Europe-only versus worldwide cover: choosing your area

Area of cover is the biggest decision on an international health plan and the biggest lever on its price. IPMIEMEA explains the choice between Europe-only, worldwide excluding the USA and worldwide cover for people living in Spain, Portugal, Germany and the UK.

What area of cover means

Area of cover is the list of countries in which your plan pays for treatment. It is not where you travel; it is where you can be treated. Your country of residence must be inside it, and so must any country where you would want to be treated for a serious illness. Outside the area, most plans pay nothing, or only for emergencies for a limited number of days.

International private medical insurance (IPMI) is priced on the area, because the insurer is pricing the cost of treating you in the most expensive place you could be treated within it. That makes area the single biggest lever on your premium, ahead of the level of cover and the excess. Our cost guide places it among the other drivers.

For people living in Europe, the choice usually comes down to three options, and this guide takes each in turn.

The three options

Some insurers offer a fourth option for people who live outside Europe: an area that excludes the USA and Europe together. That option is not for European residents, because it excludes the country they live in. If you see it on a quote for a European address, something has gone wrong.

When Europe-only is the right choice

Europe-only cover is the least expensive, and it is the right choice more often than people expect. It suits you if:

• You live in Spain, Portugal, Germany or the UK and expect to stay.
• Your travel is mainly within Europe, with occasional trips elsewhere that short-term travel insurance can handle.
• If you were seriously ill, you would want to be treated where you live or in your home country, and both are in Europe.
• Your family is in Europe.

Two cautions. First, check the definition. One insurer's Europe includes the UK and Switzerland; another's may not, and some include countries on the edge of the continent that others leave out. If you live in the UK, or would want treatment there, confirm in writing that the area includes it. Second, check the emergency cover outside the area. Most plans include some, limited by days per trip or per year, and that is what covers you on a holiday beyond Europe. It is for emergencies only, not for anything planned or ongoing.

When to choose worldwide excluding the USA

This is the usual middle ground, and the right choice if any of the following apply:

• You travel regularly outside Europe for work or family.
• Your home country is outside Europe and you would want the option of treatment there.
• You may move outside Europe during the life of the policy. Many readers of this site are moving between Europe and the Gulf, and this is the area that covers both without a change of plan.
• You spend part of each year outside Europe, beyond what emergency cover would handle.

The cost is higher than Europe-only, but considerably lower than full worldwide cover, because the United States is excluded. Check whether the insurer excludes any other high-cost territories under this heading, and check any limit on the number of days you can spend outside your country of residence; some plans require you to live in the stated country for most of the year.

When worldwide cover is worth paying for

Worldwide cover includes the United States, and American healthcare costs are far higher than anywhere else in the world. That is why the step from worldwide excluding the USA to full worldwide is the most expensive step on any plan. It is worth taking only if you have a concrete reason:

• You will live or work in the USA during the policy year.
• You visit the USA often or for long periods, beyond what travel insurance would sensibly cover.
• You want the option of treatment in the USA for a serious illness, and you have thought about what that would involve.

A short holiday in the USA is not usually a reason. Travel insurance bought for the trip is the normal way to cover that, and many international plans allow it alongside. If none of the reasons above apply, worldwide excluding the USA gives you cover almost everywhere at a materially lower price.

How the UK is treated

The UK is the point where European area definitions differ most, and it matters to many readers of this site. Three situations come up.

• You live in the UK. Your area must include the UK. A Europe-only area that includes the UK is the cheapest option; confirm the definition. An area that excludes Europe and the UK together is for people living elsewhere.
• You live in Spain, Portugal or Germany and would want treatment in the UK. Confirm that the insurer's Europe includes the UK. If it does not, you need a wider area.
• You are moving from the UK to the Gulf, or back. Worldwide excluding the USA covers both ends of the move without a change of plan. Tell the insurer when your country of residence changes, because the premium follows it.

Several insurers publish their limits in pounds sterling, which UK readers find convenient; Bupa Global is one, and its area options are described on its page. Our UK page explains how international cover sits alongside the NHS.

Moving between Europe and the Gulf

A large share of the people who use this site are not choosing between Europe and the rest of the world in the abstract. They are moving from Manchester to Dubai, from Riyadh to the Algarve, or from Frankfurt to Doha, and they want one plan that works at both ends.

For that situation, worldwide excluding the USA is almost always the right area. It covers the Gulf and Europe in full, it allows treatment at home in either direction, and it means the plan does not need to be rewritten when the move happens. The premium will change when your country of residence changes, because insurers price on residence, but the cover, the underwriting and the claims history continue. Buy it before you move, so that cover starts on the day you arrive, and tell the insurer the destination so the first premium is set correctly. The Gulf country pages for the UAE and Saudi Arabia explain the employer-cover context at that end.

Changing the area later

You are not locked in. Most insurers let you widen the area at renewal, and some allow it mid-year if you move. Narrowing the area is also usually possible at renewal, with a corresponding fall in premium. The practical approach is to buy the area you need now, and review it each year against where you actually travelled and where you expect to be.

Two things to check before relying on this. First, whether widening the area triggers any new underwriting; it normally does not, but ask. Second, whether a move to a new country of residence is accepted at all, because insurers maintain lists of countries they will and will not cover residents of. If you may move somewhere unusual, check it before you buy, not after.

How to decide

1. Write down where you live, where you travelled in the last year and where you expect to travel in the next.
2. Decide where you would want to be treated for a serious illness. Be honest; many people say "at home" when it comes to it.
3. Decide whether you may move during the life of the policy, and where.
4. Choose the smallest area that includes all of the above.
5. Check the insurer's definition of that area, especially on the UK.
6. Check the emergency cover outside the area and any limit on days away from your country of residence.

Country detail is on the Spain, Portugal, Germany and UK pages, and the full picture is in our EMEA guide.

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.