hangar, but with the extension and improvements undertaken in the last year, the infrastructure of the base has been transformed. The medical centre now provides modern accommodation for both medical and allied health staff, including rooms for consultations, observation and resuscitation, as well as a waiting room and facilities for medical and dental staff and students.

Senior medical officer Dr Mike Hill noted: “Our patient care areas have improved dramatically. When critically ill patients are waiting to be transferred, we now have first-class facilities to tend to them. The

extra storage capacity for equipment gives us a more efficient working environment too.” Judy Whitehead, nurse manager of the base, added: “Direct access from the resuscitation/patient area to the tarmac, with greatly improved stretcher bay, makes patient transfers much more efficient. We now have a modern, user-friendly facility with space for training sessions to be undertaken onsite.”

Swedish Government orders new SAS AMAT systemSAS Technical Services has received an order from the Swedish Government for a second SAS Advanced Medical Air Transport System (SAS AMAT System) shipset for the Boeing 737 NG. The SAS AMAT system allows the conversion of a commercial airliner to transport multiple casualties.

The new shipset is scheduled for delivery in December 2009 and comes after the original SAS AMAT System shipset was successfully used on a European Union (EU) mission in November 2008 to repatriate EU citizens from Mumbai, India, after the terrorist attacks in the city.With this delivery the Swedish Government will have two SAS AMAT System shipsets available for the Swedish National Air Medevac (SNAM) system.

Six hours after a call, the SNAM system provides an airworthy and patient-safe environment for the air transport of six intensive care patients, six to twelve stretcher patients and approximately 23 walking wounded or relatives in each aircraft.SAS Technical Services has developed and certified the SAS AMAT System as a flexible solution for providing advanced intensive-care capability in fixed and rotary-wing aircraft with no requirement for prior modifications. Thanks to a modular design, the SAS AMAT Systems can be adapted to meet the customer’s specific requirements ranging from customised installations on commercial airliners and business jets to medevac capability for military aircraft.The Micus AB’s mobile intensive care unit stretcher, a key component in the SAS AMAT System, is designed to enable transport between different treatment facilities without having to switch between different stretcher systems and risking disruption in treatment. It features a self-contained system with oxygen and electrical power for use when power and oxygen from external sources are not available. The design also makes it suitable as an advanced emergency medical treatment unit, in environments were this is required.

SAS

RFDS

Dennis Keim

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The sudden eruption of swine flu out of Mexico not only scored a heavy punch to a tourism industry already reeling from overcapacity and economic anaemia, but sent dazed travellers back to the drawing board to struggle with fine print that was sometimes contradictory, often obscure, and too often inconsistent with what they were hearing from tour companies, air carriers, cruise lines and their own governments. In short, the message left by the highly contagious flu, now given the upscale title of H1N1 virus (thanks to governments protective of their pig farmers), was caveat emptor and don’t expect to get your holiday money back without a struggle.When it first emerged, virtually overnight in April, swine flu primarily hit holiday and business traffic into and out of Mexico, but within days cases were confirmed throughout the United States and Canada, the remainder of the Americas, as well as in the UK, Europe, Asia, and Australasia. Airlines promptly cancelled flights and began handing out surgical masks, travel insurers took to their websites posting warnings about what would be covered should their customers or their itineraries be disrupted by swine flu. Tour companies sent empty planes to repatriate vacationing clients, cruise ships wiped Mexico off their charts and sent their boats to alternative ports; governments posted advisories warning their citizens to avoid all ‘non essential’ travel to Mexico; border agents went on heightened alert looking for sicker than normal people. China even temporarily quarantined a group of students suspected of carrying the flu from Canada (none of whom had been to Mexico but as Canada was one of the primary vectors with numbers of confirmed cases, they were suspect nonetheless). China also banned the importation of Canadian pork, just as an afterthought. And throughout it all,

holidaymakers, honeymooners, backpackers and business travellers sat disconsolate on their bags in airports waiting to be repatriated, or to be given the news that their flights had been cancelled and they best check with their carriers, tour companies or travel insurers for recourse.

Covered or not?Virtually all insurers would cover travellers for swine flu symptoms and treatment contracted at their destination – so long as they didn’t travel there after their government had warned against it. But dealing with the prospect of rearranging thousands of dollars worth of travel after their trip had been cancelled or

interrupted, was not so straightforward.Thomson, Thomas Cook and others in the UK immediately announced stoppage of trips to Mexico, sent empty planes for those who wanted to return and told their customers they could get credits for flights to different destinations. Thomson reported it had approximately 2,500 customers in Mexico at the time, Thomas Cook about 3,000. Thomas Cook said passengers due to fly within the next seven days could re-arrange their travel but not claim a full

refund. Thomson offered refunds for a limited time and allowed customers to rearrange their plans at no extra cost – up to their original value.Montreal based Transat AT Inc., Canada’s largest tour operator, postponed flights to Mexico until 1 June, and sent equipment to pick up its customers and staff as did Air Canada and Air Canada Vacations. Air Canada told stranded passengers they would be allowed to rebook at a later date to different destinations, but would not receive refunds – a common practice among other airlines. In the US, most airlines cancelled flights to Mexico, but full refunds were hard to come by, the airlines offering rebooking to other destinations; not much

consolation for people who had Cancun, Cozumel or Acapulco firmly in their sights. American travel insurers also rushed to get advisories on what was coverable vis-à-vis swine flu up on their websites, several making a strong pitch for customers to add Cancel for Any Reason or Change of Mind supplements in future to their more standard interruption or cancellation policies. The cancellation clauses of insurers such as CSA, Travel Guard, Travel Insured, and TravelSafe, however, did kick in if the

policyholder wanted to cancel their trip because they didn’t feel safe and were worried about swine flu.

Elusive solutionsMuch of the reaction from tour operators, airlines and travel insurers has hinged on the actions of their own governments in ‘advising’ their citizens about travel to certain countries. Many governments have tiered systems of advisories: cautionary, avoid certain areas, avoid all non-essential travel, and avoid all travel.Normally, once the government warns against travel to a given country (in this case Mexico because of swine flu) certain protocols kick in – or are supposed to. But that does not mean adherence is universal.Nathan LaFayette, executive vice president of Travel Guard Canada, said that in the case of Mexico and swine flu, once Foreign Affairs and International Trade Canada advised Canadians to avoid non-essential travel to Mexico, coverage was available to policyholders for cancellation or for costs to re-route around the region, and if an insured were in Mexico when the warning was issued, the insurer would pay to bring them back home. “No trip cancellation coverage is available if the policy was purchased after the warning was issued,” he clarified. Generally, that is the pattern followed by most insurers.Interviewed in the UK by ITIJ, marketing and PR executive for Essential Travel Ltd Jennie Sheldon said: “Virtually no insurance policy will offer cover for travel to a country to which the FCO (Foreign and Commonwealth Office) is advising against all but essential travel. It now falls into the general exclusions section of our insurance policies and we are unable to offer cover for anyone traveling there.” If, however, a vacationer bought a trip to Mexico several months ago, said Ms Sheldon, “We

Mexican swine flu: a test of confidence?After rattling travellers, tour operators and insurers, the dreaded swine flu has unquestionably tested the preparedness and resolve of those involved in the travel and insurance markets. Milan Korock investigates what he describes as a ‘wake-up call’ to the industry

Will customers in future be satisfied with the insurance products they are offered to protect

against such threats … How can they trust government advisories if vendors and suppliers

put their own spin on how to interpret them?

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NEWSANALYSIS 23

advise them to speak to their airline, hotel, tour operator or travel agent, who should be able to offer an alternative holiday or a refund. However, our underwriter AXA has taken the decision to give consideration, on a contingency basis, to cancellation or curtailment claims from those customers who are able to demonstrate that despite exhaustive attempts, they have been unsuccessful in seeking redress from any of those other sources.” Note the word ‘exhaustive’. Getting refunds out of cash strapped airlines or tour operators can be exhaustive indeed, but what about travel insurers?Some of the best practical advice about applying travel insurance to swine flu and similar situations was issued in a press release by the Travel Health Insurance Association of Canada, which urged travellers to always get ‘a clear, plain language explanation of their trip cancellation benefits and how they integrate with the benefits and exclusions of their air carrier, tour company or cruise line’. It further said that policies have limitations and exclusions so travellers need to understand where they stand ‘should their trip to a given destination be suddenly cancelled, or should their destination resort close down, or should their government issue an advisory warning them not to travel to a certain country or parts of it’.The California Insurance Commissioner, on 30 April, warned travellers that not all insurance policies will fully reimburse trip cancellations due to the H1N1 flu outbreak. Steve Poizner said that ‘cancel for any reason’ policies, which are available at an extra cost, are the only types of travel insurance that will typically reimburse a policyholder for reasons pertaining to the H1N1 flu. “Travellers should educate themselves on their travel insurance options and decide which, if any, travel insurance product might be appropriate for them,” he said. Cancel for Any Reason or Change of Mind policies allow purchasers to pull out of a trip if they sense trouble on the horizon, but coverage is not absolute and there are limitations. In Canada, Manulife Global states: “If you change your mind and decide not to travel for any reason before you leave home and you have booked your trip and purchased this insurance from the same travel agent, we will pay up to 50 per cent of the covered amount for the prepaid portion of your trip that is non-refundable and non transferable to another date. You must cancel your trip 16 days or more before your departure date.”

Are travellers caught in the middle?In the UK, Which?, the consumer rights group, has accused some travel insurance companies of acting unreasonably by refusing to compensate policyholders for not travelling to Mexico after the FCO warned against it. Which? says there are too many impediments to claiming a refund on the cost of a holiday, in that many insurers are only offering to cover the cost of altering the holiday destinations offered by the travel company. The country’s travel association ABTA said in a statement that it believes most travel policies won’t cover policyholders for cancellations due only to official government guidelines or to travellers cancelling of their own will. The Association of British Insurers, however, insists that most UK travel insurance policies do cover this type of cancellation

and that policyholders should check with their insurer to make sure of that.The lesson of swine flu is that this is not a ‘Mexican’ phenomenon but a generic one and it can happen anywhere, at any time. Though the WHO has warned of a possible pandemic arising out of the Mexican flu variant, to date the repercussions have been quite modest, certainly not on the scale of

SARS. That might yet change, but to date this has been more of a wake-up call than a raging fire. Will customers in future be satisfied with the insurance products they are offered to protect against such threats, will they demand more, and will they accept airline assurances that they can trade in one location for another but overlook refunds? How can they trust government advisories if vendors and suppliers put their own spin on how to interpret them? And will they tolerate having to read pages and pages of fine print just to find that the liability for covering them has shifted to another player somewhere down the food chain?Can tour companies sustain many more of these wake-up calls? According to Price Waterhouse Coopers, between January and March 2009, 27 British travel companies collapsed compared to 11 in the same period last year. Over the past 12 months, some 78 companies have failed, up from 49 the previous year. It warns that this coming September – when cash flows slow following the peak summer period – will see another rush of failures. That is the same month that XL, Britain’s third largest operator, collapsed last year affecting up to 300,000 holidaymakers.In the end, we may find that the Mexican swine flu was but a blip on the world’s growing pandemic fear meter. But it has clearly left behind many questions about how prepared the travel industry and its various components – including travel insurers – are in dealing with any repeats – big or small.

American travel insurers also rushed to get advisories on what was coverable vis-à-vis swine flu up on their websites, several making a strong

pitch for customers to add Cancel for Any Reason or Change of Mind supplements in future

In the UK, Which?, the consumer rights group, has accused some travel insurance companies of acting unreasonably by refusing to compensate

policyholders for not travelling to Mexico after the FCO warned against it

Following a decline in the number of cases in Mexico, the British Foreign and Commonwealth Office and the US Centres for Disease Control and Prevention both lifted their travel advisories concerning the country at the beginning of May.In a bid to repair the financial damage that swine flu has inflicted on Mexico, the Tourism Board in the country is planning a revival package that could include a 50-per-cent reduction in cruise tax. As ITIJ went to press, the total number of swine flu cases worldwide reached 15, 510, with 99 deaths.

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Scheduled airline failure and the collapse of the travel industry

Michael WardSales and marketing manager, International Passenger Protection

Michael began by giving delegates an update on the current state of the marketplace, including showing the statistic that 2008 saw the largest volume of airline collapses in the history of aviation, and according to PricewaterhouseCoopers, 2009 will continue this downward trend. Factors affecting the slowdown, he continued, include the price of oil, exchange rate changes and low inflation. Michael then explained how costly airline failure can be, and the necessity of some form of protection, whether it be through credit card, travel insurance, the UK Air Transport Organisers’ License (ATOL) or the Association of British Travel Agents (ABTA). When asked whether or not scheduled airline failure (SAF) should really be a risk travel insurers take on, Michael pointed out that it will become one if it isn’t already, thanks mainly to consumer expectation. He showed how certain aggregator websites have been using details such as SAF cover to illustrate the differences between certain travel insurance policies, and with high profile airline collapses such as XL in 2008, consumers will soon demand that such coverage be in place. He predicted that by the end of 2009, some 60 per cent of travel insurance policies available to the UK market will incorporate some form of SAF insurance.

David MoesliDeputy director, Consumer Protection Group, Civil Aviation Authority

David explained in detail the different types of financial protection that are available to UK holidaymakers and highlighted the loopholes in the ATOL scheme that leave some tourists without any form of compensation, should the airline they are flying with go into administration. The reason, he explained, that airlines are excluded from the ATOL scheme is an historic one – in the past, scheduled airlines were usually part or fully owned by a country’s government, meaning that they simply would not fail.

This, obviously, is no longer the case, yet the law in the UK remains the same.Financial protection that is available in the UK, though,

includes ATOL, ABTA, the Association of Independent Tour Operators and Travel Trust Association. These, explained David, are all meant to be complementary, and all cover slightly different things. Most recently, the government has put in place an air travel trust fund to replace the ATOL bond scheme as the primary level of protection for passengers, but consumer awareness of this scheme is somewhat limited, despite the industry’s undertaking to promote guidance and awareness of it. The money for the fund will come from a £1 air passenger charge for each person on a flight.David then gave on overview of several future possibilities for the aviation industry, including an ‘all flights’ protection levy that is

being considered by the European Union; a proposal to increase the air passenger charge from £1 to £3; a government consultation on ATOL reformation; and it is hoped that a definition of the term ‘package holiday’ will be given.

Andrew Cooper Director general, Federation of Tour Operators and Association of British Travel Agents

Andrew began by delving into the question of where the industry is currently going wrong, including long-standing overlaps in the different types of cover, as well as the difficulties

surrounding the definition of the term ‘package holiday’, which was created in the 1970s and hasn’t been altered since. The problem with that, he continued, is that the marketplace has changed dramatically, with the advent of dynamically packaged holidays and independent travellers. For instance, in 1997, 96 per cent of leisure holiday sales were ATOL protected, yet in 2008, of the 47 million travellers who left the UK, just 24 million enjoyed the same cover. The changing market can be attributed to the increase in low-cost carriers, second home ownership, the Internet and the sales policies of the large tour operators, who are catering to customer demand with complex holiday plans. The average UK consumer, though, simply assumes they are protected, but little clarity is being offered to them at the point of sale.

Andrew then offered delegates some of the future options for improving the situation, including government intervention through the possible hike of the air passenger charge; an improvement in public awareness; reliance upon market solutions being put

forward such as SAF and credit card protection; or, finally, the industry could do nothing. Andrew offered his preferred solutions to the issue, including for the short term a change in regulation to incorporate dynamically packaged holidays and, in the long term, to meet consumer expectations and put a proper structured protection scheme in place.

Natalie MilesHead of group insurance, TUI Travel

Natalie gave the audience an in-depth analysis of how the TUI Travel Group trades around the world, including mentioning the many subsidiaries that are part of the Group that are operating successfully, even in the midst of

a recession. She explained that, as a result of the company reducing capacity in 2009, the summer ’09 average selling price has actually risen by 10 per cent, and the public are showing their propensity for travel, even when the budget is tighter than normal. Thirty per cent of TUI Travel’s customers are demanding package holidays, perhaps as a result of the collapses seen in the aviation industry throughout 2008 and continuing into this year.The impact that SAF has had on TUI is felt indirectly through the cost of the new air passenger charge of £1, which could be hiked up to £3 if the government has its way. Concern in the industry, said Natalie, centres on the fact that the increased cost

could serve to distort the market as travel agents will have to include it in prices given to the customer, yet low-cost carriers could get away with undercutting the prices offered by agents. Natalie also reiterated a point that had been mentioned before, which is that of consumer education – figures from the firm showed that more than 50 per cent of consumers believe they are protected when booking a flight only.Natalie then showed that TUI has taken action to protect its customers from scheduled airline failure as it retains the credit risks of its dynamic package holidays, so if an airline were to fail, TUI would be responsible for the cost of repatriating the customer.

Policy wording – 10 top tips

Martin Cutts Research director, Plain Language Commission

Martin surprised the audience with his lively take on what some might deem a difficult topic – the humour of the small print in insurance policies. Sceptics of plain language, began Martin, might be surprised to

learn how simple it can be to alter a complex policy and thus make it instantly more accessible to a higher percentage of the population. His top ten tips were given using some excellent examples of very ‘unplain’

English, such as when he failed to find a bar of soap in a hotel room recently, and upon ringing reception to ask for one, was told the ‘facial bar’ he had seen in the bathroom earlier was, in fact, just soap.Martin’s most vital recommendations to the insurance audience were:- To keep average sentence length to under 20 words;- To use familiar words and explain clearly any that aren’t – there should be no assumptions made on the part of the insurer that the consumer knows as much as they do;- To be concise, only using as many words as are necessary;

- To use the active voice rather than the passive wherever possible – it is far easier to read- To use clear, crisp and lively verbs;- To use vertical lists in order to break up large swathes of complicated text;- To make headings self-explanatory or predictive and not to use bold as it dazzles the reader and they then notice little else on the page;- To proofread more carefully (at this point some shocking examples of real policy wording were shown!)- Not to use continual capitals, as humans often read a word by looking at the shape of the letters, and by using continuous capitals it makes it more difficult to digest;- Not to use initial (legal) capitals for defined terms, or any other inappropriate purpose: for instance, ‘Your Policy protects You in the event of an Accident’.A quiz was then given to the audience, and there were some rather red faces when the results revealed some delegates’ less-than-perfect knowledge of spelling and grammar.

The European Gender Directive

Mark WaterstoneObstetrician

As European insurers are no longer allowed to ask a potential client whether or not they are pregnant when assessing the risk, the problem of premature births abroad could become increasingly important in the industry, costing companies hundreds of thousands of pounds.

The welcome functionThe Welcome Function, sponsored by Baptist Health, was thoroughly enjoyed by all who attended. The volume of chatter in the room, combined with some serious faces, showed that both business and pleasure were on the minds of the delegates. A very successful function, ITIC would like to thank Baptist Health for providing the drinks for the evening.

INTERNATIONAL TRAVEL INSURANCE CONFERENCE

Conference ReviewThe RANDOLPh hOTeL OXFORD • UK

19th-20th May 2009

Michael Ward

Andrew Cooper

David Moesli

Natalie Miles

Martin Cutts

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ITIC REVIEW 25

Mark gave an overview of some of the complications that travelling, and flying in particular, can bring on or exacerbate in pregnant travellers, and the costs that can be incurred when something does go wrong abroad. He showed that between two and eight per cent of travel insurance claims that involved the provision of emergency assistance were for obstetric cases and indicated that when a pregnancy does have complications, they can happen very suddenly and be very dangerous to both mother and child.One of the problems facing the insurance industry is that pregnant women are given conflicting advice on when it is and isn’t safe to fly – for instance, there is an assumption that it is safe to travel in the first three months of pregnancy, when in actual fact it is a very unstable time for the baby and very dangerous. The Gender Directive could also result in more ‘tourist obstetrics’, whereby a pregnant woman about to give birth purposefully travels to another country in order to obtain a passport from that country for her child.Risks to pregnant travellers are numerous and can be serious, resulting in the worst case scenario in the repatriation of a corpse – but even in the best case, the care for a premature baby that arrived whilst the insured was on holiday in the US could effectively put a travel insurer under huge pressure and seriously affect the whole book of business it offers. It was pointed out that insurers now have no incentive to offer travel as part of their business, as the unknown risk is simply too high.

Daniel ScognamiglioSenior solicitor, Blake Lapthorne

Daniel began by asking delegates who among them had actually acted to change their policy wording since the Gender Directive had come into action – the absolute prohibition on discrimination on the ground of pregnancy is one the industry must come to terms with if they are to be compliant. There is a lack of clarity about the Directive, explained Daniel, due to the difficulty of whether to interpret the Directive through a purposive or constructionist approach in the UK. The insurance industry can also be found to discriminate in both direct and indirect ways, making it even more difficult for an insurer to make sure they are following the rules directly – especially when solicitors are offering different advice, as many are. Some are telling the insurers to take out of their policy wording any reference to maternity or pregnancy (and transgender clients), while others are allowing the insurer to leave it in as long as it isn’t used in a discriminatory way.

In order to try and work with the Directive, rather than against it, Daniel suggested ways in which the industry could still manage their risk. An insurer could use dissuasive tactics, such as relying on a health and safety warning about the dangers of flying for pregnant women, or alternatively the industry could work more with airlines, asking them to be active in assessing pregnant travellers that seem to be near to term.Daniel’s conclusion was that the consequences of non-compliance with the Gender Directive could serve to be a very expensive mistake for an insurance company, and his recommendation was that firms remove any and all references to maternity, pregnancy or transgender.

Scott RobertsSenior broker, Acumus Insurance

Scott discussed the impact and expense that pre-term babies have on the travel insurance industry as a whole, offering statistics on how frequently premature births occur and the likelihood that an insurer’s client will suffer from one. Pregnancy, as Scott pointed out, is an extremely emotive topic, and the last thing the insurance industry needs is bad publicity from denying a claim for a premature baby – the media will be straight on it and the insurer loses out again.Scott’s statistics showed that seven per cent of births in England and Wales are premature, which is of concern to the industry. Generally, it was demonstrated that a typical travel insurance claim for a premature baby’s birth is settled for between £80,000 and £250,000 – although one claims company said that it had not witnessed a premature baby claim that reached over £11,000.There are several options open to travel insurers that can mitigate the effects of high worth claims, continued Scott: reinsurance policies; lifestyle screening and underwriting; policy wording changes; lobbying airlines to be more proactive in stopping pregnant women over a certain number of weeks travelling; reserving a more accurate amount of money for premature baby claims; working even more closely with cost containment companies; and properly explaining the dangers of travelling while pregnant to female clients.Finally, Scott urged the travel insurance industry to respond to requests from the Association of British Insurers for more information on claims statistics relating to age in order to demonstrate the true nature of the claims, or else the impending Equality Bill could end up being far worse for the industry.

Mobile phone technology and travel insurance

Nicholas ThurlowDirector, Text2Insure

Nicholas began by offering his views on the role of the mobile phone in today’s society, showing that the average person sends nearly four text messages

per day, and there are more phones than people in the UK alone. More than 50 per cent of the world’s population pay to use a mobile phone, he added, showing the potential market available. Due to the advent of new technology, the travel insurance industry has had to develop a multi-channel approach, and using mobile technology is another sensible step forward, as it gives companies the opportunity to assist in most key touch points on a customer’s journey.The advantages of using mobile technology to assist customers are convenience, the flexibility offered to both customer and company, as well as an enhanced overall customer experience. Importantly, though, the texting service must be complementary to other means of communication, not a replacement. However, on the other side, insurers must be aware that there are some disadvantages to using text services, which include: some customers’ lack of familiarity with mobiles; a discomfort among the public that the document details are not ‘in writing’, therefore not legally binding; a belief that the cost of such communication will be borne by the customer; and a misconception among the public that the service replaces other means of communication.Moving onto future trends, Nicholas showed that other services, such as dental surgeries, are using text services very successfully as a way of reminding patients of their appointments. Such schemes should increase customer trust in text services, which will result in more consumers expecting such services in the future.

Travis VincentRegional security manager, International SOS

Travis explained how vital communication is in his role of keeping clients safe in some of the most volatile regions in the world. There are three key considerations that should be made when a company is deciding where to use technology to help businesses working remotely, and those are: the efficacy of the information provided; the operational procedures of the company; and the method of transmission and receipt of the information (i.e. the type of mobile device being used). A company that is considering introducing mobile technology to assist its workers should also carry out a travel risk assessment, and consider how the firm already keeps in regular contact with its remote employees.Travis showed how International SOS keeps in touch with its clients through its own technology, which can highlight problem areas around the world, including security or medical alerts, so the company is immediately aware of any risk facing the country. Once aware, the company is able to check to see if it has clients present in the affected area and can take the necessary steps, if there are dangers to the client, to contact and evacuate the person. It is vital, continued Travis, that any communications system put in place be reliable, capable, robust, flexible, secure and economical. In his opinion, the most critical communications tools available on today’s market are the quad band mobile phone, satellite phone, BGAN

(broadband global area network), VHF radio and a local SIM card. The importance of communication in high-risk environments cannot be underestimated, concluded Travis – it can be a lifesaving tool.

Rob MalcolmVice-president, business development, MBLOX Ltd

Rob, a self-confessed ‘mobile phone geek’, offered delegates further insight into the possibilities for improved business that mobile phones can give to companies, from engaging more with customers to saving money. A key point of mobile phone technology, though, he continued, is that it must both make and save a company money if it is to be successfully instituted.Mobile channels of communication that are already on offer to the public include SMS, MMS, push email (Blackberries etc.), instant messaging and Twitter. Elsewhere, though, data applications are changing the nature of mobile phones and driving the industry towards innovation and increased use of the Web and WAP applications.Ways in which travel insurers could make use of mobile technology could include enabling the insured to pay for cover through their mobile account, either instantaneously or through their monthly bill. In addition, for an assistance company seeking to locate a client in a country where there has been a security alert, a mobile phone’s GPS signal could be used to determine whether the client is in any immediate danger. There are data protection problems with this particular use of the technology, despite the clear advantages it offers insurers and assistance firms.In the future, Rob predicted that ‘sender pays data’ technology will become more popular – ‘sender pays data’ is the technology that allows a brand to offer data to its clients at the company’s own cost, thus removing customer uncertainty about the value of the service. Smart Pipe Enablers, said Rob, will also rise in popularity as they allow networks to be opened up to other companies that can further identify the needs of the customer. More popular in the US at the moment, there is a move to utilise advertising-funded messages to clients, so they receive an advert and the data at the same time. In conclusion, Rob indicated that as mobile phones continue to develop at an alarming rate, the penetration of smart phones will increase, offering customers richer applications and further possibilities for those companies that can offer consumers what they want.

Mark Waterstone

Daniel Scognamiglio

Scott Roberts

Rob Malcolm

Travis Vincent

Nicholas Thurlow

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Age discrimination – an update

Kate CarrAssistant director, markets and regulation, Association of British Insurers

Kate gave a very detailed presentation on ‘the story so far’ in relation to the UK Age Discrimination Bill, which has been in the development process for the last several years, and following seemingly endless proposals, consultations and reviews, is nearly ready for implementation. (For all the background on the legislation, please see ITIJ 98, March 2009, Discrimination, the new regime.)One particular issue that was highlighted by Kate was that of age banding – a particular problem for a division of the insurance industry that uses broad age categories to quantify risk. If the Bill states that age bands must be narrowed, Kate indicated that this could bring higher costs for insurers and business could become more complex for distributors, while the cross subsidy used by many insurers could be removed. If age limits are removed completely by the Bill, this could mean total withdrawal from the

market of some products, it could become more difficult to incentivise safe behaviour among insureds

and there would be less diversity of product features.Kate also gave delegates an update on the current state of play with the European Union Equality Bill, which has some concerning features. The wording provided in the Bill does not yet provide sufficient protection to the industry, said Kate, and the ABI has asked for a definition of ‘legitimate aim’ to be given before further action is taken.As if coping with current UK and European legislation were not difficult enough, Kate reminded delegates that the UK Age Discrimination Bill and European Equality Bill are coming into

action at different times. UK legislation is slated to be introduced in 2012, while the European legislation will be introduced in either 2013 or 2014. The cost of compliance with both pieces of legislation will be significant, and put the UK at a competitive disadvantage with the rest of Europe.Industry action to try and counteract the effects of the Age Discrimination Bill include: offering ‘signposts’ to customers when one insurer cannot offer cover, but knows another that can; making commercial deals between insurers to offer referrals to customers, and the production of a good practice guide.

Samantha O’ConnorHead of business development, Columbus Insurance Group

Sam offered delegates an insight into which providers are and are not providing cover without age limitation applied already, the latter being shown to be a very small proportion of providers on the market. On single trips, there were only a few companies shown to not place age limits on their policies, while for annual multi-trip insurance, that figure came down even further. Sam presented statistics showing that instead of the over-80s, the highest number of travel insurance claims came from the 50 to 65-year-old age bracket, with 18 per cent of all claims stemming from this age group, while over-65s account for just four per cent of claims.Sam indicated that in her opinion, age banding doesn’t really make sense – it could be made more sensible and fairer by simply instigating a year-on-year increment for travel insurance policies. In the future, it is hoped that all single-trip insurance policies will disregard age banding in favour of more accurate risk assessments, but for annual policies, the situation is more complex. The difficulties of mid-term medical changes continue to plague the industry, and Sam issued a call to other industry personnel to help develop a way in which annual policies could become non age-banded.During the spirited debate that followed the session, it seemed most of the delegates were in agreement that age banding is passé and should be abolished in favour of offering more ‘signposts’ to customers about which insurers offer non-age limited coverage. There was also some concern voiced among delegates that the decision-makers behind the Age Discrimination Bill are not fully aware of the effects that the Bill will have on travel insurers.

Swine flu preparation

Charlie EasmonManaging director, The Number One Health Group

Charlie’s presentation had everyone washing their hands and covering their mouths soon afterwards, as he showed that the world must prepare for a worst-case scenario with regards to the outbreak of swine flu, despite hoping for the best. When considering what could happen next in the development of the disease and its progress across the world, processes of containment that have been used must be evaluated in their efficacy – social distancing, for instance, slows down the spread of the disease, but will not stop it. Charlie predicted that in the next 12 months, there will be three waves of outbreaks of swine flu, and could cause at least the same amount of damage as normal flu (economies already suffer when seasonal flu hits its annual peak). If those outbreaks were to coincide with an outbreak of H5N1 bird flu and normal seasonal flu, the effects could be near disastrous for global industry.

At the time of writing, the World Health Organization had increased its threat level to phase five, and Charlie predicted that it would soon move up to phase six, due to the prevalence of human-to-human transmission and a higher death rate (0.8 per cent) than was seen with Severe Acute Respiratory Syndrome. Charlie then gave delegates the latest information regarding symptoms that employers should be on the lookout for, as per government guidelines.The insurance industry in general will feel the heat for the next several months through claims stemming from swine flu, predicted Charlie, as problems with industry and the provision of public services will quickly become an issue if a sizeable outbreak were to occur. Companies, then, should seek to mitigate the risk to their staff and their bottom line through recognising the symptoms, then planning and enforcing a business continuity plan should staff become ill. Plans that companies have in place should include hygiene information, the organisation of ‘flu buddies’, limitations on staff travel and social distancing.

Geoff WhitingGeoff entertained the delegates just before the conference drew to a close. Following on from Charlie Easmon’s presentation on swine flu, he lightened the mood significantly. Chatting about topics as diverse as travel, customer service, football and driving, the audience were soon chuckling along. Despite the fact that audience participation

was definitely not on the cards, Geoff managed to involve several delegates and kept up an amusing patter that brought the event to its conclusion, and got an enthusiastic round of applause from those in attendance.

Kate Carr

Samantha O’Connor

Charlie Easmon

Geoff Whiting

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Registration & conference details www.itic.org.uk/athens

athens

INTERNATIONAL TRAVEL INSURANCE CONFERENCE

athensathens2-5 November 2009

SHERATON HOTEL GRANDE BRETAGNE, GREECE

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International Travel Insurance Journal

28 ITIC REVIEW

Finale DinnerSet in the beautiful Rhodes House, the finale dinner was again voted by all to be a resounding success. The magician kept attendees entertained with some impressive magic tricks, while the band played jazz in the background before and during dinner. Also making the rounds was a caricaturist, who captured the essence of some of the delegates.The attendance at the finale dinner was once again a testament to the popularity of ITIC, and the dancing that followed in the club showed that once again, ITIC delegates know how to enjoy themselves!

Welcome function Baptist Health International

Oxford Maps United Health International

Delegate badges Euro-Center

Conference folders Rowland Brothers

Delegate lists V Creative design

The ITIC organisers would like to thank all the sponsors who helped to make the conference the success it was:

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The rules:

• One vote per category per subscriber to ITIJ

• Votes/nominations must be received by 31st August 2009 to: [email protected]

• Only registered company domain names will be accepted. Hotmail, Yahoo and other Web-based emails will not be accepted

• The fi nalists within each catergory will be contacted on Friday 4th September and provided with the criteria and deadline for submitting their presentation

After the phenomenal success of the Budapest 2008 ITIJ Awards, we are proud to announce that this year’s ceremony will once again provide the industry with an outstanding occasion that celebrates excellence and achievement in the global Travel Insurance industry.

ITIJ is read by the top players in Travel Insurance today and it is this readership that allows us to compile the most comprehensive vote available. Each individual that subscribes to ITIJ will have the opportunity to vote for their top-rated company in each of the nominations categories.

Once all the votes are in, a shortlist of the top three to fi ve companies in each category will be drawn up (based on the number of votes received). Each of these fi nalists will then be asked to create a presentation that will be considered by an independent judging panel, which will decide the ultimate winners on the night.

The fi nalists’ presentations will be screened at the ITIC Gala Dinner awards evening in Athens on Thursday 5th November.

The categories:• Air Ambulance provider of the year• Assistance/Claims Handler of the year• Cost Containment company and

provider of the year (to include PPOs and general services)

• Insurer/Underwriter of the year• Intermediary of the year

(to include all retailers of travel insurance)

• ITIJ marketing campaign of the year(judged independently)

ITIJ AWARDS 2009

ITIJ AWARDS 2009 : : ITIJ AWARDS 2009 : : ITIJ AWARDS 2009 : : ITIJ AWARDS 2009

Visit www.itij.co.uk/awards for more information

ONE READER – ONE VOTE!

AWARDS 2009

2009

2009

Ath

ens

2009

For further information advice contact us at: [email protected] or telephone the conference department on +44 (0)1179 22 6600

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International Travel Insurance Journal

30 FEATURE

In the fast-growing adventure tourism sector, the risk of injury and death is an unfortunate fact of life. Matthew Davies explores the difficulties a UK adventure travel company could face when a participant is injured on an expedition or adventure holiday overseas, and how combined planning by the operator’s insurer and the insured (adventure travel company) could reduce potential future legal complications.

Most liability insurers are familiar with the concept of early intervention or even third party capture as valid claims handling and mitigation processes, but what if the claimant is on the other side of the world? When dealing with an overseas investigation or an overseas coroner’s inquest, operators and insurers who fail to take control of a claim from the outset can damage their prospects of mounting a successful defence. Meanwhile, costs can easily spiral out of control. Imagine the scenario: an incident occurs on an expedition overseas where a British traveller is injured, perhaps fatally. As the tabloid media get wind of the story, the travel operator is vilified and the usual cycle of ‘more must be done to ensure safety in this sector’ begins to do the rounds. The outrage of the injured party or their family is fuelled by the press coverage, and the risk that a claim will follow will be magnified. It is with no little irony that a road traffic accident attracts little media interest, despite the fact that the number of people killed in road traffic collisions worldwide, on a daily basis, equates on average to the equivalent of ten jumbo jets crashing with no survivors. However, as the above example illustrates, public perception can often be based on unsubstantiated facts and wild media reports from unnamed sources that fail to materialise in any official or subsequent investigation. While this is something of an irritant, it has to be taken seriously by operators and insurers. Bad publicity for a tourist destination or operator can cause significant reputational damage for the insured and ultimately, if they fail the adventure travel company’s insurers will not receive premiums from the insured in the future.Early interventionIf an incident involves a fatality, an inquest will follow. In the example above, upon the body landing back in the UK, the UK coroner into whose jurisdiction the deceased arrives, will open and immediately adjourn an inquest. Often, the UK inquest will be postponed until the outcome of the overseas inquest is know. And here’s the catch. Inquests are not always covered by the tour operators policy or if they are, it is sometimes within the insurer’s discretion to fund the inquest if the outcome (whilst technically, the “verdict” at the inquest should not dealing with the issue of Civil liability) may impact on the Civil Proceedings to follow. The UK Coroner is likely to request a full copy of the file of papers of the overseas Coroner once the overseas inquest has concluded, before conducting the UK inquest.The problem for insurers is that if they are not directing the proceedings from the earliest possible moment, ensuring that the adventure travel company insured are legally represented at the overseas inquest, problems may arise, from crucial evidence not being preserved, through to families of the deceased uk citizen being represented at overseas inquests by Counsel and expert witnesses, with the insured operator often unaware of the workings of the process or potential implications arising from the inquest that could impact upon any future civil claim brought by the injured customer or

, in the case of a fatality, by dependents of the estate of the deceased. It is likely it was the local service provider or ground handler that was running the activity at the time of the incident. If that ground handler is unrepresented whilst the family is not, the insured’s position (the insured may not be represented at all) may be damaged, particularly in light of the fact that the Package Travel Regulations 1992 will see a claim being issued against the insured by the family of the deceased or by the injured person.Given the legal time limits for issuing a claim form (three years from the date of incident for an adult and until the age of 21 for a minor), it is often likely that much of the evidence will either have deteriorated (witnesses’ recollections) or that witnesses (particularly given the transient nature of employees in the travel service sector in many countries) will simply be untraceable. Insurers should be notified under the policy as soon as possible after the event – that will be a Condition of the Policy. However, a letter of claim may not follow for many years – rest assured the Claimant will have collated all possible evidence at the earliest possible opportunity and will take all possible advantage in the delay prior to issuing proceedings.Travel insurance cover?The injured party may have their own travel insurance, taken out independently of the adventure travel package and this may have legal expenses insurance cover to fund the injured party in bringing a claim in the UK (pursuant to the terms and conditions of the holiday contract).

Laws of adventure

Of course, the number of incidents in the expedition industry is very small and most of the providers in

this sector operate excellent safety systems

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FEATURE 31

If any subsequent claim were to succeed, then the injured party’s solicitors would, if successful, have their costs, subject to court rules, paid by the adventure travel company’s insurers in addition to the damages (compensation).In terms of the repatriation costs, if the tour operator was at fault and the injured party’s own travel insurance policy covered the costs of the repatriation, then that insurer may seek to recover those costs. Insurers I have spoken to have experience of claims being brought as a separate claim or as a bolt on to the personal injury claim.Taking actionThe adventure company’s insurers may, in many cases, save significant sums by having a procedure in place for cost effectively gathering evidence from overseas jurisdictions at the outset; dispatching investigators and specialist lawyers who understand the intricacies of the process as early as possible. During this period, the relevant ground handlers can be traced, statements obtained and, if possible, indemnities from their insurers. There is nothing more frustrating than facing a claim many years down the line, to find that the insured operator had no indemnity contract in place with their ground handler or that the insured did have such a contract, but did not keep a signed copy and did not secure a copy of the insurance policy required under the contract.

Had this been managed from the outset, even if the ground handler has long ceased trading, any future claim could be directed to the insurer. Fail to do so and the opportunity is lost, for once the ground handler has ceased trading your chances of securing insurers’ details are virtually non-existent. Securing witness evidence early (perhaps by telephone using teams with multi-lingual staff) can pay dividends, as can ensuring that evidence is collated early, supporting the insured at the inquest and allowing an early and definitive denial of liability with such overwhelming evidence to avoid a claim being pursued.Of course, the number of incidents in the expedition industry is very small and most of the providers in this sector operate excellent safety systems and emergency back-up procedures. Indeed, many of them work together to ensure safety standards – organisations such as the Expedition Providers’ Association and The Year Out Group – both of which have their own safety standards. In addition, many of the industry bodies, along with experts in the field and those representing consumers, have come together to develop the new British Standard for safety on overseas expeditions/adventurous activities – BS:8848 (being the height of Everest in metres). This has been developed for adventurous activities abroad with the aim of reducing the risk of injury or illness.

The task for brokers and insurers should be to go that one step further and encourage their clients to seek the knowledge and tools that can help them stay conversant with the risks they face in the adventure travel sector. Many insurers and brokers are now going one step further; encouraging insured’s to attend specialist training courses. In association with a number of specialist brokers and insurers, we run two day training seminars for the travel sector throughout the year, including those specifically tailored to the outdoor and adventure travel sector, covering such issues as company formation, booking terms and condition, advertising, data protection, police response to incidents in the uk and overseas, coroners inquests, indemnity contracts with service providers, Health and Safety Prosecutions, Liability issues in the UK and overseas, concluding in a full mock trial with participants as witnesses. The insurers and brokers involved encourage their insured to attend, to minimise liabilities, ensuring that corporate structure and terms and conditions afford all possible protection to the insured (and thereby insurers). Similarly, the insured understand their potential liabilities and can respond appropriately to investigate when incidents arise. Ideally, insured’s will have indemnity contracts with service providers AND will have a copy of the valid and relevant insurance policy, making redirecting a claim far easier and therefore that any early investigation by insurers is likely to pay dividends and save the insurer money. Several of the insurers are contemplating offering premium discounts to their insureds who attend the future seminars in our programme

(including specialist health and safety courses for companies on the sector such as Off Site Safety Management (Risk assessment, venture planning, legal liabilities, contingency planning, crisis response and management, media response) as well as vehicle safety assessment courses from our specialist Health and Safety Advisers.The old military adage that ‘Proper Prior Planning Prevents Poor Performance’ is as relevant today as it has ever been. Working together from the outset not only protects the insured’s and insurers’ position, it also confirms your sector expertise and client commitment to the insured.

Matthew Davies is a partner in the travel and leisure team of international practice Hill Dickinson LLP. He is a fellow of the Royal Geographical Society and a solicitor advocate (all Higher Courts). Matt heads up the outdoor activity and adventure travel team at Hill Dickinson LLP and is a recognised leader in the field in Chambers and Partners Legal directory. He has dealt with numerous sector cases both within the UK and overseas. He also acts for tour operators and expedition companies providing and delivering legal and crisis response services and safety training for clients as far afield as China. He was a member of the core drafting team for BS:8848 – The new British standard for safety in overseas expeditions.

Insurers I have spoken to have experience of claims being brought as a separate claim or as a bolt on to

the personal injury claim

operators and insurers who fail to take control of a claim from the outset can damage their prospects of

mounting a successful defence

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32 ASSISTANCE&HEALTHCAREWORLDMARKETS

Hungary’s healthcare system has its roots in the old socialist model, but is gradually

privatising certain services. Dr Peter Felkai tells us how to get the best out of the current system

Hungary, a landlocked country in central Europe, has a population of just 10 million people; but it has a rich cultural history and an enticing capital city in Budapest, and as such is a popular travel destination for vacationers to the continent. But do visitors to Hungary know much about the level of medical care available in the country, and how the healthcare system operates? Well, no, because they don’t expect to have to come into contact with the health service whilst on vacation, but it still surprises me that some twenty years ago, when I began to treat foreign tourists in Hungary, almost all US visitors carried a little package of sterile, disposable syringes, as well as some basic antibiotics. I was completely shocked then, because I thought Hungary was famous for its good quality medical care compared to other former socialist countries. But the tourists (probably upon the advice of their home doctor or travel agent) treated Hungary as a developing country. Still recently, however – five years after joining the EU, and one year after becoming part of the Schengen Area – I get questions at international medical congresses, which indicate a continued, general ignorance about medical care in my country, so it is with great pleasure that I take this opportunity to tell you more about the level of care available. With the help of this article, doctors and assistance companies providing pre-travel advice for their customers will be able to see that Hungary is a safe place to send their clients. According to statistical data from 2007, some six to seven per cent of total tourist expenditure was on ‘healthcare, medicine and sport’ (predominantly spa treatments). There are no exact figures for the morbidity rate of foreign tourists to Hungary, but generally some 30 per cent of visitors face some kind of medical issue during their trip, which often involves having to seek medical advice or treatment.

A little bit differentWith the downfall of the socialist regime in 1989, Hungary transformed itself from an ‘unknown, far away land’ into a popular tourist destination. But even under the socialist system, Hungary was a rather well organised country, often dubbed the ‘happiest barrack in the socialist camp’, and its

medical system functioned well. The fall of the ‘Iron Curtain’ and the restoration of democracy made the information gap between East and West regarding medicine disappear altogether, but new ‘curtains’ have arisen, making the management of healthcare for travellers to the country difficult. Besides the language barrier, the healthcare system is different from that in many other countries. These differences are based on the historical circumstances of the past 45 years and can be summarised as follows:

1. Almost all the hospitals in Hungary are state-run (by central or local government), and hence they are run on a not-for-profit basis. They all have a service agreement with the National Health Insurance Fund (HIF), which is a separate administrative organisation under the supervision of the Ministry of Health, Social and Family Affairs, whose main income is from public health insurance contributions. Hungary’s previous healthcare system relied on institutional care, where emphasis was placed on the development of large hospitals (with 1,500 to 2,000 beds) and university clinics. That has changed and there are currently 155 hospitals in Hungary, mostly owned by local governments. The national institutes (for cardiology, oncology, pulmonology, and so forth) and rehabilitation centres belong directly to the Ministry of Health, and the country’s four medical schools between them own five clinics. The hospitals’ operational costs are covered by the HIF. Hospitals widely accept the European Health Insurance Card, which only covers the cost of treatment for conditions needing urgent attention and only where the healthcare provider has a contract with the ministry of health in the patient’s home country.

2. The hierarchic structure of healthcare has meant rigidity in the healthcare system. Until 1992, the Hungarian population could not choose their own doctor and had to go to their local district physician; and if hospital treatment was needed, patients were normally admitted to their district hospital. Today, a hierarchy still remains in place whereby patients needing specialist intervention will need to first visit their GP for a referral to hospital, where in turn they will be referred to a specialist consultant. 3. The majority of Hungarian hospitals do not cover all medical specialties. Municipal hospitals and those in the capital city predominantly offer only basic

services (such as internal, obstetric, basic surgery, and so forth). The larger, county hospitals, however, usually cover the whole spectrum of specialties; although out of almost 600 hospitals across the country, this amounts to only 10 per cent of medical establishments. Either way, those patients needing specific treatment based on their diagnosis can be directed by their GP or the emergency doctor into a clinic with a suitable care structure. That’s why it doesn’t make sense for a foreigner to go directly to the nearest hospital, as in a non-emergency situation, a different clinic may be more suitable. Outpatient clinics are predominantly state-run and offer a wide range of treatments as they are often affiliated with hospitals, but private outpatient clinics are becoming increasingly prevalent, offering mainly gynaecology and dentistry services, but also sometimes lab services, consultations, and sometimes ECG and RTG. If any costly intervention or investigation is needed, private clinics immediately refer their patients into the state system for further treatment. 4. Most hospitals have failed to create emergency wards. Hospital admissions in Hungary are usually made by general practitioners or family doctors –

who establish the initial diagnosis – or by ambulance staff in an emergency. In emergency situations, the ambulance staff will know which hospitals are running emergency wards on that particular day and will be able to take the patient to an appropriate facility. Meanwhile, if a foreign visitor goes to a hospital, in a non-emergency situation, without a medical referral (e.g. signed by a GP) he can expect a long wait in the reception area of what is probably an inappropriate facility. To make the things worse, it is often hard to find a receptionist, or any competent person, who can inform the foreign visitor what to do, or where he should go, as generally hospitals have no reception ‘desk’, just a doctor on duty who would be called upon if the ‘difficult’ situation of a foreign tourist arriving at the hospital arose. 5. According to Hungarian medical regulation it is illegal to release medical information for anybody without the prior consent of the patient, and telephone consultations are strictly prohibited. In any case, the extremely overburdened treating doctor doesn’t generally have time to update insurance company representatives or assistance doctors by telephone. In fact, to reach anybody in the hospital

Hungary for change

repatriating ill travellers from Hungary is difficult. This is, in large part, due to complicated regulations

regarding payments

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ASSISTANCE&HEALTHCAREWORLDMARKETS 33

is a tough business: generally there is no bedside telephone, and the telephone operator in the reception area speaks fluent Hungarian only.

Coming of ageAfter the Second World War, as a result of the Yalta Treaty, Hungary belonged to the Soviet sphere of interest. As with the general state administration, the healthcare system followed the Soviet model. The key ideology was – and remains – that taking care of inhabitants’ healthcare issues are exclusively the task of the state. Then, as now, there was only one social security insurance company, which was run by the state. The negative side of this model was the total control of all healthcare facilities (including dental care, pharmacies, general practitioner’s offices, hospitals, and nursing homes) by the state. The positive side was that all medical treatment was free of charge for all, at any time and at any level. Even the price of medicines was heavily subsidised, and sometimes free for poor people. Obviously, with such a limited budget, the healthcare system could not develop properly, and even everyday healthcare was organised according to the Soviet model, with no private care (except for a few dentists). However, following the privatisation of family doctor services, outpatient services began to be privatised in stages, and doctors were offered the opportunity to purchase specialist consultation rooms under closely specified conditions. Furthermore, under the previous system, hospital budgets were determined by bed occupancy rates. Therefore, there was no incentive to release patients

on a timely basis. But in 1993, new methods of paying health facilities were introduced. Now, for inpatient care, payment is based on the DRG system as in the United States, while a German-style ‘points’ system is used for determining payment for outpatient care based on a fee-for-service schedule. Accordingly, hospitals receive funding from the HIF on the basis of patient volume and types of treatment offered, regardless of the length of time patients stay. Thus, physicians have been encouraged to shorten inpatient stays, which has in turn created a growing need for outpatient and home-care health services. Moreover, the aim for politically induced centralisation yielded striking results both in organisational and in scientific fields of activity, where decentralisation would have only caused parallelisms in patient care or a pseudo-competitiveness at the expense of the sick.So, prior to the political and economic changes in 1989/90, the government managed all aspects of the country’s healthcare sector, but the Local Government Act (1990) transferred responsibility for the ownership, management and provision of health/social services to local governments. Major capital investments are now financed by the owners (local governments in most cases) or co-financed with the Ministry of Health. All recurring expenditures are financed and administered by the HIF. According to a government report prepared in early 2000 for a European Union Commission, the major tasks of the healthcare system for the immediate future are to improve public health, to increase efficiency with regards to the financing healthcare

providers, and to eliminate regional differences in the quality of services. To address these issues, the following measures are expected to be taken over the next few years. First, outpatient services will be privatised in stages. Second, the nature of the HIF financing of healthcare services will be reviewed. Third, the system of co-payment will be extended, increasing the role of households in financing products and services. Each of these measures offers obvious opportunities to healthcare service providers and related industries, including the insurance and assistance industries.In 1992, the Minister of Welfare's Decree created the Family Physician Service. Previously, the system of ‘panel physicians’ required citizens to seek medical treatment only from designated district doctors. Now, individuals have the freedom to choose their own family physician. Family doctors refer patients requiring more sophisticated interventions to hospitals, outpatient clinics and/or diagnostic centres and labs for examinations and testing.Overall, the privatisation of various health services has proceeded most rapidly in the pharmaceutical, dentistry and family physician areas, while private sector development has been faster for ambulatory and diagnostic services, but negligible for outpatient and hospital care – areas where both costs and reimbursement mechanisms have thus far remained largely within the public sector. However, new mechanisms have been established to allow private physicians to act as independent contractors to health agencies, and private companies are now providing many former inpatient services, such as nursing, through home-care services. The production and distribution of health aid products, such as disposables, wheelchairs, crutches and test kits, has also been fully privatised.With therapeutic protocols that are different to those in other countries, insufficient diagnostic facilities, and ongoing language barriers, repatriating ill travellers from Hungary is difficult. This is, in large

part, due to complicated irregularities regarding payments. For example, hospitals are often unable to accept payment if their central office is closed; some hospitals stipulate that all payments must be made in cash; many hospitals offering differing pricing structures have no instructions regarding when to apply either one or the other. Generally, state-run hospitals are poorly prepared for paying customers.Furthermore, as standards of medical facilities are uneven, with ill-defined separation of private and public healthcare facilities, treating foreign patients has become a lucrative business. However, many healthcare providers are eager to engage in the treatment of foreign visitors, with or without a licence, and as such foreign insurance companies often experience difficulties finding reliable medical providers in Hungary.In 2004, Hungary joined the EU, bringing many benefits to the country; but as the Eastern boundary of the EU, Hungary saw the arrival of an ever-larger number of migrants and refuges. This has created many problems for the country’s healthcare infrastructure: while Hungary’s traditional medical care system could hardly provide adequate care to local inhabitants, the system has had to care for an influx of migrants and refugees; and it certainly was not prepared for caring for the many travellers who started visiting the country.

Recent developments The main issue now facing Hungary is whether to create a multi-insurance model by combining the social insurance model with the advanced possibilities of private insurance provision. The maintenance or even potential rebuilding of the old medical facilities will require an enormous quantity of money, especially given the introduction of EU regulations and standards into the country, which have required more investment and have increased running costs; but the question is how to raise these funds. The government proposed sharing such expenses with

new mechanisms have been established to allow private physicians to act as independent contractors to health agencies, and private companies are now providing many former inpatient services through

home-care services

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34 ASSISTANCE&HEALTHCAREWORLDMARKETS

private investors, but a referendum in 2008 refused the multi-insurance model and the privatisation of medical facilities. The Hungarian people, who generally have a low income, are afraid of the potential rise in the cost of their medical treatment that might be caused by profit-oriented medical care.The alternative has been for the government to decrease the cost of the healthcare and especially hospitals’ maintenance costs by centralising medical care. Thus, smaller hospitals have been affiliated into the nearest larger one or closed altogether. Still, there were recently 38 physicians and 80 hospital beds (60 acute beds) per 10,000 people in Hungary. The average for EU countries – where per capita budgets for healthcare are generally three times higher than Hungary’s – are 25 physicians and 70 beds (50 acute) per 10,000. But, as a result of the ongoing reform of Hungary’s healthcare, the number of hospital beds has been reduced by twenty per cent and will be reduced further.This work by the present government has, overall, helped lead to an increase in the quality of care available in Hungary, although hotel functions within public hospitals remain generally poor. Most hospitals try to offer extra beds for ‘VIP’ – or paying – clients, i.e. those who choose to pay out-of-pocket for better or faster treatment, and such facilities are not too expensive (nearly the same price as a bed in a three-star hotel) but ensure a comfortable hotel and catering service besides the high quality medical

care. Newly built hospitals have EU-standard patient rooms, with two beds and an en-suite bathroom. Nevertheless, private entrepreneurs have recognised the huge demand for better conditions and faster access to treatment, and have set up various types of private service, focusing on improving hospital

treating foreign patients has become a lucrative business. However, many healthcare providers are eager to engage in the treatment of foreign visitors,

with or without a licence, and as such foreign insurance companies often experience difficulties

finding reliable medical providers in Hungary

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ASSISTANCE&HEALTHCAREWORLDMARKETS 35

accommodation and the quality of nursing – the more profitable aspects of medical care.Unfortunately, new and non-licensed medical providers have also appeared, and there are not enough officials to eliminate them, as along with the rationalisation of the healthcare administration came a decline in the monitoring and control of medical facilities. Additionally, because providing medical services to foreigners is a lucrative business, there are a huge number of blindfolding tricks directed at tourists and expatriates that are used by unscrupulous medical providers. The first is to use misleading wording, such as ‘private hospital’ to often mean nothing more than a simple nursing home that also offers perhaps a delivery suite and outpatient surgery, but within a luxurious environment and with staff who speak several languages, but which has no blood bank, advanced instruments or proven track record in safe medical treatment. In such facilities, almost all the doctors are part-time employees, who run to the private facility after their office hours in the state-run hospitals, where they have a full-time job. Another misleading term is ‘clinic’, which in Western countries means a medical facility for outpatient services, but until recently in Hungary solely meant a university hospital. Generally, prices are high in private facilities (compared with the services provided) and overcharging is not unheard of in some less scrupulous establishments. There have also been reports of unnecessary testing, investigations and repeat check-ups, and as a local supervisory doctor for many foreign insurance companies I can speak from experience when I say I encounter such situations day after day.

Tools of our timeForeign nationals may stay in Hungary temporarily, or live permanently in the country as an employee, retiree, student, dependent, refugee, asylum seeker or by having admitted status. From the point of view of health insurance, entitlement to healthcare differs by specific

groups of foreigners. Those qualifying as insured must prove entitlement to benefits of the Hungarian health insurance scheme by presenting their certificate of entitlement, or in other cases, in keeping with relevant agreements (e.g. by presenting their passport). As in any country, if your client has medical problem, he should, where possible, call his assistance helpline in the first instance, as the company will surely have a license for referring the patient to hospital, and they probably know the most appropriate hospital facility available in the region. If the client does not require inpatient treatment, outpatient treatment by a local correspondent doctor is more cheaply and more effectively carried out at the patient’s place of residence or accommodation. Moreover, this way the patient needs not face either the language barriers often faced in hospitals, or the long wait time prevalent in the public hospital arena or GP’s office.This said, where hospital treatment is needed, visitors to the country should be encouraged to use state-run facilities, as they provide good and professional care. Emergency services in Hungary are free of charge, and can be summoned by anybody through telephone number 112, where operators speak mostly English but sometimes German.

ITIJ AHWM rATIngHeAlTHCARe COsT HHH

ACCess TO eMeRgenCy CARe HH

OveRAll qUAlITy OF CARe HHH

Please note: These ratings are an overview of what ITIJ believes to be a fair reflection of the general standards in the country, and do not represent any one hospital or service. ITIJ recognises that some individual facilities and services would receive different ratings than others, and to those shown in our chart, should ratings of each be done separately.

ITIJ spoke to Dennis Diokno, managing director of FirstMed, a private clinic in Budapest to find out his views on the progress of the private sector in Hungary. This is what he had to say:

“Having been involved with the start-up and management of American-style clinics in Russia and China, I founded American Clinics International to meet the growing demand for international-standard medical services in central and eastern Europe, opening FirtstMed in 1999. The overwhelming majority of Eastern Bloc countries have extremely inefficient healthcare systems that were formed during the Soviet era. The fall of communism allowed countries to change their medical systems, but unfortunately healthcare was not a priority in most of the former Soviet bloc countries. Hungary is no exception. While Hungarian political parties always talk about the need for change, they never have the political will when elected to make the tough decisions to change the system. Thus, the healthcare system is in rapid decay. Over the last several years, the Hungarian government has closed numerous hospitals and clinics all over the country, and these closures have resulted in the further centralization of important medical services.The decay of the Hungarian medical system does not really affect tourists with basic or even somewhat urgent medical needs as there are private clinics that can provide adequate treatment. In fact, there are six or seven clinics that offer primary and some urgent care treatment in Budapest. As far as I am aware, the only two such clinics that are foreign-owned are FirstMed and Medicover. However, such clinics vary significantly in the level of customer services they can provide, as well as their English language capability. Those tourists or expatriates who are fortunate to find their way to foreign clinics such as the FirstMed Center benefit from a full range of services extending beyond those that can actually be provided on-site. For those cases that the clinic cannot handle, we use our extensive network of providers to coordinate treatment with local facilities. Again, the ability to refer such cases really varies from clinic to clinic.It is important to note that the level of quality and service can very dramatically within Hungarian hospitals, but many of our consultants play significant roles at their respective hospitals and departments. Furthermore, an important factor to consider is a clinic’s overall ability to communicate in the patient’s (and his/her insurance/assistance company’s) language. Additionally, will the facility follow through with additional assistance after a referral?

Finding emergency services or wards is a problem that a tourist or even an assistance company can face. Hungary has a system of rotating emergency medical services. Thus it’s important to either know which hospital is providing emergency services on any given day or to call the EMS dispatcher directly.

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International Travel Insurance Journal

36 PROFILE

Man on a MissionDr Sutuspun Kajornboon, director of Bangkok Hospital Medical Center’s (BMC) Aviation Medicine

Department, spoke to ITIJ about his life and work in medicine and aviation and how his mission to

set up a medevac unit has earned BMC’s HEMS service EURAMI accreditation

Where were you born, where did you study, and where do you live now? I was born in Bangkok, Thailand and attended Elementary School in Bangkok before studying at junior high and high school in Fairfax, Virginia, in the US. I went on to complete a BS at Virginia Polytechnic Institute and State University in the Thailand, and then an MD at Mahidol University, training at Siriraj Hospital Faculty of Medicine. I also completed my post graduate study and obtained a Diploma in Aerospace Medicine at the School of Aerospace Medicine USAF, in San Antonio, Texas, as well as a Diploma in Aviation Medicine in the UK.

How did you come to work in the realm of aviation medicine and in particular your role at BMC? During the last few years of communist insurgency in Thailand, I was working as a young flight surgeon in the Royal Thai Air Force and that was the beginning of my experience in medical evacuation, treating critically wounded soldiers. I was stationed at a fighter air base for the first three years and was fascinated by medicine and aviation. I was later trained as a flight surgeon with USAF. I knew then that the way of life as an aviation medicine doctor was not like your ordinary hospital doctor. It was in 1999, whilst I was working evenings as a part-time GP at the International Medical Service of Bangkok Hospital, when the hospital director offered me a full-time position with the mission of setting up a medevac unit.

How has BMC’s medevac service developed since its instigation and how do you see it develop in the future?Before setting up Bangkok Hospital’s Medevac Service I needed time to increase my overall knowledge of aeromedical transportation. I not only established a medevac unit, but also organised the complete medevac system, including a fit-to-fly evaluation process for patients who would be travelling by air immediately after sickness or surgery, and airman medical examinations. With the help of three other flight surgeons, the Aviation Medicine Department was finally set up in 2006. The medevac unit was initially established as an extension of the regular hospital services, and it remains so today. The difference today is that instead of a team of two crew members, we are a team of 30 flight nurses and specialised physicians, and instead of minimum required training and experience, we now have a fully functional training and education centre, special care equipment and HEMS. Our organisation

has become much more professional. Medevac was not a core service of the hospital, but seeing as the hospital is a super tertiary care hospital, this has proved to be a good idea, especially since most of the patients are usually critically ill or injured in the ICU and cannot be transferred by just a simple ambulance, due to a deteriorating condition or too great a distance.

BMC’s HEMS service received EURAMI accreditation at the end of last year. Why is such accreditation so important? Having a medevac HEMS team set up and having some medical equipment and standardised procedure does not mean that you have a good medevac organisation. I always think in the back of my mind, ‘Are we up to international standard and can we do it better’? Having done several fixed-wing air ambulance cases and commercial flight cases, the HEMS were totally different, and we have done only a small number of civilian cases. My experience in moving patients in helicopters was from the

military, so we decided to follow the guidelines recommended by EURAMI to ensure we had internationally recognised standards. Shane Brooks, our medevac operation manager, was assigned to process the accreditation that kept us on our toes. When we actually received accreditation, I realised that we had become a much more international operation. The Bangkok Hospital Aviation Medicine Department and HEMS service that is now certified by EURAMI may have increased the trust of insurers and clients due to the quality commitment and high safety standards. We understand it can be hard for companies or clients to know they are making the right decision about aeromedical transportation, but choosing a EURAMI-certified air medical service will make the decision easier.

Is BMC’s helicopter utilized by international assistance clients? If so, could you tell us a little more about this? How else is the HEMS service used?Recently we have had a few international assistance customers, and we certainly hope to develop this side of the business further. Our first HEMS case enabled us to learn what we needed to do to improve our clients’ satisfaction. Resultantly, we improved templates for flight missions and improved our written standard operating procedures and manuals, amongst other things; and we now have proper alarm codes, which we can activate and handle in seconds. Since we are the first dedicated HEMS provider in Thailand, even the Thai Civil Aviation Authority uses our knowledge to keep themselves updated on operations.Our helicopter always takes off with two pilots and a team of one doctor and one nurse. It is fully prepared with all the critical care equipment fixed to the wall, such as an oxygen supply ventilator, 12-lead ECG monitor with external defibrillator and pacemaker, infusion and syringe pumps, suction pumps, and BP, pulse, oxygen saturation and capnometer. It is like we are bringing the ICU to the patient. If we know the

diagnosis, for instance myocardial infarction, I would put a cardiologist onboard with an intra-aortic balloon pump to stabilize any unstable cardiac cases. It is like we are taking a specialist and a CCU to the patient. The treatment would be started at origin whether it is a rural hospital or a primary health centre with no cardiologist. Although roadside accident rescue is not possible at this time, it may be in the near future.

What is the nature of wider HEMS services in Thailand today? How many other helicopters operate HEMS services in the country? In Thailand, this type of helicopter service had been limited to the police and military as the internal security laws are very strict. We are working towards overcoming those barriers of understanding, and due to the Thai authority’s compassionate outlook on people who are suffering and its recognition that lives are on the line, they agreed to support our efforts. With their support we were able to cut down the time of response from a seven-day-flight plan to a 15-minute approval.

Did you find the recent ITIC event in Budapest useful and productive from a business perspective? The ITIC was worthwhile from both a business networking and educational perspective. And as a regional medical hub, I think the choice of Thailand for the ITIC Pacific in June 2009 is an excellent one. It will also be a great opportunity to share information about our country’s development and learn new ways to meet the needs of the travel insurance community.

What do you do in your spare time? I love to play golf as it gets me outdoors and lets me enjoy the pretty, natural scenery. I am lucky if I get in two rounds of golf a month. After the hospital, most of my remaining time is spent doing medical consultations for Bangkok Airways, for example assessing fitness-to-fly via MEDIFs. I also take care of the aircrew for Thai Airways International.

What motivates you, and do you have a guiding philosophy? In Buddhism, there are many pathways to end all of your suffering. Making good merit or doing good deeds will put you on the right path toward your goal. So I go on in life trying to help other human beings in every way possible to get these merits. To help another person who is suffering from an illness/accident, or to be part of the process of getting them to proper treatment, not only brings me merit but also provides me with the satisfaction of a successful medevac mission or repatriation. The smiling, happy and appreciative faces of the patients who have been through such traumatic events are worth more than any monetary gratification.

My experience in moving patients in helicopters was from the military, so we decided to follow the

guidelines recommended by eURAMI to ensure we had internationally recognised standards.

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37IPMI NEWS

Worries over critical illnessA recent survey by HSBC Insurance has found that more people in Hong Kong are worried about falling ill than they are about job security and investment losses, despite the economic gloom that is pervasive in many markets around the world. The survey showed that 59 per cent of people in the region are most concerned about getting cancer or some other type of critical illness, while 38 per cent are most concerned about their jobs, 21 per cent about investment woes and 19 per cent say they are most concerned about accumulating sufficient income for retirement.Managing director of Insurance Business for Hong Kong at HSBC Jason Sadler commented on the survey’s results: “Hong Kong people are clearly concerned about loss of health and the devastating impact a major illness can have on them. What used to be people’s worst case scenarios – critical illness, losing a job and a lack of a financial safety net – are increasingly becoming a reality for many Hong Kong people … forcing them to recognise the importance of planning for life’s unthinkable events.”When asked what action they had taken to mitigate such worries, respondents to the survey showed a penchant for insurance. Sixty-seven per cent said they had purchased a life insurance policy, 64 per cent had bought medical or critical illness cover, while 39 per cent had saved more in the bank. Sadler added: “This new focus on protection, which had been derailed by recent years’ market exuberance, is important not only as a short-term response to the current crisis, but as part of a long-term financial planning strategy.”

Struggling US hospitals focus on international patientsAmerican hospitals have taken a tough knock in recent times. Jose Quesada sees inbound medical tourism as one way for American hospitals to make money again

The current economic crisis is affecting US hospitals on many different fronts, from a reduction in patient volumes to an increase in bad debt producing a negative effect on financial results. Last year, according to Moody’s Investors Service, not-for-profit hospitals received 27 credit upgrades versus 53 credit downgrades; this is the largest number of downgrades since 2001. The rise in unemployment has worsened an already delicate situation regarding uninsured patients; from December 2008 to March 2009, more than 2.7 million people lost their jobs bringing the total number of job losses to 5.3 million in the last twelve months. Resultantly, it is estimated that the number of uninsured has increased by 3.7 million in the last year alone, surpassing more than 50 million or 16.7 per cent of the total US population. Uninsured patients delay elective medical care therefore misusing emergency rooms, which are costlier to operate. In addition, these patients are unable to pay for care or are covered by Medicaid or other public programs designed for low income populations, increasing the financial burden on hospitals. A survey conducted in March 2009 by the American Hospital Association reported that 58 per cent of hospitals have seen an increase in emergency department visits; it also reported a 70-per-cent rise in uncompensated care as a percentage of total gross revenues. Thus, during the calendar year 2009, US hospitals will have lower revenues due to a shift from private payers to Medicaid for elective admissions and procedures and higher bad debt expense as a result of increased uncompensated and charity care.

Tapping potentialInbound medical tourism, and the treatment of foreign tourists, accounts for approximately $5 billion dollars or 400,000 patients a year in the US, according to the Deloitte Center for Health Solutions. This represents an opportunity for US hospitals to diversify revenue; usually hospitals with dedicated international centres generate five to 10 per cent of total revenue from international patients, who come mainly from Latin America, the Caribbean, Europe and the Middle East. Some are cash paying patients, usually wealthy people travelling to US looking for high-tech care, but patients with international insurance products represent the largest inbound group. The policies held by this sector generally cover most of the medical care they receive except for normal copayments

and deductibles. In addition, hospitals benefit financially because reimbursement rates from these commercial payers are usually higher than from government-sponsored plans.For many years, the US has been a leading destination for medical tourism, with hospitals and physicians alike perceived worldwide to provide outstanding medical care with state-of-the-art technology. Regardless of stringent travel requirements in recent years, patients continue to travel from all over the world looking for the best care at top hospitals for complex medical conditions such as cancer, trauma, diabetes and cardiovascular problems. This trend will continue in the future; it might slow down under the current economic climate, but it will definitely gain strength again once growth recovers.International patients require a portfolio of logistic services while travelling abroad for medical care. Hospitals must have well-trained personnel to assist with visas, hotels, transportation and translation services. They should also provide timely access to physicians during scheduling appointments and procedures. Similar services need to be provided for travellers on vacation or business who get injured or sick and require emergency medical services.US hospitals are well positioned to manage complex chronic medical conditions while providing excellent customer service; their international departments play a critical role in coordinating concierge, medical and financial services for these patients. International insurance products to access US healthcare providers are becoming an important feature for global insurers, with companies such as BUPA offering such a product in several countries. Furthermore, strategic relationships with international insurance companies, third party administrators and cost containment companies will boost revenues and contribute positively to the bottom line of US hospitals.

AAR teams with InterGlobalInterGlobal Insurance Company has teamed up with Uganda-based African Air Rescue to offer people in the region international health insurance. Mark Ochola, general manager for AAR, noted: “The Health Platinum Plan targets locals, expatriates and will be extended to the whole of the East African region.” The scheme will be administered by InterGlobal, and will allow members to visit any public or private hospital in the region and receive medical care without paying any fees upfront. Ochola also noted that the scheme would offer cover for a wide range of both in- and out-patient procedures, including chronic medical conditions and terminal illness benefits, depending on the type of plan chosen.

Indian insurers ask for uniform chargesThe Business Standard of India has reported that the country’s General Insurance Council (GIC), which represents non-life insurers, has asked that the Insurance Regulatory and Development Authority (IRDA) regulate hospital charges. The newspaper reported that Mr G. Srinivasan, chairman and managing director of United India Insurance and member of the GIC, feels that price regulation of hospitals is necessary due to an absence of uniformity, which has meant the health portfolios of general insurance companies are suffering. IRDA has recently been investigating the performance and role of third-party administrators (TPAs) in the Indian health insurance sector, with a report on the issue due out soon. Industry experts have said that the expectation is regulation of TPAs as well.

In related news, The Economic Times has reported that the health insurance industry increased in capacity by around 30 per cent year-on-year, thanks to a heightened awareness of such products among the population and steadily increasing healthcare costs. Hopes for the future of the sector remain high, with Antony Jacob, chief executive of Apollo DKV, saying that he predicts the business will grow by between 30 and 40 per cent over the course of the next financial year. Despite the increased awareness among the Indian population about health insurance products, penetration remains very

low at just two per cent, so opportunities still abound for the sector.

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International Travel Insurance Journal

IPMI NEWS38

One of Asia’s largest private healthcare companies, Parkway Health, has recently unveiled a series of fi xed-price, all-in-one healthcare packages that cover various surgical procedures. The announcement was

made at the organisation’s Gleneagles Hospital in Singapore, which is one of the hospitals where clients can take advantage of the new packages on offer.According to Dr Lim Cheok Peng, executive vice-chairman, managing director, group president and CEO of Parkway Holdings, there are now more than 25 fi xed-price packages on offer to provide patients

with 100-per-cent certainty that their hospital bill will be what they expect (barring complications). The price guarantee can be used only at those Parkway hospitals that have received accreditation from Joint

Commission International – East Shore Hospital, Gleneagles Hospital and Mount Elizabeth Hospital, all of which are in Singapore. The packages offer cover for areas such as cardiology, ENT surgery, gastroenterology, obstetrics and gynaecology.Dr Lim explained: “The 34 new healthcare packages are arguably the most inclusive and comprehensive to be offered to date by a healthcare provider. These fi xed-price packages include all costs relating to inpatient

care, such as hospitalisation, nursing care, facility charges and doctors’ fees.” He went on to say that the packages have been developed in response to the global recession: “These are tough times. We hope that with these all-in-one packages, both local and foreign patients will be encouraged not to delay or put off much needed surgery.”

MedSave USAKaren Ann Bagni – Director of Operations & Customer Relations

390 Rabro Drive, Hauppage, NY 11788, USA

tel: fax:

+ 1 631 780 5006+ 1 516 622 1742

email: website:

[email protected]. medsaveusa.com

Star HealthcareGigi Galen – President

850 7th Avenue, Suite 803, New York, 10019, USA

tel: fax:

+ 1 212 581 8228+ 1 212 581 8272

email: website:

[email protected]

Alliance International Medical ServicesBernadette Bretton – Managing Director

Private Bag X5, Benmore Gardens, 2010, Johannesburg, SOUTH AFRICA

tel: fax:

+ 27 11 245 5777+ 27 11 783 9277

email: website:

[email protected]

Interhealth TechnologiesKevin Thomas – Director - International

P O Box 3058, Bedfordview, 2008, SOUTH AFRICA

tel: fax:

+ 27 11 622 8010+ 27 11 622 8264

email: website:

[email protected]

Dr. Colin Plotkin ConsultingDr Colin Plotkin – Managing Director

27-3088 Francis Road, Richmond, British Columbia, V7C 5V9, CANADA

tel: fax:

+ 1 604 241 9677+ 1 604 241 0733

email: website:

[email protected]

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ENT Expatriate Healthcare

Lee Gerry – Healthcare Manager

46-48 East Smithfield, London E1W 1AW, UNITED KINGDOM

tel: fax:

+44 (0)870 428 5140+44 (0)870 428 5141

email: website:

[email protected]

Baptist Health InternationalYohandra Fuentes – Finance Manager

Suite 601-E, 8940 North Kendall Drive, Miami, FL 33176, USA

tel: fax:

+ 1 786 596 2373+ 1 786 596 5979

email: website:

[email protected]/international

Jackson Memorial Hospital InternationalMario Mendez – MD - EVP/Managing DirectorJackson Medical Towers, East Tower, Suite 829,1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA24hr tel:

tel: + 1 305 355 1212+ 1 305 355 5544

email: website:

[email protected]

University of Miami Health SystemJose Quesada – Director of Finance & Operations

1099 N.W. 14th Street, Miami, Florida 33136, USA

tel: fax:

+ 1 305 243 9100+ 1 305 243 9101

email: website: www.uhealthinternational.com

IPMI SERVICE DIRECTORY

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CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICESAIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINEAIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDERAIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENINGASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCECATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTSCOST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES

Direct fl ights could increase patient numbers

Opportunity knocks in AustraliaA golden opportunity seems to be arising for providers of international private medical insurance (IPMI), as expatriates in Australia are hit hard by increases to their ordinary private medical insurance premiums. Around 6,000 Britons reside in Australia, all of whom are required, as part of the conditions of their residency, not to become a burden on the state, meaning PMI is obligatory. However, thanks to swift rises in the price of cover, it is believed that some expatriates are being forced to return to their countries of origin.Most expats present in Australia have a 410 visa, which allows the holder to own property, travel freely in and out of Australia and work for a maximum of 20 hours per week. Such visas are also known as temporary residence permits, but many people with this type of visa only hold it because they could not meet the requirements of the permanent residency visa, which requires that 50 per cent of a couple’s children must settle in Australia. According to the vice-president of the British Expat Retirees in Australia (Beria) group, this is a sticking point as those on 410 visas pay much higher premiums for their health insurance than a permanent resident. John Wittering told a national newspaper: “We feel as if we’re aliens in limbo. The only health insurance we’re eligible for is visitors’ cover, which is almost twice as expensive as residents’ cover.”Further complicating the issue is the fact that

residents’ healthcare premiums are controlled by the government, but visitors’ premiums are not. Unhappy with the current arrangement, Beria is to petition the government, asking it to give long-term 410 visa holders permanent residential status.

Parkway Health launches all-in-one care South Korea seizes opportunityThe Korean Tourism Organisation and Council for Korean Medicine Overseas Promotion have together recently launched a trial tour for cosmetic surgery travellers from China through six Chinese travel agencies, and have also recently sent a delegation to Tokyo in order to promote the country as a destination for Japanese medical travellers. In order to facilitate the country’s plans to offer healthcare to 50,000 foreigners in 2009, 44 major hospitals, including Seoul National University Hospital, Samsung Medical Centre, Asian Medical Centre and Yonsei Severance Hospital, have all agreed they will reserve fi ve per cent of their bed allocation for foreign patients.Previously, hospitals and clinics in South Korea have been banned from directly advertising their services to potential patients, but following a change in the law on 1 May, many state-licensed facilities are seeking to augment their revenues through attracting more patients from foreign climes, in particular from China, Japan, Russia and Mongolia. Last year, fi gures showed that some 34 per cent of foreign patients treated in South Korea came from the US, but it is hoped that an agreement with a large airline company, Asiana Airlines, will bring more customers from in and around Asia.The moves and plans for the promotion of South Korean medical tourism have their detractors, with some in the industry pointing out that there are still many obstacles to overcome before the project is deemed a success – not least of which is the language barrier, as few medical staff speak fl uent English.

Following the launch of a daily fl ight between Texas and Qatar, Texas Medical Center (TMC) has said it is expecting even more patients from the Middle East nation to seek treatment in the US. The fi rst fl ight took place on 30 March and carried two patients to America for medical care, with another patient fl own out the following day.Akbar al-Baker, CEO of Qatar Airways, noted that a

number of Qataris have already undergone treatment in the US, a fact confi rmed by an offi cial from the Medical Center. Rosanna Moreno, TMC international affairs advisory council chair, added: “TMC caters annually to over 14,000 international patients, predominantly from the Gulf. We have [now] started receiving patients from Qatar.”

Gleneagles Hospital

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39IPMI NEWS

Patent filed to fuse tourism and insuranceMRI Limited, a knowledge process outsourcing company, has recently branched out into the fields of medical tourism and insurance. The firm has filed a patent with the US Patent & Trademark Office (USPTO) for technology that enables the integration of a health insurance policy includes cover for medical tourism, which has been dubbed Offsurance.Offsurance, says the company, incorporates a novel method of underwriting and implementing low premium health insurance policies. According to the firm’s CEO, Dr Fazal Raheman, Offsurance is a ‘path-breaking technology that can potentially reduce the US healthcare expense by over 50 per cent’. He added: “There is absolutely no intellectual property precedence in this exponentially growing segment of insurance.” Regarding the predicted timeline for the new product, Raheman said: “Because Offsurance is the first and only pending patent, we target the grant of the patent within the next six to nine months under the USPTO’s new accelerated examination programme. With the speed with which we have developed the technology, we are quite confident of achieving our targets, not only of the timely grant of the US patent, but closing strategic alliance deals with corporate partners and investors for the product launch.”The aim of the product is to offer benefits to members of typical US health insurance plans that do not offer out-of-country care through reduced premiums – they would pay a low premium rate for the insurance, which would then cover them for both elective and essential surgery abroad. For foreign speciality hospitals, the benefits would be the provision of a steady stream of patients and guaranteed fees. However, MRI Limited must find potential investors and corporate partners with whom they can develop the project, before the predicted October 2009 launch date.Offsurance is a joint venture between UK-based MRI Limited and MRI FZE, a technology development and consulting firm based in Dubai.

Singapore doctor search site launchedThe Singapore Tourism Board (STB), in collaboration with MedicaView International, Inc., has announced the launch of a new website offering information on Singapore as a destination for medical tourism travellers. Aimed in particular at American medical tourists, the site offers users a streamlined process to help them find, compare and choose medical providers in Singapore. John Linss, president and CEO of MedicaView International, said the number of US citizens expressing interest in medical care abroad is steadily increasing, but it is still hard for them to find all the information they require in one place.The site offers users a simple form to select doctors or hospitals in Singapore, based on the medical procedure required. Also available is information on accreditation of the facility and doctors’ credentials, along with the option of requesting a price estimate. In addition, the site offers a continuity of care programme that offers links between doctors in the US and doctors in Singapore to provide for electronic medical records to be accessible to both. Travel insurance that includes cover for surgical complications and the flights over to Singapore can also all be organised through the same website.

Military fails to ask for reimbursementThe US Pentagon is failing to bill American International Group (AIG) for the medical care it is providing to private contract workers in Iraq and Afghanistan.There are hundreds of thousands of civilians present in the war zones, and when they are injured on the job, the medical care they receive should be paid for by insurers as part of the insurance purchased by the government for workers employed by private contract companies. However, an audit by the Pentagon’s inspector general has concluded that the military is failing to demand fair compensation from AIG, CNA and others for the care it is giving to private individuals, rather than the soldiers they are supposed to treat. In one example cited by the report, it is said that at Bagram Air Base in Afghanistan, one third of people who were given treatment by army medical personnel

were civilian contractors, creating a burden for staff that should be treating wounded soldiers.Following the publication of the report, US Senator Bernard Sanders has called on Senator Edward Kennedy, chairman of the Senate Committee on Health, Education, Labour and Pensions, to look at ‘the very costly and damaging problems that have resulted from the inadequate oversight of billions of dollars’ that has been paid to AIG and other insurers over the years for medical cover for civilian contractors. It was discovered in 2008 that the insurance companies involved charged the US government $1.5 billion in premiums and paid out $900 million in costs. A subsequent investigation by the Los Angeles Times, ABC News and ProPublica found that insurers responsible for such cover routinely denied claims from injured

civilian contractors, resulting in delays of treatment.The US Department of Defense is clear in its statement that defence contractors should ‘ensure’ that the government is reimbursed for any medical care that is given to contract workers in war zones. However, the report from the inspector general found that there is no one agency responsible for carrying out enforcement of the policy and, as a result, the Pentagon is paying twice for the medical care of such personnel – once through the insurance premiums and again as it fails to bill the insurers for provision of care. Due to a lack of record keeping, the report has stated it is impossible to know the true cost the situation has caused to the government, but it was noted that since the start of the wars, more than 31,000 private contractors have filed injury claims.

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40 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Air Ambulance InternationalMr Peter Veazey – CEO

P.O. Box 1044, Magnolia. Texas 77353, USA

tel: fax:

+1 832 934 2390+1 832 934 2395

email: website:

[email protected]

Air Ambulance NetworkKirk Pacheco – President

905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA

24hr tel: fax:

+ 1 727 934 3999+ 1 727 937 0276

email: website:

[email protected]

Air Ambulance Worldwide Inc.Mark Jones – President

35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA

tel: fax:

+1 727 781 1198+1 727 786 0897

email: website:

[email protected]

AMREF Flying Doctor ServiceDr Bettina Vadera – Medical Director

Wilson Airport, LangataRoad, PO Box 18617, Nairobi, KENYA

tel: fax:

+254 20 600 090+254 20 344 170

email: website:

[email protected] www.amref.org

European Air AmbulancePatrick Schomaker – Director Sales & Marketing

175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: fax:

+49 711 7007 7007+49 711 7007 7009

email: website:

[email protected]

JET ICUMike Honeycutt – Vice President

17076 Helicopter Drive, Brooksville, FL 34604, USA

tel: fax:

+1 352 796 2540+1 352 796 2549

email: website:

[email protected]

Netcare 911 AeromedicalWayne Thomson – Flight Operations Manager

Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA

tel: fax:

+27 10 209 8387+27 10 209 8405

email: website:

[email protected]

Skyservice Air AmbulanceDavid Ewing – VP International Market DevelopmentYUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, CANADA

tel: fax:

+1 514 497 7000+1 514 636 0096

email: website:

[email protected]/airambulance

Air Ambulance InternationalMr Peter Veazey – CEO

P.O. Box 1044, Magnolia. Texas 77353, USA

tel: fax:

+1 832 934 2390+1 832 934 2395

email: website:

[email protected]

Air Ambulance NetworkKirk Pacheco – President

905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA

24hr tel: fax:

+ 1 727 934 3999+ 1 727 937 0276

email: website:

[email protected]

Air Ambulance Worldwide Inc.Mark Jones – President

35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA

tel: fax:

+1 727 781 1198+1 727 786 0897

email: website:

[email protected]

CareFlight InternationalColin Robshaw – Co-ordinator

Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA

tel: fax:

+61 1300 655 855+61 2 4751 2995

email: website:

[email protected]

European Air AmbulancePatrick Schomaker – Director Sales & Marketing

175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: fax:

+49 711 7007 7007+49 711 7007 7009

email: website:

[email protected]

Goodmans Rescue 24 Hrs Ground & Air AmbulancesDr Satish K Bhardwaj – Director

M-2 Greater Kailash-Part 1, New Delhi 110048, INDIA

tel: fax:

+91 11 2923 1665+91 11 2923 4665

email: website:

[email protected]

Hope Ambulance ServiceDr Charles Johnson – Medical Director

56 Upavon Road, Singapore 507745, SINGAPORE

tel: fax:

+65 6100 1911+65 6400 5254

email: website:

[email protected]

JET ICUMike Honeycutt – Vice President

17076 Helicopter Drive, Brooksville, FL 34604, USA

tel: fax:

+1 352 796 2540+1 352 796 2549

email: website:

[email protected]

Medical WingsDr Sommart Somsiri – Medical Director222 Room 3259, Donmuang Int Airport Moo 10, Viphavadee-Rangsit Rd, Sikan, Don Muang, Bangkok 10210, THAILAND

tel: fax:

+662 247 3392+662 535 4355

email: website:

[email protected]

MediflightChris Craft – Operations Manager

Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, AUSTRALIA

tel: fax:

+61 8 8378 6938+61 8 8423 3077

email: website:

[email protected]

OzevacAnne Mordey – Operations Manager

PO Box 299, Hampton, Victoria 3188, AUSTRALIA

tel: fax:

+61 409 537 333 email: website:

[email protected]

Skyservice Air AmbulanceDavid Ewing – VP International Market DevelopmentYUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, CANADA

tel: fax:

+1 514 497 7000+1 514 636 0096

email: website:

[email protected]/airambulance

South Pacific Air AmbulanceScotty Watson – Managing Director

NEW ZEALAND AUSTRALIA SINGAPORE

tel: fax:

+64 9256 9000+64 9256 9111

email: website:

[email protected]

ADAC-Ambulance ServiceRobert Glueck – Marketing & Sales Director

Am Westpark 8, 81373 Munich, GERMANY

tel: 24h Alarm:

+49 89 76 76 52 85+49 89 76 76 50 05

email: website:

[email protected]/ambulance

(EU

RO

PE)

(AU

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LAS

IA)

AIR

AM

BU

LAN

CE

(AFR

ICA

)

AIR

AM

BU

LAN

CE

( AU

ST

RA

LAS

IA)

CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES

AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE

AIR AMBULANCE INTERIOR

COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER

AIRCRAFT PERFORMANCE SOLUTION

CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING

ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE

CATASTROPHIC CLAIMS SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS

COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES

Page 41: Insurance gamble doesn’t payInsurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody,

41SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected]

JET ICUMike Honeycutt – Vice President

17076 Helicopter Drive, Brooksville, FL 34604, USA

tel: fax:

+1 352 796 2540+1 352 796 2549

email: website:

[email protected]

Mayoral Executive JetPaulo Vassar – Commercial Director

Dominguez Toledo S.A., 118 La Orotava, Malaga 29006, SPAIN

tel: fax:

+34 952 048 609+34 924 048 612

email: website:

[email protected]

Med Call GmbHMichael Diefenbach – CEO

Black and Decker Str. 1-3, 65510, Idstein, GERMANY

tel: fax:

+49 61 2695 3708-0+49 61 2695 3708-11

email: website:

[email protected]

Medic’Air InternationalDr Herve Raffin – General Manager

35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE

tel: fax:

+33 141 72 1414+33 148 57 1010

email: website:

[email protected]

Skyservice Air AmbulanceDavid Ewing – VP International Market DevelopmentYUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, CANADA

tel: fax:

+1 514 497 7000+1 514 636 0096

email: website:

[email protected]/airambulance

Swiss Air Ambulance / REGAWalter Stunzi – PR / Marketing Manager

PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND

tel: fax:

+41 333 333 333+41 44 654 3590

email: website:

[email protected]

Air Ambulance InternationalMr Peter Veazey – CEO

P.O. Box 1044, Magnolia. Texas 77353, USA

tel: fax:

+1 832 934 2390+1 832 934 2395

email: website:

[email protected]

Air Ambulance NetworkKirk Pacheco – President

905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA

24hr tel: fax:

+ 1 727 934 3999+ 1 727 937 0276

email: website:

[email protected]

Air Ambulance Worldwide Inc.Mark Jones – President

35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA

tel: fax:

+1 727 781 1198+1 727 786 0897

email: website:

[email protected]

Air Medical LtdGlenn Salt – Flight Operations Manager

Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK

tel: tel:

+44 1865 842 887+44 1865 370 642

email: website:

[email protected]

AirMed International LLCJeffrey T Tolbert – President

1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA

tel: fax:

+1 205 443 4840+1 205 443 4841

email: website:

[email protected]

Augsburg Air AmbulanceRoland Schoberth – Director

Roseggerstr 17, D-86368, Gersthofen, GERMANY

tel: tel:

+49 821 299 1020+49 821 299 2030

email: website:

[email protected]

Euro-flite Air AmbulanceJuhani Missonen – Coordinator

Helsinki International Airport, PO Box 187, FIN-01531, Vantaa, FINLAND

tel: fax:

+358 20510 1900+358 20510 1901

email: website:

[email protected]

European Air AmbulancePatrick Schomaker – Director Sales & Marketing

175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: fax:

+49 711 7007 7007+49 711 7007 7009

email: website:

[email protected]

FAI – rent-a-jet AGVolker Lemke – Director Sales & Marketing

Flughafenstrasse 100, D-90268 Nuremberg, GERMANY

tel: fax:

+49 911 36009 31+49 911 36009 59

email: website:

[email protected]

German Red Cross Air Ambulance ServiceAndreas Speich – Managing Director

Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY

tel: fax:

+49 228 2300 23+49 228 2300 27

email: website:

[email protected]

IFRADr Christian Steindl – Director

Bahnhofplatz 13/5, POB 160, 3500 Krems, AUSTRIA

tel: fax:

+43 2732 825 610+43 2732 851 01

email: website:

[email protected]

Jet Executive International CharterGünter Krahé – Marketing & SalesMündelheimer Weg 50, D-40472, Düsseldorf, GERMANY“Homebase FRA & MUC”

tel: fax:

+49 211 602 7775+49 211 602 77766

email: website:

[email protected]

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Page 42: Insurance gamble doesn’t payInsurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody,

42 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Tyrol Air AmbulanceJakob Ringler – Managing Director

PO Box 81, A-6026, Innsbruck Airport, AUSTRIA

tel: fax:

+43 512 224 220+43 512 288 888

email: website:

[email protected]

Advanced Paramedic Stephen J Woodburn – CEOHangar #18 - Peace River Airport, P.O. Box 7320, Peace River,Alberta T8S 1S9, USA

tel: fax:

+ 1 780 624-4911+ 1 780 624-4577

email: website:

[email protected]

AerojetStuart Hayman – President

4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA

tel: fax:

+1 954 730 9300+1 954 485 6564

email: website:

[email protected]

Air Ambulance InternationalMr Peter Veazey – CEO

P.O. Box 1044, Magnolia. Texas 77353, USA

tel: fax:

+1 832 934 2390+1 832 934 2395

email: website:

[email protected]

Air Ambulance NetworkKirk Pacheco – President

905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA

24hr tel: fax:

+ 1 727 934 3999+ 1 727 937 0276

email: website:

[email protected]

Air Ambulance Professionals, Inc.Brian L. Weisz – PresidentFt. Lauderdale Executive Airport, 1535 South Perimeter Rd, Hangar 36B Ft. Lauderdale, Florida 33309, USA

tel: fax:

+1 954 491 0555+1 954 491 6114

email: website:

[email protected]

Air Ambulance Worldwide Inc.Mark Jones – President

35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA

tel: fax:

+1 727 781 1198+1 727 786 0897

email: website:

[email protected]

AirMed International LLCJeffrey T Tolbert – President

1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA

tel: fax:

+1 205 443 4840+1 205 443 4841

email: website:

[email protected]

European Air AmbulancePatrick Schomaker – Director Sales & Marketing

175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: fax:

+49 711 7007 7007+49 711 7007 7009

email: website:

[email protected]

JET ICUMike Honeycutt – Vice President

17076 Helicopter Drive, Brooksville, FL 34604, USA

tel: fax:

+1 352 796 2540+1 352 796 2549

email: website:

[email protected]

Life Flight International Inc.Chris Connor – OperationsVictoria International Airport, Shell Aero Center, 104-1962 Canso Road, North Saanich, British Columbia V8L 5VF, CANADA

tel: fax:

+1 250 655 1630+1 250 656 9394

email: website:

[email protected]

Skyservice Air AmbulanceDavid Ewing – VP International Market DevelopmentYUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, CANADA

tel: fax:

+1 514 497 7000+1 514 636 0096

email: website:

[email protected]/airambulance

AIMSBernadette Breton – Managing Director

Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA

tel: fax:

+27 11 245 5777+27 11 783 9277

email: website:

[email protected]

AMREF Flying Doctor ServiceDr Bettina Vadera – Medical Director

Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: fax:

+254 20 600 090+254 20 344 170

email: website:

[email protected]

Interhealth TechnologiesKevin Thomas – Director - International

P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: fax:

+27 11 622 8010+27 11 622 8264

email: website:

[email protected]

Netcare 911 International AssistanceBrenda Durow – International Assistance Manager

Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA

tel: fax:

+27 10 209 8387+27 10 209 8405

email: website:

[email protected]

West African Rescue AssociationFlorian Zagel – Managing Director

Klotey Cresent 6, North Labone, Accra, GHANA

tel: fax:

+233 244 312 496/7+233 21 781 259

email: website:

[email protected]

Asia Medical Assistance IndiaAbhijeet Sachdev – Group VP

DLF City-ll, M.G Road, New Delhi, Gurgaon 122002, INDIA

tel: fax:

+91 9899 198 198+91 2440 147 28

email: website:

[email protected]

Asia Medical Assistance NepalBikash Gurung – General Manager

35 Pyukha Marg, PO Box 156, Katmandu, NEPAL

tel: fax:

+977 980 366 4163+911 244 014 728

email: website:

[email protected]

Asia Medical Assistance ThailandJane Bailey – CEO50 Soi Sukhumvit, 19 Sukhumvit Road, Klongtoey Nau, Wattana, Bangkok 10110, THAILAND

tel: fax:

+91 9899 198 198+66 225 822 77

email: website:

[email protected]

Assistance OnlineBertrand Guichoux – CEO

Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA

tel: fax:

+86 21 6104 9500+86 21 6104 9484

email: website:

bertrand-guichoux@assistance-online.com.cnwww.assistanceonline-china.com

Customer Care Pty LtdJanine Benson – Operations Manager

Level 3, 60 Miller Street, North Sydney 2060, NSW, AUSTRALIA

tel: fax:

+612 9202 8222+612 9202 8220

email: website:

[email protected]

Global Assistance & HealthcareMario Babin – Chief Executive Officer

Jalan Pattimura, 15 Kebayoran Baru, Jakaita, 12110, INDONESIA

tel: fax:

+62 21 725 8115+62 21 725 7961

email: website:

[email protected]

South Pacific Air AmbulanceScotty Watson – Managing Director

NEW ZEALAND AUSTRALIA SINGAPORE

tel: fax:

+64 9256 9000+64 9256 9111

email: website:

[email protected]

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Page 43: Insurance gamble doesn’t payInsurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody,

43SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected]

ADAC-Ambulance ServiceRobert Glueck – Marketing & Sales Director

Am Westpark 8, 81373 Munich, GERMANY

tel: 24h Alarm:

+49 89 76 76 52 85+49 89 76 76 50 05

email: website:

[email protected]/ambulance

ARC Europe SAHans Biekmann – Network Director

Avenue des Olympiades 2, 1140 Brussels, BELGIUM

tel: fax:

+32 2 706 6660+32 2 706 6601

email: website:

[email protected]

Assistance PlusLiana Absaliamova – General Manager

6th Floor, 19 Zhukov Proezd, Moscow 115054, RUSSIA

tel: fax:

+7 495 748 8735+7 495 748 8741

email: website:

[email protected]

CNASCarole Luisy – Managing Director

80 rue des alliés, 38100, Grenoble, FRANCE

tel: fax:

+33 438 49 83 49+33 438 49 83 40

email: website:

[email protected]

Global Voyager AssistanceCostas Danilenko – CEO

PO Box II, 125124 Moscow, RUSSIA

tel: fax:

+7 495 775 0999+7 495 775 0998

email: website:

[email protected]

Global Excel ManagementMichael Drew – Vice-President Sales73 Queen Street, Sherbrooke, QC J1M 0C9, CANADA17548 Deer Isle Circle, Winter Garden, FL 34787 USA

tel: fax:

+1 866 566 1130+1 819 566 8335

email: website:

[email protected]

Medex Assistance CorporationLinda McGee – SVP of Sales

8501 LaSalle Road, Suite 200, Baltimore, MD 21286, USA

tel: fax:

+1 410 453 6300+1 410 453 6301

email: website:

[email protected]

On Call InternationalMichael J. Kelly – President & CEO

One Delaware Drive, Salem, NH 03079, USA

tel: fax:

+ 888 289 0567+1 603 328 1770

email: website:

[email protected]

OneWorld AssistTaka Katsube – Director Assistance & Cost Managment

10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA

tel: fax:

+1 604 303 2113+1 604 276 4593

email: website:

[email protected]

SelectCare WorldwideJacques LeTual – Director of Business Development

#1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: toll free:

+1 416 340 7265+1 866 261 6718

email: website:

jacques.letual@selectcareworldwide.comwww.selectcareworldwide.com

Cardinal AssistanceAlberto C. Chapur – PresidentAv. Cordoba 890 7° piso, (C 1054AAU) Capital Federal, Buenos Aires, ARGENTINA

tel: fax:

+54 11 4129 7514+54 11 4328 3822

email: website:

[email protected]. cardinalassistance.com

med con team GmbHMichael Weinlich – Managing Director

Gerhard-Kindler-Str.8, 72770 Reutlingen, GERMANY

tel: fax:

+49 7121 433 660+49 7121 433 619

email: website:

[email protected]

Save Assistance FranceFranck Molinier – Director of Business Development

19 rue de Provence, 78310 Maurepas, FRANCE

tel: 24 tel:

+33 13062 6752+33 13062 1122

email: website:

[email protected]

SOS InternationalHelle Drager Sandahl – Communications & Marketing Manager

Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: fax:

+45 7010 5055+45 7010 5056

email: website:

[email protected]

ASISTUREmilio Guevara – Managing Director

Prado 208, e/ Colon y Trocadero, Habana Vieja, Ciudad Habana 10100, CUBA

tel: fax:

+537 8664499+537 8668087

email: website:

[email protected]

CONNEX Assistance Middle East Lara Helmi – International Network Director

Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE

tel: fax:

+97 14 257 82 84+97 14 257 82 85

email: website:

[email protected]

Goral AssistanceMarcel Kadoche – International Network & Development Manager

Corex House, P.O. Box: 12815, Herzeliya Pituah 46733, ISRAEL

tel: fax:

+972 9 957 9930+972 9 957 9931

email: website:

[email protected]

Dr Colin Plotkin ConsultingDr Colin Plotkin – Managing Director

27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: fax:

+1 604 241 9677+1 604 241 0733

email: website:

[email protected]

To have your company listed in our service directory

contact the sales department now:

[email protected] or telephone: +44 (0)117 922 66 00

AIMSBernadette Breton – Managing Director

Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA

tel: fax:

+27 11 245 5777+27 11 783 9277

email: website:

[email protected]

Interhealth TechnologiesKevin Thomas – Director - International

P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: fax:

+27 11 622 8010+27 11 622 8264

email: website:

[email protected]

ChargeCare InternationalChristiane Burniston – Managing Director

Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

tel: fax:

+44 1865 400 007+44 845 003 9923

email: website:

[email protected]

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CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES

AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE

AIR AMBULANCE INTERIOR

COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER

AIRCRAFT PERFORMANCE SOLUTION

CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING

ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE

CATASTROPHIC CLAIMS SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS

COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES

CA

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Page 44: Insurance gamble doesn’t payInsurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody,

44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Medical Claims International SpainFatima Guillen Grande – Managing Director

C/Ciudad de Aguilas No.2, Local 2A, Madrid 28030, SPAIN

tel: fax:

00 34 913 016 14500 34 913 016 160

email: website:

[email protected]

Capone & Associates, IncVirginia S. Capone – President

100 Springhouse Drive, Suite 103, Collegeville, PA 19426, USA

tel: fax:

+1.610.831.5580+1.610.831.5581

email: website:

[email protected]

Global Excel ManagementMichael Drew – Vice-President Sales73 Queen St, Sherbrooke, QC J1M 0C9, CANADA17548 Deer Isle Circle, Winter Gdn, FL 34787 USA

tel: fax:

+1 866 566 1130+1 819 566 8335

email: website:

[email protected]

Global Medical ManagementRaija Itzchaki – COO

7901 SW 36th Street, Suite 100, Davie, FL 33328, USA

tel: fax:

+1 954 370 6404+1 954 370 8613

email: website:

[email protected]

Medsave USAKaren Ann Bagni – Director of Operations & Customer Relations

390 Rabro Drive, Hauppauge, NY 11788, USA

tel: fax:

+1 631 780 5006+1 516 622 1742

email: website:

[email protected]

OneWorld AssistTaka Katsube – Director Assistance & Cost Managment

10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA

tel: fax:

+1 604 303 2113+1 604 276 4593

email: website:

[email protected]

SelectCare WorldwideJacques LeTual – Director of Business Development

#1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: toll free:

+1 416 340 7265+1 866 261 6718

email: website:

jacques.letual@selectcareworldwide.comwww.selectcareworldwide.com

Star HealthcareGigi Galen – President

850 7th Avenue, Suite 803, New York, 10019, USA

tel: fax:

+ 1 212 581 8228+ 1 212 581 8272

email: website:

[email protected]

United Health InternationalPhilip Brun – Director of Business Development

15500 New Barn Road, Suite 200, Miami Lakes, FL 33014, USA

tel: fax:

+1 305 594 9291 Ext.3312+1 305 594 9201

email: website:

[email protected]

Global Assistance & HealthcareNathan Hannah – TPA Manager Asia / Pacific

Jalan Pattimura, 15 Kebayoran Baru, Jakaita, 12110, INDONESIA

tel: fax:

+62 21 725 8115+62 21 725 8951

email: website:

[email protected]

Global Excel ManagementMichael Drew – Vice President of Sales73 Queen St, Sherbrooke, QC J1M 0C9, CANADA17548 Deer Isle Circle, Winter Gdn, FL 34787 USA

tel: fax:

+1 866 566 1130+1 819 566 8335

email: website:

[email protected]

Interhealth TechnologiesKevin Thomas – Director - International

P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: fax:

+27 11 622 8010+27 11 622 8264

email: website:

[email protected]

SelectCare WorldwideJacques LeTual – Director of Business Development

#1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: toll free:

+1 416 340 7265+1 866 261 6718

email: website:

jacques.letual@selectcareworldwide.comwww.selectcareworldwide.com

Star HealthcareGigi Galen – President

850 7th Avenue, Suite 803, New York, 10019, USA

tel: fax:

+ 1 212 581 8228+ 1 212 581 8272

email: website:

[email protected]

Medsave USAKaren Ann Bagni – Director of Operations & Customer Relations

390 Rabro Drive, Hauppauge, NY 11788, USA

tel: fax:

+1 631 780 5006+1 516 622 1742

email: website:

[email protected]

To have your company listed in our service directory

contact the sales department now:

[email protected] or telephone: +44 (0)117 922 66 00

MedEscort InternationalCraig Poliner – President

1730 Vultee Street, Allentown, PA 18103, USA

US tel: fax:

+1 610 791 3111+1 610 791 9189

email: website:

[email protected] www.medescort.com

Voyageur Aeromedical TravelMarc Lucas – General Manager

Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: fax:

+44 (0)117 927 3554+44 (0)117 925 5940

email: website:

[email protected]

Lufthansa Medical ServicesDoris Ehring – Manager Sales & MarketingLufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, Frankfurt/Main, GERMANY

tel: fax:

+49 (0)69690-20904+49 (0)69690-58147

email: website:

[email protected]

ADACChristoph Ullrich – Director of Purchase / International Network

Am West Park 8, 81373 Munich, GERMANY

tel: 24hr Alm:

+49 89 7676 2912+49 89 7676 5005

email: website:

[email protected]/ambulance

Funeral Home AURIGA Ltd.Helen Pradova – Chief of International Department

B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC

tel: fax:

+420 724 257 899+420 416 735 800

email: website:

[email protected]

Funeralcare InternationalRoger Waddington

221 Upper Richmond Road, Putney, London SW15 6SQ, UK

tel: fax:

+44 20 8788 5303+44 20 8788 2525

email: website:

funeralcare.international@letsco-operate.comwww.co-operativefuneralcare.co.uk

Global Networks Funeral AssistanceCristina Almudi – Managing Director

23 Blindmans Lane, Cheshunt, Hertfordshire EN8 9DR, UK

tel: fax:

+44 1992 640 066+44 1992 785 030

email: website:

[email protected]

John Allison Monkhouse Co., Ltd (Thailand)Apple Kaewprasert – General ManagerPresident Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton Klongtoey, Bangkok, THAILAND

tel: fax:

+66 2382 5345-7+66 81 584 5942

email: website:

[email protected]

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45SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected]

AMREF Flying Doctor ServiceDr Bettina Vadera – Medical Director

Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: fax:

+254 20 600 090+254 20 344 170

email: website:

[email protected]

Voyageur Aeromedical TravelMarc Lucas – General Manager

Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: fax:

+44 (0)117 927 3554+44 (0)117 925 5940

email: website:

[email protected]

Air Ambulance NetworkKirk Pacheco – President

905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA

24hr tel: fax:

+ 1 727 934 3999+ 1 727 937 0276

email: website:

[email protected]

Air Ambulance Worldwide Inc.Mark Jones – President

35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA

tel: fax:

+1 727 781 1198+1 727 786 0897

email: website:

[email protected]

Life Flight International Inc.Chris Connor – OperationsVictoria International Airport, Viscount Business Center, 103-9800 McDonald Park Road, Sidney, British Columbia, CANADA

tel: fax:

+1 250 655 1630+1 250 656 9394

email: website:

[email protected]

MedEscort InternationalCraig Poliner – President

1730 Vultee Street, Allentown, PA 18103, USA

tel: fax:

+1 610 791 3111+1 610 791 9189

email: website:

[email protected] www.medescort.com

AMREF Flying Doctor ServiceDr Bettina Vadera – Medical Director

Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: fax:

+254 20 600 090+254 20 344 170

email: website:

[email protected]

Travel ScreenSandra Howell – General Manager

The Seedbed Centre, Vanguard Way, Shoeburyness, Essex SS3 9QY, UK

tel: fax:

+44 1702 587 007+44 1702 584 731

email: website:

[email protected]

Voyageur Aeromedical TravelMarc Lucas – General Manager

Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: fax:

+44 (0)117 927 3554+44 (0)117 925 5940

email: website:

[email protected]

V Creative DesignSteve Annette – New Media Director

Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: fax:

+44 (0)117 929 4636+44 (0)117 925 2040

email: website:

[email protected]

KCH Repatriation SpecialistsEmerson De Luca – General Manager

83 Westbourne Grove, Bayswater, London W2 4UL, UK

tel: fax:

+44 20 7313 6920+44 20 7313 6999

email: website:

[email protected]. kchrepatriation.com

Rowland Brothers InternationalMelanie Walkling – Partner

299-305 Whitehorse Road, West Croydon, Surrey CR0 2HR, UK

tel: fax:

+44 20 8684 2324+44 20 8684 8000

email: website:

info@rowlandbrothersinternational.co.ukwww.rowlandbrothersinternational.co.uk

ServilusaVanda Castro – Manager International DepartmentAgencias Funerarias SA, International Dept. Rua do Entreposto Industrial, 8-2 Esq, 2610-135 Amadora, PORTUGAL

tel: fax:

+35 121 470 6300+35 121 470 6499

email: website:

[email protected]

Xanit Hospital de BenalmadenaDr. Juan Bosco Rodriguez Hurtado – Director

Camino de Gilabert s/n, Benalmadena, 29630 Malaga, SPAIN

tel: fax:

+34 952 367 190+34 952 367 191

email: website:

[email protected]

Baptist Health Int. Center of MiamiYohandra Fuentes – Finance Manager

8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA

tel: fax:

+1 786 596 2373+1 786 596 5979

email: website:

[email protected]/international

Integrated Healthcare ServicesBrenda Escobar - Int. Services Manager

450 E. Las Olas Blvd., Ft. Lauderdale, Fl 33301, USA

tel: tel:

+ 1 305 222 6750+ 1 305 222 6751

email: website:

[email protected]

Jackson Memorial Hospital InternationalMario Mendez – MD - EVP/Managing DirectorJackson Medical Towers, East Tower, Suite 829,1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA24hr tel:

tel: + 1 305 355 1212+ 1 305 355 5544

email: website:

[email protected]

University of Miami Health SystemJose Quesada M.D., M.B.A. – Director Finance & Operations

1099 N.W. 14th Street, Miami, Florida 33136, USA

tel: fax:

+1 305 243 9100+1 305 243 9101

email: website:

[email protected]

CareFlight InternationalSue Robshaw – Co-ordinator

Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA

tel: fax:

+61 1300 655 855+61 2 4751 2995

email: website:

[email protected]

Medical WingsDr Sommart Somsiri – Medical Director222 Room 3259, Bangkok Int Airport, Viphavadee-Rangsit Rd, Sikan, Don Muang, Bangkok 10210, THAILAND

tel: fax:

+662 247 3392+662 535 4355

email: website:

[email protected]

Medic’Air International 每递安国际Dr Huaqun Gao – Medical Director

885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA

tel: fax:

+86 2163 558289+86 2163 558285

email: website:

[email protected]

MediflightChris Craft – Operations Manager

Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, AUSTRALIA

tel: fax:

+61 8 8378 6938+61 8 8423 3077

email: website:

[email protected]

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CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES

AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE

AIR AMBULANCE INTERIOR

COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER

AIRCRAFT PERFORMANCE SOLUTION

CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING

ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE

CATASTROPHIC CLAIMS SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS

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International Travel Insurance Journal

46 REGULARS

The Claimers illustrated by Chris Duggan, story by Ian Cameron © Voyageur Publishing & Events Ltd

DIARY DATES16-18 June

International Travel Insurance ConferenceMandarin Oriental Bangkok, Thailand

1-4 JulyGlobal Risk ConferenceCardiff University, UK

7-9 JulyNational Conference of Insurance LegislatorsPhiladelphia, Pennsylvania, US

16-18 JulyIndependent Insurance Agents ConferenceWisconsin, US

22-23 July3rd Asian Conference on MicroinsuranceChina

11-13 AugustVermont Captive Insurance Association MeetingBurlington, VA, US

29 August-1 SeptemberChartered Property Casualty Underwriters Society MeetingSt Johns, Newfoundland, Canada

13-16 SeptemberCanadian Risk and Insurance Management SocietySt Johns, Newfoundland, Canada

13-16 SeptemberInternational Union of Marine Insurance conferenceBruges, Belgium

14-16 SeptemberArgus de l’AssuranceCannes, France

20-23 SeptemberSociety of Insurance ResearchOrlando, Florida, US

20-23 SeptemberNational Association of Mutual Insurance Companies ConventionAtlanta, Georgia, US

Grapevine• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE

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GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE

TV tips help backpackersThree Brits who were backpacking across Malaysia had a close call recently, when they become lost in the jungle with only memories of a far-distant television show to help them find their way out. Chiara Maddocks, her brother Rory, and Rachel Hodson, said they relied on memories of an episode of Ray Mears’ Survival Guide about how to follow a watercourse downstream to find a way out of the jungle and towards the coastline.The tourists, wearing only shorts and flip flops, were visiting the island of Langkawi when the incident occurred. Having followed a steep trail uphill for several hours, they turned back, but found the descent too difficult and abandoned the guide rope in the search for a better way down. As night fell, the three adventurers took shelter in a clearing they found using the lights from their digital cameras. Chiara said: “It was terrifying, we had no food or water and knew we couldn’t survive for long. We hadn’t told anyone we were going on the trail, so no one was searching for us. But Rory remembered watching a Ray Mears programme about surviving in the wilderness. That was the turning point that led us to safety.”When morning came, they followed the course of a stream in the hope they would be led to the coast. After trekking all day and navigating a 50-foot waterfall they finally reached a beach. They then thought they spotted masts in the water and started to swim towards them (Mears did not advise this course of action!), but in fact found the ‘masts’ were fishing markers. The two girls ended up clinging onto rocks in the bay, while the young man climbed up on a rock and passed out. They were all later rescued by a fisherman.

Canadian province borrows UK beachIn its latest bid to attract more tourists to the region, Alberta, a land-locked Canadian province,

has used an advertisement that shows a beautiful beach – the problem is that the beach in question is really in the north of England. A promotional video for the province, made by PR firm Calder

Bateman, shows a clip of a boy and girl running through sand dunes and tall grass on Bamburgh beach, Northumberland.The anomaly was spotted by a Canadian boat enthusiast who saw the video on the Internet and liked the look of the coastline

enough to attempt to pinpoint its exact location. Following numerous emails to tourism officials in Canada, he was told that the beach he wanted was not as accessible as he first thought.Sheelagh Caygill, marketing executive for Northumberland Tourism, said: “We think it’s quite funny, a landlocked province in Canada presenting an image of itself as an island. But Northumberland Tourism is really thrilled that a picture of a beach in our area is being used for the Alberta campaign.”Olga Guthrie, manager of the brand initiative for Alberta’s public affairs bureau, said: “This [image of the beach] represents Albertans’ concern for the future of the world. There is no attempt to make people think that the place pictured is actually Alberta.”

Naked ramblers bannedNude tourists have been banned from entering the small Swiss canton of Appenzell Inner Rhodes after residents voted overwhelmingly to impose the ban, with a fine of £120 for those who choose to ignore it. The local government recommended the ban after people objected to encountering hikers wearing nothing but their socks and boots, which was unacceptable, according to a statement: “The reactions of the population have shown that such appearances over a large area are perceived as thoroughly disturbing and irritating.” A similar move is expected in the neighbouring canton of Appenzell Outer Rhodes.German websites that promote nude hiking describe the activity as ‘a special experience of nature, free and healthy’ – not so free if they get caught in Appenzell.

Dear Editor,With reference to your feature in the last issue (ITIJ 100), I agree that the past decade has seen dramatic changes to our sector and undoubtedly standards across the marketplace have improved. In the UK, both internally and externally, General Insurance Standards Council self regulation and then Financial Services Authority statutory regulation have pushed us all to focus on customer outcomes where previously the market was perhaps guided by the fact that only four per cent of customers ‘use’ the product each year. However, whilst acknowledging these positives, I am guarded towards the future because of a potentially damaging skills gap in terms of talented travel insurance professionals coming through the ranks – most worryingly at the insurer level.For as long as I can remember, the UK travel insurance market has been driven by a number of notable insurer figures capable of knowledgeable, stimulating debate on the full gambit of industry topics and related disciplines. I am unsure that the next 10 years will benefit from the same level of professional expertise cajoling, agitating and provoking the market stakeholders into more innovative, effective solutions. Many modern insurers now compartmentalise the underwriting role into all sorts of professional sub-sets. Pricing, finance, IT, claims and the dreaded compliance all get their say in the underwriting life cycle and a by product of this, in my opinion, has been some chaotic processes and unfortunately the erosion of the co-ordinated skill set of the specialist class underwriter. This is of course only an opinion, and a greatly simplified one at that. There remain some very effective travel underwriters out there, writing very successfully but as I look around there are certainly far fewer of them and those that remain seem limited by colleagues with a fraction of their skill. Everyday my life is punctuated by poor customer outcomes caused by non-underwriters underwriting – normally with the expert looking on shaking their head in disbelief. Over the next decade, we must guard against the demise of this wonderful, rare underwriting creature as they are the second most important element of our market ecosystem … second only to that magnificent beast, the broker!Yours sincerely,Phil Denman Managing Director – Healix Insurance Services Ltd

Dear Mr Denman,Thank you for your letter and your observations. Here’s to keeping up standards in the industry.Sarah WatsonEditor ITIJ

Letter to the editor

Page 47: Insurance gamble doesn’t payInsurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody,

47ONTHEMOVE

www.itij.co.uk

Groupama appoints key account manager The UK’s Groupama Insurances has chosen Louise Welsh as key account manager for the North East region. This further boost to Groupama’s frontline account management team will see Louise managing relationships with the company’s brokers from Sheffield up to the south of Scotland.Louise joins Groupama from RSA – Global Division, where she was responsible for developing a panel of brokers in Manchester and Glasgow. She commented: “This appointment will allow me to use my knowledge, skills and expertise to the full to maximise business opportunities and build upon the strong relationships Groupama has already formed with partner brokers in the North East.” She added: “Groupama’s steadfast focus on the broker and intermediary market was critical to my decision to take this role.”Anne Harrison, regional business development manager for Groupama said: “We are delighted that Louise has joined our team … 2009 is going to be a challenging year for brokers but the local expertise offered by key account managers like Louise is designed to provide the support they need – right on their doorstep.”

JLT expands UK teamUK-based JLT Benefit Solutions Ltd (JLT) has doubled its investment team with a number of key appointments, following the company’s continued success in investment. Consultants Vanessa Wakefield of Mercer and Nnamdi Odozi of KPMG are two of the names to have joined JLT in its Leeds and London offices.Steve Barker, head of investment, employee benefits at JLT, said: “In the current economic climate, clients are very focused on making the right investment decisions. Whether they are changing a scheme or reviewing their benefits, understanding investment decisions and their repercussions is a key part of the process. These new appointments demonstrate our continued success in investment, both working solely on investment advice to clients or as part of larger JLT teams working across employee benefits requirements.”Elsewhere, the company has appointed James Lewis as a senior sales consultant working across JLT’s administration services in London. A former client services director for Aon Consulting, James looks forward to driving this area of business forward, and noted: “JLT already has a well established position in administration [and] whilst 2009 may be a challenging year for clients, this will only serve to highlight the importance of working with the right administration provider and … will emphasise JLT’s ability and expertise.”Malcolm Reynolds, commercial director at JLT, concluded: “I am really pleased to welcome James to the team. He is a key appointment that will cement our position in this market.”

Apollo introduces FrancisApollo Medical Holdings has announced the introduction of Kyle W. D. Francis as its new executive vice president of business development and strategy. Francis has over 10 years experience in the financial and transactional sectors and served for nine years as member of the Healthcare Services Investment Banking Division of Oppenheimer & Co. and CIBC World Markets. Warren Hosseinion, chief executive officer of Apollo Medical Holdings, commented on Francis’s appointment: “Kyle has a long and distinguished track record in structuring successful ventures as well as successfully directing mergers and acquisitions in the healthcare services industry,” adding “I am delighted to add this world-class talent to the senior management team.”

Vanbreda appoints new head of relationsVanbreda International has appointed Joris Smets as the new head of its Provider Relations Department, where he will be responsible for managing, improving and extending the company’s network of in-and-outpatient healthcare providers. Smets will continue to raise the company’s awareness with in-network and out-of-network

providers, while also focusing on optimising its own network by adapting it to the needs of various clients. Prior to this new position, Smets acted as account manager of ExpatPlus, where he was in charge of sales and distribution.

De Luca chosen by KenyonKenyon Repatriation Ltd has announced the appointment of Emerson De Luca as general manager; he has been with the company for over four years working on corporate development and social responsibility projects, finance and also assisting with repatriations worldwide, including being involved in the Spanish air disaster of August 2008. Emerson has a Masters in Globalisation, has a managing and counselling background, and speaks five languages. He has travelled to most parts of the world on behalf of the company, giving the firm the confidence to assure its clients that the service it is offering is of the highest standard. Chairman Dr Barry Albin Dyer has said he is pleased to welcome Emerson to head the team and looks forward to challenging new projects that will take the company forward in 2009.

JCI names Middle East MDJoint Commission International (JCI) has named Dr Asharf Ismail as managing director of its Middle East office in Dubai, United Arab Emirates. The founder of the Egyptian Society for Quality in Healthcare brings with him a wealth of experience in hospital accreditation, healthcare quality management, performance improvement and development of human resources, and Karen Timmons, president of JCI, is ‘pleased to have him’ as the leader of the company’s Middle East operations. She said: “Dr Ismail’s experience and relationships with key healthcare leaders in the Middle East will strengthen our existing alliances, offer opportunities for new partnerships and help bring a foundation for improvements in quality and patient safety.”Dr Ismail has previously served as a consultant on JCI accreditation preparation and in this new post he will represent JCI in the Middle East and India, providing expert counsel on performance improvement, patient safety and JCI accreditation for a variety of healthcare organisations.

Addition to FirstAssist’s travel team

New CEO for Travel GuardAIU Holdings’ Travel Guard unit has named Dean Silvey as its new president and chief executive officer. Silvey succeeds the company’s founder John Noel, and joins from Orbitz where he was senior vice president and chief operating officer for its business and alliance marketing sector. John Doyle, president of AIU’s property casualty group, believes that Silvey’s extensive travel and technology experience, combined with various senior management positions within Atlas Travel Technologies, Rosenbluth International, Neon Systems and VerticalNet Inc., will take the organisation to ‘new heights’. Silvey commented: “This is an opportunity for me to join a company that has established an outstanding reputation in the travel industry … I look forward to working with Travel Guard’s first-class management team.”

Promotion at Penningtons Penningtons Solicitors has announced that Mark Lee, specialist in international travel litigation, has been promoted to partner after joining the company last October as head of its travel group. Mr Lee, who is a member of the Travel and Tourism Lawyers Association, the Association of Personal Injury Lawyers, the British Spanish Lawyers Association and the Pan European Organisation of Personal Injury Lawyers, has represented clients on cases in over 30 jurisdictions worldwide, advises tour operators on their terms/conditions and potential liability to consumers, and assists travel insurance policyholders in a defendant capacity when required.Pennington’s chief executive, David Raine, commented on the appointment: “It further strengthens [the firm’s] travel team and confirms our commitment to extending the range of services that we offer to clients in this field.”

FirstAssist has announced the appointment of Darren Jennings to its travel management team. Jennings joins the company as its new travel portfolio manager, and is to work alongside the head of travel sales and strategy to continue the company’s growing portfolio. He will also be responsible for product management

and development. Jennings’ 15 years as a specialist broker, including positions at Aon, Primary Group and Acumus, has helped cement his place at FirstAssist. Managing director Alistair Hardie believes the new appointment will ‘further strengthen’ the company’s position in the travel sector.

Louise Welsh

Joris Smets

Mark Lee

Page 48: Insurance gamble doesn’t payInsurance gamble doesn’t pay Holiday activity trends call for insurance checks Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody,