What international health insurance costs in the Gulf and Europe

There is no list price for international health insurance. IPMIEMEA explains the seven things that set your premium in the Gulf and Europe, why two people in the same city pay very different amounts, and how to bring the number down without weakening the cover.

Why there is no single price

People ask what international private medical insurance (IPMI) costs the way they ask what a flight costs, and the honest answer is the same: it depends on where you are going, when, in which seat, and with whom. Insurers price each policy individually. The same cover for two people of the same age in the same city can come out quite differently, and the same person can be quoted very differently by two insurers for similar cover.

That is not a reason to give up on understanding the number. It is a reason to understand the drivers, because once you know what moves the price you can decide what to change. There are seven. This guide takes them in turn, without quoting figures, because any figure we gave would be wrong for you. For a published view of how premiums compare by country of residence, the HealthiNomad Premium Index maintains a country table.

Age

Age is the driver you cannot change, and it is the steadiest. Premiums rise as you get older because the likelihood and cost of treatment rise. Most insurers price in age bands, so the premium steps up as you cross from one band into the next rather than rising a little each year, and the steps become larger in later life.

Insurers also differ in how steeply their rates climb. One may be competitive for people in their thirties and expensive for people in their sixties; another may be the reverse. That is a reason to compare on your own age rather than on a general reputation for being cheap or dear.

Two things follow. The first is that a plan which looks affordable at forty needs to still be affordable at sixty-five, so it is worth asking an insurer how its premiums move through the bands rather than only what today's number is. The second is that children are generally the cheapest people to insure, which is why family plans are often better value per person than they look.

Area of cover

After age, area of cover is the biggest lever and the one you control most. The insurer is pricing the cost of treating you in the most expensive place you could be treated within the area, so a wider area costs more.

• Regional cover, meaning Europe only or the Middle East and Gulf only, is the least expensive. It suits people who live and travel within one region.
• Worldwide excluding the USA is the usual middle ground. It covers travel almost everywhere at a materially lower cost than full worldwide cover.
• Worldwide including the USA is the most expensive, because American healthcare costs are far higher than anywhere else. Pay for it only if you need it.

The rule is simple: buy the smallest area that includes where you live, where you travel and where you would want to be treated if seriously ill. You can usually widen the area at renewal if your life changes. Our Europe-only versus worldwide guide works through the choice.

Level of cover

Plans are built from a core of inpatient cover plus modules. Each module you add raises the premium, and some raise it a lot.

• Inpatient only. Hospital treatment, surgery, cancer care and intensive care. The least expensive structure, and a sound choice for someone who will pay for routine care themselves or use a public system or employer plan for it.
• Inpatient plus outpatient. Adds consultations, tests, physiotherapy and prescriptions. This is the module that moves the premium most, because outpatient care is used often. Limited outpatient cover, with an annual cap or a per-visit excess, sits between the two.
• Maternity, dental, optical and wellness. Each adds cost. Maternity in particular is priced for the fact that people who buy it tend to use it.
• Annual limit. A higher overall limit costs more, though the difference between a high limit and a very high one is usually smaller than people expect.

Our guide to inpatient versus outpatient cover explains what each module includes so that you can decide what to pay for.

Excess and cost sharing

An excess, also called a deductible, is the amount you pay towards treatment before the insurer pays. Co-insurance is a share of each bill you pay. Both lower the premium, because you are taking on part of the cost. The higher the excess, the lower the premium.

Cost sharing also changes how you use the plan. With no excess, people claim for every consultation and the insurer prices for that. With a meaningful excess, the plan becomes cover for the things you could not pay for yourself, which is what insurance is for, and the premium reflects it.

Insurers structure this in different ways: an excess per year or per claim, an excess that applies to outpatient care only or to everything, and co-insurance that applies up to an annual cap. Read which one you are being offered. The sensible test is whether you could pay the excess without hesitation if you needed treatment tomorrow. If so, a higher excess is usually good value. If not, choose a lower one and accept the higher premium.

Who is covered

A policy for one person costs less than a policy for a family, obviously, but the shape matters. Each adult is priced on their own age. Children are generally inexpensive, and many insurers price them at a flat rate or offer a discount for several children on one plan. Covering a spouse who also has employer cover is a judgement: the employer plan may be enough for them, or the family may prefer one plan with one set of terms.

In the Gulf this is where the comparison usually bites, because employer policies often cover the employee alone. Adding a family to an international plan is frequently the real purchase, and the employee's own cover is almost incidental. Our guide to Gulf mandatory insurance and top-up cover covers that in detail.

Medical history

Your medical history affects the premium in two ways. An insurer may accept a condition and charge a loading, which is a higher premium to reflect the expected cost. Or it may exclude the condition, in which case the premium is unaffected but the condition is not covered. Which happens depends on the condition, the insurer and the underwriting route.

Under a moratorium there is no loading, because recent conditions are excluded automatically. Under full medical underwriting you may be offered a choice between a loading and an exclusion. If you are switching from another plan, the new insurer may continue your existing terms. Our guide to pre-existing conditions explains the routes. The one thing not to do is leave something out to keep the premium down; that is the surest way to have a claim refused.

Country of residence

Premiums are set by where you live, not where you buy or where you come from. The insurer is pricing the cost of healthcare in your country of residence, the way its hospitals bill, and the regulatory and tax environment there. Within the region this site covers, the Gulf states and the countries of Western Europe sit at different points, and the difference between two countries can be larger than the difference between two insurers in the same country.

For that reason, always tell the insurer where you will actually live, and tell them when it changes. If you are moving, get quotes for the destination, not the departure point. The published country table linked in the first section gives a sense of how countries compare, and our country pages for the UAE, Saudi Arabia, Spain, Germany and the UK explain the local picture.

How to lower the premium without weakening the cover

1. Choose the right area, not the biggest. Worldwide excluding the USA rather than worldwide, or regional rather than worldwide, if that genuinely covers your life.
2. Take an excess you can afford. The premium saving is real and the risk is bounded.
3. Buy outpatient cover with a limit, or none, if you have a public system or employer plan for routine care.
4. Add modules only if you will use them. Maternity, dental and wellness are easy to add later at renewal in many plans.
5. Compare insurers, not just plans. Two insurers can price the same person very differently for similar cover.
6. Review at renewal. Premiums rise with age and with medical inflation. A plan that was the best value three years ago may not be now.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to a regulated broker.