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Evolution of the Global Health Care Management Model
The Goal: High Quality CareWorldwide, integrated health care delivery system providing the highest quality of care available in any given locale and bringing together worldwide best practices.
Networks a mile wide and a few facilities deep: care in countries where no networks or pre-arranged payment systems exist and Medical CPI (200 Countries)
Widen the Circle of Care: Post treatment coordination and recuperative care
Managing dynamic change in global healthcare, IEAP, dental, and disability
Local insurance requirements to support VISA concerns and Healthcare Reform
Corporate Global Wellness Initiatives
Expatriate population continues to age and get more diverse
Number of employees = 500 employees vs. 50 expat employees
Location of employees = 50 miles from store vs. World Wide (30 different countries)
Number of Hospital = 5 to 10 local Hospitals vs. 1,000+ Possible Hospitals
Number of Providers = 200 in-network/500 out vs. 100,000 Worldwide Providers
Location of Dependents =For locals, most families live together vs. internationally, many spouses may not live in same location, and students tend to go to colleges in different countries
Type of care available = For locals, care is similar across providers vs. internationally, care can be very advanced to primitive
Currency = US dollars only vs. any currency available
State compliance = 3 or 4 US states vs. 200 different countries
ID Card = 1-800 number vs. Global Call Collect
Claim Adjudication = Auto adjudication vs. Direct Pay or Pay and Claim
Difficult administrative issues– “Hardware” and “Software” match– Paying for emergency care in countries where no
networks or pre-arranged payment systems exist– Local insurance requirements to support VISA
concerns– Payment using any type of currency available
Multitudes of clinical protocols and dangers:– Post treatment coordination and recuperative care– Avoid counterfeit prescription medications– Dealing with local traditional non-medical treatments– Medical evacuation protocols, post treatment options– Unscreened blood supplies
fund to pay claims for Medicare eligible Australians
– Having private health insurance with an AUS registered health fund allows Australia taxpayers to claim exemption from 1% Medicare Levy Surcharge, if eligible
– Minimum benefits are required to allow for 457 Visa Letters to be issued for non-Australians working in Australia
Middle East
Saudi Arabia• Coverage has to be provided by
a locally-admitted carrier• Minimum coverage requirements
(CCHI)United Arab Emirates
• Coverage has to be provided by a locally-admitted carrier
• Plans must be filed with local authorities (HAAD)
No discrimination in favor of highly compensated individuals. Dependent age rises to 26 years Minimum loss ratio requirements (80%/85%) Broker commission in/out of the program? Is the individual mandate legal or not? 2018: Introduction to high value plans ($11,200/$27,500) What waivers will be granted? What state requirements? Will insurers withdraw from markets? Will Americans be allowed on “offshore” plans after 2014?
Global Plan Options: Post Healthcare Reform (PPACA)
It appears that domestically sitused expatriate plans will be subject to some of the new law provisions.
– leave US citizens on a US PPACA compliant plan but cover the TCN/KLNs under a separate “offshore” policy, again assuming the US employer has a place of business in a location where a local policy can be legally issued;
OR– create a sub-group under the US policy made up of only TCNs and KLNs
with cover that differs from the PPACA compliant cover provided to the other group on the principles that (a) these groups could be grandfathered (if renewing), and (b) presumably the PPACA was not intended to require certain types of cover for non US citizens based outside the United States and thus a client is willing to assume the risk that it is unlikely that the government would pursue non-PPACA-compliant levels of cover for non-citizens residing outside the United States.
– Don’t forget other issues like Massachusetts Credible Coverage Minimums
Access to internationally-recognized experts for confirmation of life-threatening/life-altering diagnoses and treatment recommendations, without requiring the expat to travel or incur out-of-pocket expenses.
Look for:
• Utilization of a specific world-class vendor (recognized expertise)
• Intended for use for serious illness, complex cases
• Provision of more treatment options beyond what’s available locally
• Receive world-class opinions without the cost/disruption of traveling
Wellness Program: Health Assessment Collects individuals’ health information by asking a series of questions: Personalized health risk report to make changes to unhealthy lifestyle
habits:– Behavior modification to instill healthy habits before condition
appears– Self-directed, online programs available in many languages and
culturally adapted– Targets four key areas of modifiable health risks:
Prepare for “Black Swan” Events (ICE Strategy) Gap Analysis between Healthcare Provider, Workers
Compensation Provider, Evacuation Vendor Harmonize Medical Evacuation and Security Evacuation Review Legal Requirements at Local and Global Country Level Have Global Dental and EAP Providers More Local Options Before Evacuation Screen Chronic Conditions Before Deployment Have Regional Options in Place Understand Healthcare Reform Initiatives by Country Offer Wellness and Pre-Departure Tools Consider Segmented Expatriate and Third Country National
Plans Recognize Corporate Duty of Care Requirements
“Sometimes I'm confused by what I think is really obvious. But what I think is really obvious obviously isn't obvious...” Michael Stipe, Lead Singer REM
Are global health plan higher or lower than domestic? Are there any downsides to putting in a plan? How is eligibility handled? Can you do VISA letters to help with immigration requirements? What reporting in offered? Are there countries where the program does not work? Should we purchase war risk or terrorism coverage? Discuss employer contribution strategies for expats, TCNs and Key Locals? How do you do implementation meetings? How does healthcare reform(s) affect our global benefit levels? How should we handle short term assignments? How does HR and Risk Management manage multiple vendors? Does the evacuation, healthcare or workers compensation vendor take the
lead on medical emergencies? What do you think about multinational pooling?
CIGNA International Expatriate Benefits – A Market Leader in Global Healthcare
What we offer…
►Global access to quality health care coupled with integrated products and very personalized service
Our products…
►Medical, dental, vision, behavioral, pharmacy, life insurance, personal accident, disability, business travel and wellness programs
►Leverage CIGNA HealthCare’s capabilities, where applicable
►Focus on consumer through global access to quality health care and personalized service
►Multi-lingual customer service representatives, 24/7/365►Global networks with Direct-to-provider payment system
with more than 150 countries
How we distribute…
►Primarily through benefits brokers and consultants to multinational organizations with employees serving on long- and short-term international assignments
Leadership Statistics
►30+ years of experience
►49% of Fortune 100 companies are customers
►4.8 million policyholders worldwide
►Actively selling in 27 countries and jurisdictions with service capabilities in virtually any country
►A global workforce of 4,000 experienced professionals