Ian Youngman from IMTJ continues his review of the use and availability of specialist travel insurance for medical tourism. Globally only a handful of agencies and insurers have introduced specialist medical travel insurance covers, and in the last five years, of those that launched, less than one in three have survived.
There has not been a rush by the insurance industry to offer cover for specialist medical travel; the industry is concerned about what they see as high risk and adverse selection.
Lack of demand
A more pressing problem is that agents, travel agents, hospitals and consumers are reluctant to pay a price that is or is expected to be substantially more than a normal travel policy. Even in developed countries where travel insurance has been around for decades, as many as one in three people still travel abroad without any travel insurance. In many less developed countries, travel insurance may not even be available, or only bought by a small minority of travellers.
Medical malpractice and negligence
An overseas medical practitioner and the health facility may be legally responsible if medical negligence can be demonstrated. Medical malpractice suits can cost time and money to pursue. Hospitals wheel out specialist lawyers, experts, and doctors to seek to prove that there was no malpractice, and any applicant’s life gets put under microscopic investigation.
To pursue a claim for medical negligence, a departure from the accepted standards for procedures in the country in which the surgery was carried out must be demonstrated. So not only must the legal claim be brought using the local legal system, but the claim must be established according to local medical standards of practice and local laws – not the standards in the country the medical tourist comes from. Some legal systems permit waivers to exclude claims for negligence. As a result, claims for medical negligence face poor prospects of success, and are likely to succeed only in cases where the negligence is obvious and it is possible to retain a good local lawyer with language skills.
For cosmetic surgery, it is difficult to prove medical negligence for various reasons. As a result, the patient will usually need to meet the cost of reconstructive cosmetic surgery from their own pocket.
Even if medical negligence is demonstrated, recovery can be an expensive and uncertain process. Medical indemnity insurance is not compulsory in many countries, and even if it exists, may be limited in amount, or exclude foreign tourists.
Medical complications insurance
Not every operation or process succeeds. There can be many reasons for this, of which malpractice is only one. So insurance for medical complications is a good idea. Medical complications insurance provides some cover if the treatment has to be remedied or corrected. Medical complications insurance is not medical negligence insurance, and does not enable patients to sue hospitals, doctors or agencies.
Providers of medical travel insurance schemes
I can only find three live active schemes around the world.
Custom Assurance
Custom Assurance Placements, a US broker, offers Global Protective Solutions, underwritten at Lloyd’s of London. In addition to the regular travel accident exposure, the benefits have been enhanced to include complications that occur outside the home country and for up to 6 months after the initial procedure once returned home. It includes complication coverage for death, disability, additional costs of travel, family coordination, and residence modification. It is offered on an individual or group basis and for anybody traveling from almost anywhere.
Seven Corners
This US broker offers specialist travel insurance for medical tourists going from almost anywhere in the world to almost anywhere, but not for medical procedures carried out in the USA. It is underwritten at Lloyd’s of London. It is for medical, dental and cosmetic treatment, with some exceptions. The biggest limitation is that it only applies to treatment in one of the 500 plus hospitals accredited by JCI.
Bordercross Worldwide offers normal travel cover plus cover for medical complications. Worldwide medical cover to resolve medical conditions arising from complications incurred from scheduled treatment abroad, even after returning home.
Sure Insurance Services
This UK insurance introducer offers insurance underwritten at Lloyd’s of London by Jubilee. IVF Travel Shield only covers those travelling from the UK for fertility treatment. Sure provides travel insurance cover available for the person treated and a travelling companion, plus cover for complications related to treatment. Personal accident cover is included, as is death during or resulting from an operation.
Conclusion
What cover there is has limitations in who it covers, the treatment covered, and the hospital/clinic covered. Several high profile schemes have vanished almost overnight, and when writing this, one cover that had been around for a few years had a flash message ‘This scheme is not currently available’.
Selling cover on an individual basis is an uphill struggle as customers do not want to pay for it, agencies seem reluctant to sell it, and travel agents prefer to sell their own regular travel cover. Brokers and insurers struggle to make any money from it.
In theory, individual covers may work if the industry can educate customers and agencies that normal travel cover is of little or no use. But the message has not got through to medical travellers; we have seen scheme after scheme fold.
The way forward? Provision on a group basis with agencies and hospitals including it on a compulsory basis as part of all medical tourism packages.
But on group cover we get into huge regulatory problems of which countries can or cannot be covered by the insurers, whether or not the sellers are regulated to or legally able to offer insurance and so on. For example, although the covers above underwritten at Lloyd’s are global – that insurance body has limitations (itself a moving feast) as there are certain countries where insurance cannot be legally provided. So, any patient travelling to or from that country cannot be legally covered.
The only other way is to go the other way round and get conventional insurers to cover it. This may seem a dumb idea, but if they are happy to cover people who ski on holiday, covering medical tourists must be a much lower risk if you are only covering medical complications insurance. It would be interesting to compare the percentage of skiers who hurt themselves against the percentage of medical tourists who suffer medical complications. My bet… is on skiers producing not only the highest percentage but the highest average claim costs.
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