IPMI policy jargon – a minefield for the unwary advisor

As an adviser who doesn’t arrange international private medical insurance (IPMI) for clients on a daily basis, what’s not included in a policy is as important as what is included. After all, the last thing you’ll want is for a client to submit a claim for something they aren’t covered for.

In my latest piece, I’ll be highlighting a few things to watch out for when you have a client with an IPMI need – helping you to avoid any awkward conversations in the future.

Choosing IPMI cover for your clients isn’t straightforward when it’s not your core market. The market’s different insurers offer a range of plans with different options and benefits. The cover combinations are almost endless and it’s worth highlighting a few of the key points to be aware of.

Modular Benefit Options

Much like domestic health insurance, IPMI plans come with the option to exclude certain benefits in exchange for lower premiums. Pregnancy is a good example of a relatively clear cut benefit that is not always needed. Dental and vision are further examples, although the decision to include or exclude this cover is more subjective and often down to customer budgets.

Overall Policy Cover Limit

Of course, it’s not just about the specific benefits that are excluded from your policy, it’s also about your overall cover limit. One plan might feature an overall annual payment limit of US$7,000,000 whereas a seemingly comparable plan may be limited to US$5,000,000. Both are large numbers that will only be breeched in rare medical cases, but the $2,000,000 difference could be crucial to someone in a very unfortunate position.

Individual Benefit Limits

At a more micro level, one plan may have a limited scope to pay out for prescription drugs compared to another that refunds this benefit in full. And a third plan may offer comprehensive cover for dental compared to one that’s more limited in scope. This degree of variation at an individual benefit level can make it difficult to effectively compare and contrast different policies and to make the right recommendations to your clients.

Policy Exclusions

Exclusions for specific conditions are another factor to consider. Insurers may exclude cover on the basis of pre-existing conditions. If your client has (or has had) a particular condition, the insurer may deny cover, at least for a year or two.

What the insurer will offer as regards pre-existing conditions is complicated and based on a number of factors. Members of a large group plan may not be denied cover at all. Whereas individuals with a chronic illness may not be able to find insurance cover for that condition.

Deductibles and Excesses

Deductibles, or excesses, are a further factor that are, in a sense, self-imposed cover limitations. But clients who do not fully understand what they have bought may be frustrated by a high deductible plan that doesn’t pay out until they have themselves paid for thousands of dollars of treatment.

That said, deductibles can be very useful. For clients on limited budgets it can be worthwhile to think of their cover as insurance for major health events. Even if a high annual deductible is not breached in a calendar year they will be safe in the knowledge that, should a major health event occur requiring extensive treatment, they will be covered.

Helping your clients select the right IPMI policy for their needs is essential for their ongoing healthcare. As with any type of investment or protection product, ensuring they understand exactly what is and isn’t covered is essential. After all, you’ll want to avoid any awkward conversations if reality were to fall short of expectations.