International health insurance in EMEA: the complete guide

International health insurance for people living in the Gulf and Europe, explained in plain English. IPMIEMEA sets out what it is, who needs it, what it covers, how it differs from employer, local and travel cover, and how to choose a plan.

What international health insurance is

International private medical insurance (IPMI) is health cover that follows you across borders. Instead of being tied to one country's system, one employer or one hospital network, it pays for private treatment in the countries inside your chosen area of cover. It is bought for a year at a time, renewed annually, and designed so that once you are accepted you can keep it for as long as you want, wherever you live within the area.

It is private insurance, so it pays for private treatment. It does not replace a public system where one exists, and it does not on its own satisfy every local rule about insurance; both of those points come up again below. What it does is give you a consistent standard of private care, under one contract, across the countries you choose.

That portability is the point. A Spanish domestic policy covers Spain. A UAE employer policy covers the UAE, and only while you work for that employer. An international plan covers you in both, and in the countries in between, under one set of terms.

The product is sold under several names. "International health insurance", "expat health insurance", "global medical insurance" and "IPMI" all mean the same thing. What distinguishes a plan is not the name but four things: the area of cover, the level of cover, the way medical history is handled, and the insurer behind it.

Who needs it in the Gulf and Europe

The region covered by this site splits into two broad groups, and they buy international cover for different reasons.

Expats in the Gulf

In the UAE, Saudi Arabia, Qatar and Bahrain, healthcare for expats is private and insurance is generally mandatory, with employers responsible for arranging cover. Most expats therefore already hold a policy. They add international cover because the employer policy is basic, covers them alone and not their family, stops at the border, or ends with the job. Our guide to Gulf mandatory insurance and top-up cover goes into that in detail.

Expats in Europe

In Spain, Portugal, Germany and the UK there is a public system. Whether an expat can use it depends on residence status, employment and, in some cases, the arrangements between countries. International cover is bought by people who are not yet entitled to public care, who need a policy for a residence visa, who want private access and shorter waits, or who want cover that moves with them around Europe and beyond. Our Europe-only versus worldwide guide helps with the area choice.

People moving between the two

A large share of the readers of this site are moving from one to the other: London to Dubai, Riyadh to Lisbon, Doha back to Manchester. For them the most important feature of an international plan is that it does not need to be rebought, and they are not re-underwritten, when they move.

What it covers

Almost every international plan is built in layers. The core is inpatient cover. Everything else is a module or a tier you choose.

• Inpatient and day-patient care. Hospital admissions, surgery, cancer treatment, intensive care, and procedures done in a day without an overnight stay. This is the expensive part of healthcare and the reason the product exists.
• Outpatient care. GP and specialist consultations, diagnostic tests and scans, physiotherapy and prescribed medicines. Usually optional, and the module that moves the premium most after area of cover.
• Evacuation and repatriation. Transport to the nearest suitable facility when the treatment you need is not available locally, and return home afterwards or in the event of death. Included on some plans, optional on others.
• Maternity. Antenatal care, delivery, complications and newborn care, almost always with a waiting period before you can claim.
• Dental, optical and wellness. Routine dental, major dental, eye tests, health screening and vaccinations, usually on the higher tiers.
• Mental health and chronic conditions. Treatment varies widely between plans. Read the wording rather than the brochure.

Two numbers set the shape of any plan: the annual limit, which is the most the insurer pays in a year, and the area of cover. Our guide to inpatient versus outpatient cover explains the modules in more depth.

International, local and travel cover compared

These three are often confused. They solve different problems.

If you are settling somewhere for a year or more, travel insurance is the wrong tool. It covers emergencies on a trip, not a life. If you have local or employer cover, the question is whether it does enough, and the answer is on its benefit schedule.

Area of cover: the decision that matters most

Area of cover is where you are covered, and it is the biggest single driver of price. In this region the common options are:

• Regional. Europe only, or the Middle East and Gulf only, sometimes with a small allowance for emergencies elsewhere. The cheapest option, and the right one for many people who stay put.
• Worldwide excluding the USA. Everywhere except the United States, where healthcare costs are far higher than anywhere else. The usual choice for people who travel beyond their region or may move.
• Worldwide. Including the USA. Only worth paying for if you will need or want treatment there.

Three practical points. First, check how an insurer defines its regions; some European areas include the UK and some do not. Second, your country of residence must be inside the area, not just the countries you visit. Third, you can usually widen the area at renewal, so start with what you need now.

Our Europe-only versus worldwide guide works through the choice for European readers; the Gulf country pages cover the regional option there.

Underwriting and pre-existing conditions

Every individual plan is underwritten, which means the insurer decides what it will cover based on your medical history. There are three routes you will meet.

• Full medical underwriting. You answer a questionnaire. The insurer accepts, excludes or loads each condition and tells you in writing.
• Moratorium. No questionnaire. Conditions from a set period before the start date are excluded automatically, and may be covered later if you go a set period without symptoms, treatment or advice for them.
• Switch terms. When you move from one insurer to another, the new insurer may agree to continue the terms of your existing plan rather than underwrite you again.

Group employer policies, common in the Gulf, often do not underwrite individuals at all, which is why a condition covered by your employer may be excluded on an individual plan. Declare accurately, keep copies, and get any decision in writing. Our guide to pre-existing conditions explains each route and the vocabulary.

What it costs, and what moves the price

There is no single price. The same cover for the same person can be quoted very differently by different insurers, and the same insurer will quote very differently for two people. The drivers are age, area of cover, level of cover, excess, who is covered, medical history and country of residence. None of them is a surprise, but the size of each effect is, and the only way to see it is to get real quotes.

Our cost guide explains each driver without numbers and points to the published country table. Two rules of thumb apply everywhere: buy the smallest area that covers your life, and take an excess you could pay without thinking twice.

How to choose a plan

1. Start from what you already hold. An employer policy, public entitlement or an existing plan. Write down what it does not do.
2. Decide the area. Where you live, where you travel, where you would want serious treatment.
3. Decide the level. Inpatient only, or inpatient with outpatient. Add maternity, dental and others only if you will use them.
4. Decide the excess. Higher excess, lower premium.
5. Check the underwriting route. And declare everything.
6. Check the practicalities. Direct billing where you live, pre-authorisation rules, and whether the plan satisfies any visa or employer requirement.
7. Compare on real price. Brochures are not quotes.

Country detail: UAE, Saudi Arabia, Qatar, Bahrain, Spain, Portugal, Germany and the UK. Insurer profiles are on the insurers hub, and real client experiences are in our customer stories.

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.