A global, practical field guide to choosing health cover for expats, digital nomads, retirees, and internationally mobile families — without getting caught out by the small print.
- Why understanding international health insurance matters more than you think
- What “international health insurance” actually means (and what it doesn’t)
- The main types: travel medical vs local private vs IPMI
- What international plans typically cover (and where the fine print hides)
- Pre-existing conditions and underwriting: the part that decides your real coverage
- Networks, direct billing, reimbursement: how you actually use the policy
- Evacuation and repatriation: cover you hope you never need
- How pricing really works: age, area of cover, underwriting, deductibles, and design choices
- A word on brokers: where help changes the outcome
- What people get wrong about international health insurance
- How to choose a plan: a decision framework
- Red flags and sales tactics to watch for
- Case study #1
- Case study #2
- The pre-purchase checklist
- Bottom line: what to do this week if you’re moving abroad soon
Why understanding international health insurance matters more than you think
Getting ready to live abroad comes with a checklist that’s equal parts exciting and daunting: booking flights, finding somewhere to live, setting up banking, and maybe sorting schools for the children. Health insurance is rarely the fun part. It’s paperwork, policy wording, and that lingering question: “Do I really need this?” A lot of people put it off until reality bites.
The truth is, if you’re planning to spend more than a short holiday abroad, understanding international health insurance — and arranging the right cover — can save you from serious financial strain and avoidable stress later on. It’s not just about healthcare; it’s about stopping a medical event from escalating into a wider crisis that derails your life overseas.
For expats, digital nomads, retirees and internationally mobile families, this is often one of the most important (and most under-valued) decisions. Insurance can’t stop you getting ill or injured, but it can dramatically reduce the number of difficult choices you might otherwise face: flying home at short notice, draining your savings to pay a hospital bill, or delaying treatment because it’s too complex to arrange abroad.
What “international health insurance” actually means (and what it doesn’t)
Let’s start with a clear definition. International health insurance (often referred to as IPMI — International Private Medical Insurance) is designed for people who are living outside their home country for an extended period. It isn’t travel insurance, and it isn’t a domestic private medical plan tied to one country. It’s built for expats and internationally mobile lives.
Where a typical travel policy covers emergencies on a short trip, international health insurance is intended to operate more like a full private medical policy that “travels” with you — covering routine care and ongoing treatment as well as emergencies, subject to your policy terms, exclusions and limits.
If you relocate abroad for work, study, retirement, or an open-ended adventure, an international plan may cover GP or primary care appointments, specialist consultations, hospital treatment, check-ups, prescriptions and more — broadly in line with the benefits you select. Importantly, it is typically an annual policy that can be renewed, rather than one-off trip cover.
International plans are designed to work across borders, with an area of cover that may be multi-country or worldwide (sometimes with specific regional exclusions). In short, international health insurance means portable private medical cover for long-term expats. It does not mean “everything is covered everywhere”; there will be exclusions, limits and conditions, which we’ll come on to.
The main types: travel medical vs local private vs IPMI
If you’re going abroad, you’ll usually come across three broad product types: travel insurance, local private health insurance, and international health insurance (IPMI). Each is designed for a different purpose. Mixing them up — or buying one assuming it does the job of another — is where people get caught out.
| Product | Designed for | What it usually does well | What it usually won’t do |
|---|---|---|---|
| International Health Insurance (IPMI) | Living abroad long-term; life across multiple countries | Comprehensive medical cover (inpatient and often outpatient); ongoing/chronic care (subject to underwriting); choice of hospitals and specialists across countries; optional benefits such as maternity, mental health, dental; evacuation benefits are often included or available as an option | Automatically cover all pre-existing conditions (usually subject to underwriting); travel-related cover (for example, baggage); “no paperwork” claims handling; entitlement to public/state healthcare systems |
| Travel Medical Insurance | Short trips or fixed-duration travel (often < 3–12 months) | Emergency medical treatment while travelling; emergency evacuation or repatriation; sometimes cover for trip disruption | Routine or preventive care; long-term monitoring; ongoing treatment once you return home (cover often ends when you return) |
| Local Private Health Insurance | Residents of a specific country | Designed to work within that country’s healthcare system; can be good value if you’re settled | True portability across borders; seamless multi-country living; evacuation to another country |
Travel insurance is geared towards trip disruption and urgent medical issues — often with the aim of stabilising you and getting you home. International health insurance is built for longer-term living abroad.
What international plans typically cover (and where the fine print hides)
International health insurance is often sold in tiers or modules, but most plans share a common core: cover for major medical events, with options to add everyday healthcare benefits.
Common core benefits
- Inpatient and day-patient treatment: Hospital stays and many surgical procedures. Inpatient usually means an overnight stay; day-patient means hospital treatment without an overnight admission.
- Outpatient treatment: GP/primary care and specialist visits, diagnostics (blood tests, scans), and sometimes rehabilitation. This is often optional or tier-dependent.
- Emergency medical evacuation: Transport to an appropriate facility if adequate care isn’t available locally, in line with the policy terms.
- Repatriation: In some plans, transport back to your home country (or another defined destination) once stabilised, depending on the policy wording.
- Chronic condition management: Ongoing care for long-term illnesses, subject to underwriting, exclusions and any limits.
Optional benefits and enhancements
- Maternity: Often an optional benefit (or only available on higher tiers) and typically subject to a waiting period before claims are payable.
- Mental health: Increasingly included, but often with limits or sub-limits.
- Dental and optical: Often optional, commonly with their own annual caps.
- Preventive and wellness: Sometimes included, but usually tightly defined.
This is where people get caught out: exclusions, sub-limits and waiting periods. A brochure might say a benefit is “included”, but the policy may cap it, restrict it, or exclude related conditions and treatments. Always read the policy wording — even if it’s dull — because that is the contract you’re buying.
Pre-existing conditions and underwriting: the part that decides your real coverage
Pre-existing conditions generally refer to medical issues you had symptoms of, were treated for, took medication for, or sought medical advice about before your policy starts. Insurers’ definitions vary, but the principle is consistent: your medical history matters.
Underwriting is the insurer’s process for assessing risk and setting your terms. Many individual international plans will exclude pre-existing conditions or charge extra to cover them, depending on the condition and severity.
Two common approaches
- Full medical underwriting (FMU): You disclose your medical history up front; the insurer then decides what to cover, what to exclude, and whether to apply a premium loading (an extra premium).
- Moratorium underwriting: Pre-existing conditions are excluded for a set period from the start of cover, and may become covered later if there is no treatment, medication, advice, or recurrence during that period (as defined in the policy).
The cardinal rule: don’t withhold information. Incomplete or inaccurate disclosure can cause serious problems at claim stage.
The underwriting outcome (what is covered versus excluded) often matters more than the headline list of benefits. Two people with the same insurer can end up with very different cover, depending on their medical history.
Networks, direct billing, reimbursement: how you actually use the policy
A policy is only as useful as your ability to access care and have bills settled. Most international insurers have a network of hospitals and clinics where they can support direct billing (the provider invoices the insurer), reducing the need for you to pay large amounts up front.
Insurers describe this in different ways — for example, that they can pay network providers directly, or that using the network helps you avoid paying fees up front. In practice, it usually depends on the provider, the treatment type, and whether pre-authorisation is required.
Outside the network, you’ll often claim by reimbursement: you pay first and then submit a claim for repayment, less any excess/deductible, co-insurance and any policy limits.
Key terms, plainly
- Networks: The list of hospitals and clinics with agreed billing arrangements with your insurer.
- Direct billing: The insurer pays the provider directly (often subject to pre-authorisation).
- Reimbursement: You pay first, then the insurer reimburses you once the claim has been assessed.
- Pre-authorisation: Approval required for certain treatments (commonly inpatient admissions and higher-cost procedures).
Evacuation and repatriation: cover you hope you never need
- Evacuation: Transport to the nearest appropriate medical facility when adequate care isn’t available locally.
- Repatriation: Returning you to your home country (or a defined destination) for ongoing care, or, in the worst case, repatriation of mortal remains (where included).
These benefits are about both clinical outcomes and financial protection. Without cover, medical evacuation can be extremely expensive. With cover, there is typically an assistance team coordinating treatment and logistics, in line with the policy terms.
How pricing really works: age, area of cover, underwriting, deductibles, and design choices
Premiums are usually driven by factors such as age, area of cover, benefit design, and underwriting outcomes. Many insurers also point out that choosing higher cost-sharing (for example, a higher excess/deductible) or reducing the area of cover can lower the premium.
Cost levers you actually control
- Area of cover: Worldwide versus excluding certain regions.
- Deductible (often called an excess): The amount you pay towards eligible claims before the plan contributes (as defined in the policy).
- Co-insurance: The percentage you pay after the deductible/excess.
- Co-payment: A fixed amount per visit or service (less common in IPMI than in some domestic systems, but included in some plan designs).
- Benefit modules: Adding outpatient, maternity, dental, optical and wellness benefits typically increases the premium.
A word on brokers: where help changes the outcome
You can buy direct from insurers. A specialist broker can also help by translating your circumstances into coverage priorities, comparing policy wordings, guiding you through underwriting and disclosures, and supporting you with pre-authorisations or claims escalation. Done well, that can reduce surprises and cut down the administrative burden.
- Chronic conditions or a complex medical history
- Maternity planning
- Living across multiple countries
- Families with children
- High-cost medications
- Complex mental health needs
Questions to ask any broker (or insurer) before you buy
- What are the main exclusions, in plain English?
- How are pre-existing conditions handled: FMU or moratorium?
- Is outpatient cover included? If not, what does it cost to add?
- Are mental health benefits included, and what are the limits/sub-limits?
- Is maternity included, and what is the waiting period and limit?
- How do the excess/deductible, co-insurance and co-payments work in real numbers?
- Which providers offer direct billing where I will actually be?
- What requires pre-authorisation (for example, MRI, surgery, inpatient admissions)?
- What are the annual limits and any sub-limits?
- How do renewals work, and can terms change at renewal?
- How are prescriptions covered, and are there caps or restrictions?
- If I move mid-year, what changes (premium, area of cover, administration)?
What people get wrong about international health insurance
- “Travel insurance will cover me abroad just the same.” Wrong. Travel insurance is designed for trips and emergencies, not long-term living abroad. It also often ends when you return home.
- “I’m young and healthy, so I can skip insurance.” Risky. Accidents and sudden illness don’t care how old you are.
- “I’ll pay out of pocket for small stuff and fly home for anything major.” Not always workable. You may not be fit to travel, and evacuation itself can be very expensive.
- “All plans are the same, so I’ll pick the cheapest.” Usually false. Price differences often reflect gaps in cover, limits, exclusions, or how claims are handled.
- “If I feel fine now, pre-existing conditions don’t matter.” Misunderstood. Underwriting is based on history, not how you feel today.
- “Maternity is automatically included.” Often not. It is frequently optional and usually subject to a waiting period.
- “Mental health isn’t covered anywhere.” Outdated. Many plans include it, but often with limits.
- “Direct billing means I never pay up front.” Not guaranteed. It depends on provider arrangements, the type of treatment, and whether approvals are needed.
- “Evacuation is rare so it doesn’t matter.” Rare isn’t irrelevant. It’s exactly the kind of high-cost, low-frequency risk insurance is designed to protect against.
- “I can buy later if I need it.” Timing matters. Conditions that arise before you buy may be treated as pre-existing and excluded.
How to choose a plan: a decision framework
- Map the next 12–24 months: Countries, travel frequency, and likely changes.
- Decide where you would want serious care: This shapes your area of cover and evacuation preferences.
- Pick the depth of cover: Inpatient-only versus inpatient plus outpatient.
- Choose add-ons deliberately: Maternity, mental health, prescriptions, dental/optical.
- Set cost-sharing you can live with: Excess/deductible, co-insurance, and co-payments.
- Scrutinise exclusions and sub-limits: Especially for diagnostics, rehabilitation and chronic needs.
- Check networks and direct billing: Focus on where you will actually seek care.
- Understand pre-authorisation: What requires it and how quickly approvals are handled.
- Pressure-test renewals: Whether cover is renewable and how changes are communicated.
- Store documents: Keep the policy wording, disclosures and confirmations together.
Red flags and sales tactics to watch for
- “Everything is covered.” Ask for the key exclusions in writing.
- Pressure to rush. Credible advice allows time to read the documents.
- Vague answers on pre-existing conditions. You need clarity on the underwriting basis and likely outcomes.
- Suspiciously low pricing. Ask what’s missing (outpatient cover, limits, exclusions, network restrictions).
- No policy wording up front. If you can’t read it, you can’t compare responsibly.
- Glossing over waiting periods. Especially for maternity and certain benefits.
- Dodging renewal questions. Long-term value often lives in how renewals work.
- “Don’t mention that condition.” Walk away — non-disclosure can backfire.
Slow the process down. Ask for the documents. Ask the awkward questions. If someone becomes irritated by reasonable due diligence, that tells you a lot.
Case study #1
Scenario: Mariana and Luis move from Mexico to Spain with their two children. They expect to settle long-term, but their first year is messy: temporary housing, changing addresses, new schools, and a learning curve around local healthcare access and appointment systems. They assume a travel medical policy will “cover them until everything is sorted”. It does cover emergencies, but it quickly fails the day-to-day test: GP or primary care visits for recurring ear infections, a paediatric dermatology appointment for eczema flare-ups, and allergy testing. Those are not the dramatic hospital events travel insurance is designed for, and the paperwork starts to feel relentless.
What mattered in practice: Their priorities were straightforward. They wanted reliable outpatient cover (paediatric appointments, tests, specialist consultations), prescription support for recurring medication, and direct billing where possible so they were not constantly fronting the costs. They also cared about continuity if they travelled back to Mexico for family visits or if one parent needed to spend a few months abroad for work.
Plan design that fit: They chose an family IPMI plan with inpatient plus outpatient cover, a mid-level annual excess/deductible (so routine paediatric appointments didn’t become a monthly budgeting headache), and clear benefits for diagnostics and specialist care. They paid close attention to sub-limits for outpatient tests and therapies, because that is often where “comprehensive” policies quietly tighten up. They also confirmed how newborn cover would work if they decided to have another child, including any maternity waiting period and what paperwork was needed to add a baby quickly after birth.
Outcome: The family still used local providers and learned the system, but insurance stopped being a weekly stressor. The children’s routine care became more predictable, and when Luis needed imaging for a back problem, they knew exactly what required pre-authorisation, how to choose a facility more likely to accept direct billing, and what documents to keep for claims.
Lesson: Families moving abroad are rarely tripped up by one dramatic emergency. They get worn down by the steady drumbeat of outpatient care: paediatrics, tests, prescriptions and specialist visits. Choose cover that matches that reality, not just headline “hospital cover”.
Case study #2
Scenario: Camille, a 30-year-old French marketing manager, is relocating to New York City for a multi-year role. Unlike a short trip, this move comes with a hard reality: she needs valid medical cover in the US from day one. She starts out thinking she’ll keep costs down by choosing the simplest plan available, but quickly learns that in the US, a policy that only “sort of” works can leave you badly exposed when you actually need care.
The real decision: Camille has two practical options. Either she joins an employer plan (if provided), or she buys an international plan that explicitly includes the US. She chooses an individual international plan with US cover because her employer cover starts later than her arrival date and she wants continuity if she changes jobs.
What mattered in practice: Camille’s priorities were less about children and more about predictability and access. She focused on: network usability (which doctors and hospitals are realistically accessible), direct billing or claims support so she isn’t permanently paying up front, and a clear understanding of the excess/deductible, co-insurance and co-payments in real numbers. She also wanted outpatient cover that wasn’t just a token add-on, because in NYC even “routine” care can involve specialist consultations and diagnostics.
Plan design that fit: Knowing US-inclusive cover is expensive, Camille used the available design levers to keep it sensible: she selected an excess/deductible she could comfortably afford, chose co-insurance with a defined cap (where available), and avoided unnecessary add-ons. She also reviewed benefit sub-limits that can matter in day-to-day claims, such as physiotherapy session caps, mental health visit limits, and prescription restrictions. Finally, she confirmed what requires pre-authorisation (often scans and non-emergency procedures) and how to obtain it quickly.
Outcome: Four months in, Camille develops persistent knee pain. She needs an orthopaedic consultation, imaging, and physiotherapy. Because she chose US-inclusive cover and checked how the network works, she avoids the worst surprises: she uses an in-network provider, obtains pre-authorisation for imaging, and understands what she will pay under her excess/deductible and co-insurance. The process is still admin-heavy, but it’s manageable — and crucially, it’s not a financial free-fall.
Lesson: In a high-cost setting, you’re not shopping for “cheap insurance”. You’re shopping for usable access and cost predictability. Start by confirming US eligibility, then control the premium through the excess/deductible, sensible add-ons, and a realistic network strategy.
The pre-purchase checklist
- Area of cover: Confirm it matches your likely travel and any high-cost regions you may visit.
- Depth of cover: Choose inpatient-only vs inpatient plus outpatient deliberately.
- Declare pre-existing conditions: Be complete and accurate; ask how they will be handled.
- Waiting periods: Note maternity waiting periods and any other benefit waiting periods.
- Cost-sharing: Understand the excess/deductible, co-insurance and co-payments in real numbers.
- Limits and sub-limits: Check overall annual limits and any caps for key benefits.
- Networks and direct billing: Check access to providers where you will actually use care.
- Pre-authorisation: Know what needs approval before treatment.
- Exclusions: Identify any exclusions relevant to your lifestyle.
- Renewals: Confirm renewability and how changes are communicated.
- Document storage: Keep the policy wording, disclosures and confirmations in one place.
Tip: Keep a simple “insurance essentials” note on your phone: policy number, emergency helpline, insurer app login, and a photo of your membership card.
Bottom line: what to do if you’re moving abroad soon
Treat international health insurance like essential infrastructure. Map where you’re likely to be, decide what “good care” looks like for you, disclose your medical history properly, compare policy wording (not just price), and choose cost-sharing you can genuinely afford. If your situation is more complex — family needs, chronic conditions, maternity planning, or living across multiple countries — expert support can help reduce surprises and administrative burden.
The goal isn’t to buy the most expensive plan. It’s to buy the plan that still works when life gets messy.
