The recent case in the UK of a man having his travel insurance claim investigated because he gave ‘too much detail’ has sparked controversy over what constitutes an overly accurate, and therefore possible fraudulent, claim. Mandy Aitchison reports on the case

The debate was ignited when Insure and Go received a claim from a young man who had been travelling in South America when his backpack, which contained mostly clothes, was taken from a bus station in Peru. He sent a list of the items that had been stolen to the insurer, which totalled around

£1,000; and in most cases he was able to give details of the price of the item, brand name, whether it was bought on card or with cash and the place and month in which the item was purchased. Now, it is fair to say that some insurers might want to give this claimant a hearty pat

ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS JULY 2008 • ISSUE 90

NOW INSIDE: privatehealthcarenews GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS

continued on page 9

continued on page 9

The devil is in the detail

A recent report has shown that the travel insurance industry is fast gaining ground in India, where more people are travelling further afield than ever before. James Wallis checks out the research

Express Travelworld, an Indian magazine aimed at travel industry professionals, has reported that penetration into the market for travel insurance has an annual growth rate of around 20 per cent, from Rs1.5 billion (US$5.8 million) in 2006/07 to Rs3 billion in 2007/08. The publication cited an unnamed industry insider as saying: “The reason for the low penetration of travel insurance is excessive regulation related to who can sell it and remuneration given to the people selling it. For example, the remuneration given to insurance and corporate insurance agents is 15 per cent, while

Indians inspired

Page 38Page 18

Page 20

Page 28Page 26

On 10 June, Florida-based air ambulance provider Air Trek had its operating license revoked by the Federal Aviation Administration (FAA). The action comes less than a month after the federal body suspended the carrier’s license. Sarah Lee has the latest on the debate

Following the suspension, further inspections of the company headquarters were undertaken, which, according to the FAA, turned up more serious problems than those previously cited, leading to the revocation of the licence. Kathleen Bergen, a spokeswoman for the FAA’s southern region, said: “Our findings as part of that investigation indicated that revocation was in order as opposed to the suspension.” The emergency revocation letter from the FAA cited 14 different air traffic safety violations, which included flying an aircraft that had not been deemed safe to fly, failure to follow weight guidelines, deceptively recording maintenance shortfalls, allowing pilots to make international flights without proper training or certification, and allowing pilots to fly after they had failed required tests. In conclusion, the letter stated: “Air Trek’s systematic non compliance with regulatory requirements in unacceptable and a danger to the flying public.”

FAA licence revoked

International Travel Insurance Journal

IN THIS ISSUE

REGULARSNews continued 4Company brief 8Editorial comment 12Insurance matters 9Health matters 12Air ambulance news 14Travel matters 16Profile 38Private Healthcare News 33Service directory 40Grapevine 46Diary dates 46On the move 47

FEATURES

News analysis: Can’t take the heat 18Milan Korcok details the latest developments and asks why hospitals in Canada are refusing to repatriate patients from elsewhere in the world.

Feature: Sport: how dangerous can it be? 20Stewart Farr guides insurers through the latest adventure sports on offer to holidaymakers, and asks whether cover should be continued for increasingly dangerous activities.

Feature: Takaful: The global growth of Islamic finance 26Susan Dingwall and Ffion Flockhart have together created a guide for insurers with regards to how takaful works and how it can be incorporated into a current book of business

Assistance world markets: Argentina 28Alberto Chapur of Cardinal Assistance gives readers the lowdown on operating an assistance company in a market that is still under development

PHN feature: The crumbling safety net 38As state healthcare services around the world increasingly struggle against a growing demand for their services, private insurers are stepping in to offer tailor-made products to local as well as expatriate populations. Milan Korcok looks at this morphing industry and asks what the future may hold

Stewart Farr is a freelance journalist with 30 years’ experience in writing on insurance matters, especially in the areas of life, travel and business insurance, investment and pension planning and in healthcare provision. For 25 years he edited a monthly journal for life insurance and pension practitioners.

David Ing is a freelance journalist covering mainly travel and tourism issues in Spain. He writes on air transport for a leading international news agency, as well as contributing special features to Newsweek and writing in-fl ight magazine articles and guidebooks.

Milan Korcok is an award-winning freelance health policy and economics writer who covers travel insur-ance, public health, and medical education issues in Canada and the US. He has been writing about health fi nancing and policy issues in these countries since the 1960s and is a frequent contributor to leading North American professional journals and consumer media. He lives in Fort Lauderdale, Florida.

ITIJ CONTRIBUTORS

2

International Travel Insurance Journal

Published on behalf of Voyageur Publishing& Events Ltd, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or fi rm mentioned is hereby excluded.

Printed by Pensord Press, South Wales, United Kingdom

Copyright © Voyageur Publishing 2008. Materials in this publication may not be reproduced in any form without permission INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522

Editor-in-chief: Ian CameronEditor: Sarah LeeAssistant editor: Mandy AitchisonCopy editor: James WallisDesigners: Eli Butler Steve Annette US correspondent: Milan KorcokConference manager: Denise ClementsProduction: Helen Watts

Kirsty DiclaudioAdvertising sales: David Fitzpatrick James MillerFinance: Cathy Knott

Louise GoddardIllustrations: Chris Duggan

ITIJVoyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK

editorial: +44 (0)117 929 4636

advertising: +44 (0)117 925 5151

fax editorial: +44 (0)117 925 2040

fax advertising: +44 (0)117 929 2023

email: mail@itij.co.uk

web: www.itij.co.uk

design: V Creative Design

WOULD YOU LIKE TO SUBSCRIBE? VISIT www.itij.co.uk

International Travel Insurance Journal ■ www.itij.co.uk

ITIJ TEAM

International Travel Insurance Journal

4 NEWS

Travel rise sparks insurance boomThanks to affordable flight fares and the increasing number of people in India who enjoy a disposable income, Indians are travelling in far greater numbers than have ever been seen before. Industry sources place the number of people who travelled to foreign destinations from India last year at around six million, with most indicating that the number will reach 10 million this year. However, all of these extra travellers mean more and more people are placing themselves at risk through a lack of travel insurance.To try and ensure Indians understand what travel insurance does and does not cover, a national paper has recently extolled the virtues of the cover, advising Indians that it is a ‘must-have’ before embarking on international travel. Foreign visitors to the Schengen countries are required to provide proof they have travel insurance before a visa is issued, which could save an Indian family thousands of pounds in medical treatment and repatriation costs. As Khalid Sohail, head of travel insurance for Tata AIG General, pointed out to consumers: “When you travel to the US or any European country, you are moving to a higher price index zone. So the local mediclaim policy will not cover you once you cross the Indian peripheries.”Sudhir Menon, head of travel insurance for ICICI Lombard, agreed that in particular, insurance for travel to the US is imperative, as ‘it is the most expensive place for medical treatment’. The newspaper also gave consumers a guide to what is covered, as well as information on how to start the

claims process. As a final word of warning, travellers were also told to check the small print.Further evidence, as if it were needed, of the growing prevalence of travel in India is the news that more and more low-cost carriers in the country are teaming up

with insurance companies to offer travel insurance that includes flight delay, trip cancellation and baggage loss. Starting the bandwagon was SpiceJet, which tied up with Tata AIG; GoAir has now followed suit with the same insurer and Deccan has said it is in the process of hammering out the details of a deal with ICICI Lombard. A new entrant to the low-cost market, Delhi-based Indigo Airlines, is also said to be looking for a partner through which to offer the insurance. Customer response to these offerings has been overwhelmingly positive, according to those in the industry. Siddhanta Sharma, chairman of SpiceJet, said: “On the first day itself, we sold around 1,000 policies.”Deccan CEO Ramki Sundaram agreed that it had been a good move by the airlines: “Passengers are seeing significant relevance in these products. It’s not just the financial incentive, but an added attraction to passengers.”

AXA joins with AmadeusDavid Ing reports from Spain

AXA Assistance has agreed a deal with reservation system Amadeus in Spain to offer a new dedicated policy that it hopes will significantly boost insurance sales through travel agents in what has traditionally been one of Europe’s weakest markets. The two companies say the tie-up will reach more than 9,100 points of sale, enabling policies to be issued in less than 30 seconds through the Amadeus Selling Platform, saving agents valuable time in having to switch to other web pages or making phone calls. Amadeus already carries two insurance companies in its system, but says the AXA policy will be the first geared especially to cancellations, offering agents a ‘very specific and easy product to sell’.The new link recognises the important role played by travel agencies as the main channel for reaching travellers, says AXA’s marketing director in Spain, Enrique Lamarca. With the cutting of commissions on airline tickets and other travel products, the income derived from insurance is becoming ‘increasingly more important for many agencies’.Yet while the number of consumers taking out holiday insurance policies in Spain is rising, they still represent less than 20 per cent, well below other European countries such as the UK. One of AXA’s main aims is ‘to increase the number of travellers who think spontaneously of taking out insurance when they book a trip’, said Lamarca: “We have created a very fast and simple product, focused on what the travel agencies are asking of us.”The new agreement fits in with Amadeus’s objectives of offering agency clients a wider range of complementary products and services that provide added value for the sector, said the company’s marketing director Iñigo García-Aranda: “We are aware of the growth in demand for travel insurance on the part of the consumer, and the income that the sale of such services generates for the agent.” Last year Amadeus España handled more than 38 million bookings in Spain. AXA Assistance’s annual sales in the country reached €56 million.

Drivers warnedExpensive charges for excess waiver policies from many leading car rental companies in Europe could leave customers spending a lot more than they bargained for unless they take some basic precautions, according to standalone excess insurance specialist Insurance4carhire.com. The firm has issued a warning to the thousands of Brits that hire cars in Europe every year to look closely at the small print on the hire document or else be caught out by damage clauses that could lead to the person’s card being debited for a sizeable amount.Larry Ursich, spokesman for the online insurer, told consumers: “It is essential that people hiring a car be aware that, although the vehicle is insured, the excess may not be covered. And those charges can range from £300 to a wallet-hammering £1,500.” He added that although some car rental companies do sell their own excess cover, it is often expensive and not always as comprehensive as one would hope: “Even if you pay to reduce the excess to zero, you may still be liable for damage to windows, tyres, roof and undercarriage.”Consumers were also advised to check whether the insurance covers all aspects of a planned trip – for example, whether or not it covers off-roading in Australia. Customers should also inspect the car thoroughly with a member of the car hire firm present to agree on any scratches or dents that are already there and even take pictures of the damage.

It has been reported that the Bank of Ireland is considering pulling out of the Irish travel insurance market due to increasing pressure and competition from online insurers.The Bank of Ireland offers a travel insurance service on request through its extensive branch network, but change could be in the offing. A spokesperson for the bank told insurance media that sales of travel insurance are being evaluated and considered for their profitability: “We review all our products on a regular basis, both in terms of pricing and product attributes, and can confirm that this particular product is currently under review, given the increasing competition from budget online propositions.” She added, though, that existing policyholders would not experience any problems in terms of claims handling or advice, even if the review results in the withdrawal of the product

from the marketplace – all policies that have been sold will be honoured until their renewal date.In related news, a new survey conducted by TNS-MRBI on behalf of Irish insurer Vhi has shown that nearly half of all Irish tourists questioned admitted to travelling overseas without any form of travel insurance at all. Twenty-five per cent of those surveyed who did have travel insurance also said they had chosen the policy on price, rather than benefits, highlighting the Bank of Ireland’s problem with travel insurance being a price-driven purchase. Furthermore, the survey stated that over €11 million was paid out to Irish tourists in 2007 for emergency medical treatment received abroad – an increase of 30 per cent on the previous year, and another timely reminder of the importance of medical treatment protection as part of a travel insurance policy.

Bank of Ireland reviews market

www.itij.co.uk

NEWS 5

Karma weighs in againIn the last issue of ITIJ, we reported that UK travel insurer Karma had criticised other insurance companies for discriminating against those people with controllable medical conditions such as diabetes by quoting higher premiums. Now, the company has highlighted another area where they

think the industry is being discriminatory.According to research carried out by the company, some travel insurers are pressurising senior citizens into spending more than a week’s pension on over-inflated premiums. The firm’s research showed that there were large disparities between the cheapest and most expensive Internet-based premiums for a two-week holiday in Spain for a 65 and 66-year old – the difference was over £183, which is significantly more than a British couple’s weekly pension of £145.Brian Wright, managing director of Karma, said: “Insurers were recently criticised for not catering to the needs of elderly travellers and our research reveals just how widespread age discrimination is. Over a third will not cover those aged 65 plus and around 70 per cent refuse to cover over-75s. Those who do provide cover are quoting extortionate premiums – how can the difference between our premium of £25.03 and the most expensive at £208.70 be justified?”The Office of National Statistics has recently reported that life expectancy at 65 has reached its highest ever level for both men and women, and this group of people has more disposable income and more time and inclination to travel than many others. As Wright pointed out: “This age group is healthier and more adventurous than previous generations and yet many are having their pension pots raided by discriminatory insurers. My worry is that people priced out of insurance will either rely on their European Health Insurance Card, which gives very basic cover and is not accepted by private Spanish hospitals for example, or travel without any cover at all.”

Mondial reports healthy growthMondial Assistance Group has announced positive results for the past year, with the ongoing success of its travel and healthcare divisions playing a strong role in supporting the growth of the firm. Mike Webb, managing director for Mondial in the UK, explained further: “We continue to increase our presence on all continents and in all of our activities. We also continue to lay the foundations for our growth by responding to new market needs in areas such as e-commerce and healthcare, and in developing markets like Brazil, China, India, Russia and now Mexico.”The company’s travel business has played an important role in helping Mondial to improve its financial results,

and according to the firm, at the heart of this success is the delivery of e-commerce solutions such as the e-Magin Platform, which is used by more than 45 airlines worldwide. Throughout 2007, as was reported in ITIJ’s Company Brief section, Mondial completed on a number of tie-ups with airlines to offer travel insurance and assistance services through the airline’s websites.Healthcare and lifecare activities also experienced strong growth last year, remaining at the centre of Mondial Assistance Group’s development strategy. Thorough research and development at the company also lead to new offerings on the table that had been adapted to the current state of play in the travel market.

Parents reminded to buy for kidsSeven Corners, a US-based travel health insurer, has issued a warning that reminds parents to purchase travel insurance for their children who have recently graduated high school or college and are planning to travel internationally this summer.Justin Tysdal, executive officer and co-founder of the Seven Corners, told worried parents: “Accidents, medical emergencies, disease outbreaks, terrorist activity, natural disasters and airline cancellations are just a few unplanned events that can put your child in jeopardy. No matter how careful your young graduate is, one simple fact remains – anything can happen when you travel abroad.”

A match made in heavenResearch by a British newspaper has found that the uptake of wedding and travel insurance is on the up, as more couples opt to get hitched abroad. Those taking the plunge in the sun realise the benefits of having cover for items such as the wedding dress, reception venue and gifts through their wedding insurance, while appreciating the need for a travel policy to cover them for travel to the wedding destination and for their honeymoon. Figures show that one in five British couples now opt to get married abroad, be it on a beach in Sri Lanka or in New York City, thanks to the fact that it can cost up to 50 per cent less than a normal wedding in the UK.

International Travel Insurance Journal

6 NEWS

UK festival season startsSummer has officially arrived in the UK, and with it comes festival season. With more music festivals going on in Europe than ever before, plenty of Brits who are fed up with three-foot deep mud at Glastonbury are heading off to the Continent for some sunshine and tunes. However, the problem is that this group of adventurers is unlikely to take out travel insurance, especially when they have already spent hundreds of euros on a travel ticket.Peter Gerrard of insurance price comparison site moneysupermarket.com has issued a word of warning to these festival-goers, advising them to buy insurance to protect their mobile phones, cameras and iPods against the risk of theft or damage – both of which occur with startling frequency at a festival. He also told attendees to use lockers and safes, where provided, and avoid leaving expensive items in tents. “You won’t be covered if you’re just leaving them around, say, in your tent or shared room,” he warned. “If you just leave them lying around then you’re seen to be being negligent.”

Poolside gadgets warningChris Rolland, head of American Express Insurance Services, has warned that people heading abroad and taking gadgets with them need to make sure their travel insurance policy offers cover for the items. The advices comes at a time when laptops and BlackBerries are fast becoming regular poolside accessories – one in seven Britons surveyed said they use either one or both to keep in touch with the office while they are abroad. One in five workers claim they are never able to switch off; it ‘fills them with dread’ that they are contactable 24/7, yet 82 per cent of workers are using portable technology while on holiday.Rolland said: “The fact that workers are able to carry their emails and work around with them even when they’re not in the office means that mobile technology is not necessarily saving time, but in some cases it is extending the workload.” He continued: “Before going on holiday, Brits should check their insurance policies to make certain their poolside gadgets are covered up to their maximum price, just in case they are ruined with a splash.”

Australian legal action droppedAn American man whose wife died while they were scuba diving on their honeymoon in Australia has dropped his intended legal action in the US against the travel agent that arranged the trip, Getaway of Birmingham, Alabama, and travel insurers Old Republic Insurance Co. and Travelex Insurance Services.In March 2005, nearly two years after Tina’s death, Gabe Watson had intended to sue Old Republic Insurance Co. after it refused

to payout on the cost of the trip. Watson was seeking more than US$45,000

for the trip, as well as unspecified punitive damages for mental

anguish caused by the accident. The legal action called

for reimbursement for accidental death, trip interruption, medical expenses, phone calls, taxi fares, extra credit card statements and

compensation for mental and emotional

anguish. An initial inquiry into his wife’s death found that equipment failure and a medical condition had been ruled out as possible causes of her death, although investigations into the incident are continuing, with the coroner reserving his right to extradite Watson back to Australia.However, it has now been reported in a local paper that the action had been dismissed by Judge Ed Ramsey at Watson’s request. In court papers, Watson referred to the Australian investigation into his wife’s death, which caused him to ‘reasonably apprehend that he risks self-incrimination in this case’. Watson’s lawyer in the US, Bob Austin, confirmed that he had dropped the case, while his legal team in Australia believed it ‘was not in his best interest’ to pursue the damages claim.

Regulation brings opportunitiesAcumus Insurance Solutions says that travel firms could be missing out on a portion of general insurance market income by not being FSA-authorised. From 30 June, applications for authorisation began being accepted and from 1 January 2009, if unauthorised, a firm may not legally sell travel insurance.Dan Waters, director of retail policy and themes at the FSA, told firms: “Regulation is only seven months away and firms need to make sure they are fully prepared … firms are advised to apply early to ensure that they are ready in good time for the start of the new regulation.”

Meanwhile, there are sounds of discontent coming from some insurers and travel firms, who are sure the regulation will mean that fewer companies will sell travel insurance, thus affecting the number of people who fail to take out insurance before travelling. However, Acumus Insurance Solutions, a UK provider of travel insurance, says that in actual fact, through the regulation, travel firms have been given a chance to capture a piece of the £42-billion general insurance market in the UK. Acumus says that by becoming an appointed representative, travel agents and tour operators can significantly widen the spectrum of insurance products

Independent travellers warnedAn increasing number of British tourists are leaving home shores without the right travel insurance policy, according to AXA. The firm’s personal insurance director, Edward Dutton, said that more tourists are organising a holiday themselves and not checking the terms and conditions of their insurance policy, which would normally be done by a travel agent or tour operator. He continued: “We are aware from our own claims area that independent travellers have run into problems with their travel insurance.” He warned independent travellers to take extra care when choosing their travel insurance policy in order to ensure they are completely protected in the event the airline they are using folds.Chris Price, head of Direct Line Travel Insurance, agreed that independent travellers should be extra cautious when it comes to the small print of travel insurance policies: “The best way to ensure you have the appropriate cover is to contact your insurers and discuss the cover you need for the activities and equipment you are likely to use.”

Sabbaticals on the upRecent research by online travel organisers Hostel Bookers has found that almost one third of British respondents planned to take an extended break from their working lives in 2007 in order to take a gap year or sabbatical – this figure is double that of 2003. The research also showed that 27 per cent of people who were asked think a break from their

careers is exactly what they need to get re-energised and re-motivated with regards to work. And 22 per cent of those asked said they were feeling bored and disheartened by work, meaning that more and more people could be taking a long break from their working life this year as well.Chris Rolland, head of American Express Insurance

Services, commented on the research: “As an increasing number of Brits take a break from working life to embark on a sabbatical or gap year, it is important they get the right type of gap year travel insurance to suit their needs. For instance, our new gap travel insurance covers people for up to two years in order to help those who gain two-year visas for a country. It also allows people to return to the UK for a period of 14 days in case travellers feel homesick, need to re-take exams or attend a special family occasion.”

UAE terror risk changedBritish nationals in the UAE have been warned that there is now a high risk of a terror attack occurring in the region, according to the website of the Foreign and Commonwealth Office (FCO). The travel advisory states that terrorists could be planning ‘indiscriminate’ attacks in places often frequented by expatriates, of which there are millions in the area. The advisory did not, however, state the reason for the change in the level of warning from ‘general’ to ‘high’.The advice on the website makes it clear that attacks could happen at any time and could target residential compounds where there are large numbers of western expatriates, as well as military, oil, transport and aviation interests. It issues a warning to both tourists visiting the region and people living there that: “You should maintain a high level of security awareness, particularly in public places.”

continued on page 9

www.itij.co.uk

NEWS 7

Older travellers still denied coverIntune, the financial services arm of UK charity Help the Aged, has performed research that shows holidaymakers over the age of 80 are still marginalised by insurers because most policies still impose an upper age limit. The researchers examined 495 travel insurance policies and found that 97 per cent of them imposed upper age limits, while 75 per cent stopped cover at the age of 65. Intune’s figures also showed that over the last year, over-80s had taken more than 121,000 trips, usually lasting between three and six months. Stuart Castledine, Intune’s managing director, said of the research: “We have found that older people holiday more widely than younger age groups, and for a longer time. Many people are electing to work until 70, leaving it even later in life to make the most of their retirement and leisure time though travel.” Despite these figures, he continued, insurance is becoming ‘increasingly harder to find’. He agreed with research showing that customers over the age of 85 are eight times more likely to make a claim than those under 35, but said that this should not mean that older people are discouraged from travelling: “The over-80s traveller has particular requirements which may need accommodating, but they do not want a system that writes them off at a time when they should be enjoying life to the full.”The company’s research found only five insurers that had no upper age limit imposed on their policies.

New tourist danger in ItalyA spate of robberies and railway thefts in Italy being carried out using drugs to overpower victims has resulted in the death of an elderly American

tourist. The man, Hungarian-born Frank Phel, was travelling with his wife on their way back from a

Mediterranean cruise when they stopped at Rome’s Tiburtina station.The chief of Rome’s railway police, Felice Addonizio, said: “The couple were planning to take a bus from outside the station the next morning to go to Hungary, but did not know Rome and were fearful of leaving the station, so planned to get some sleep in the waiting room.” The waiting room is recognised as a magnet for petty thieves, which is where the couple were when the incident began: “There was a rough crowd arguing in the waiting room at around midnight, and the couple were given some reassurance by a middle-aged man who then offered them both a cappuccino.”

The couple awoke from their drugged sleep the next morning to find their luggage and valuables had been taken. Phel told his wife he would go and find the police when, still feeling the effects of the drugs, he walked onto the tracks, where he was killed by the Rome-Florence train. Police believed the event was suicide until they found his wife asking the bus driver to delay departure to Hungary so that she could continue to search for her husband.Police said that elsewhere in the country, gangs using narcotic spray to carry out train robberies are also on the rise – the gangs board sleeper trains and drug passengers in couchettes before hopping off at the next station.

India targetedDozens of people have been killed and more than 100 injured after six bombs were detonated in the city of Jaipur, one of India’s most prized tourist destinations. The explosions, which began in the early evening, were all set off in markets that surround the city’s pink palace, the Hawa Mahal, together with its main temple complex. The attack sparked off a red alert in the financial business hub of Mumbai and in New Delhi, the country’s capital, along with all airports and train stations.The first bomb struck a temple dedicated to the Hindu monkey god Hanuman, whose divinity is celebrated every Tuesday – the day of the attacks. According to one eyewitness: “The next bomb was near Johari bazaar and looked like it was placed near a Muslim jewellery shop. It was very busy with Hindus and Muslims. It was an attack not on Hindus or Muslims but Indians.”Johari bazaar is the city’s jewellery market and a popular destination for Western tourists seeking a bargain. However, local papers have reported that due to the main tourist season ending in March, it is ‘unlikely’ that any foreigners were hurt.British tourists have been warned by the UK Foreign and Commonwealth Office to obtain comprehensive travel insurance before travelling and to exercise particular caution when in the vicinity of government buildings, tourist sites and public events.

International Travel Insurance Journal

8 COMPANYBRIEF

Marcus Hearn launches new coverA new travel policy has been launched by UK-based Marcus Hearn, which aims to provide a competitive contract for both holidaymakers and business travellers that is flexible enough to enable the cover to be extended, if needed, to cover adventurous activities. The policy can also be adjusted to specific business needs, for example to cover a business trip where possibly dangerous manual work is being undertaken, and Marcus Hearn has said it will even cover travel to Iraq and Afghanistan.Dean Atkin, spokesman for the company, said: “We believe there is a definite need in the marketplace for a policy that not only provides a competitive contract for standard travellers, but can also cover both hazardous activities and destinations.”

More options at Travel InsuredUS-based Travel Insurance International has unveiled a trio of new travel insurance plans, under the company’s Worldwide Trip Protector brand. The new plans have stronger benefits and several new options and have been dubbed Worldwide Trip Protector, Trip Protector Gold, and Trip Protector Lite and Lite Expanded, giving options to customers who prefer to choose the level of cost, not cover.Each of the three plans offers customers a ‘menu’ of optional features that can help them to tailor their cover – options include free cover for children, cancel for any reason insurance and cancel for work reasons. Other options are increased emergency medical expense benefits that include medical evacuation in an air ambulance and flight accident protection, while travellers are also given the option of upgrading cover to include skiing and associated sports equipment.

Medex Global acquires ASI Group

Medex Global Group has now formally completed its acquisition of ASI Group (formerly Air Security International). ASI Group was founded in 1989 and is based in Houston, Texas, from where it provides global risk management services, including business intelligence and investigations, emergency evacuations and crisis management. ASI currently counts eight of the top 10 Fortune 500 companies among its clients, sharing some of those with Medex already, with which it has partnered for more than 10 years.Medex CEO Bruce Kirby said of the deal: “By adding the international security resources and expertise of ASI Group to Medex, we can provide our customers with an enhanced, fully-integrated travel protection solution.”Although the exact terms of the agreement were not disclosed, it is known that ASI Group will retain its name and locations, under the continued direction of president Charlie LeBlanc and the management team. It will operate as a wholly owned subsidiary and the combined company will employ close to 200 people.Speaking after the announcement had been made, LeBlanc said: “This is an outstanding fit for ASI both strategically and operationally. Becoming part of Medex Global Group will only strengthen our position in the marketplace and provide our clients with a truly robust set of services.”

International partners sign dealClub Méditerranée, the Europ Assistance Group (EA) and international insurer Marsh have together signed a ground-breaking deal in the tourism market, allowing the first international travel insurance scheme to be launched. It allows Club Med to offer its clients, present in 21 countries, a range of policies that have been adapted to the local market and attitudes to risk. The move will now make it possible to manage Club Med’s travel risks with a high degree of accuracy while at the same time offering unique cover solutions. Club Med and EA are already partners in France, Belgium, Italy and the UK, but are now offering an international product range.In France, the new packaged offer, known as Ecran Total, combines the advantages of a comprehensive travel policy with a range of cover features vital to any travellers planning on participating in an adventure sport, such as a cancelled skiing holiday

due to lack of snow.Club Med said that the agreement will enable the firm to ‘gain a valuable head start in the management of travel-related risks’, while EA said it demonstrated the group’s ‘capacity for innovation and dynamism when it comes to supporting all of its clients internationally’. The entire network of Marsh was party to the development of the scheme to enable Club Med to use its resources and expertise in the risk management field.

TruTravel ties with aggregatorTruTravel Insurance, powered by Meridian Management Group LLC, has recently announced a strategic marketing partnership with InsureMyTrip, the online aggregator of travel insurance offerings. TruTravel’s products are underwritten by Nationwide Mutual Insurance Company, providing comprehensive cover to consumers.President and CEO of the website Jim Grace commented: “TruTravel Insurance is a natural partner for InsureMyTrip, our premier travel insurance comparison service. We are excited that Meridian has brought two very innovative products to the market.”Kevin Leys, president of Meridian Management Group, gave more information about the nature of the new policies: “The combination of per-trip coverage plus year-round services with per-trip cancellation, interruption and other post-departure coverages brings a valuable package of benefits and services to the traveller’s lifestyle.”

LV= introduces policies

Liberty Mutual boosts valueUS-based Liberty Mutual has, for the first time, introduced a comprehensive suite of travel assistance services that have been made available to employees covered under the firm’s group life insurance policies, whether they are travelling for business or pleasure. Liberty Mutual has a global network that helps stranded travellers with everything from replacing lost prescriptions and passports to handling complex medical emergency evacuations.Kevin Krzeminski, senior vice-president of Liberty Mutual’s department of group life services, said: “Beyond financial protection, a Liberty Mutual group life policy now helps an employee weather some of travel’s toughest moments. Adding travel assistance through the group life policy is an easy way for employers to strengthen their benefit programmes.”The travel assistance services include medical evacuation, medical assistance, security and political evacuation, lost documentation and destination information so employees can find the latest on their destination’s weather, immunisation requirements, culture and currency. The scheme is run in partnership with Medex.

> worldwide AIR AMBULANCE OPERATOR> worldwide REPATRIATION & MEDEVAC> worldwide AIRLINE STRETCHER SERVICE> worldwide MEDICAL AIRLINE ESCORTS> worldwide BED-2-BED TRANSPORTS> PERSONAL MEDICAL CONSULTANCY

24 / 7 available for those in need!Tel: + 43 1 600 1212based in: VIENNA (LOWW/VIE), AUSTRIA

www. medicaljetservice.com

THERE IS LIGHT ON THE HORIZON

MJSlightonhoriz76.indd 1 24/4/07 16:01:04

British insurer Liverpool Victoria (LV=) has revealed that it will soon launch two new travel insurance products, one providing annual cover and the other offering single-trip cover. Both policies are comprehensive and include as part of their benefits £10 million in medical cover, £2,500 personal possessions cover, £500 for loss of money, £5,000 for cancellation and £250 for delays. The policies will also both offer customers insurance for delays or injuries caused by a terrorist attack. The insurer has designed the plans top be flexible and customers are

able to tailor cover to what they need – be it cover for an illness, golf clubs, winter sports or weddings.John O’Roarke, managing director of LV= general insurance, said: “Many travellers with medical conditions struggle to get travel insurance as many insurers don’t offer cover. Our policies will enable customers in this situation to go away safe in the knowledge that they are covered if they fall ill while overseas.” He continued by saying the policy could be purchased online, ‘so there is no need for a lengthy telephone interview’.

www.itij.co.uk

INSURANCEMATTERS 9

Munich Re has estimated that the 7.9-magnitude earthquake that struck China in May could cost the insurance industry between €300 million and €1 billion in insured damages. The firm said it expected its own costs related to quake damage to be in the ‘low to mid two-digit euro range’, according to Torsten Jeworrek, a management board member. He continued: “It’s not a big event for the industry with estimates of €300 million to €1 billion for the insured market loss. Economic damage of course is much worse, in the high tens of billions of euros.” Despite the fact that the earthquake killed at least 69,000 people and left more than five million homeless, insurance figures are relatively small due to a lack of penetration.The Chinese Insurance Regulatory Commission (CIRC) has called on insurers in the country to offer all due compensation to the victims of the quake. Wu Dingfu, CIRC chairman, said: “On disputed claims, insurers should decide in favour of customers and beneficiaries. If relevant documents have been lost or damaged, insurers should still pay up if they offer some information. In cases of whole families perishing, insurers should make every effort to find any remaining members.” So far, insurers say they have received around 200,000 claims for quake-related damages and paid out ¥216 million, ¥132 million of which went to life claims and the remainder to property.

Sichuan quake could cost €1 billion on the back and thank him for all the detail – after

all, they are quick enough to deny a claim for not containing enough information. However, Insure and Go took a slightly dimmer view, and wrote to him explaining that it would not cover any item for which he could not provide reasonable proof that he had owned or bought. The firm wanted to see receipts, copies of receipts or bank and credit card statements for each item on the list.The claimant’s mother contacted the BBC about the matter and said she had been surprised by the company’s reaction to the claim: “I think it would be fairer to say they need receipts for items over a certain amount, like cameras.” She went on to explain why the claim had all the detail on it: “We just felt it would be clearer for them to see what the claim was (for), not make us look suspicious!”

According to Insure and Go, though, a great deal of detail about low-value items can indicate possible fraud, and said it had several concerns about this particular claim, one of which was the unusually complete detail for the items. Perry Wilson, the company’s founder and owner, said all insurers must be vigilant to possible fraudulent claims: “Sometimes people give too much information, which obviously sparks [the question] – why would you remember all 39 items?” He added somewhat cryptically: “Give us some meat on the bone to look at this claim, to make sure we have some kind of substantiating evidence for it.” He did concede that in most cases, the company would only need to see evidence for a ‘reasonable’ cross section of lost items.David Cresswell, spokesperson for the Financial Ombudsman Service, said that while claimants should

prepare themselves to be scrutinised by insurers, the companies must have evidence that fraud has been attempted before they are allowed to refuse a claim. He continued with reference to the current claim: “If that comes as a dispute to us, we’d be saying to the insurance company: ‘Why would there be fraud in this case, where’s the proof of it?’” Industry sources agreed that there was such as a thing as ‘the too perfect claim’, but in the vast majority of cases the opposite problem is true. And Malcolm Tarling, spokesman for the Association of British Insurers, agrees that more information is better than too little: “When you lose items on your holidays, the golden rule is to give your insurer full and detailed information.” He added, though, that ‘companies have a responsibility to their customers to make sure they weed out the small number of claims that may be fraudulent’.

The devil is in the detail continued from page 1

Indians inspiredthat of a broker is 17.5 per cent.” Not only is there a disparity between the commissions paid, the source continued, but the initial investment for both outlets is high, giving agents less incentive.Travel agents also have to endure the same problem, and as most do not have sufficient profit margins for large investments, most steer clear of providing travel insurance at all. The view of the industry was made clear by the same insider: “Travel insurance is a commoditised product and it is time for the travel fraternity to have talks with the regulators and treat it differently.” However, the report goes on to say that those insurance companies surveyed would appear to prefer selling insurance online, partly because of lower overhead costs meaning the policies can be cheaper to the end user. Other companies, meanwhile, argue that travel agents shouldn’t sell insurance as they may not be certified, do not have the expertise, or simply may not have the most appropriate products in their portfolio.There are signs that the travel insurance market in India will continue its current rise, despite the problems associated with the sale of the product. In particular, several Indian airlines, both domestic and international, are partnering with insurers to offer travel insurance in conjunction with booking a flight. As the portion of those wealthy enough to travel in India increases, so too will the number of people choosing air travel, thus increasing the size of the market the insurers can penetrate. Insurers are also interested in train travel in the country and are reported to be in talks with the Indian Railway Catering Tourism Corporation to integrate a travel insurance offer to its online reservation systems. The growing affluence of the Indian people also means a rise in travellers going to Europe and the 15 Schengen countries, all of which require a travel health insurance policy that is valid for the entire duration of the trip before entry is granted.

continued from page 1

they can offer, as well as securing and growing current travel insurance revenues. John Bibby, managing director of Acumus Insurance Solutions, said: “Only a minority of the more than six thousand UK travel agencies have grasped the implications that authorisation allows a company to sell a range of general insurance products. The winners will capitalise on significant trading opportunities; just as large supermarket chains are white-labelling financial and insurance products as a source of extra income, it is the logical next step for travel organisations to tap into a broader range of insurance products.” It is vital, though, that the travel agents pick ‘the right regulated principal’ to be appointed to, Bibby warned firms: “You need someone who is going to work

with you and provide the right support in areas such as training, audit, distribution systems and access to complementary insurance products.” The best option for most firms will be to become appointed representatives, said Bibby, because ‘the travel insurance industry is full of providers who are more than happy to take their share of the spoils without ever really committing to a full partnership’.Options offered by Bibby include the possibility of offering wedding insurance to people travelling abroad to get married, two weeks of medical cover for a holiday could be extended to an annual private medical insurance policy, or pet insurance could be offered if the pet is going into the kennel/cattery while the owner is on holiday.

Regulation brings opportunitiescontinued from page 6

Standard and Poor’s has said that the disruption to the European insurance market caused by the credit crunch is limited compared to the amount of hassle and disruption that has happened and will continue to happen as a result of Solvency II. Credit analyst with the company Simon Marshall said: “To date, the insurance operations of groups headquartered in Europe have disclosed $7-billion mark-to-market losses associated with subprime losses, but we continue to believe that the broader disruption in capital markets has had a relatively minor impact on individual industry participants.” Although a major catastrophe could change this, he continued, as the market is not in any condition to cope with massive recapitalisation. Marshall said that Solvency II will be much more significant for the industry than the subprime crisis has been, as it will inevitable accelerate consolidation of companies in the region. “The results from QIS3 indicate to use that Solvency II would force more than 25 per cent of Europe’s insurers to face major strategic decisions,” he continued. “They may need to reduce scale, reduce risk, raise capital, employ more risk mitigation, merge with other insurers, be acquired or close to new business.”

Solvency II more hassle than crunch

International Travel Insurance Journal

10 INSURANCEMATTERS

A panel of American insurance executives, speaking at a Standard & Poor’s (S&P) conference recently, said they see tough times ahead for the industry over the next few years, as lower prices affect profitability and a more uncertain risk landscape requires improved risk modelling. Worries from the executives include the possibility that pricing for the sector as a whole could go so low it could be undercut by claims.William Berkley, chairman of WR Berkley Corporation, said that he had seen far more severe price competition recently, adding that his company had seen an average pricing fall of around seven per cent this year over figures from last year. Berkley said that the industry as a whole should break even this year, although it could sink into debt in 2009 as there are signs that the cost of claims could spiral out of control. For the past three years, he continued, insurance rates have been softening as claims were reduced for property and casualty lines, along with few major natural disasters and several tort reforms.Henry Keeling, COO at XL Capital, agreed that the market will be challenging in the future, and admitted that his company had also seen a decline of around seven per cent on business from clients renewing policies. In his opinion, pricing is more of an issue for property/casualty lines than casualty lines, or coverage for legal liability for losses stemming from injury or damage to property of others. He went on to say: “We have not seen wholesale deterioration in terms and conditions for casualty.”Frederick Eppinger, chief executive of the Hannover Insurance group, concurred: “I think with commercial [insurance], we are in for another three years of pain.”John Iten, a director of S&P, said the firm currently

rates the US commercial lines as ‘stable’, but added that he sees pricing for US commercial lines falling at least throughout this year and into next, which could lead to the rating being changed to ‘negative’ as soon as the end of 2008.Laline Carvalho, S&P’s director for reinsurance, said similar concerns prevail in that industry as well. Speaking at the conference, Carvalho reported that although the reinsurance sector has a stable outlook now, and will do for the next six months; beyond that time, the rating could change if reinsurance rates continue to decline.

US chiefs predict tough times

Swiss Re has rocked the financial world with a bigger than expected write-down on a troubled credit deal that had already caused a SFr1.2-billion loss last November. The world’s largest reinsurer announced that it is to make a further write-down of SFr819 million on the two credit default swaps that took the initial hit. The latest figure was more than three times the amount the group predicted when it reported 2007 results in February this year. The increased write-down has pushed first-quarter net profits down to SFr642 million, which is well below analysts’ estimates and 53 per cent lower than in the same period last year.Despite the bad news of the increased write-down, chief financial officer George Quinn expressed confidence about the business and its outlook. He told the Financial Times that good performance in its asset management, property and casualty and life and health operations had mitigated some of the impact of the credit crunch turmoil. Jacques Aigrain, chief executive, noted: “Despite the continuing turmoil in the financial markets, we remain confident in our earnings power and our ability to maximise

shareholder returns.” However, figures show that operating income in property and casualty fell by six per cent year on year, while the all-important combined ratio of the firm was 96.9 per cent, up over three percentage points. In addition, operating profits in the life and health division fell by 45 per cent to SFr 449 million.

Swiss Re increases write-down

Although the same was predicted last year, when the hurricane season was surprisingly light, Aon Corp. has warned risk managers and insurance companies that they should employ robust enterprise risk management strategies and business continuity programmes to cope with what forecasters are predicting to be an active summer of hurricanes and tropical storms. The National Oceanic and Atmospheric Administration’s updated forecast has predicted between 12 and 16 named storms between 1 June and 30 November this year, and other weather forecasters are in agreement.“While predictions of hurricane activity are important, insurance and reinsurance buyers must remember that any storm can cause massive destruction, whether that storm occurs in a season of above-normal activity or below-normal activity,” said Steven Drews, meteorologist and associate vice-president of Impact Forecasting LLC, a unit of Aon Re Global. Aon believes that the low severity and number of property catastrophe losses since 2006 has resulted in favourable pricing for traditional reinsurance schemes for mid-year renewals for insurers.

Active hurricane season predicted

Aviva to cut insurance jobsNorwich Union’s parent company Aviva has announced that it will cut up to 1,800 jobs in the next two years as it restructures its insurance operations. Although Aviva called the move ‘rationalisation’, workers union Unite said the job cuts were ‘brutal’, adding: “This news for staff that their jobs are now in jeopardy is truly devastating.” Norwich Union is to shift its operations away from cities including Glasgow, Leeds, Sheffield, Birmingham, Bristol and Southampton, while offices in Dundee, Ipswich, Exeter and Worthing will also be affected in some way, though the company has yet to release the details. The bulk of operations will now be focused in locations the firm has called its ‘seven centres of excellence’: Norwich, Perth, Bishopbriggs, Stretford, Manchester, Leicester and Southend.

Willis movesWillis Group Holdings Ltd, the world’s third-largest insurance brokerage by market share, is to buy smaller rival Hilb Rogal & Hobbs Co. (HRH) for $1.7 billion as it seeks to boost business as insurance rates are softening. Willis has also said it is prepared to take on $400 million of HRH’s debt in a cash and stock deal that has been valued at $46 per share. According to industry analysts, the purchase is the largest transaction for the industry since Marsh & McLennan acquired the Sedgwick Group in 1998.Willis said that the deal with HRH will help it ‘expand its footprint’ in the North American market, as although it has headquarters in New York, the firm is domiciled in Bermuda. It expects the purchase to effectively double its revenue in the region. Once the deal is completed, the group will be known as Willis HRH in North America.In 2007, HRH’s revenue was $800 million, with all except $57 million of that sum derived from the North American market. It has more than 140 offices across the US as well as two in the UK. In all, the companies will have a combined revenue of around $3.4 billion, based on figures from 2007.In related news, Willis has said that it is planning to have 100-per-cent ownership of its venture in China, where it expects annual growth revenue to be at

least 20 per cent on the back of increases of 23 per cent in 2006 and 24 per cent in 2007. The plan is to increase its stake in Shanghai-based Willis Insurance Brokers Co. from 50 per cent to between 80 and 100 per cent in the next 12 to 18 months, according to Sarah Turvill, chairwoman of Willis International.At the moment, Willis operates 20 offices across China, although plans are also in the pipeline to increase the number of employees from around 200 to 500 by 2011. There are also signs that the insurer wants to set up a back-up and client services centre in Shanghai later this year that would offer documenting, billing and accounting support to its fast-expanding businesses. Ms Turvill also said that the company might expand and relocate the back-up centre to a second-tier city in northern or western China in 2010 in order to better serve its Greater China business.

www.itij.co.uk

INSURANCEMATTERS 11

The recent trend among Spanish banks to seek specialist partners to take a share in their insurance portfolios shows no sign of abating. David Ing has the details

The latest Spanish bank seeking a partner to take a share of its insurance portfolio is the country’s third largest savings bank, the Caixa Catalunya, taking the place of Banco Sabadell, which is reported to have attracted as many as 15 potential associates since it began looking for a similar tie-up.As with Banco Sabadell, Barcelona-based Caixa Catalunya wants a recognised insurance group to take an equal 50-per-cent stake in its existing business. The search is being carried out by Morgan Stanley, with offers due to be scrutinised at the end of the summer. The savings bank has said it aims to use the deal primarily to free up capital that is currently tied up because of the regulatory restrictions on insurance companies owned by financial entities. But

it also believes the alliance with a specialist will help give an added boost to sales of its own products which are currently offered under the Ascat brand name. The proposed partnership could also open the door to developing further types of general insurance policies to sell exclusively through its network of 1,200 branches, it says.Caixa Catalunya, whose president is former national deputy prime-minister Narcis Serra, says that in recent months it has already received several offers from specialists and that there is ‘a lot of interest’ in such a deal. The optimism seems borne out by the case of Banco Sabadell, which has attracted widespread attention from leading domestic and foreign companies since it began looking for a potential suitor, according to financial analysts. Bankinter is among the larger banks that have already gone down the same path. The Caixa Sabadell was the last to close a deal when Zurich took a 50 per cent stake for €323 million in April.

Caixa Catalunya seeks partners

Singapore reinsurer ACR Capital Holdings (ACR) has announced that it is to tie-up with Malaysian national investment company Khazanah Nasional and Dubai Banking Group, which is the global Shariah-compliant investment company of Dubai Group, to set up one large retakaful company. The new company will be called ACR Re Takaful Holdings, and will be based in the hotspot of the Dubai International Finance Centre; with a starting capital of around US$300 million, it will signify the creation of the world’s largest retakaful entity.However, the firm will not simply be one large company, as John Tan, chief executive of ACR, explained: “We plan to set up retakaful businesses in Malaysia and in the Middle East as soon as possible. We are in discussions with regulators in both locations and hope to commence operations in the near future.” He noted that the creation of ACR Re Takaful Holdings was significant progress for the region, as previously much of the retakaful business had been given to international markets outside of Asia: “Establishing ACR Re Takaful Holdings will allow us to retain the business – within local markets and in accordance with Islamic principles.”

Retakaful giant set up

Insurance consumers in Thailand could well be facing higher premiums and bigger insurance bills as companies there try to pass on their costs in a bid to cope with the country’s rampant inflation problems. The Nation, an English language newspaper in Thailand, cited Kheedhej Anansiriprapha, chief executive of AXA Thailand, as saying that insurers are feeling the pinch as costs spiral out of control. In just a few short months, the average cost of a medical bill, car part

and services charge have become more expensive. Anansiriprapha was also quoted as saying that the loss ratio for the entire non-life insurance industry has hit 71 per cent, which he described as ‘code red’ – it was reported that some insurers had already defaulted on payment to some garages. If prices of goods continue the current rise upwards, said Anansiripraph, then an increase in insurance premiums of at least five per cent would be inevitable.

Premium increase in Thailand

AIG posts record lossAIG has posted its biggest ever quarterly loss, due, says the firm, to its continuing exposure to bad US mortgage debts. Reporting its results for the first three months of this year, AIG said that it made a net loss of $7.81 billion, disastrous in comparison to the same period a year ago, when the company

reported a profit of $4.13 billion. The loss was caused by a $9.11-billion charge for the decline in value of US mortgage products that AIG had insured. The announcement marks the second consecutive period of loss for the company.As a result of the record loss, AIG has been downgraded by Standard & Poor’s (S&P) – its counterparty credit ratings on AIG and several of its subsidiaries have dropped to ‘AA-/A-1+’ from ‘AA/A-1+’. S&P noted that the company’s loss included post-tax write downs of $5.9 billion related to AIG Finance Corp’s super superior credit default swap portfolio and said in a statement:

“When combined with charges taken in 2007, this brings the cumulative after-tax charges to more than $13 billion on the CDS portfolio and to $6.7 billion for impairment of investments.” S&P also warned that if AIG’s proposed $12.5-billion capital raising ends up not raising enough, then its rating could be further lowered, by as much as ‘two notches’.

M&A still hot in AsiaMerger and acquisition (M&A) activity involving financial institutions in Asia has reached unprecedented levels, according to the latest report by PricewaterhouseCoopers (PwC), which shows that the effects of the credit crunch have yet to be felt in certain corners of the world. PwC’s report, entitled Going for Growth in Asia: Navigating the way, states that the busiest sector in terms of M&A is life insurance, with 83 per cent of those surveyed having completed a deal in the past three years. In total, M&A in Asian financial services was up from US$68.5 billion in 2006 to $105.9 million in 2007.As part of the report, 281 senior executives were surveyed, 75 per cent of whom said their firm had been involved in an M&A deal in the past three years, a figure up from 73 per cent two years ago. When the question was only focused on Chinese organisations, the figure rose to 86 per cent, while in India activity also picked up, but not on the same scale, with just 66 per cent of those asked saying they had been involved in a merger.Dominic Nixon, PwC Asia financial services leader, commented: “Asian economies are in robust shape, registering only a single-digit percentage fall in total M&A transactions in 2007, as compared to the double-digit percentages in Europe and North America.” He added that steady growth in the gross domestic products of the

countries, combined with an emergence of a wealthy consumer class, have both created a fertile ground for M&A activity. “The Asian consumer is already powerful

and is changing the way financial institutions operate in the region. Banks and insurers are enhancing their investment management divisions and wealth management options.”

International Travel Insurance Journal

12 HEALTHMATTERS

Summer warnings to touristsWith the arrival of summer in the Northern Hemisphere, and the US Centres for Disease Control and Prevention (CDC) has issued a warning to travellers of several events that will increase the rate of travel this summer, thus increasing the risk that a bug could travel further. It points out that apart from the usual travel-related health risks in the summertime, there are also two international sporting events that are expected specifically to increase travel from the US to certain European countries and Asia.The European football finals in Austria and Switzerland have already kicked off, and travellers have been advised to ensure they are up to date with their vaccinations, especially for measles. So far, 2,800 people have been reported as suffering from measles in several European countries, including in

the host nations. The Swiss health authorities have recommended that all visitors receive the MMR (measles, mumps and rubella) vaccine.Meanwhile, the Olympic and Paralympic Games in Beijing are expected to attract around 600,000 foreign visitors and athletes, in addition to the 2.5 million expected domestic visitors. The CDC has a special webpage dedicated to giving travellers tips on how to avoid disease risks. One risk in particular that has again been highlighted is a risk of measles – this year, several US residents have acquired measles as a result of travelling to China or because they had been in contact with someone who had. There is also a risk present from the hand, foot and mouth disease that has made tens of thousands of people ill in China and killed several children.

Mongolia advice updateThe British Foreign and Commonwealth Office (FCO) has reviewed and reissued its advice for Mongolia, with amendments to its air travel and health sections. Although the country is not considered a hotbed for tourism, figures show that there were nearly 6,000 British visitors alone in 2006. Despite the fact that most visits went off without a problem, the most common type of incident that required consular assistance was for lost, stolen or expired passports.With regards to health, the FCO website states: “Mongolia has occasional outbreaks of foot and mouth and other infectious diseases. During these outbreaks affected areas may be quarantined and you may not be able to travel to them. If you are in an affected area, you may not be allowed to leave.” It says that so far this year, there have been over 1,000 cases reported of people infected with foot and mouth. In

addition, says the website, ‘during the summer hunting season, there may be isolated cases of bubonic plague, although these are usually confined to the hunters’. Travellers are advised to seek medical advice before travelling to ensure that all appropriate vaccinations are in place.The FCO also warned that there are ‘some doubts’ about the maintenance of some Mongolian-registered aircraft used by domestic airlines.

Editoral commentI’m particularly excited this month about our features in ITIJ and PHN. Following on from our lead ITIJ story last month about Canadian hospitals hindering the repatriation process, we have an interesting News Analysis feature that looks into the problem of bed shortages in the country, and asks whether hospitals in Canada could be doing more to service their travel insurance and assistance clients. Furthermore in ITIJ, we have features on cover for dangerous sports – what is covered, what should be covered, and how we convey this to travel insurance purchasers – and the spread of Takaful insurance, not just within Muslim countries but also its infiltration into Western banking and insurance systems. Takaful policies may be something you’ve never considered, but you’ve probably heard of them, and you’re going to be hearing a lot more about them if this boom continues. So, what is the relevance of Takaful for the travel insurance industry and what would a Takaful travel insurance policy look like? We reveal all. Our PHN feature, meanwhile, looks at how the travel and health insurance industries are changing, growing, and converging to cater for the growing number of global expatriates. All interesting stuff – I hope you enjoy this issue!

Sarah LeeEditor

sarah@itij.co.uk

TB patients on the looseHealth authorities in South Africa have said they are to send out a team wearing protective clothing in order to hunt down some escaped hospital patients, all of whom are suffering from a drug-resistant strain of the tuberculosis, three of whom have the extremely infectious XDR-TB. The patient breakout was from the Jose Pearson hospital in Port Elizabeth, where a security guard let one of the patients leave to go shopping. When the other patients heard about this, they too wanted to leave, but the same security guard attempted to stop them before being overpowered.The area’s provincial health authority says that three of the 19 patients that escaped had gone straight home to their families, who were in the process of returning their family member to hospital, while 12 others had simply returned to the hospital itself. In December last year, a similar incident occurred when 49 patients with drug-resistant TB escaped from the same hospital by cutting through fencing; court orders had to be obtained in order to force the dangerous patients back into the safety of a hospital ward.

International Travel Insurance Journal

14 AIRAMBULANCENEWS

Spotlight on MBB BO 105

The MBB BO 105 is a light, twin-engined, multi-purpose helicopter that was developed

in 1972 by Bölkow of Stuttgart, Germany. Production began under Messerschmitt-Bölkow-Blohm (MBB), which was bought by Eurocopter in 1991. The BO 105 was produced until 2001, when it was replaced in the product line by the EC 135.

Specifi cations

Capacity: Flight crew 1 Stretchers 2Length: 11.86 mRotor diameter: 9.84 mHeight: 3 mEmpty weight: 1,301 kgMax take-off weight: 2,500 kgMax speed: 242 km/hRange: 564 km

DRF improves patient careGerman air rescue organisation DRF has ordered 30 new defi brillation and patient monitoring units for its air rescue centres. Following extensive tests, DRF chose the Corpulus3 system, made by German company GS Elektromedizinische Geräte G Stemple GmbH (GS). The system combines several functions, thus helping to cut both the cost of the device and its weight in an aircraft. Günter Stemple, CEO of GS, handed the fi rst unit over to Dr Jörg Braun, director of medical services for DRF, on 6 May in Stuttgart.The Corpulus3 system replaces two other units that have served DRF so far – a defi brillator with a monitor and a separate patient monitoring device. GS states that one of the advantages of using the new system is that it can be split up into three modules, all of which can

communicate with each other via radio, thus making it possible to adapt the system to the particular needs of a mission. Dr Braun expanded: “In an emergency rescue, a crew quite often has to work in diffi cult

circumstances. An example: an injured person is freed from his destroyed car by fi refi ghters. There is little space, heavy equipment is being used. In this situation, the Corpulus3 offers us the possibility to leave a little measuring device with the patient and to clip off the rest of the system. Data is transferred via radio. The emergency physician can monitor the patient continually without any cable being in the way of the rescue team.” In addition, he continued, patient data can be sent directly from the Corpulus3 to the treating hospital via fax, allowing the receiving medical team plenty of time to prepare for the patient before they arrive.

FAA criticised over Air Trek groundingThe suspension of Air Trek’s operating licence by the FAA in May has drawn criticism from the National Air Transportation Association (NATA), who said the Federal Aviation Administration’s (FAA) recent use of emergency suspensions ‘calls into question fairness in regulatory oversight of the Part 135 community when compared to their Part 121 counterparts and raises concerns about the true authority given to local FAA inspectors’.In a letter to FAA acting administrator Robert A Sturgell, NATA president James K Coyne stated: “Despite repeated assertions from the FAA that the agency would ensure fairness in the evaluation of operational control, it has become clear that the FAA favours certain classes of air carriers over others. Over the last 24 months, the FAA has issued, or threatened to issue, numerous emergency suspension or emergency revocation orders to Part 135 carriers that have ultimately resulted in the loss of certifi cates for the operators involved. However, while Part 135 air carriers have received the ultimate penalty for operational infractions, their Part 121 counterparts are simply fi ned and permitted to operate.”Coyne described NATA’s operator members as being in a Catch-22 situation: “Their FAA-assigned local

inspectors are granted authority by the Administrator to inspect, oversee and ensure compliance with the regulations. Operators document their procedures for compliance in various manuals that are approved by the FAA via the local offi ce. Operators seek guidance when compliance questions arise from their local inspectors. Yet clearly, operators cannot rely upon what they are told by their local FAA offi ce. Time and again, inspection teams from FAA headquarters or regional offi ces descend upon an operator and determine that even though processes were approved locally they are now deemed defi cient and noncompliant. Often, these inspection and enforcement actions occur without the agency even bringing the local inspectors into the process.”He continued to say that NATA agrees the FAA must ensure compliance with the regulations, but the FAA ‘must also provide a reliable mechanism for an operator to have assurance that his or her business is indeed compliant’, stating that it is ‘inexcusable and discriminatory’ for the FAA to take enforcement against an operator when the action in question was known to and approved by the operator’s local FAA inspector.Air Trek’s licence has since been revoked - see page 1.

New plane for Jet ExecutiveGermany-based Jet Executive has announced the full air ambulance charter availability of its completely refurbished and painted Challenger 600. The aircraft is equipped with state-of-the-art Swiss-made Bucher stretchers, an Oxylog 3000 and Servo 300 ventilation systems. In addition, a Propaq monitoring system, Braun syringe pumps, LP10 defi brillators, complete immobilisation sets and a complete set-up of medications make it possible to meet the needs of any patient. The fi rm can also cater for neo-natal transfers, offering two Draeger 5400 incubators and ventilations systems.According to Jet Executive, what makes the Challenger special is that it offers single stretcher plus eight confi gurations as well as double stretcher plus fi ve accompanying passengers, ‘so it is the perfect aircraft to carry those patients who want to move relatives and/or their personal doctors on board the same aircraft, or to combine fl ights picking up various patients and relatives in one fl ight operation’ said Jet Executive’s marketing and sales director Gunther Krahé.

Royal Med adds Learjet 60Royal Med, based in the Middle East, has introduced a Lear 60 to its fl eet, enhancing its capabilities as a medevac service. Royal Med is a division of Royal Jet, which is an international luxury fl ight service headquartered in Abu Dhabi and chaired by Sheikh Hamdan Bin Mubarak Al Nahyan.President and CEO of Royal Jet Shane O’Hare, speaking at the announcement of the new aircraft, explained: “We have made signifi cant investments in Royal Med’s infrastructure, personnel and aircraft in order to provide the highest quality of aeromedical transport. Now with the addition of the Learjet 60 this will add more fl exibility to our medevac services and offers a greater fl ying range than the Learjet 35s.” The purchase of the Lear 60 brings the total number of Royal Med’s fl eet to nine, with four different aircraft types now available to users. Each one is fi tted out with the latest medical equipment and intensive care facilities.

www.itij.co.uk

AIRAMBULANCENEWS 15

Air medical transfer is not only a life saving solution for patients, it is also a part of the macro and micro healthcare investment plans of medical facilities large and small, state and private, all of whom need to factor in how to deal with such cases. Dr Fatih Mehmet Gul tells of how despite a boom in healthcare provision in the Middle East, aeromedical services seem to be out of sight and out of mind

Investment initiativeThe Middle East region is currently experiencing rapid economic growth, powered by record oil prices, especially in the six Gulf Co-operation Council (GCC) countries. As a result, cash-rich governments are splashing out on new infrastructure projects, and the healthcare sector is benefiting nicely, with expenditure in this area predicted to rise to new heights in the next three years. The private medical sector is growing fast and health insurance sales are rising steadily, with the result that there is a new focus on raising the quality of medical care provided in the region. Even though several of the new major healthcare projects are not yet complete, talk of planning for patient transfers and international repatriations is still pending, and incorporating such procedures into the hospitals’ planning stage is just not happening. The main problem, however, is the lack of companies offering aeromedical services – both for short-haul or internal hospital transfers, or indeed for international repatriation work. Even ground ambulance procurement is a problem for these new advanced healthcare facilities, who may have the latest technological medical equipment and pristine facilities, but who lack available facilities to transfer patients either internationally or locally. Where they do have sufficient ground ambulances, inner-city traffic is becoming a big problem for primary and secondary patient transfers in cities such as Dubai and Abu Dhabi, but this is a separate planning issue that needs to be addressed.

Booming businessThe Middle East’s aviation industry recorded above average growth of 5.5-per-cent between 2002 and 2005, where the global average growth rate was 4.8 per cent. By further considering the

demographics of the region, where 100 million people are under the age of 24 and millions more are expatriates, it becomes clear that air travel will increasingly be seen as a necessity rather than a luxury in the region. Indeed, between now and 2020, the Middle East is forecast to lead world passenger traffic growth, with current travel demand up 18 per cent. What does this mean for

aeromedical services in the region? Well, the more people entering the region, the more people that are likely to need hospital treatment and the use of aeromedical services to and from the region.Since it is so difficult to find a local partner providing air medical services, most insurance policies in the region do not yet include the provision of such services. International air ambulance companies are also thin on the ground, which doesn’t help the situation. More investment

– both from local investors with the backing of local hospitals, and from international air ambulance operators – is needed in the Middle East.

Work in progressRegardless of the existence of a few private air ambulance companies with their own fleets, almost all air medical services in the region are currently being conducted by governmental agencies such as the army, and the police; most of these flights are only offered for intra-hospital transfers. Further problems with this system lie in the fact that it often takes a comparatively long time to gain the necessary governmental approval to use an aircraft for such a purpose, especially problematic given the fact that fleet capacity is low anyway. The quality of medical care on such flights is also low, and overall quality is not assured by internationally recognised agencies such as CAMTS and EURAMI.So, the Middle East has a real and growing need for aeromedical services. Air ambulance operators that establish themselves in the region have a market ripe for promoting their services too. In the next few years, the region will become even more affluent and people will continue their search for better services in every sector, meaning the patient transfer offering will have to catch up with that of its medical facility sister. The best way it’s going to do this is to bring in newcomers to the region, as has been the case in other areas of the healthcare sector.

Middle East seeks AA operators

Dr Fatih Mehmet Gul is a Flight Physician with an MBA in finance. He is the project manager for Saudi HEMS, which is the first civilian helicopter ambulance service in the Middle East. He is also founder of Air Ambulance Arabia.

Raisbeck celebratesRaisbeck Engineering has announced that the 75th ZR Lite Performance System is currently being installed by Duncan Aviation, an authorised dealer of Raisbeck for the past 20 years. The Lear 35 that is being kitted out is operated by MaCair Jet SA of Buenos Aires, Argentina on behalf of Albanesi SA and Swiss Medical Group SA. MaCair’s director of maintenance Daniel Kucharzcuk said of the new system: “Raisbeck systems enhance the performance of the 30 series Learjet at a relatively low cost. The fact that ZR Lite pays for

itself in a short time is an added bonus! In short, ZR Lite brings my crew better performance and adds safety for my passengers, all while reducing fuel burn.”

Air ambulance takes to the skiesThe new Great Western air ambulance service has now started in the UK, based in the home town of the ITIJ team – Bristol. The helicopter is crewed by critical care paramedics and doctors and carries advanced life-saving equipment. Initially, the plan is to operate the aircraft five days a week, but only as long as it raises the necessary £1.3 million annually to keep flying. Tim Lynch, chief executive of Great Western Ambulance Service, said: “The new air ambulance has been set up in response to an identified gap in air ambulance cover for the people of Avon. It will save lives – and complement the existing paramedic teams on the ground.”

Obesity problem addressedThe growing girth of some air ambulance passengers has been noted as an issue of concern by several aeromedical providers, and was highlighted recently by a case reported in Waypoint, AirMed & Rescue Magazine when a Hercules plane was used to airlift a patient to hospital after it was found he couldn’t fit into the jet supplied by the Royal Flying Doctors Service. Now, however, an American company, Airlift Northwest, has announced new measures to help such companies deal with overweight patients. Mardie Rhodes, a spokeswoman for the non-profit air ambulance operator, said: “There’s been a real issue with the size and girth of some of the patients we’ve been asked to transport.” In order to cope with the problem, the firm has started to ask hospitals and emergency site dispatchers to fill out a special form when requesting transport for anyone weighing more than 250 pounds. The form asks for detailed information, including measurements of the patient’s stomach.Jeff Richey, a regional manager for Airlift Northwest, said this type of information is critical to the successful completion of a transfer. For the safety of the flight crew, they need to know whether or not they will physically be able to lift the patient without injuring themselves. In addition, it is vital that the crew knows for sure whether the patient will fit into the helicopter or jet, or whether when they are inside, they will take up too much room, making it impossible for the crew to manoeuvre in flight. The new policy on reporting details of a patient’s size aims to eliminate such problems from the equation, making for safer and faster transfers. According to Richey, at least once a year the Airlift Northwest crew are called out, only to find out the patient is too big to fly, so they ended up loading them onto ground ambulances and accompanying the patients to hospital that way – this is hardly ideal though. “In our business, we’re called on to move a patient quickly,” said Richey, “We’re delaying the

transport if we can’t take them physically in the aircraft.”Statistics from the US Centers for Disease Control and Prevention show that one third of all American adults – roughly 72 million people – are considered to be obese. Given that obesity rates have been increasing steadily over the past two decades, those numbers are only going one way, so the air ambulance industry must be properly prepared to deal with such patients when the need arises. Indeed, other companies in the industry have also introduced measures designed specifically to deal with obese patients. American Medical Response has placed a larger ambulance in the Portland area, complete with heavy-duty lifting equipment to move obese patients, said spokesperson Lucie Drum. The big ambulance has a larger patient compartment, carries a gurney that is capable of supporting 1,000 pounds, and a sports ramp for patient loading. Elsewhere, the Fire Department of Seattle now carries a device known as a Mage Mover – a tough fabric sheet with 12 handles on that can carry up to 1,500 pounds, as well as wider backboards.The Association of Air Medical Services has agreed that the problem needs addressing urgently by air ambulances, as there is nowhere that weight has more importance than in an aircraft. There have even been incidents reported where a helicopter has arrived to find an obese patient, and had to fly around for a while burning off fuel so that the patient could be safely transported – hardly a favourable option given today’s record fuel prices. If you’ve had an experience like any mentioned in this article, please contact ITIJ with details at mail@itij.co.uk.

International Travel Insurance Journal

16 TRAVELMATTERS

No holiday? No wayNew research from American Express Travellers Cheques has revealed that more than 38 per cent of those surveyed would refuse to forego their summer holiday this year, despite money worries being higher up the agenda than ever. Instead, showed the survey, people preferred to ration their daily expenditure in the run up to the summer to mitigate the cost of travelling.American Express interviewed 2,000 Britons about their holiday budgeting plans this year in order to find out if the travel industry is going to feel the credit crunch. Those interviewed said they are expecting to spend an average of £773 while they are on holiday, in addition to the flights and accommodation already paid for. In order to fund this spending money, however, 22 per cent of respondents said they would not buy a new outfit, 21 per cent said they would not dine out and 15 per cent said they would cut nights spent in the pub before they leave for their holiday. Thirteen per cent of respondents said they are delaying a major home purchase in order to travel, such as buying a new sofa, while one in ten people said they would not purchase any new garden furniture this summer.Across the spectrum of the UK as a whole, those in the north of Scotland seem to be the least likely to feel the pinch this summer as despite having the highest estimated holiday spend of anywhere in the UK (£1,231), they also have the highest proportion of people who say they will not need to make any sacrifices in order to fund their holiday. Those in the southwest of England are the most frugal when they are abroad, with an average spend of just £644. People aged 35 to 44, possibly with children to entertain, are the biggest spenders while abroad, expected to spend 50 per cent more than those aged between 18 and 24.Kristie Bayley, vice-president of American Express Travellers Cheques, commented: “Whilst people are thinking about their spending now, it’s the last thing they want to worry about when they are actually enjoying their break.”

Fuel fears hit UnitedThe increasing cost of aviation fuel has forced United Airlines to scrap more than one-fifth of its aircraft fleet as the industry tries to come to terms with soaring costs and new forecasts that have predicted the sector faces a $60-billion funding gap. United, the second-biggest US airline, has announced that it is to retire 100 of its 455 planes – 94 short-haul Boeing 737s and six jumbo jets. The carrier has also said that the number of job losses will rise from a previously predicted 500 to between 1,400 and 1,600 people, along with the scrapping of Ted, the airline’s budget brand. Most of the reductions in flights will be on domestic services in the US, with the 11 daily flights to London so far unaffected.

The decision by United follows swiftly in the footsteps of an announcement by American Airlines that it was going to scrap 75 planes and cut services by 11 to 12 per cent. Michael Boyd, an aviation consultant at US-based Boyd group, said that the planes were being removed by United because they are older aircraft that could be axed without any liability to leasing agencies: “They’re being parked because they’re paid for, not because they’re fuel guzzlers.” In his opinion, United is more likely to trim the frequency on routes as opposed to abandoning them altogether, although he added a disclaimer to that opinion: “Their management track record has been so clumsy, I don’t know how successfully they are going to do this. They’ve not been running an airline – they’ve been running a merger partner.”Analysis performed by USA Today found that certain American destinations are already losing out to cancelled flights – Orlando, Las Vegas and Hawaii have all experienced lower visitor numbers this year.

Honeymooners shun beachesThe traditional two-week honeymoon by the sea now seems to be shunned by modern couples as being old-fashioned, according to a survey of UK honeymooners who used Teletext.co.uk to book their holiday. Instead of the normal beach holiday, today’s British honeymooners are choosing to take city breaks, adventure holidays, a cruise or simply stay in the UK. Of the more than 2,000 people who participated in the survey, four in five said they would not choose to go on a traditional beach holiday – 58 per cent of respondents said the idea was ‘passé’, while 56 per cent said the idea of being surrounded by other couples ‘filled them with dread’. However, this new, youthful outlook on what makes a honeymoon comes with a higher price tag – the average honeymoon this year will cost £2,580, with most of that going towards the flights (£1,029) and accommodation (£1,008).

Thailand targets the girls

The Tourism Authority of Thailand has recently launched an online marketing campaign that has been designed to target women travellers worldwide. Her Own Way: Thailand – the Woman’s Paradise has

now gone live on the Internet. The micro-site specialises in specific grouped female products with the aim of influencing more women travellers to choose Thailand as their holiday destination. Activities such as golf, shopping, spa days, beauty therapies and accommodation with special female facilities are all highlighted on the website. According to the Tourism Authority, the targets are women from Japan, Hong Kong, Singapore and the Middle East. On the website, women are given insights into selecting single-woman friendly accommodation, personal safety and other issues that, says the Authority, ‘are pertinent to helping female travellers to enjoy safe and cost-effective stays in Thailand’. Thai Airways has offered support in the form of exclusive deals through the airlines’ Royal Orchid Plus female members’ database.

Cyclone damage will affect tourismPhysical damage caused by Burma’s cyclone, coupled with the government’s reluctance to co-operate with international aid agencies and governments, will deepen the wounds of the already fractured tourism industry, according to Parita Chitakasem, research manager at Euromonitor International.Although Burma was receiving negative press long before the cyclone hit, there was an existing tourism infrastructure that was improving annually. Latest full-year records showed that the country received just under 350,000 visitors in 2006 – numbers from 2007 took a hit at the end of the year after protests by Buddhist monks were aired across the world and tourism fell drastically. Arrivals at that time plunged to 50 per cent of normal numbers, while hotel occupancy rates dropped off by 70 per cent.The biggest losses in tourism will be felt in the capital Rangoon, according to Chitakasem, where tour

groups and airlines cancelled services out of fear that the city was both damaged and dangerous and market stalls and tourist attractions were closed. Over the next three to four months, Chitakasem predicts that new arrival numbers will fall by around 70 per cent, while shortages of food, water and petrol will also result in many embassies in the West discouraging their citizens from visiting.The government in Burma has many worries right now, not least of which is how to bring back the tourists. Industry analysts have predicted that efforts will be concentrated in Muse, where the country shares a border with China, along with other regions in the north that were unaffected by the cyclone and as such will be easier to develop as tourist hubs. Although the number of Western tourists will probably stay reasonably small, Chitakasem forecast that tourists incoming from China and Thailand will help to boost revenue.

International Travel Insurance Journal

18 NEWSANALYSIS

A Canadian vacationer in Hawaii suffers a stroke and after successful clinical stabilisation is booked for an air ambulance transfer home to Alberta for rehabilitation. A lot of time-consuming and complicated professional assistance work is expended in the process: to say nothing of intense stress on the patient and his family. Then comes the response from a government bureaucrat: if the patient is privately insured and being treated in Hawaii, the only way to get him into hospital at home is to bring him back to Emergency and let him line up with the others. No priority. No pre-arranged transfer. No assurance of a bed. The alternative is to wait, and wait.And waiting is what Canadian patients, travel insurers and their emergency assistance representatives worldwide are doing as hospital admissions staffs and health ministry bureaucrats who run the provincially-administered health systems portion out hospital beds to those already waiting in emergency rooms, bumping patients with private insurance to the end of the queue.

Deferring prioritiesKieran Bridge, travel health insurance lawyer and past president of the Travel Health Insurance Association of Canada (THIA), says that such deferral ‘is simply another tool for rationing healthcare … with the overall goal of reducing the cost to the provincial government of providing healthcare’.Bridge notes that one THIA member reported to him that during the last snowbird season (October 2007 to April 2008), at least eight repatriations required a wait of at least five days, and one of them took 16 days from the time of medical authorization to transfer.The problem, say other emergency assistance professionals, is not limited to Alberta, or even British Columbia where it is said to be worst, but to Canada’s most populous province Ontario, and other areas as well. Dr Ferial Ladak, medical director of Global Excel Management Inc., a Quebec-based assistance company that manages cases and repatriations for residents of all provinces, says that delays in bed procurement occur almost ‘every time [they] have a patient who is not acute and needs rehab, especially in Ontario and Alberta’. She says that one patient – a truck driver who had an accident in the United States – had to wait one month for a hospital bed in his home province. “We nearly had the patient’s family go to the press. The family wanted him home, so that was not a case of trying to repat for our benefit.”

As for intensive care beds, ‘we certainly get bumped’, she says. “I have been told outright that if there are patients in other hospitals in the province waiting to be transferred to that particular hospital they will get priority, (especially) for such services as catheterisations and bypasses.”Without doubt, the problem of rationing hospital beds is exacerbated by overcrowded emergency rooms, limited ward space and budgetary restraints on healthcare imposed by provincial governments. Canada’s government-controlled universal healthcare system prohibits private health insurance for services covered by provincial plans, although it encourages private coverage for out-of-country emergency

medical care. That coverage, however, is limited to emergency services, not to continuing or follow-up care, and is predicated and priced on getting the stabilised patient back to his home province as quickly as prudence permits. It is designed as a supplement to provincial coverage, and is in fact not allowed to duplicate it – despite the fact it is often required to do just that when beds are deferred.

Therein lies the problemMila Pejovic, associate director of travel assistance and medical case management for World Travel Protection Assist, tells ITIJ that many ‘hospital bed coordinators and receiving doctors do not consider patients coming from Florida (or other foreign locations) their priority

as they are already getting proper medical care’. She says: “They sometimes even comment that insurance companies only worry about costs.” This is regardless of the

actual need for that patient to be transferred. “The receiving hospitals sometimes just refuse up front to take the patient,” says Pejovic. “They say ‘we are full’, or just inform us that they cannot take patients from out of the country as they have other patients already waiting in the hallways to be admitted.”Some family physicians are more empathetic than others and do get involved in trying to secure beds for their patients who are seeking to be transferred home, she admits. “But a lot of them, regrettably, are not.” General practitioners without admitting privileges, for example, ‘often do not see urgency (in facilitating transfer) as the patient is well taken care of in another country’. “They perceive this as assisting insurance companies not patients,” she says. In general, Pejovic concludes, ‘we are faced with huge obstacles in each and every step of the process’. And the biggest obstacles, from her perspective, are in Ontario and British Columbia.To patients and their families, encountering these delays in getting back to hospitals in their communities, to the health system they thought they could count on and for which they have paid all their lives, is incomprehensible. “We end up,” says Dr Ladak, “with angry patients, families and doctors, as well as stressed out case workers. The clients cannot believe that we have as much trouble as we do in securing beds, and they and the doctors get more and more agitated as the

days go by. Finally, the procedures get done in the US because everyone is unhappy.” The result is not only personal agitation, but very substantial cost. Provincial health insurance

agencies pay only minimal amounts for emergency medical services encountered abroad by Canadian travellers. British Columbia, for example, pays only

as little as $75 a day for hospital care out of Canada; Alberta $100. Ontario pays up to $400 per day, but often doles out less, depending upon acuity of care. This leaves the remainder to be paid by travel health insurance policies or by travellers themselves if they are not insured or are inadequately covered because of pre-existing conditions or other limitations.

Waiting game“Last year’s numbers suggest we had to wait an average of five days for a bed,” says Global Excel’s Dr Ladak. “And if you consider that a day in a US hospital can cost from $4,000 to $10,000 that can be significant.” WTP’s Pejovic says that though most hospitals agree to put patients awaiting repatriation on their waiting lists ‘it is not unusual during [the] busy season to wait a week or two for a bed, even longer’. “And all of this has a huge impact on our operation, as bed

Can’t take the heat?

deferral ‘is simply another

tool for rationing healthcare’

the problem of rationing hospital

beds is exacerbated by overcrowded

emergency rooms, limited ward space

and budgetary restraints

With news in ITIJ’s last issue that Canadian repatriations are being hindered by bed shortages in the country, Milan Korcok asks: is travel insurance a convenient safety valve for Canada’s overheated health system?

www.itij.co.uk

NEWSANALYSIS 19

search is extremely labour sensitive, and arranging for a repatriation sometimes requires a whole day of focused effort for just one bed,” she explains, adding: “In the meantime, patients can deteriorate and become untransportable.”What is especially galling to many leisure, business or student travellers and their advocacy groups, is that Canada’s universal, publicly-funded healthcare system ‘guarantees’ portability of health benefits between provinces, although that guarantee is more vaguely interpreted when it comes to out-of-country benefits. The Canadian Snowbird Association, which represents travelling seniors, has for years lobbied governments to at least pay for out-of-country services up to what it costs for those same services to be provided domestically. The federal government, because it cost shares provincial health insurance, has the power to impose fines on provinces that contravene portability rules, but has rarely used that power, and clearly, $75 a day doesn’t cut it.The argument goes that if those needing repatriation can at least get back to Canada on their own travel insurance ticket – which does pay for medically necessary repatriation – they should not be discriminated against and bumped out of the queue because they had the good sense to buy private insurance. Health ministry officials have, on the other hand, argued that people who are already in a hospital – albeit a foreign one – and receiving good care, should not displace patients at home who can’t get beyond their crowded emergency rooms.The problem with that reasoning, says Bridge, is that many of these officials are unaware of the huge amounts charged by foreign hospitals, especially those in the US, and are equally unaware of the pittances the provinces pay toward these charges: “When I explained to the medical director of B.C. Bedline (the provincial agency charged with allotting hospital beds in that province) that the B.C. Medical Services Plan typically pays only about five per cent of the cost of US hospital care, he told me I was being ‘ludicrous’.” He had obviously never seen a US medical bill, added Bridge.

Compounding the problemWhat compounds the repatriation problem, say some experts, is that not only are many patients

denied beds in their own communities close to family and friends, they are sometimes declined beds elsewhere in their province by regional health authorities keeping an iron grip on their own parochial resources. Dr Robert MacMillan, medical director for Medipac International, one of the largest providers of snowbird insurance for Canada’s seniors, recently told a travel insurance industry conference that ‘unfortunately, (if) you even try to get a hospital bed outside your own community, people say “they’re not in our catchment area”’. WTP’s Pejovic concurs that though dealing with hospitals in the patient’s normal catchment area is difficult enough, trying to secure an admission beyond that area ‘becomes virtually impossible’.Some have argued, convincingly, that this rigidity in apportioning hospital beds is contrary to the spirit and intent of the portability provisions of the Canada Health Act that governs the criteria provinces must meet in order to get their share of federal funding to run their health insurance programmes. Bridge notes that in British Columbia, his home province, hospitals in one health region routinely refuse to accept repatriated patients whose homes are in another. (B.C. is divided into six health regions or authorities, one of which bisects Greater Vancouver). Thus, in practical terms, he says, if someone living in North Vancouver needs to be repatriated, B.C. Bedline will not even call St Paul’s Hospital in downtown Vancouver (a different region) for a bed for that patient.“There is no legal basis for this discrimination,” says Bridge. “All British Columbians pay provincial taxes to cover the cost of medical care. They do not pay taxes to regional health authorities, which are simply administrative bureaucracies set up by the Ministry of Health.”Bridge has argued, on behalf of THIA, that there is no legal requirement for hospitals to use B.C. Bedline, which he says has no legal standing and was set up simply as an administrative tool by the Ministry of Health: thus there is no legal basis for hospitals telling assistance companies they cannot accept repatriated patients unless they are directed to do so by B.C. Bedline. In response, the chief operating officer of Healthlines

Services B.C. (an agency funded by the B.C. Health Ministry) challenged THIA, in March 2008, to substantiate the allegations of illegality. Does this mean the question of repatriating Canadian patients from foreign hospital beds can only be settled in the courts? Is it inevitable that transferring sick people from one clinical environment to another will ultimately be decided by clerks and not by treating and receiving doctors and assistance professionals?

If so, how might they deal with Dr Ladak’s recent dilemma in trying to repatriate a young Ottawa area motor cycle accident patient who was confined for weeks in a US hospital bed but not considered a priority by Ottawa hospital authorities: “The patient kept crying that he wanted to come home, which had his family very upset. His head injury had made him very emotional and he did not understand things as well. He just wanted to come home.”

The result is not only personal agitation, but very substantial cost

though dealing with hospitals in the patient’s normal catchment area is

difficult enough, trying to secure an admission beyond that area ‘becomes

virtually impossible’

International Travel Insurance Journal

20 FEATURE

Many popular recreational holiday pastimes, such as jet-skiing, are no longer covered on basic holiday insurance policies. Stewart Farr asks whether the public is commonly aware of this fact, and whether travel insurers are thus playing fair

Insurance is all about perceived risk – a fact highlighted perfectly amongst travel insurance providers when dangerous sports cover comes into play. Another known fact is that consumers rarely, if at all, read the small print of policies. In combination, these two facts inevitably result in rejected claims. Travel insurance is, admittedly, one of the more complex types of insurance on the market, and most people buy it without being clear about what it does and does not cover. They are also prone to behavioural changes whilst on holiday, making snap decisions to pursue exercise or sporting activities, blissfully unaware that these are not covered by their insurance. Arguably, it’s their own fault if accident or disaster ensues, but this confusion over – or indifference to – what the policy provides in the way of cover is not helped by the divergence of underwriting opinion among insurance companies as to what constitutes a dangerous sport or pastime.

What of statistics?In some respects, this variance of risk opinion is to be expected given that insurers, as well as compiling and accessing data banks for all the relevant accident

Sport:how dangerous can it be?

www.itij.co.uk

FEATURE 21

and mortality statistics, also draw upon past claims experience and reassurance capabilities when fixing premium levels and determining exclusions. The consumer doesn’t know this and feels aggrieved to find that horse-riding, for example, is not covered in his standard travel insurance package.Can there be agreement on what is and what isn’t a dangerous sport; what should be covered as ‘standard’, and what falls into the ‘hazardous’ category, thus meriting non-inclusion? Is it really possible to isolate those sports (the ‘extreme’ variety such as base jumping being automatically excluded) with a dangerous element and then rank them according to risk acceptability? What criteria do you use?If death is the yardstick, then angling apparently leads the field in the UK (drownings, fishing lines getting caught in overhead power cables), closely followed by horseriding (including eventing and show jumping), climbing and car racing. But is angling a sport or a pastime? If injury is the determining factor, rugby gets the vote as the most dangerous sport; it has been reported that rugby players are three times

more likely to get injured playing their sport than someone taking part in martial arts.However, a doctor writing to The Times two years ago noted that, if measured by the number of fatalities occuring during play, then bowls is the most dangerous sport of all, as participants are generally elderly and subsequently prone to heart attacks and strokes. He also maintained that the sport which leads to most insurance claims is surfing, mainly due to injuries incurred while removing boards from the roof of the car!In the US, it could be argued that cheerleading is the most dangerous sport. Statistics from the National Collegiate Athletic Association (NCAA) suggest it may be even riskier than American football, the sport it was created to support. The NCAA’s Catastrophic Injury Insurance Program found that 25 per cent of its claims for college student athletes since 1998 have resulted from cheerleading, placing it a close second to football in the danger stakes. This claims statistic is remarkable given that the ratio of cheerleaders to football players in US colleges is around 12 to 100.

Categorising riskA potential customer who surfs the Internet to get a fix on whether his or her intended sporting activity could be prone to insurance exclusion is not guaranteed an edifying experience. Lists of unacceptable activities vary and have resulted in a lot of controversy over insurance company policy on sport. There is a tendency to categorise along the

following lines, but it is by no means uniform and to many self-styled sporting experts the risk ranking would seem to be unfair if not deliberately obtuse.The most risky category includes bungee jumping, mountaineering (over 4,500 metres), powerboat racing and any professional sport. Next down the ladder comes hang gliding, parachuting and paragliding, pot holing and rock climbing, off-piste skiing, ski racing/jumping, heli-skiing and ice hockey. Middle range risk takes in scuba diving, wintersports including snowboarding, and piloting aircraft, all considered more dangerous than hot air ballooning, microlighting, skateboarding and whitewater rafting/canoeing.Sports categorised with the least risk include amateur contact sport, for example fencing, boxing, polo, soccer, mountain biking, high diving and jet skiing. Finally, there’s a relatively ‘safe as houses’

this confusion over – or indifference to – what the policy

provides in the way of cover is not helped by the divergence of

underwriting opinion among insurance companies as to

what constitutes a dangerous sport or

pastime

It is the customer or client’s reasonable expectations of the

level of cover and the fairness or otherwise

of exclusions that should dictate

whether a risk is assessed as standard.

International Travel Insurance Journal

22 FEATURE

category that covers non-contact sports such as abseiling, motorcycle touring, yachting (inside territorial water!), tour operators’ safaris (not using guns) and trekking, so long as it is not in remote or mountainous areas.This form of ranking is at odds with many people’s view of what is or isn’t a hazardous sport. The fact that insurance companies themselves don’t trek a uniform path to risk just adds further confusion. In North America, for instance, skiing is not considered a dangerous sport and parachuting and paragliding only perceived by some insurers as very high risk. The levying of additional premiums for, say, scuba diving might not apply if the customer can demonstrate proficiency or a certificate of expertise.Most European insurers, in contrast, exclude skiing

and winter sports from standard travel insurance, instead offering a specialised package of cover. Direct Line is typical of several companies that offer a ‘policy for people taking part in winter sports, which does have a higher premium but offers extensive coverage for customers who want to enjoy the ski slopes with the peace of mind offered by travel insurance’. The company’s head of travel insurance, Chris Price, added: “We recognise that sporting activities are a major part of many people’s holidays and we want to provide them with the best cover we can. For activities with a history of high frequency and high value claims, we will often pay the customer’s medical and personal accident costs but will not cover personal liability for damage to third parties or their property.”

As with other travel insurance providers, the mantra from Direct Line is that customers wishing to ensure they have the cover they need should contact their insurer prior to the trip to discuss what sporting activities they plan to undertake. Winter sports are noted for their high accident quotient, expensive medical treatment and/or repatriation; there is also the spectre of legal costs involved in determining who was at fault. “If a customer is on holiday and is injured as the result of an accident caused by someone else, we provide legal assistance cover to help the customer obtain costs from the responsible party,” said Price.

Meeting expectations?Although, sensibly, most insurance companies won’t add dangerous sports cover to the policy once the customer is in situ (and on a whim has decided, for instance, to execute a high dive from the top of Iguassu Falls), there is a much greater awareness of intention to participate in hazardous pastimes. Back packing and adventure holidays have grown in popularity and some insurance policies now make an effort to provide standard cover for hitherto exotic activities that are now more commonplace.“Travellers want much more out of their trip than just a typical beach holiday nowadays,” said Paul Dittmer, marketing manager with UK company Columbus Travel Insurance. “Armed with guidebooks, they are clued up with what’s on offer for the adrenaline junkie in them – and travel insurance companies are responding and including the more popular sports for free with the policy.” His company covers activities such as scuba diving, elephant rides and walking up Sydney Harbour Bridge, ‘for free because we found so many people were asking for them.’A genuine attempt to provide customer service or just glib marketing speak? Probably neither; just that Columbus has found from its claims experience that such pursuits can be categorised as low risk. The company, after all, does load its premiums for certain sports it views as higher risk, such as kayaking (5 per cent extra) or heli-skiing (50 per cent).While statistics show that most accidents and injuries whilst travelling actually occur in hotels rather than on the ski slope or in a remote, isolated location (in fact many of the accidents occur in the hotel room), the trend for adventure holidays can pose problems for risk assessment. When does an adventure holiday become an extreme one and how can underwriters calculate the risk incurred by dangerous sporting in such circumstances? As reported earlier in ITIJ, the British Insurance Brokers Association has worked hard to ensure that pursuits one sees as extreme, for example paragliding, hot air ballooning, even horse riding, are now covered as standard in insurance policies.Nonetheless, the ultimate extreme trips with their high hazardous sports component are likely to remain non-standard. They are the remit of the specialist broker who can access the financial

underwriting expertise required, is cognisant of the varying levels of reassurance used by different insurance companies, and can locate impaired life insurance for individuals involved in dangerous activities and pastimes. Lloyd’s of London is well known for such specialist underwriting but here it is argued that although the market is increasing it is still too diverse to collate meaningful figures on the number of policies or claims. In essence, there is not enough of the risk to enable an accurate estimate of all possible costs and thus arrive at a ‘standard’ policy with a competitive price.Time is needed, perhaps another decade, before sufficient claims experience has built up to determine what sports are dangerous to the extent of always meriting non-standard cover and what activities deserve to have the rules relaxed. In the meantime, no doubt, ombudsmen, such as the UK’s Financial Ombudsman’s Service (FOS), will continue to see a high level of travel insurance complaints, partly due to the fact that such insurance has not kept abreast of changing holiday fashions. The FOS gets a lot of disputes over terminology: many of its complainants don’t view scooter riding, surfing, jet skiing or bungee jumping as dangerous, while their insurers do.It can be maintained that the customer is at fault here, should pay more attention to the conditions and exclusions of a travel insurance policy and should understand the difference between standard and non-standard. However, an off-the-record view expressed to me by a leading North American insurer is that the situation is really market driven and down to what customers expect from their travel insurance.It is the customer or client’s reasonable expectations of the level of cover and the fairness or otherwise of exclusions that should dictate whether a risk is assessed as standard. Customers need to understand that some sports attract a higher risk rating, but it is reasonable and eminently possible to achieve this understanding upfront in the marketing literature; there’s no excuse in pointing out that the small print should have been read.

This form of ranking is at odds with many people’s view of what is or isn’t a hazardous

sport. The fact that insurance companies themselves don’t trek

a uniform path to risk just adds further

confusion

the sport which leads to most insurance claims is surfing,

mainly due to injuries incurred while

removing boards from the roof of the car!

• International

Travel Insurance Conference

•International

Private Healthcare Conference

• International Air

Ambulance Forum•

International Pet Insurance Conference

•Assistance Medicine

•

conference sponsors

International Travel Insurance Awards Evening

After yet another successful year of the 2007 Venice ITIJ Awards, we are proud to announce that this year’s ceremony will even better last year’s event to once again provide the industry with an outstanding occasion that celebrates excellence and achievement in the global Travel Insurance and Private Healthcare industries.

ITIJ is read by the top players in Travel Insurance today and it is this readership that allows us to compile the most comprehensive vote available. Each individual that subscribes to ITIJ will have the opportunity to vote for their top-rated company in each of the nominations categories.

Once all the votes are in, a shortlist of the top three to fi ve companies in each category will be drawn up (based on the number of votes received). Each of these fi nalists will then be asked to create a presentation that will be considered by an independent judging panel, which will decide the ultimate winners on the night.

The fi nalists’ presentations will be screened at the ITIC Gala Dinner awards evening in Budapest on Friday 14th November.

The categories:• Air Ambulance provider of the year• Assistance/Claims Handler of the year• Cost Containment company and provider of the year (to include PPOs and general services)

• Insurer/Underwriter of the year• Intermediary of the year (to include all retailers of travel insurance)

• ITIJ marketing campaign of the year (judged independently)

• Best International Healthcare Insurer

ITIJ AWARDS 2008

The rules:

• One vote per category per subscriber to ITIJ

• Votes/nominations must be received by 28th August 2008Go to: www.itij.co.uk/awards

• Only registered company domain names will be accepted. Hotmail, Yahoo and other Web-based emails will not be accepted

• The fi nalists within each catergory will be contacted on Monday 1st September and provided with the criteria and deadline for submitting their presentation

: : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : :

visit www.itij.co.uk/awards for more information

ONE READER – ONE VOTE!

conference sponsors

International Travel Insurance Journal

26 FEATURE

Recent projections have shown that the global Islamic insurance or

‘takaful’ industry could be worth up to US$15 billion within the next decade. Susan Dingwall and Ffion Flockhart explain what this could mean for travel insurers

Since the establishment of the first takaful operator in the Sudan in 1979, there are now over 250 takaful operators worldwide. In its World Takaful Report 2008, Ernst & Young comments that the takaful market is growing at an annual rate of 20 per cent and will, in all likelihood, reach US$4.3 billion by 2010.Whilst Malaysia is seen as the most mature takaful market, with a long established regulatory framework and a developed product range, the Gulf Cooperative Countries (GCC) now account for over 33 per cent of the global takaful market, and the region is seen by many as the driver to the development of the industry. Many regional

hubs have developed in the GCC, such as the Dubai International Financial Centre, Bahrain and Qatar, each of which is striving to differentiate itself in order to attract both conventional and takaful business. However, whilst there is a boom in competition in the takaful market in the Middle East, arguably, the most interesting developments are occurring in the West, with the 2007 Oliver Wyman report suggesting that, in a market that could potentially amount to more than $20 billion annually, over 20 per cent of the demand could be from non-Muslim customers.

What is takaful?In simple terms, takaful is Shariah-compliant insurance akin to mutual insurance, whereby the participants (or, in conventional terms, policyholders) pool their funds together to ‘guarantee each other’ in the event of a loss. Losses are paid from the pool of funds created by the donations (in conventional terms, premiums) of the participants. The takaful operator manages the takaful operations on behalf of the participants, deals with any claims and invests the contributions in ethical Shariah-compliant investments. To the extent there is a surplus in the fund at the end of a policy period, the takaful operator will ordinarily make a distribution to the participants in proportion to their participation. This is a unique selling point for takaful compared with conventional insurance which, when coupled with the ethical investment strategy, is also likely to be attractive to non-Muslims. This has certainly proven to be the case in Malaysia where a relatively significant percentage of non-Muslims opt for takaful cover.Shariah scholars have determined that conventional insurance products are contrary to the principles of Shariah law as they contain unacceptable elements of risk and uncertainty. In a conventional contract of insurance, the risk of loss passes to the insurer upon payment of a premium by the insured. Since it is uncertain as to whether a loss will in fact occur, the contract is seen as a form of gambling. In 1985, the Islamic Fiqh Academy ruled that a takaful contract, which is based on the principles of charity and co-operation, was acceptable on the grounds that participants co-operate with each other for the common good and no advantage is derived at the cost of others. On the investment side, Shariah law prohibits investment in certain industries and requires the use of financial instruments that are free of usury. This means that no investments can be made in interest-bearing instruments such as government bonds or equity investments in companies that deal with, for example, the manufacture or sale of alcohol, armaments, gambling or pork products.

Takaful & conventional travel insurersCurrently, the main products offered by takaful operators tend to be personal lines products such as motor and home contents cover as well as life cover in the Middle East. However, the basic principles of takaful will apply in the same way to travel products. Some Western insurers have entered the takaful market through alliances with Islamic operators. For example, SABB Takaful, an associated member of the HSBC Group operating through a network of 75 branches in Saudi Arabia, offers a fully comprehensive Shariah compliant takaful travel product. SABB Takaful offers a wide range of cover from medical and hospitalisation expenses incurred due to accidental injuries, loss of money and documents and loss of personal belongings to flight delays. Other conventional insurers have obtained licenses to operate takaful companies in various jurisdictions, for example, Hannover Re and AIG have been granted retakaful and takaful licences respectively to operate in Bahrain, and Munich Re is licensed to sell retakaful products in Malaysia. For conventional travel insurers who wish to expand their current portfolio to include takaful products, it will be necessary to completely separate the conventional business from the takaful business. This will normally necessitate the incorporation of a new company, subsidiary or takaful window to ensure the complete segregation of funds and a Shariah compliant investment strategy. The latter is generally seen as the most problematic for conventional insurers given the relatively small size of the Islamic finance market compared with the

Takaful: the global growth of Islamic insurance

Shariah scholars have determined that

conventional insurance products are contrary to the principles of Shariah

law as they contain unacceptable elements of

risk and uncertainty

www.itij.co.uk

FEATURE 27

conventional investment market. However, this is gradually changing with the UK government recently making a number of announcements that are intended to promote London as the leading centre for Islamic finance.

Potential growth of the takaful marketSince the launch of the first Islamic Bank in September 2004, London has become the centre of Islamic finance in the West, offering Shariah-compliant products in a range of asset classes. Now, the Financial Services Authority has authorised Principle Insurance Company Limited (‘Principle’) as the first takaful operator in the UK. Bradley Brandon-Cross, the Chief Executive of Principle, recently stated: “London is leading the way as the government has introduced reforms to help Islamic finance. [Principle Insurance] will give Muslims in this country the opportunity to choose Shariah-compliant insurance products.” Principle forecasts up to 200,000 participants within five years, with strong growth expected over the coming months. This development is significant for the Western market as a whole, as authorisation in one European Economic Area (EEA) state provides a platform for ‘passporting’ into the rest of Europe, leading to the potential for considerable expansion of the global takaful market.In Europe, takaful products and operators will inevitably be subject to layers of regulation. In addition to operating according to the principles of Shariah law, they will also be subject to the EU regulatory regime for insurers on both federal and state levels. On a federal level, the rights of insurers to carry on business throughout the EEA derive from the European Commission (EC) Treaty, which sets out both the freedom of establishment (Article 43) and the freedom to provide cross-border services (Article 49). A single set of rules has been put into place governing the authorisation and supervision of insurance companies and takaful operators by the Member State in which their head office is located.The freedoms of establishment and the provision of cross-border services enshrined in the EC Treaty enable takaful operators to carry on business across the EU on the basis of a single authorisation. This enables a takaful operator that has been authorised in one Member State (the home Member State) to carry on its business in any host Member State within the EEA without the need for further authorisation. The passporting process, however, differs depending upon whether the takaful operator wishes to establish a branch in the host Member State or simply provide cross-border services.One of the most important aspects in determining the continuing success of takaful in Europe is the

regulatory landscape, which has the potential both to encourage and inhibit growth. Strong regulation can be advantageous, particularly in securing a good rating, an essential element in terms of aiding international investment and growth. On the other hand, strong regulation on a Member State level in areas of business that have not been harmonised at Community level can constrict cross-selling opportunities across European states.

The future?As the market grows, so too will the range of products offered. It is expected that takaful travel products will be in great demand not only amongst the Muslim population but also amongst non-Muslims that are attracted by the unique selling points of takaful, such as the redistribution of profits and the ethical investment policy. In the medium to long term, the maturity of the European insurance markets is likely to provide a strong platform for the growth and development of takaful products across the EEA. In highlighting the growing interest in the takaful and retakaful markets in the West, a

recent report by Oliver Wyman stated: “Western Europe, home to less than one per cent of the world’s 1.6 billion Muslims, makes up 40 per cent of the potential Muslim demand…adding the US brings the total up to 60 per cent”. Although there remain challenges, these statistics provide a strong indication that the takaful market in the West is only just beginning to show its true potential.

One of the most important aspects in determining the

continuing success of takaful in Europe is the regulatory landscape, which has the potential both to encourage and

inhibit growth

For conventional travel insurers who wish to expand their current portfolio to include

takaful products, it will be necessary to completely

separate the conventional business from the takaful

business.

Susan Dingwall is a partner, and Ffion Flockhart is an associate, with the international law firm, Norton Rose. Susan leads the firm’s takaful practice and she and Ffion have acted for a number of takaful operators in establishing their businesses (including providing regulatory advice, drafting takaful and retakful wordings and advising upon retakaful arrangements). In 2006, the Financial Times recognised the work carried out by Norton Rose in developing its expertise in takaful by giving it an award for innovation in the category Legal Expertise/Strategy in its innovative lawyers awards.

International Travel Insurance Journal

28 ASSISTANCE&HEALTHCAREWORLDMARKETS

Argentinianaccolades

In the eyes of those who are not familiar with the region, Latin America is often thought of as an entity; perhaps because most of its population is predominantly Spanish-speaking, or because of shared features associated with its Latin lineage. However, Latin America is composed of 42 countries, 21 of which are located in the Caribbean, eight in Central America and 13 in South America. Th e total population of the region is 560 million, 8.5 per cent of world’s total population. Regarding the socio-political situation in Latin America, the region is democratic, although social inequality and poverty still remain the main challenges in the area.In this issue, we will focus on Argentina, situated in the far south of America. It has 40 million inhabitants, most of who are descended from Spaniards and Italians. It is the second largest

country in South America, after Brazil; the fourth largest in America and eighth largest in the world. Th e index of human development, level of economic growth and quality of life are all very high. A nation of keen travellers, and one that receives more than four million visitors each year, it has a well developed assistance industry, and healthcare facilities off ering an international standard of care. But what is the uptake of these services, and how well does the system work in practice?

Close to homeTh e majority of travellers entering Latin American countries do so from within the region. In fact, 59 per cent of arrivals to Latin American countries are from other Latin American countries. Sixteen per cent of arrivals are from Europe – mainly Spain and Italy –

Having begun off ering assistance services in the 1970s,

Argentina leads the way in Latin America when it comes

to helping travellers in need. Alberto Camel Chapur puts the

country’s healthcare and assistance market into context

www.itij.co.uk

ASSISTANCE&HEALTHCAREWORLDMARKETS 29

ten per cent come from the United Sates and Canada, and the remaining 15 per cent come from Asia. In 2006, tourism numbers to Argentina reached 4,100,000 – a fi gure that increased by 11 per cent the following year. Th e country is the most popular destination for tourists travelling from Chile, Brazil, Uruguay, Spain and Italy, amongst others. Th us, most people entering Argentina – whether from another Latin American country or from anywhere else in the world – carry with them some form of travel assistance or travel insurance policy. And although these visitors, when coming from outside of Latin America, are generally covered by

multinational assistance companies such as AXA Assistance, Europ Assistance, AIG Assist or Mondial Assistance; there are a number of companies that originate in Argentina, such as Cardinal Assistance, Assist-card and Grupo IMAS, which also provide assistance services on a worldwide basis. As for Latin Americans travelling to other countries, the vast majority of are now aware of the benefi ts of carrying travel assistance coverage, which has led to substantial growth in the industry over the past few years. Today, over 60 per cent of the travelling population of Latin America is aware of the security provided by medical assistance services, and many

most people entering Argentina … carry with them some form of travel assistance or travel

insurance policy

It stands to reason then that travel assistance companies do not also have

to be insurance companies

International Travel Insurance Journal

30 ASSISTANCE&HEALTHCAREWORLDMARKETS

now purchase such a policy each time they travel. There is no chamber or association that regulates travel assistance companies in Argentina, so specific data on the country is not available, but companies operating in the country have experienced growth in product sales and have recognised an expanding consumer interest in travel assistance in recent years, reflecting the trend in the wider geographic region.

What’s in a name?A fundamental difference in the way that trip cover for travellers is offered and provided in Latin America, compared to most other parts of the world, lies in the way such services are rendered. Essentially, Latin American travellers are sold ‘travel assistance’ services, as opposed to ‘travel insurance’ policies: the objective of travel assistance being to provide the service in a direct manner at the moment

an event occurs, without the traveller having to pay money; whereas insurance can compel the policyholder to pay costs on the spot, to be later reimbursed. The problem in the latter scenario is that the traveller may not have the money to pay for treatment on the spot. This makes ‘travel assistance’ a more attractive product, and one that is relatively easy to market.It stands to reason then that travel assistance companies do not also have to be insurance companies. Thus, they are not regulated by government agencies such as the Healthcare Ministry or the Insurance Bureau.For cultural reasons, many Latin American travellers expect a service similar to the one provided by their pre-paid medicine plan at home when travelling out of country, and they are quite reluctant to accept the differences in medical coverage when travelling abroad. Thus, ‘house calls’ are something Latin

Americans often expect to have access to when visiting Europe or the United States. Assistance products in Argentina are very similar although coverage limits may vary. The limits on a typical worldwide travel assistance product include:

Medical assistance in case of illness or accident: between US$25,000 and US$100,000Medical expenses for pre-existing conditions: between US$500 and US$1,500Medical expenses for sports-related accidents: between US$500 and US$1,500Medication: between US$1,000 and US$3,000Dental care:up to US$1,500

Most travel assistance companies do provide a rounded product, in that they offer coverage for baggage and legal assistance, as well as medical coverage. Trip cancellation or early return coverage, however, is only available through insurance companies. Typical travel assistance policies also include the provision of medication, dental services, sanitary transfer, and the repatriation of mortal remains. Companies of the calibre of Cardinal Assistance or AIG Travel additionally offer exclusive benefits such as coverage for pre-existing illnesses and sporting accidents, guarantee of return trip, and even a 24-hour helpline.

Leading the wayThe first travel assistance companies in Argentina opened their doors in the 1970s, and now this industry is well developed. Today, there are around seven local and foreign-owned multinational assistance companies operating in the country. These include: AXA Assistance, Europ Assistance, AIG Assist and Mondial Assistance, together with Cardinal Assistance, Assist-card and Grupo IMAS. These businesses all offer assistance services although only two or three are multi-product and multi-channel companies that also provide roadside assistance and home assistance, amongst others.Thus, in the Latin American region, Argentina, together with Uruguay and Brazil, is a leader in the development of travel assistance services, and as mentioned there is a growing awareness within the country of the need for such cover when venturing

abroad. Companies such as Cardinal Assistance and Assist Card have a wide range of products with similar coverage levels as those products found in most advanced European countries.Along with travel agencies, the Internet is the most popular research tool when planning a trip. Over the last two years, it has also become an increasingly popular channel through which to purchase assistance products – either directly from an assistance company or via a broker. Assistance

companies

also offer their products through the corporate market, particularly via credit cards, which also generally tie up with insurance companies, HMOs and loyalty clubs.

in the Latin American region, Argentina, together with Uruguay and Brazil, is a leader in the development of travel

assistance services

www.itij.co.uk

ASSISTANCE&HEALTHCAREWORLDMARKETS 31

Caring for healthAlthough the state’s responsibility for individual sanitary services varies substantially between the countries of Latin America, in general all have adopted measures that ensure universal access to basic medical services. Medical expenses in the region are ‘accessible’ (lower than in the United States, Europe and Asia). Nevertheless, many travellers visiting Latin America, and indeed Argentina, do so bearing a travel insurance policy. Below is a scheme of health models in Latin American countries:The type of medical assistance provided to foreign visitors in Latin America is shown below. These figures are also reflective of the provision of such services specifically within Argentina:

Outpatient/house calls 54%Outpatient/house calls & lab tests 20%Hospitalisations 4%Ground and air evacuations & repatriations of mortal remains 1%Odontology 8%Baggage loss/legal assistance, etc 13%There is an overpopulation of medical doctors in Argentina – three per 1,000 inhabitants – the highest average of any Latin American country, following Cuba. The reason for this is that medicine was one of the few highly regarded university course options provided in the country until a few years

ago, when the choice of careers offered through university study was small. Today, most doctors work in both the public and private healthcare sectors.Argentina has around 160,000 permanent hospital beds, distributed between 1,280 public hospitals and 2,040 private clinics. Fourteen per cent of beds are located in the country’s capital Buenos Aires, a city that accounts for eight per cent of the population. The wider Buenos Aires Province has 48 per cent of beds to take care of 50 per cent of the total population of the country. Cordoba has approximately 12 per cent and Santa Fe has seven per cent of total beds. In the different cities around the country, there are excellent public hospital services, although facilities such as room comfort,

décor and catering, are quite deficient. The private sector, made up of community hospitals (such us the German medical centre, the British and the Italian medical centres), clinics owned by private health companies, and private clinics, in general offer the highest quality of medical services – as in most other countries – as they have greater financial and technical resources.Overall, the quality of hospital care varies widely

There is an overpopulation of medical doctors in Argentina

amongst different medical institutions and different medical specialties, although there are institutions providing a quality of care comparable to international standards in all specialties, such as cardiovascular and neurological. In Argentina, such institutions treat the same amount of foreign visitors as they do indigenous people.The top private clinics and hospitals – such as Hospital Aleman, Anchorena, Sanatorio Otamendi-Miroli, Clinica Suizo Argentina, Sanatorio Agote, Sanatorio Mater Dei, Hospital Britanico, Privado de la Comunidad, Hospital Privado de Cordoba, Hospital Italiano de la Plata, Hospital Español, Sanatorio Allende, and Clinica del Sol – are based in the capital city and in tourist areas like Calafate, Iguazu, Mar del Plata, Cordoba, Bariloche, Mendoza and Salta. All such establishments have plenty of experience in treating foreigners that have some form of travel assistance. In such cases, the cost of care to the assistance company is similar to the price that would be paid by the local population. The majority of the foreign patients are tourists, although for the last 15 years medical tourism to the country has been increasing – both for cosmetic surgery as well as cardiovascular treatment.

Alberto Camel Chapur is the president of Cardinal Assistance, an Argentinean company established over ten years ago that is dedicated to providing travel, road and home assistance 24 hours a day, every day of the year. Cardinal Assistance also provides cost containment services, and specialises in the provision of co-ordination services, administration and cost management. It is the sole assistance company in South America that provides state-of-the-art Contact Center services. Cardinal Assistance operates all over the world, with commercial offices located in the US, Brazil, Chile, Uruguay, Colombia, Peru, Ecuador, Venezuela and Bolivia.

ITIJ AHWM rATIngHealtHcare cost HHHH

access to emergency care HHHH

overall quality of care HHH

ems (air ambulances) HHHH

Please note: These ratings are an overview of what ITIJ believes to be a fair reflection of the general standards in the country, and do not represent any one hospital or service. ITIJ recognises that some individual facilities and services would receive different ratings than others, and to those shown in our chart, should ratings of each be done separately.

International Travel Insurance Journal

32 PROFILE

ITIJ: Do you have a favourite holiday destination?MW: No – Actually I prefer to take in different destination to find variety and find new impressions, meeting new types of people. Every country has its own speciality and charm, so no favourite. I do a lot of travel in general, some for work, but I have lived in Tokyo and the US for school. I really like to move around and experience life and get different impressions.

ITIJ: How often do you travel for work?MW: Once or twice a month I am abroad, usually in Europe. As business travellers see so many nice places, chill out destinations for holiday are more and more preferred. Our last destination was Tuscany in Italy, enjoying the perfect landscape, good food, red wine and some sports next to extensive relaxation.

ITIJ: What’s the worst job you’ve ever done?MW: I think I’ve been very lucky and all the jobs I have had have been challenging, but about 20

years ago probably my least favourite job was doing presentations – I used to get very nervous before speaking at a conference or even just a business presentation – I even had an increased heart rate three days before the meeting! Once I was doing a presentation on lab results at university in Vienna, and I had no idea about what it was I was saying and it was awful, but I went on a course to try and calm myself down and I think it worked.

ITIJ: If you were to have a fantasy dinner party with guests alive or dead, who would you invite?MW: I think I would invite Bill Clinton, Nelson Mandela, Mahatma Ghandi, Meryl Streep, Julia

Roberts and Princess Diana – it would be very intense but very stimulating. All of them are special personalities sticking to their inner beliefs and weaknesses. They are somewhat authentic, which makes them interesting to listen to.

ITIJ: Who would play you in a movie of your life?MW: Dustin Hoffman – I think he looks a bit like me, and he’s a fantastic actor. He does have the ability to slip into a certain personality and played very convincingly. Just think about Tootsie, Papillon or Rain Man. Especially the last one shows how interested he is in a special behaviour of someone else and how he manages to reproduce a very realistic behaviour.

ITIJ: How do you like to relax after work?MW: Sometimes it is important just doing nothing. It took me several years to find out that the promoter personality cannot just drive on forever. On the other hand sports are very important to feel satisfied. I enjoy skiing, tennis and classic dancing.

ITIJ: Do you find it hard to switch off after you have dealt with a particularly harrowing case?MW: As an emergency physician you see a lot of cases that others never see in their life or just on horrible movies. Cases, like a mother driving with a car over the head of her baby or a drowned child in the garden pool, do touch your emotions. The most important part to coping with harrowing cases such as these is to do an honest debrief with the involved team after completion of the case. The question is: ‘Have we done everything according to the state of the art to help the patient’? Usually the answer is ‘yes’, even though there is always some room for improvement. Once you are convinced that you have done a good job, then the rest has to be put into God’s faith.

ITIJ: What are you proudest of in your life?MW: My two daughters – 18 and 14 years old, they make me very happy. We all had our fun when we were younger, and I think it’s important that they do too.

ITIJ: What have you been up to recently in your work life?MW: As a physician I want to provide good medicine to my patients. I’m very happy that EURAMI accreditation became internationally

recognised. At the moment about ten air ambulance providers on several continents are in the pipeline for accreditation. In addition we supported the idea of the Flymi empty leg option tool, as it is providing information about quality and not just the price to the client.On the business side we started our new enterprise med con team as an excellence centre in the field of worldwide emergency medicine, assistance medicine and telemedicine. As the Steinbeis scientific centre we were involved in the EU telemedical project WISECOM, which looked for optimal technical and medical solutions to build up the communication infrastructure at the first 24 hours after a major catastrophe. And finally we are planning a large medical centre in Stuttgart, Germany, to provide state of the art medical care in combination with excellence service.

ITIJ: Where do you see the future of the air ambulance industry going?MW: I think in general, the future of the industry is secure, as put simply there is no other possible way of transporting patients in need quickly and safely. As the normal aircraft industry is improving, so is business aviation and the sector as a whole is developing and moving at a relatively rapid pace. Take, for example, the launch of the A380.

Will the A380’s ability to take patients have an effect on the number of patients transported by air ambulance?MW: No, it won’t directly, but indirectly there are some issues raised. More people use aircraft a great deal now as it is now so affordable and regular, and people are travelling further and further away. Inevitably, some of these patients will need

transporting back home after an accident, and until the medical care infrastructure in remote regions is on a par with Western medicine infrastructure, the air ambulance industry is safe. It will be a long time until the same medical service and infrastructure is available in every country around the world, and until that time, air ambulances are not merely safe, they are integral. Nobody cares about the medical care in a country until something actually goes wrong – travellers’ education needs to be improved so that people are more aware of dangers inherent to a country. Also, as there a more pre-existing medical condition travellers going abroad now, there is a high likelihood that air ambulances will become even more highly utilised.The problem with travellers these days is that they don’t understand the value of travel insurance – they are more than happy to pay for a new gadget or piece of clothing for the holiday, but then they say ‘I can’t afford travel insurance!’ – this is not acceptable. People just don’t care and think about that – no-one wants to think about bad things that can go wrong when travelling, but at the end of the day, all risks must be considered by the traveller. It is very affordable now as well, especially when it is considered that it is only three per cent of the cost of the holiday package.

ITIJ sat down for a cup of coffee with Michael Weinlich to catch up and find out what he has been up to recently

A moment with Michael

ApologiesIn the last issue of ITIJ, we incorrectly stated that the subjects of our profile, Susanne Holst and Thorkild Lykke, were from International SOS, when in fact they are both international network managers for SOS International.

www.itij.co.uk

GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 33

privatehealthcarenewsGLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS

Private hospitals oppose increasePrivate hospital operators in Thailand have said they are opposed to a proposal by economist Ammar Siamwalla that suggests a 30-per-cent increase should be imposed on bills for foreign patients. James Wallis has the latest from Bangkok

Operators in the private hospital fraternity say that increasing foreign patients’ bills could mean that Thailand would lose its battle with neighbouring countries to become a regional medical care hub.Private Hospital Association of Thailand president Aurchat Kanjanapitak asked: “Who would come here if our medical treatment costs were higher than their original country or our rival nations?” He added that as a result of the increased fees, it would be almost inevitable that providers would lose out to their competitors in Malaysia and Singapore, both of which are also attempting to market themselves as key healthcare destinations.The suggestion was given by Siamwalla in order to solve the problem of a severe lack of doctors and nurses, saying that the revenue generated by increased billing could increase government revenue by as much as Bt6 million and these extra funds could be used to fund the national health scheme, which is in a poor state due to the skills shortage. A recent study by the Thai Ministry of Health predicted that by 2015, the number of outpatients will increase to eight million and inpatients to 400,000, due to medical tourism. In order to cope

After more than a year of intensive research and development, the Dubai Health Authority (DHA) has unveiled the future direction of the government’s health strategy at a meeting in Dubai. Mandy Aitchison has the details of the plan

At a presentation in Dubai attended by over 500 people from a range of stakeholder groups including government departments, healthcare experts, insurers and representatives from private and public hospitals, director general of the DHA Qadhi Saeed Al Murooshid said: “A dynamic and well regulated healthcare sector is important to our future growth and prosperity. What we hope is that there is a

high quality, accessible and affordable healthcare system in place to look after us when we need it.” The government has recognised, he continued, that as Dubai continues to grow at an incredible rate, it must develop a healthcare service that is driven by international best practices.The DHA was created a year ago with a remit to drive up standards of care and improve the health of everyone living and working in the emirate and under the new plans just announced, several strategies to do so were revealed by Murooshid: “We will promote international accreditation of all healthcare services and promote partnership between the public and private sectors, attracting

international experience and expertise. We will also deliver effective regulation across the whole of Dubai’s health sector, increasing transparency and accountability within the system.” He also plans to drive up efficiency in the sector in order to improve accessibility and sustainability.The difficulties inherent in introducing a new healthcare vision have not been underestimated by the government, who said that the transition programme would be introduced slowly over the next four years, completing in 2012, with the DHA health funding process implemented by 2015. Several details were given about the role of the DHA under the new plan, including the fact that the DHA

will be separated from all health service delivery. Within the new structure, it is not responsible for the provision of health services; instead the services will be delivered by a government-owned public corporation. Murooshid said that the separation would allow the DHA to be completely independent in managing the wider health sector, as well as removing a potential conflict of interest that exists when a government both regulates and delivers healthcare. The aim is to give government-owned hospitals and primary healthcare facilities more freedom, more flexibility and accountability as they will be responsible for their own service planning

DHA unveils universal plancontinued on page 36

continued on page 37

International Travel Insurance Journal

34 privatehealthcarenews

GE takes Asia’s healthcare pulseUS-based General Electric Co.’s $17-billion healthcare unit head has said he expects revenue from its Asia Pacific division to grow at an average of 22 per cent annually over the next three to five years. The estimate is three times the 5.7 per cent revenue growth predicted worldwide by GE Healthcare, and double the estimated 11 per cent growth in Asia’s healthcare technology market.Clarence Wu, general manager of Integrated IT Solutions at GE Healthcare Asia, told Reuters that governments and private firms throughout Asia are expected to invest heavily in enhancing healthcare provision in the future: “There is very strong growth from both public and private sectors across Asia. When a government decides to invest in healthcare IT infrastructure, it is typically a multi-year programme, so we are seeing a sustained high growth essentially across the region.”Last year, GE Healthcare Asia contributed $1.8 billion to GE’s coffers, meaning the company is now vying for market share with Philips, Siemens and Toshiba.The top three countries investing in healthcare IT are Japan, China and Australia, with Japan alone making up around half of that spending, according to Vlad Dimitriu, vice-president of Asia Pacific Health industry insights at consultancy firm IDC.

Back to basics for US plannersPlans for truly universal healthcare in the US seem increasingly unlikely to be realised. Milan Korcok reports

With economic hard times persisting, and budget deficits choking state legislators, US dreams of ‘universal healthcare’ are being replaced by more pedestrian efforts at reform such as stripped down insurance plans, health cost restraints and regulatory mandates: in effect, the creeping incrementalism that has failed so far to bring any real relief to the nation’s uninsured.Forget the high-flown rhetoric of Democratic presidential aspirant Barack Obama touting the Holy Grail of universal healthcare. The reality is that the expansion of health coverage is being scraped out inch by inch in State Houses by governors forced to think small. Though Massachusetts’ government-mandated universal health insurance scheme continues to enrol more members than expected, premiums and co-payments for the private insurance options have risen beyond their targets and state subsidies for those who can’t afford full premiums are pushing the programme’s costs beyond the $869 million projected by Governor Deval Patrick for the 2009 budget year. The programme has simply proven too popular – and expensive – for its own good. In the meantime, California’s version of the Massachusetts plan, pumped so hard by Governor Arnold Schwarzenegger, was sunk in the state legislature earlier this year by the weight of a projected $14.9-billion cost. Not during these times, said his Republican legislative confrères. Governor Schwarzenegger is now looking for less ambitious ways

to the cover the state’s nearly six million uninsured. Enter Governor Charlie Crist, Republican governor of Florida, with a modest, but well supported, measure to provide stripped-down, low-cost cover for that state’s almost four million uninsured, arguing that a little insurance is better than none. Under the Crist initiative, which he signed into law in May 2008, with full bipartisan support, insurers would be allowed to offer scaled-back, basic care coverage for as little as $150 a month. That is about 60 per cent less than the average policy for a single person. Insurers would also be prohibited from rejecting applicants based on age or health status. By comparison, members of Massachusetts’ Commonwealth Care, the state agency set up to offer residents choices of low-cost health plans, the lowest premiums range from $39 to $116 per month pegged to co-payment and income levels. People with incomes between $21,000 and $26,000 pay $77 per month. Those earning less than $15,000 pay no premiums. Currently, one out of five people in Florida are without health insurance, the highest ratio of uninsured in the nation. The Crist programme, known as Cover Florida, will be open to uninsured people aged 19 to 64 and will allow insurance companies to join a state program in which they will be required to provide basic care such as drugs, emergency care and hospitalisation – including preventive services, office visits, screenings, surgery, durable medical equipment and diabetes supplies, but be exempt from including many of the 52 services that standard policies must cover by state regulation, such as acupuncture, podiatry, certain screenings and certain transplants. In Florida,

Google releases Google HealthGoogle Inc. has now unveiled Google Health, a long-awaited US health information service that combines the web company’s classic search services with a user’s personal health records.The password-protected service stores a user’s basic medical history and gathers relevant information connected to their specific health conditions. One particular feature of the website is that it includes a link to help users find doctors by location or speciality, while the ‘virtual pillbox’ reminds patients when they need to take their medications and also warns of potential drug mixes that could be hazardous.Partners with Google in the venture include Walgreen Co., Longs Drug Stores Corp., CVS Caremark Group, AllScripts and the Cleveland Clinic; the company had previously said it was working with insurers such as Aetna.

Draft bill not popularDespite all the problems dogging South Africa’s private healthcare providers, Netcare Ltd has announced that first-half profit rose by 14 per cent this year after the number of patients treated rose through the company’s acquisitions. Net income climbed to R13 million (US$43 million) in the six months ended 31 March, from R279 million a year earlier, while sales rose by 16 per cent to R10.3 billion. The firm told the Johannesburg stock exchange that acquisitions in London and South Africa had helped to add R334 million to sales figures during the period in question. Netcare also released figures that showed more South Africans are buying private medical cover – a five-per-cent rise to 7.4 million in the last year, while more people are also paying cash to use private hospitals.Meanwhile, on 2 June, Manto Tshabalala-Msimang, health minister, introduced a draft bill in Parliament that proposed medical fees, tariffs and hospital costs in the private healthcare industry be regulated according to set fee structures.Understandably, the industry did not react positively to the news, with Dr Kgosi Letlape, chair of the South African Medical Association (SAMA) calling the proposed fixing of tariffs ‘unethical and diabolical’. He went on to say that these measures would not ‘improve access and quality in healthcare’. Mark Bishop, head of funder relations at Netcare, told reporters that the firm had ‘a continued sense of discomfort at the appointment of a non-independent facilitator, and the fact that neither the facilitator nor the Department of Health accepts any liability should the results of regulations cause damages to any organisation or individual’.Discovery Health said in a press release that it ‘shares the minister’s concern about the rising cost of healthcare and how this affects affordability for consumers’. It continued, though, by saying: “We believe that this form of regulation is not the most appropriate way to lower healthcare costs, and may well lead to distortions in the market and other negative unintended consequences.”Medi-Clinic CEO Kurt Pretorius went one step further and in a briefing in Cape Town, said the plan to regulate prices could tip the private hospital industry into an ‘Eskom scenario’. “Eskom’s tariffs were too low and it caught up with them,” he said, referring to the company’s battle to meet electricity demand. However, providers of the government’s medical schemes are of a different opinion; Janine Louw, principal officer of the Naspers Medical Scheme, said: “Already, as a result of these proposed measures, certain costs, such as those of anaesthetic gases, have been cut. This can only benefit medical scheme members. It’s a small start, but a start nevertheless.”

Chinese market to triple by 2015China’s health insurance market is predicted to triple in size by 2015 to ¥120 billion (US$17.3 billion), according to German private health insurer DKV Deutsche Krankenversicherung (DKV). The company attributes the phenomenal growth rate to the country’s ageing population and expanding economy.Other industry forecasts have been slightly more modest, saying that by 2010 health insurance premiums in China could reach as much as ¥60 billion. Swiss Re, which has now entered into the market, reported in one study recently that China spent

more than ¥1 trillion in 2007, with commercial medical insurance covering less than six per cent of that figure, which goes to show the potential of the marketplace.

There was a 6.8-per-cent rise in the number of people covered by private medical insurance in Spain’s Basque Country in 2006 according to EUSTAT data, with the greatest increase in the number of collective policies. The population covered by insurance in the region came to 341,616, meaning a rise of nearly seven per cent on the previous year and the highest number recorded in the last 11 years. Forty-seven per cent of those were covered by individual or family-type policies, followed by collective insurance (aimed at companies), with 35.9 per cent, and public mutual societies with 16.6 per cent. The EUSTAT report noted that special mention should be given to the increasing importance of collective policies, as the number of insured has grown by 71.4 per cent between 1999 and 2006 with an accumulated annual growth rate of eight per cent. The total value of premiums collected by the health insurers came to

€184.8 million, representing around 4.4 per cent of the State total and 0.3 per cent of the Basque Country’s gross domestic product. Details shown in the report included information about the number of claims made, which was 1,257,073, making an average of 3.7 visits per policyholder.

Basque numbers up

continued on page 36

www.itij.co.uk

GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 35

US insurers pitch changesSome of the most important US health insurance companies have added their voices to the growing debate over the reformation of the nation’s healthcare system by pitching several clinical and payment policy changes.America’s Health Insurance Plans, a trade group for major players such as Aetna and UnitedHealth Group, said the proposals could shave around $145 billion off the nation’s $2-trillion healthcare bill, a figure confirmed by PricewaterhouseCoopers. The US Centres for Medicare and Medicaid Services said recently that US healthcare spending is now around 16 per cent of gross domestic product (GDP) and is likely to top 20 per cent of GDP by 2017.The proposed changes would include giving doctors, patients and payers access to research that compares

treatments to guide clinical decision making – such research is somewhat rare these days, as most manufacturers have little financial incentive to do so. The plan would also include aligning patient outcomes and safety with reimbursement, an idea that has been put forward in other reform proposals as well. It also supports a focus on disease management, aimed at preventing and controlling chronic conditions, as management is usually a lot less expensive than emergency treatment.Len Nicholas, healthcare economist at the New American Foundation, said the proposals seemed reasonable: “I think the important lesson is – they get a range of savings that is reasonable. It suggests there is a growing consensus that these elements are what are needed for change to happen.”

Private losses overestimated in OzStuart Rodger, a healthcare actuary with Deloitte, has said that some predictions made over the future of the Australian private health insurance industry could be considered ‘alarmist’. A report commissioned by the Australian Medical Association states that the plan by the Federal Government to increase the Medicare surcharge threshold will fuel a cycle of unaffordable private health insurance (PHN 89, June 2008, Private

numbers lost in Oz). Now however, Rodger said the fallout from the surcharge would be dependent on how people over 30 responded to the news.In Rodger’s opinion, people over the age of 30 should consider the costs of leaving the private medical system with the intention of rejoining it later on: “I think the real issue for consumers to think about is if you’re over 30 and you leave the system and then you want to get back into it, you’re going to be hit with a penalty that’s going to last for a long time. You really should think twice about leaving the system.” However, he added that provided people make sensible decisions, the predictions made about thousands of people withdrawing from private health insurance are ‘probably a bit too alarmist’.

Patients to rate hospitalsIn a new online survey, private hospital patients in Ireland are now able to give their own verdicts on the care they receive. Launched in 2006, the ‘Rate My Hospital’ online forum has so far only been available to users of public hospitals, but in a groundbreaking move, the website, run by IrishHealth, is now asking for the opinions and experiences of patients who have attended the 17 private hospitals in Ireland. The news was released at a time when the Department of Health is continuing its stance that private hospitals do not need to be inspected.The first comments to appear on the website served to highlight the divisive nature of private healthcare, with one individual saying: “In my opinion, all they care about is making money. It is your wallet they look after, not your health, although the surgeons are fantastic.”Another blogger gave their positive opinion on the Beacon Hospital in Sandyford: “They made me feel very at ease even though I was anxious about surgery. Dr Ahmed was also very good and followed up very quickly for after-care procedures.”And while one former patient gave an excellent review of another facility, another gave a somewhat damning report: “Some wards are dirty, and in general I felt nurses ignored the hygiene needs of those who needed help the most.”The IrishHealth website has served to highlight several patient worries over public hospitals in the past, helping to improve certain practices, but it also rewards those hospitals that have consistently received positive reviews through badges of merit. Website administrators have also noted that due to the reluctance of Mary Harney, Ireland’s current Minister for Health and Children, to legislate for the inspection of private hospitals, the survey is now the only form of independent analysis of standards in the Irish private healthcare sector.Meanwhile, TreatmentAbroad, the online medical tourism portal, has launched a ratings and review system for medical tourists to share their experiences. Keith Pollard, managing director of the company, said of the addition to the website: “The ratings and reviews service is intended to inform patient choice. Patients need to be clued up on overseas medical treatment, and some may be apprehensive about the risks of travelling for treatment. Patients who have become ‘medical tourists’ generally tend to be extremely positive about their experience, so the addition of ratings and reviews on the site will further build patient confidence.”

International Travel Insurance Journal

36 privatehealthcarenews

Dr. Colin Plotkin Consulting

27-3088 Francis Road, Richmond, British Columbia, CANADA V7C 5V9

Tel: +1 604 241 9677Facsimile: +1 604 241 0733

Web: www.plotkinconsulting.com email: colin@plotkinconsulting.com

privatehospitals

Portugal

Rua 25 de Abril, 12 Vila da Luz, 8600-174, LGS, Portugal

Web: www.luzdoc.come-mail: info@luzdoc.comTel: +351 282 780 700

Facsimile: +351 282 780 709specialiTy: General Medical

Spain

Medical CenterVirginia Villanueva de Pedro

Medical Director

Web: www.caribeasistencia.com/cmcbwww.centromedicocaribecancun.com

e-mail: vvilla@mapfre.comTel: +00 34 91 581 6707

specialiTy: Primary Care Attention

Thailand

Bangkok International Hospital. 2, Soi Soonvijai 7, New Petchburi Rd,

Bangkok 10320 THAILAND

Web: www.bangkokhospital.come-mail: jane@bgh.co.thTel: +66 2 310 3000

Facsimile: +66 2 310 3105specialiTy: general medical

8940 North Kendall Drive, Suite 601-E, Miami, FL 33176

Web: www.baptisthealth.net/internationalemail: international@baptisthealth.net

Tel: +1 786 596 2373Facsimile: +1 786 596 5979specialiTy: General Health

United States

Jackson Memorial Hospital International Jackson Medical Towers, East Tower, Suite 829, 1500 NW 12th Avenue,

Miami, FL 33136 - 9998 USA

Web: www.jmhi.org e-mail: info@jmhi.org

24hr Tel: +1 305 355 1212 Tel: +1 305 355 5544

Facsimile: +1 305 355 5545

Private Bag X5, Benmore Gardens 2010, Johannesburg, SoUTH AFRICA

Tel: +27 11 245 5777Facsimile: +27 11 783 9277

Web: www.aims.org.zae-mail: contact@aims.org.za

costcontainment

Jeffrey Baker – President1400 Old Country Road, Suite 109

Westbury , NY11590 USA

e-mail: jbaker@medsaveusa.com Web: www.medsaveusa.com

Tel: +1 516 622 1784 Facsimile: +1 516 294 6761

Gigi Galen – President850 7th Avenue, Suite 803

New York, 10019 USA

e-mail: ggontheroad@aol.com Web: www.starhealthcarenet.com

Tel: +1 212 581 8228 Facsimile: +1 212 581 8272

healthcareinsurance

1st Flr Suite, West Hs, 46 High St, orpington, Kent, BR6 0JQ, UK

Web: www.travelandmedical.co.uke-mail: sales@travelandmedical.co.uk

Tel: +44 845 058 8000Facsimile: +44 845 053 3000

Jose Quesada M.D., M.B.A. – Director Finance & operations

1099 N.W. 14th StreetMiami, Florida, USA

Web: www.uhealthinternational.com E-mail: ihcinfo@med.miami.edu

Tel: +1 305 243 9100 Facsimile: +1 305 243 9101

with these numbers of patients, Thailand needs more doctors – hundreds more, according to the study.The problem as far as the Health Ministry is concerned was made clear by the author of the study, Thinakorn Noree, who said: “The private sector will consume a large number of [these] physicians and cause shortages for public hospitals.”Aurchate admitted that private hospitals have been attracting doctors who might otherwise have gone to work in the public sector, but said that in the past few years, the brain drain had accounted for only 50 out of 1,800 specialists. He suggested that instead, the shortage of doctors was a result of mismanagement in medical worker distribution throughout the country, and that the government should sort it out rather than simply placing the blame on private facilities.

Private hospitals oppose fee increase

continued from page 33

privatehospitalsON THE MOVE

Alegro appoints GodardToronto-based Alegro Health Corporation, a provider of medical, surgical and disability management services, has announced that it has appointed Paul Godard to the position of chief financial officer.Brenda Rasmussen, president and CEO of the firm, commented: “Paul brings extensive financial and management experience to our team. With his exceptional knowledge of the public/private healthcare industry in Ontario, Paul adds an insight that will play a key role in our growth strategy.”Paul joins Alegro with over 20 years of management experience, most recently in the position of managing director of Shouldice Hospital, where he was responsible for the financial leadership of the organisation.

InterGlobal hires operations director

InterGlobal, the international private medical insurer, has appointed Derek Stroud as its group operations director. Derek brings with him over 28 years of experience in global operations and customer services within the insurance, retail and

utilities industries. Before joining InterGlobal, Derek held the position of head of service, employee benefit at Aegon Scottish Equitable and also ran his own independent management consultancy that specialised in customer services, general management and change management.In his new role at InterGlobal, Derek will take charge of the firm’s claims and customer services functions across its 10 globally positioned offices. Stephen Hartigan, chief executive of the firm, noted: “Derek will make a great contribution to InterGlobal. His priorities are to consolidate our global operations, rationalise processes and strengthen our customer service.”

William Russell chooses new managersInternational expatriate insurance specialist William Russell has promoted Nichola Duncan to UK claims manager and Katy Butler to claims manager for the Asia Pacific region, based in Kuala Lumpur. Nichola joined the firm in 2004 to administer expatriate private medical insurance outpatient claims. Following her promotion, she is now responsible for the management of William Russell’s UK claims department, heading a team of six claims specialists and managing over 2,000 private medical insurance outpatient claims a year.Kay Butler, meanwhile, joined the firm in the UK in 2005. She transferred to the Hong Kong office

in 2006 to manage Asia Pacific health insurance claims, and was instrumental in establishing the company’s Kuala Lumpur office last year. Katy will be managing a team of eight claims specialists who administer over 3,600 claims a year from China, Hong Kong, Indonesia, Vietnam, Japan and elsewhere in the region.Tim Coyne, international technical manager of William

Russell, said: “Both Katy and Nichola have demonstrated their flair for claims management and a real commitment in delivering the best possible service to our members. It is these qualities which have been recognised in their promotions to head the claims teams in Malaysia and the UK.”

children are eligible for a government subsidised programme and the elderly are eligible for federally-funded Medicare.The bonus in this plan, says Crist, is that it will not add ‘a dime’ to existing state health budgets. And that is a big selling factor for other state governors who are treading the same path. Minnesota’s Republican governor Tim Pawlenty, long an advocate of universal health insurance, recently vetoed a bill that would have expanded health insurance access to workers saying the costs were excessive and irresponsible. He is now drawing up plans for less ambitious, but more doable coverage – perhaps along the lines of Florida’s Governor Crist.Pawlenty recently told the New York Times: “The system is busted, and you can’t take a system that is growing at several times the rate of inflation and subsidise your way to a solution.” At least a dozen other states are now experimenting with stripped-down policies and are shifting their focus away from grand schemes like universal coverage, back to the gritty business of cutting and restraining health costs, pressuring or persuading insurance companies, hospitals, doctors and businesses to find ways to do more for less – and resorting to mandation and heavier regulation if necessary.

Back to basics for US planners

continued from page 33

Nichola Duncan & Katy Butler

Derek Stroud

www.itij.co.uk

GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 37

COMPANY BRIEFPatriot signs with Arizona FoundationNew York-based Patriot Health, an administrator and service provider of medical plans for the underinsured in the US, has announced that it has contracted with the Arizona Foundation for Medical Care (AFMC) to include its PPO network for all

Arizona-based Patriot members.Bob Smith, director of marketing and network management for the AFMC, said of the deal: “We are pleased that our PPO, with its large physician, hospital, speciality and lab networks will now be included in all Limited Medical plans offered to Patriot Health members residing in Arizona.”Jason Krouse, CMO of the Cost Containment Group, which is

Patriot’s parent company, added: “Patriot Health has a corporate philosophy of developing plans that offer its members the broadest selection of providers with the deepest discount available. Patriot Health members will now benefit from the deep discounts included in the AFMC PPO network.”

Boots unveils insurance forayHealth insurance in the UK has now hit the high street, with the news that chemist chain Boots has teamed up with PruHealth to offer medical cover to the masses. The new policy offers access to more than 13,000 consultants across the UK, as well as giving policyholders the opportunity to use any National Health Service private patient unit and private hospitals.Commenting on the tie-up, Kevin Johnson, head of Boots insurance services, said: “It is a great opportunity for us to use our position on the high street to offer the public greater access to private healthcare.”Shaun Matisonn, chief executive of PruHealth, agreed that the deal with Boots should ‘make private health insurance more accessible and affordable’.

GCC-specific plans launchedDubai Insurance Company and international expat insurer William Russell have partnered in order to launch a range of international health, income protection and life insurance plans that have been designed specifically for expatriates and small to medium-sized expat employers. The plans, which are underwritten by Dubai Insurance Company and administered by William Russell, have been called GlobalHealth, GlobalLife and GlobalIncomeProtection. Corporate GlobalHealth plan members will gain access to an ever-growing network of clinics, hospitals and pharmacies across the Gulf region through specialist claims administrator Neuron. In addition, there is also an option available where members can add employee benefits such as group life, travel, accident and long-

term disability insurance protection.Abdellatif Abuqurah, general manager of the Dubai Insurance Company, said: “The expatriate workforce in Dubai and throughout the GCC is vital to the continued success and development of the region. We see a real need for a range of specialist protection policies designed to meet the needs of small to medium-sized businesses and individual expatriates.”Peter Hogg of Neuron agreed that the last thing a busy expatriate needs when in a foreign country is to worry about which hospital to go to if they fall ill and added: “We offer corporate GlobalHealth members peace of mind with cashless access to medical care within our expanding GCC network, and the freedom to have their treatment outside the network if they prefer.”

IMG launches UAE planInternational Medical Group (IMG) and Abu Dhabi-based Al Wathba National Insurance Company PSC (AWNIC) have together announced the launch of MediGlobal Health Insurance, an international healthcare plan that meets all the local requirements of the Emirate of Abu Dhabi as well as offering options that cater to differing laws across the UAE.Carl Carter, managing director of IMG Europe Ltd, said: “We have worked very closely with AWNIC to deliver effective local and international cover with one seamless plan specially designed for the UAE market.” President of IMG Joe Brougher added that the firm was ‘particularly pleased to be partnering with an insurance company like AWNIC’.The need for such a specific product had been identified by Bassam Chilmeran, general manager of AWNIC: “Our

review of the UAE health insurance sector showed that the market was lacking a product that could effectively combine local underwriting and service with international coverage and emergency services. After an extensive review of the companies operating in the international market, we found that IMG stood above the market with its superior international service and global reputation.”

DHA unveils universal planand delivery. It is hoped that this will allow the facilities to run both more efficiently and effectively by increasing capacity and creating more equal opportunities between public and private hospitals. Murooshid added: “For patients, this will result in greater choice, more accountability, better service and in the longer term, higher quality healthcare.”Regarding the difficult topic of healthcare regulation, Murooshid said: “Regulation will be one of the main tools available to the DHA to allow it to manage the healthcare sector. At the moment, the regulation of the sector in Dubai is fragmented into different facilities subject to different legislation and different processes. This has led to inconsistent standards and duplication as well as a high regulatory burden on

health service providers.” The plan is for the DHA’s regulation team to work with the Federal Ministry of Health to streamline the current processes, helping to build confidence in the system and make it more efficient for both users and operators. Murooshid went on to state: “The DHA’s health regulation team will create a single government body responsible for health service professionals and services. It will bring together current regulatory activities into one co-ordinated system, responsive to the needs of the public and health providers.” The team will also be responsible for managing complaints and malpractice investigations.Concerning the new funding system, the director general noted that the objective is to reach the same

standards of healthcare services that are in developed countries, adding ‘it will be compulsory for everyone and will be largely employer or sponsor-funded’. Under the new system, UAE nationals will continue to receive existing levels of cover and care; there will be no distinction between public or private health service providers and, for the first time, access to affordable healthcare will be extended to everyone living in Dubai to meet their basic medical needs. Where there is no employer to sponsor cover, the individual resident of Dubai will be responsible for the payment for dependents and those they sponsor – this payment is called a Health Benefits Contribution, with the exact figure still to be agreed upon. Everyone in Dubai will be issued with a

health card and, subject to availability, will be able to register with a public or private outpatient clinic of their choice. The new health funding system is projected to be implemented in January 2009, when patients can start registering at clinics. In his concluding comments to the presentation, Murooshid said: “Further announcements on the progress of the DHA programme will be made as we continue the implementation and engagement process. However, as we build and develop a new health system, healthcare provision must always be balanced with a need to help the public to lead healthier and safer lifestyles, consequently, the DHA will have a far more proactive approach to working across government to ensure that Dubai is a healthier place.”

Aetna teams with On Call International

On Call International, a provider of customised medical, security and travel assistance for international travellers as well as expatriates and students, has announced a new partnership with student health insurance administrator Aetna Student Health. Under the terms of the collaboration, On Call will provide its emergency medical and travel assistance services to Aetna’s 450,000 student members.On Call International specialises in high-touch

emergency evacuations from any point on the globe through its partnership with the International Assistance Group and says that no matter where a student may be travelling, a multilingual team is on hand 24/7 to respond to calls for help. US-trained physicians are made immediately available to react to a student’s medical needs, including the need for medical evacuation, critical care monitoring and evaluation, as well as physician and hospital referrals or prescription drug assistance. In addition, On Call is to provide security and legal services to Aetna’s student members, including political evacuation in the event of social or governmental unrest and access to a legal hotline and bail bond.

Michael Kelly, president of On Call International, said: “Aetna Student Health is a world-class organisation, which understands the unique and often critical circumstances that can arise with student travel. As an emergency healthcare and travel assistance business, we manage these urgent situations every day, which makes our partnership a perfect fit for the health and well-being of Aetna’s students.”

continued from page 34

CNA offers new range of coverCNA Insurance, owned by US-based CNA Financial Corporations, is to launch a tailored comprehensive plan of healthcare products as part of the firm’s flagship HealthPro range. CNA HealthPro is offering product liability, clinical trials liability and professional indemnity cover to medical device manufacturers, small pharmaceutical firms and biotech companies. In addition, where there is exposure to medical professional liability, additional cover may be added to the policies.Rhonda Buege, CNA director of underwriting, said a considerable need for improved protection in the fast-moving medical technology centre had been identified by the firm and added: “We understand the importance of continuing to innovate our product range to meet the ever-changing needs of this dynamic sector. This, combined with 40 years of experience of servicing the healthcare sector in the US, has enabled us to develop a range of new solutions for a wide array of healthcare providers and organisations.”CNA is currently providing this coverage for UK organisations with plans to expand in Europe. European domiciled healthcare organisations with exposure in the US can also be protected, said the company, regardless of the amount of exposure.

International Travel Insurance Journal

phn feature38

With national or socialist health systems stretched to breaking point and looking to the private sector for a bailout, the

international travel and travel health insurance market appears poised for a robust breakout into what was formerly alien territory. Up until now, coverage of travellers, expatriates, foreign postings, students, missionaries and cross-border consultants has generally been considered a small but comfortable niche. But with the global economy transferring and shifting not only individuals but whole departments, divisions, even companies across borders into health systems already burdened by waiting lists and unmanageable costs, the need for new products and seamless cover is challenging the travel and international health insurance industry to reinvent itself.

Meeting demandCarl Carter, managing director of IMG Europe Ltd, and chairman of the Association of International Medical Insurance Providers (AIMIP), says: “There are numerous opportunities in the IPMI (international private medical insurance) market and these should be of particular interest to brokers that aren’t currently promoting IPMI.” Whereas the existing domestic PMI markets around the world are typically mature and stagnant or growing at low inflationary rates, it is commonly quoted that the IPMI market is growing at 25 per cent year upon year. “Whereas 10 years ago IPMI could have been regarded as a niche business, it is now very much a specialised class of insurance in its own right,” says Carter. Peter Rousseau, business development director at UK-based InterGlobal Ltd, stresses that the need and rationale for developing more comprehensive insurance products for the international market is a top priority not only among employers but their beneficiaries as well. Citing independent research, he notes that among employees posted abroad, the importance of medical insurance benefits ranks just behind relocation payments, home leave, schooling and housing, and above hardship benefits, goods and services, car allowance, incentive allowance and even spouse allowance.Citing data from Price Waterhouse Coopers and Goldman Sachs, Rousseau notes also that there are currently approximately 30 million expatriates of all nationalities working worldwide. In addition, the

IPMI market has grown at least between 25 and 30 per cent in the last five years, and will likely exceed $7 billion in annual premiums by the end of the decade. The data also show that the greatest growth for international expatriate assignments over the immediate short term is being experienced in China, Central and Eastern Europe, the Indian subcontinent and Southeast Asia.An example of this market penetration is IMG’s recent launch of its regionally-tailored GlobalSelect product line into China in partnership with Ping An Property and Casualty of China Ltd, which will provide exclusive distribution through Chinese insurance brokers. Ping An P&C is the third largest property and casualty insurance company in China.InterGlobal too recently expanded its already well-established presence in Asia by joining forces with BaoViet, Vietnam’s leading finance-insurance group, which will sell its health insurance plans in that country. This coupling with BaoViet, says Tony Valin, general manager of BaoViet-InterGlobal, ‘means we can offer our strong products to expats and corporations in this rapidly expanding market’. This is InterGlobal’s fifth joint venture in Asia.

Bridging the gapThe products and services sought by beneficiaries of international portfolios are not that different from those covered by domestic insurance – government-sponsored or private. All want comprehensive care; all need preventive as well as curative services; all want coverage for chronic conditions. But the trick is to integrate the offerings of international providers (which are sometimes more beneficent than are domestic national plans) into systems not meant to accommodate them, or that are close to flat broke.When the Netherlands introduced the Dutch Healthcare Act in January 2006, making enrolment in the Basic Healthcare Plan mandatory for all residents, both inbound and outbound expats and other foreign residents found their coverage benefits changed, in some cases rendered incomplete or insufficient for them and their families. Cigna International, one of the largest players in the IPMI market was able to tailor alternative cover for those outbound expats who were no longer eligible for basic mandatory insurance, and provide a ‘safety net’ for inbound expats whose cases were not totally covered by the

Basic plan.Glenn Maykish, CIGNA International Expatriate Benefits’ vice-president of international sales wrote in a trade publication that complying with home and host country benefits legislation is increasingly complex, and infractions – even innocently achieved – can invoke some serious penalties – criminal as well as civil. He noted that expatriate employees working in many countries are typically subject to numerous rules and regulations that mitigate their ability to have comprehensive, seamless cover. “Countries such as Saudi Arabia, Iceland, Switzerland, the Netherlands and others have enacted legislation that restricts coverage,” said Maykish, just as ‘covering international assignees on an insurance plan that is designed for US domestic employees is likely to be an inadequate strategy from a benefits delivery and legal compliance perspective’.At the same time, says Maykish, tailoring or

As state healthcare services around the world increasingly struggle against a growing demand for their services, private insurers are stepping in to offer tailor-made products to local as well as expatriate populations. Milan Korcok looks at this morphing industry and asks what the future may hold

The crumbling safety net

private funding of facilities and

private insurance is no longer just a possible option: it’s mandatory in most developed

and even developing

nations

www.itij.co.uk

39 phn feature

retrofitting a benefit plan for expats or others in a foreign country, and trying to bridge the gap between domestic and international coverage and services demands very specialised skills and availabilities, such as: offering 24/7 multilingual access to medically proficient professionals, providing payment guarantees to international providers, fulfilling various species of claims forms, providing access to skilled medical and clinical consultation teams, and activating the services of top line case managers with knowledge of local fee levels and payment procedures. Sound familiar? Certainly not alien turf for international travel insurers.

No longer just an optionBridging the gap between domestic resources and the expectations and requirements of increasingly affluent and mobile populations has outstripped the abilities of many socialist systems and government monopoly health plans to pay the bills without raising taxes to intolerable levels. With healthcare costs for

the majority of countries in the OECD ranging from

about nine to 16 per cent of GDP (US at the top, the OECD

average at 8.9), private funding of facilities and private insurance

is no longer just a possible option: it’s mandatory in most developed and even developing nations.Despite the ideological contradictions about multi-tiered healthcare, or

arguments about the evils of privatisation, data from virtually all nations and international

bodies document that governments alone cannot afford to foot the bill for the healthcare needs and expectations of their citizens without attaching private funding, and that boils down to more options and more demand for private insurance. Among all member nations of the OECD, 26 per cent of healthcare spending now derives from the private sector (out of pocket and private insurance). That is a steadily growing percentage. At the top of that list is the US with 55 per cent derived from the private sector, but not too far behind is Switzerland at 42 per cent, the Netherlands at 38 per cent, Australia at 33 per cent, and of course Canada (which has a single payer system that actually forbids private insurance from paying for medically necessary services), where 30 per cent of healthcare spending comes out of the private sector (most of it private insurance).And among the 30 OECD countries as a whole, 14 of them – the Czech Republic, Luxembourg, Poland, Sweden, Germany, Hungary, Iceland, New Zealand, Finland, Italy, Spain, Canada, the Netherlands, and Greece – have all decreased their reliance on public spending for health since 1990, in effect shifting to more private spending. Ironically, over that same period, the US has increased its reliance on public spending by 5.7 per cent (through expansion in Medicare, Medicaid, children’s insurance programmes, federally funded research and public health). But it still relies on the private sector for 55 per cent of its healthcare spending.The OECD warns that this shift to out-of-pocket and private insurance is inevitable. In a policy statement it concludes: “Health spending continues to rise in OECD countries and, if current trends continue governments will need to raise taxes, cut spending in other areas, or make people pay more out of their own pockets in order to maintain their existing healthcare systems.” It reports further: “Health spending has grown faster than GDP in every OECD country except Finland between 1990 and 2004. It accounted for seven per cent of GDP on average across OECD countries in 1990 but reached 8.9 per cent in 2004.”

Old systems, new timesMost national health systems relying on government monopoly, social insurance, or socialist methods of delivery and funding were devised to cover relatively static domestic populations. When Lord Beveridge drafted the foundation for Britain’s National Health

Service, enacted in 1948, Britons were not bouncing around the world taking annual holidays in Jamaica, Majorca or Phuket. They were not retiring en masse to the Algarve or the Costa del Sol. They were not colonising American businesses in New York or Los Angeles as they are today. Germans in the 1880s hardly ever left their own districts when Otto von Bismarck launched that nation’s vaunted statutory health insurance programme that still provides coverage for more than 90 per cent its citizens. Expatriation was virtually unknown. Travel insurance was an irrelevancy. Foreign postings were rare.Now, with globalisation not only a fad but a reality of everyday life, medicine without boundaries seems an inevitable goal. And expectations keep rising, not only for domestic insurance, but international cover as well. People want cancer cover, chronic care services, critical illness and maltreatment insurance, wellness and preventive care. They want to avoid waiting lists. They want access to a cardiac bypass in India that can be done next week. They want the add-ons they see promoted on the Internet. And who better to provide them than international insurers who can transition between a dozen different markets and health systems at the same time? “A drug or medical procedure may not be available in certain countries but available in others,” says IMG’s Carter. Clients need access to these. The ‘new style’ products being developed for the international market may allow someone restricted by their own medical system ‘to break free and seek their treatment anywhere in their area of cover’. Yet being able to cover clients abroad is often easier and less encumbered by regulations than extending that same cover closer to home. InterGlobal’s Rousseau notes that the old standard of international insurance as ‘medical’ insurance – kicking in only when people get sick, doesn’t do it any more. Expat insurance, like any other, must be comprehensive, it must be cost effective. Data has shown that for every $1 spent on prevention, $64 is saved in claims costs, he says. Whereas many companies cover the client as an expat, it is also necessary to ‘bridge the gap between domestic and international healthcare’, says Carter. Though IMG has been able to bridge this gap through many of its products, there are still many companies that have not, he says. “In the UK, for example, as further strain is put on the NHS, some NHS Primary Care Trusts, who manage localised care under strict budgets, have been known to turn away expats who come home for treatment.”With millions crossing borders daily for business, leisure, commerce, or just to do some shopping, the systems devised by Lord Beveridge or Otto von Bismarck simply don’t cut it: not without a private insurance safety net. And even then, there are impediments.

Time to muscle upWhen Canadians adopted their universal single payer health system called medicare – in the late sixties – it was designed to provide first dollar coverage for all medically necessary services. But now, as soon

as Canadians leave the country, their safety net is withdrawn and they need private insurance to backfill what their provincial plans will not – which is virtually everything. That’s fine: Canadians have bitten that pill and now routinely pay for private out-of-country insurance. But what many find is that even with private insurance, if they fall ill outside of the country and want to return for the care their taxes have paid for, they can’t get a bed because of overcrowded hospitals, and they have to rely on the expertise, and sometimes cunning, of their private international travel insurers to find one for them. Or if they need immediate diagnostic or therapeutic cancer care, or hip replacement, or a number of other wait-listed services, they join a months-long queue, or head to the US with cheque book in hand.Fortunately, the growing phenomenon of medical tourism is adding a lot of menu options for people constrained by their national health systems and international insurers are providing the bridge. Cigna International, for example, recently announced a formal agreement with Fortis Healthcare Limited of India to make direct payments for its members so they might have direct access to Fortis hospitals in northern India. Fortis includes the internationally recognised Escorts Heart Institute and Research Centre in New Delhi. Bupa International, Aetna, International SOS are among other major international players who currently have alliances with Fortis. If government-run health systems delivered what they were designed for, treatment shopping would not be necessary. But clearly they can’t. They need a lot of help from the private sector, and as one of the fastest growing segments of that sector, international medical insurance providers of all stripes must muscle up and show if they can lift the load.

expatriate employees

working in many countries are

typically subject to numerous rules and regulations

that mitigate their ability to have

comprehensive, seamless cover

with globalisation not only a fad but a reality of everyday

life, medicine without boundaries seems an inevitable

goal

The AIMIP, formed in 2007, represents the interests of companies offering products and services to the international medical insurance industry. AIMIP currently includes A La Carte Healthcare, Allianz Worldwide Care, Cigna International, BUPA International, Exeter Friendly Society, Medicare International, Morgan-Price, GoodHealth, IMG Europe, InterGlobal Ltd, Healthcare International and William Russell Ltd.

International Travel Insurance Journal

40 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

CATEGORY KEY Air Ambulance

Air Ambulance Interior

Aircraft Performance Solutions

Assistance Companies

Catastrophic Claims Specialist

Cost Containment

Claims Management

Claims Subrogation

Commercial Repatriation Specialists

Critical Care Patient Transport

Funeral Directors

Healthcare Clinics

Hospitals

Legal Services

Medical Escort on Commercial Airlines

Medical Provider

Medical Screening

Re-insurance

Travel Agents

Web & Design Services

AFRICA Air Ambulance Network Kirk Pacheco – President

905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com

#210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897 USA

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org LangataRoad www.amref.org PO Box 18617 Tel: +254 20 600 090

Nairobi Fax: +254 20 344 170 KENYA

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Netcare 911 Aeromedical Wayne Thomson - Flight Operations Mgr Netcare 911 House flight@netcare.co.za

49 New Road www.netcare911.co.za Halfway House Tel: +27 11 254 1392 Midrand 1685 Fax: +27 11 254 1405 SoUTH AFRICA

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

AUSTRALASIAAir Ambulance Network Kirk Pacheco – President

905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com

#210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897 USA

Asia Assistance Partners Siriporn Wongurai – Int. Ops. Director 184/235 Forum Tower thailand@aapartners.net 36 Flr Ratchadapisek Rd www.aapartners.net Huaykwang Tel: +662 645 3733-5

Bangkok 10320 Fax: +662 645 3732 THAILAND

Asia Medical Assistance Abhijeet Sachdev – Vice President DLF City-ll privat.airambulance@asiamedassist.org M.G Road www.privathealthcaregroup.com New Delhi Tel: +91 9899 198 198

Gurgaon 122002 Fax: +91 1242 235 2527 INDIA

CareFlight International Colin Robshaw – Co-ordinator Westmead Hospital Campus international@careflight.org PO Box 159 www.careflight.org Westmead Tel: +61 1300 655 855

NSW 2145 Fax: +61 2 4751 2995 AUSTRALIA

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

Goodmans Rescue 24 Hrs Ground & Air Ambulances Dr Satish K Bhardwaj – Director M-2 Greater Kailash-Part 1 grskb@yahoo.com New Delhi 110048 www.goodmansrescue.com INDIA Tel: +91 11 2923 1665

NEW Mob: +91 98 1001 2126

Fax: +91 11 2923 4665

Hope Ambulance Service Dr Charles Johnson – Medical Director 56 Upavon Road info@hopeambulance.com Singapore 507745 www.hopeambulance.com SINGAPoRE 24hr Tel: +65 6100 1911

Fax: +65 6400 5254

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Medical Wings Dr Sommart Somsiri – Medical Director 222 Room 3259 m.w@medicalwings.com

Donmuang Int Airport Moo 10 www.medicalwings.com Viphavadee-Rangsit Rd, Sikan Tel: +662 247 3392 Don Muang, Bangkok 10210 Fax:+662 535 4355 THAILAND

Mediflight Chris Craft – Operations Manager Royal Adelaide Hospital info@mediflight.com.au

North Terrace www.mediflight.com.au Adelaide Tel: +61 8 8378 6938 SA 5000 Fax:+61 8 8423 3077 AUSTRALIA

ozevac Anne Mordey – Operations Manager PO Box 299 info@ozevac.com Hampton www.ozevac.com

Victoria 3188 Tel: +61 409 537 333 NEW

AUSTRALIA

Pacific Flight Services Pte Ltd Katherine Yeo – Assistant Marketing Mgr ST Aerospace Engineering Bldg charter_flight@pacific.net.sg

Seletar West Camp www.fly-pfs.com Seletar Airport Tel: +65 6481 3756 797796 Fax: +65 6482 1727 SINGAPoRE

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

South Pacific Air Ambulance Scotty Watson – Managing Director ops@spaa.co.nz NEW ZEALAND www.spaa.co.nz

AUSTRALIA Tel: +64 9256 9000 SINGAPoRE Fax: +64 9256 9111

EURoPEADAC-Ambulance Service Robert Glueck – Marketing & Sales Director Am Westpark 8 info-ambulance@adac.de 81373 Munich www.adac.de/ambulance GERMANY Tel: +49 89 76 76 52 85 24-h alarm centre:

+49 89 76 76 50 05

AeroMed 365 Brian Brooker – Clinical Director Worth Corner Business Cntr brian.brooker@aeromed365.com

Turners Hill Road www.aeromed365.com Pound Hill Tel: +44 8707 596 999 Crawley RH10 7SL Fax: +44 8707 559599 UK

AIR AMBULANCE (CoNT.) AIR AMBULANCE

www.itij.co.uk

41SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

Medical Jet Services & Partner W Dichtl Radetzkystr 19 office@medicaljetservice.com Vienna www.medicaljetservice.com 1030 Tel: +43 1 600 1212 AUSTRIA Fax: +43 1 713 2799-19

Red Star Aviation Mustafa Atac – CEO Sabiha Gokcen Int Airport redstar@redstar-aviation.com J Blok Kurtkoy www.redstar-aviation.com 34912 Tel: +90 216 588 0216

Istanbul Fax: +90 216 588 0225 TURKEY

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

Swiss Air Ambulance/REGA Walter Stunzi – PR/Marketing Mgr PO Box 1414 ops@rega.ch Zurich Airport www.rega.ch

CH-8058 Tel: +41 333 333 333 SWITZERLAND Fax: +41 44 654 3590

Tyrol Air Ambulance Jakob Ringler – Managing Director PO Box 81 taa@taa.at A-6026 www.taa.at Innsbruck Airport Tel: +43 512 224 220

AUSTRIA Fax: +43 512 288 888

NoRTH AMERICAAerojet Stuart Hayman – President 4631 NW 31st Ave info@aero-jet.com #220 www.aero-jet.com Ft Lauderdale Tel: +1 954 730 9300

FL 33309 Fax: +1 954 485 6564 USA

Aeromedevac Air Ambulance Jesus Mendez – Provider Relations 681 Kenney Street flightrequest@aeromedevac.com Gillespie Field Airport www.aeromedevac.com El Cajon Tel: US: +1 619 284 7910 CA 92020 Tel: Mexico: 00 1-800-832-5087

USA Fax: +1 619 284-7918

Air Ambulance Network Kirk Pacheco – President 905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com

Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com

#210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897 USA

AirMed International LLC Jeffrey T Tolbert – President 1000 Urban Center Drive mgoodwin@airmed.com Suite 470 www.airmed.com Birmingham Tel: +1 205 443 4840

AL 35242 Fax: +1 205 443 4841 USA Toll Free: +1 877 633 5387

Air Medical Ltd Glenn Salt – Flight Operations Manager Oxford Airport operations@airmed.co.uk Kidlington www.airmed.co.uk Oxfordshire Tel: +44 1865 842 887

OX5 1QX Tel: +44 1865 370 642 UK

Augsburg Air Ambulance Roland Schoberth – Director Roseggerstr 17 info@ambulanzflugdienst.de D-86368 www.ambulanzflugdienst.de Gersthofen Tel: +49 821 299 1020

GERMANY Tel: +49 821 299 2030

EMC Meditrans Servé de Klerk – President Hoevestein 23 info@emc.nl Postbus 4190 www.emc.nl 4900 CD Tel: +31 162 496 000 Oosterhout Fax: +31 8 42 24 64 86

THE NETHERLANDS

Euro-flite Air Ambulance Juhani Missonen – Coordinator Helsinki International Airport juhani.missonen@jetflite.fi PO Box 187 Tel: +358 20510 1900 FIN-01531 Fax: +358 20510 1901

Vantaa FINLAND

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

FAI – rent-a-jet AG Volker Lemke – Director Sales & Marketing Flughafenstrasse 100 lemke@fai-ag.de D-90268 Nuremberg www.rent-a-jet.de

GERMANY Tel: +49 911 36009 31 Fax: +49 911 36009 59

Global Medical Support otto Karud – Marketing Director Ullevaal University Hospital gms@snla.no 0407 Oslo www.globalmedicalsupport.com NoRWAY Tel: +47 22 96 50 50

Tel/Fax: +47 22 96 50 51

IFRA Dr Christian Steindl – Director Bahnhofplatz 13/5 office@ifra.at POB 160 www.ifra.at 3500 Krems Tel: +43 2732 825 610

AUSTRIA Fax: +43 2732 851 01

Jet Executive International Charter Günter Krahé – Marketing & Sales Mündelheimer Weg 50 sales@jetexecutive.com D-40472 www.jetexecutive.com Düsseldorf Tel: +49 211 602 7775

GERMANY Fax: +49 211 602 77766 “Homebase FRA & MUC”

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Med Call GmbH Michael Diefenbach – CEO Black and Decker Str. 1-3 info@medcallgmbh.com 65510 www.medcallgmbh.com

Idstein Tel: +49 61 2695 3708-0 GERMANY Fax: +49 61 2695 3708-11

Medic’Air International Dr Herve Raffin – General Manager 35 rue Jules Ferry operations@medic-air.eu 93170 Bagnolet www.medicair.com Paris Tel: +33 141 72 1414 FRANCE Fax: +33 148 57 1010

AIR AMBULANCE (CoNT.) AIR AMBULANCE (CoNT.)

International Travel Insurance Journal

42 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

ASSISTANCE CoMPANIESAFRICA

AIMS Bernadette Breton – Managing Director Private Bag X5 contact@aims.org.za Benmore Gardens 2010 www.aims.org.za

Johannesburg Tel: +27 11 245 5777 SoUTH AFRICA Fax: +27 11 783 9277

AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org Langata Road www.amref.org PO Box 18617 Tel: +254 20 600 090 Nairobi Fax: +254 20 344 170

KENYA

Netcare 911 International Assistance Brenda Durow - International Assistance Mgr Netcare 911 House assist@netcare.co.za

49 New Road www.netcare911.co.za Halfway House Tel: +27 11 254 1387 Midrand 1685 Fax: +27 11 254 1405 SoUTH AFRICA

West African Rescue Association Florian Zagel - Managing Director Klotey Cresent 6 assist@westafrican-rescue.com

North Labone www.westafrican-rescue.com Accra Tel: +233 21 781 258 GHANA Tel: +233 244 312 496/7 Fax: +233 21 781 259

AUSTRALASIAAsia Assistance Partners Siriporn Wongurai – Int. Ops. Director 184/235 Forum Tower thailand@aapartners.net 36 Flr Ratchadapisek Rd www.aapartners.net Huaykwang Tel: +662 645 3733-5

Bangkok 10320 Fax: +662 645 3732 THAILAND

Asia Medical Assistance India Abhijeet Sachdev – Vice President DLF City-ll opsindia@asamedassist.org

M.G Road www.privathealthcaregroup.com New Delhi Tel: +91 9899 198 198 Gurgaon 122002 Fax:+91 2440 147 28 INDIA

Asia Medical Assistance Thailand Abhijeet Sachdev – Vice President 1011 10th Fl, BB Building opsbangkok@asamedassist.org

54 Sukhumvit Soi 21 (Asoke) www.privathealthcaregroup.com N Klong Toey, Wattana Tel: +66 225 833 55 Bangkok Tel: +91 9899 198 198 THAILAND Fax:+66 225 822 77

Assistance online Bertrand Guichoux – CEO Zendai Cube Edifice 6/F bertrand-guichoux@assistance-online.com.cn

58, Changliu Road, www.assistanceonline-china.com Pudong Tel: +86 21 6104 9500

NEW 200135 Shanghai Fax: +86 21 6104 9484 CHINA

Customer Care Pty Ltd Janine Benson – Operations Manager Level 3 janineb@customercare.com.au

60 Miller Street www.customercare.com.au North Sydney 2060 Tel: +612 9202 8222 NSW Fax: +612 9202 8220 AUSTRALIA

First Assistance Mary-Jo McDonald – General Manager PO Box 17-310 rescue@firstassistance.co.nz Greenlane www.firstassistance.co.nz Auckland Tel: +64 9 356 1650

NEW ZEALAND Fax: +64 9 525 1278

Global Assistance & Healthcare Mario Babin – Chief Executive Officer Jalan Pattimura global@global-assistance.net 15 Kebayoran Baru www.global-assistance.net Jakaita Tel: +62 21 725 8115 12110 Fax: +62 21 725 7961

INDoNESIA

South Pacific Air Ambulance Scotty Watson – Managing Director ops@spaa.co.nz NEW ZEALAND www.spaa.co.nz

AUSTRALIA Tel: +64 9256 9000 SINGAPoRE Fax: +64 9256 9111

EURoPE & THE MEDITERRANEANADAC-Ambulance Service Robert Glueck – Marketing & Sales Director Am Westpark 8 info-ambulance@adac.de 81373 Munich www.adac.de/ambulance GERMANY Tel: +49 89 76 76 52 85 24-h alarm centre:

+49 89 76 76 50 05

AGI Assistance Dr Jacques Guedj – Medical Director 99 Bis, Avenue du agiassistance@free.fr Général Leclerc 75014 Paris Tel: +33 1 43 95 00 55

FRANCE Fax: +33 1 43 95 00 66

AIR AMBULANCE (CoNT.)Air Ambulance Network Kirk Pacheco – President

905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Professionals, Inc. Brian L. Weisz – President Ft. Lauderdale Executive Airport sales@airambulanceprof.com 1535 South Perimeter Rd www.airambulanceprof.com Hangar 36B Ft. Lauderdale Tel: +1 954 491 0555

Florida 33309 Fax: +1 954 491 6114 USA

Air Ambulance Specialists, Inc. Donald Jones – President 8001 S.Interport Blvd. info@airaasi.com Suite 250 www.airaasi.com Englewood Toll Free: +1 800 424 7060 CO 80111 Tel: +1 720 875 9182

USA Fax: +1 720 875 9183

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com #210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 Florida 34684 Fax: +1 727 786 0897

USA

AirMed International LLC Jeffrey T Tolbert – President 1000 Urban Center Drive mgoodwin@airmed.com Suite 470 www.airmed.com Birmingham Tel: +1 205 443 4840

AL 35242 Fax: +1 205 443 4841 USA Toll Free: +1 877 633 5387

American Care Air Ambulance Joel Reynolds – General Manager 8775 Aero Drive americancareair@aol.com Suite 120 www.americancareairambulance.com San Diego Tel: +1 858 627 0515

CA 92123 Fax: +1 858 627 0534 USA

Canadian Global Air Ambulance Jeff McIntosh – President Toronto jmcintosh@canadianglobalair.ca Winnipeg www.canadianglobalair.ca Vancouver Toll Free: +1 800 563 3822 CANADA Tel: +1 204 888 5555

Fax: +1 204 888 9111

European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange alert@air-ambulance.com L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007

Fax: +49 711 7007 7009

JET ICU Bart Gray – President 17076 Helicopter Drive email@jeticu.com Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428

USA Tel: +1 727 524 9825 Fax: +1 727 524 982

Life Flight International Inc. Chris Connor – Operations Victoria International Airport info@lifeflight.ca Viscount Business Center www.lifeflight.ca

103-9800 McDonald Pk Rd Tel: +1 250 655 1630 Sidney, British Columbia Fax: +1 250 656 9394 CANADA

National Air Ambulance George Martinez – Mgr Flight Co-ordination 3495 SW 9th Ave inquiry@nationalairambulance.com Fort Lauderdale www.nationalairambulance.com

FL 33315 Tel: +1 954 359 9900 USA Fax: +1 954 359 9500

Skyservice Air Ambulance David Ewing – VP Int. Market Development YUL/Trudeau Int Airport david_ewing@skyservice.com 9785 Avenue Ryan www.skyservice.com/airambulance

Montreal (Quebec) N AmericaToll Free: +800 463 3482 H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096

AIR AMBULANCE INTERIoRAir Ambulance Technology Egon Kuntner – President A-5282 aat@airambulancetechnology.com Ranshofen www.airambulancetechnology.com

AUSTRIA Tel: +43 7722 85051 Fax: +43 7722 85051-22

AIRCRAFT PERFoRMANCE SoLUTIoNSRAISBECK Engineering Nick Nicholson – Sales Manager 4411 South Ryan Way nick@raisbeck.com Seattle WA98178 www.raisbeck.com

USA Tel: +1 206 723 2000 Fax: +1 206 723 2884

www.itij.co.uk

43SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

Medex Assistance Corporation Linda McGee – SVP of Sales 8501 LaSalle Road info@medexassist.com Suite 200 www.medexassist.com Baltimore Tel: +1 410 453 6300

MD 21286 Fax: +1 410 453 6301 USA

oneWorld Assist Taka Katsube – Dir Assist & Cost Mngment 10th Floor tkat@oneworldassist.com 6081 No.3 Road www.oneworldassist.com

Richmond, BC Tel: +1 604 303 2113 V6Y 2B2 Fax: +1 604 276 4593 CANADA

TMCA Margaret Whartom – Ops Manager 217 Broadway margaret@tmcatravel.com Suite 600 www.tmcatravel.com NYC Tel: +1 212 964 8580

NY 10007 Fax: +1 212 406 1520 USA

World Travel Protection Canada Inc. Dr Ron Mayer – President & Chf Med Officer 400 University Avenue ron.mayer@wtp.ca 15th Floor www.wtp.ca

Toronto Tel: +1 416 977 3565 Ontario M5G IS7 Fax: +1 416 205 4676 CANADA

SoUTH AMERICACardinal Assistance Alberto C. Chapur – President Av. Cordoba 890 7° piso albertoch@cardinalassistance.com (C 1054AAU) www. cardinalassistance.com

Capital Federal Tel: +54 11 4129 7514 Buenos Aires ARGENTINA

CATASTRoPHIC CLAIMS SPECIALISTDr Colin Plotkin Consulting Dr Colin Plotkin – Managing Director 27-3088 Francis Road colin@plotkinconsulting.com Richmond Tel: +1 604 241 9677 British Columbia Fax: +1 604 241 0733 V7C 5V9

CANADA

CoST CoNTAINMENTAFRICA

AIMS Bernadette Breton – Managing Director Private Bag X5 contact@aims.org.za Benmore Gardens www.aims.org.za 2010 Tel: +27 11 245 5777

Johannesburg Fax: +27 11 783 9277 SoUTH AFRICA

EURoPEChargeCare International Christiane Burniston – Managing Director Monument Business Park admin@chargecare.co.uk 1D, Park Offices www.chargecare.co.uk Warpsgrove Lane Tel: +44 1865 400 007

Chalgrove, Oxford Fax: +44 1865 400 707 UK Mobile: +44 777 44 35 649

Marm Assistance Jill Atac – CEO Sabiha Gokcen Int Airport marm@marmassistance.com J Blok Kurtkoy www.marmassistance.com

34912 Tel: +90 216 588 0588 Istanbul Fax: +90 216 588 0602 TURKEY

Medical Claims International Spain Fatima Guillen Grande – Managing Director C/Ciudad de Aguilas No.2 mcispain@mcimanager.com Local 2A www.mcimanager.com Madrid 28030 Tel: 00 34 913 016 145

SPAIN Fax: 00 34 913 016 160

oneWorld Assist Taka Katsube – Dir Assist & Cost Mngment 10th Floor tkat@oneworldassist.com 6081 No.3 Road www.oneworldassist.com

Richmond, BC Tel: +1 604 303 2113 V6Y 2B2 Fax: +1 604 276 4593 CANADA

NoRTH AMERICAGlobal Excel Management Brian Allatt – CEO 73 Queen Street, Lennoxville corpinfo@globalexcel.ca Quebec, JIM 1J3, CANADA www.globalexcel.ca

4242 Cranmore Court Tel: +1 866 566 1130 Belle Isle, FL 32812, USA Fax: +1 819 566 8335

Global Medical Management Raija Itzchaki – COO 7901 SW 36th Street contact@gmmusa.com Suite 100 www.gmmusa.com

Davie Tel: +1 954 370 6404 FL 33328 Fax: +1 954 370 8613 USA

ARC Transistance Hans Biekmann – Network Director Avenue des Olympiades 2 hans.biekmann@arctransistance.com 1140 Brussels www.arctransistance.com BELGIUM Tel: +32 2 706 6660

Fax: +32 2 706 6601

Assistance Plus Maria Berkova – General Manager 10 Building 3, Office 17 mberkova@assistplus.ru Petrovsko-Razumovskaya alleya www.assistplus.ru Moscow 127083 Tel: +7 495 785 5525

RUSSIA Fax: +7 495 786 9683

Atlantic Assist Adriano Gouveia – Operations Manager Rua da Alfandega 10-2.D info@atlanticassist.com PO Box 750 www.atlanticassist.com 9000-056 Funchal Tel: +351 291 214 200 Madeira Fax: +351 291 214 202

PoRTUGAL

Express Assist Vardan Azatian – General Director 11-th Radialnaya, 2 eac@expressassist.ru

115404 www.expressassist.ru Moscow Tel: +7 495 775 2090 RUSSIA Fax: +7 495 775 2091

Global Voyager Assistance Costas Danilenko – CEO PO Box II cdanilenko@gvassistance.com 125124 www.gvassistance.com Moscow Tel: +7 495 775 0999

RUSSIA Fax: +7 495 775 0998

Mapfre Asistencia Natalia Jorquera – Int Com & Mkt Mgr Sor Ángela de la Cruz, 6 najorqu@mapfre.com 28020 Madrid www.mapfreasistencia.com SPAIN Tel: +34 91 581 4998

Fax: +34 91 581 1850

Marm Assistance Jill Atac – CEO Sabiha Gokcen Int Airport marm@marmassistance.com J Blok Kurtkoy www.marmassistance.com 34912 Tel: +90 216 588 0588 Istanbul Fax: +90 216 588 0602

TURKEY

med con team GmbH Michael Weinlich – Managing Director Gerhard-Kindler-Str.8 operations@medconteam.com 72770 Reutlingen www.medconteam.com Tel: +49 7121 433 660

GERMANY Fax: +49 7121 433 619

MK International Emergency Serv Minas Kaloumenos – General Manager 95, Ioanninon Street mk@mkassist.gr 10444 Tel: +30 210 5154600 Athens Fax: +30 210 5131660

GREECE

Save Assistance France Franck Molinier – Director of Business Dev. 19 rue de Provence molinier@saveassistance.com 78310 www.saveassistance.com

Maurepas Tel: +33 13062 6752 24hr Alarm Cntr: +33 13062 1122 FRANCE

SoS International Helle Drager – Comms & Marketing Manager Nitivej 6 sos@sos.eu DK-2000 www.sos.eu

Frederiksberg Tel: +45 7010 5055 Copenhagen Fax: +45 7010 5056 DENMARK

TBS Team 24 d.o.o Edvard Hojnik – General Manager Ljubljanska Ulica 42 info@tbs-team24.com

2000 Maribor www.tbs-team24.com SLoVENIJA Tel: +386 2618 2301 (Croatia, Slovenia, Fax: +386 2618 5800 Bosnia-Herzegovina, Macedonia, Serbia-Montenegro, Kosovo)

NoRTH & CENTRAL AMERICAASISTUR Emilio Guevara – Managing Director Prado 208 asisten@asistur.cu e/ Colon y Trocadero www.asistur.cu Habana Vieja Tel: +537 8664499

Ciudad Habana 10100 Fax: +537 8668087 CUBA

Assured Assistance Inc. Martha Turnbull – Director of Operations 6880 Financial Drive martha.turnbull@rbc.com Mississauga Tel: +1 905 816 2495

Ontario Fax: +1 905 813 4719 L5N 7Y5 CANADA

Global Excel Management Brian Allatt – CEO 73 Queen Street corpinfo@globalexcel.ca Lennoxville, Quebec www.globalexcel.ca JIM IJ3, CANADA Tel: +1 866 566 1130

4242 Cranmore Court Fax: +1 819 566 8335 Belle Isle, Fl 32812, USA

ASSISTANCE CoMPANIES (CoNT.)ASSISTANCE CoMPANIES (CoNT.)

International Travel Insurance Journal

44 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

CoST CoNTAINMENT (CoNT.)Health Systems International Peggy Novotny – VP / Gen Mngr Intl Bus. 5975 Castle Creek Parkway pnovotny@us-hsi.com Suite 100 www.us-hsi.com Indianapolis Tel: +1 317 806 2000

IN 46250 Fax: +1 317 806 2033 USA

Medsave USA Jeffrey Baker – President 1400 Old Country Road jbaker@medsaveusa.com Suite 109 www.medsaveusa.com Westbury Tel: +1 516 622 1784

NY 11590 Fax: +1 516 294 6761 USA

Star Healthcare Gigi Galen – President 850 7th Avenue ggontheroad@aol.com Suit 803 www.starhealthcarenet.com New York 10019 Tel: +1 212 581 8228

USA Fax: +1 212 581 8272

TMCA Margaret Whartom – Ops Manager 217 Broadway margaret@tmcatravel.com Suite 600 www.tmcatravel.com NYC Tel: +1 212 964 8580 NY 10007 Fax: +1 212 406 1520

USA

United Health International Philip Brun – Director of Business Development 15500 New Barn Road p.brun@hygeia.net Suite 200 www.hygeia.net Miami Lakes Tel: +1 305 594 9291 Ext.3312 FL 33014 Fax: +1 305 594 9201

USA

CLAIMS MANAGEMENTGlobal Assistance & Healthcare Nathan Hannah – TPA Mgr Asia/Pac Jalan Pattimura nathan.hannah@global-assistance.net 15 Kebayoran Baru www.global-assistance.net Jakaita Tel: +62 21 725 8115

12110 Fax: +62 21 725 8951 INDoNESIA

Global Excel Management Brian Allatt – CEO 73 Queen Street, Lennoxville corpinfo@globalexcel.ca Quebec, JIM 1J3, CANADA www.globalexcel.ca 4242 Cranmore Court Tel: +1 866 566 1130

Belle Isle, FL 32812 USA Fax: +1 819 566 8335

Star Healthcare Gigi Galen – President 850 7th Avenue ggontheroad@aol.com Suit 803 www.starhealthcarenet.com New York Tel: +1 212 581 8228 10019 Fax: +1 212 581 8272

USA

CLAIMS SUBRoGATIoN

Medsave USA Jeffrey Baker – President 1400 Old Country Road jbaker@medsaveusa.com Suite 109 www.medsaveusa.com Westbury Tel: +1 516 622 1784

NY 11590 Fax: +1 516 294 6761 USA

CoMMERCIAL REPATRIATIoN SPECIALISTS

Voyageur Aeromedical Travel Marc Lucas – General Manager Voyageur Buildings marc@voyageur.co.uk 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 BS1 5AX Fax: +44 (0)117 925 5940

UK

MedEscort International Craig Poliner – President 1730 Vultee Street medescort@fast.net Allentown www.medescort.com PA 18103 Toll Free: +1 800 255 7182

Tel (US): 610 791 3111 USA Fax: +1 610 791 9189

FUNERAL DIRECToRSAntea International Funeral Assistance Marica Hunyadi – Managing Director

Mihálkovics utca 12 antea@t-online.hu H-1091 www.antea.hu Budapest Tel: +36 30944 0944 HUNGARY Fax: +36 1216 6107

Funeral Home AURIGA Ltd. Helen Pradova – Chief of Intnl Dept

B. Nmcové Street 1052/1 pradova.auriga@iol.cz 412 01 aurigalt@iol.cz Litomerice www.funeral-assistance.cz CZECH REPUBLIC Tel: +420 724 257 899

Fax: +420 416 735 800

Funeralcare International Roger Waddington 221 Upper Richmond Road funeralcare.international@letsco-operate.com Putney www.co-operativefuneralcare.co.uk

London Tel: +44 20 8788 5303 SW15 6SQ Fax: +44 20 8788 2525 UK

Global Networks Funeral Assistance Cristina Almudi – Managing Director

23 Blindmans Lane info@gnfa.info Cheshunt www.gnfa.info Hertfordshire Tel: +44 1992 640 066 EN8 9DR Fax: +44 1992 785 030

UK

John Allison Monkhouse Co., Ltd (Thailand) Apple Kaewprasert – General Manager

President Park View Tower apple@monkhouse.com.au 99/243 (30B) Pine Tower www. monkhouse.com.au Sukhumvit soi 24 Tel: +66 2382 5345-7

NEW Klongton Klongtoey, Bangkok Fax: +66 81 584 5942

THAILAND

KCH Repatriation Specialists Robert Rowntree – Managing Director

83 Westbourne Grove info@kchrepatriation.com Bayswater www. kchrepatriation.com London W2 4UL Tel: +44 20 7313 6920

UK Fax: +44 20 7313 6999

MK Funeral & Transportation Services Minas Kaloumenos – General Manager

95, Ioanninon Street mk@mkassist.gr 10444 Tel: +30 210 5154600 Athens Fax: +30 210 5131660

GREECE

Rowland Brothers International Melanie Walkling – Partner

299-305 Whitehorse Road info@rowlandbrothersinternational.co.uk West Croydon www.rowlandbrothersinternational.co.uk Surrey Tel: +44 20 8684 2324

CR0 2HR Fax: +44 20 8684 8000 UK

Servilusa Vanda Castro – Manager Int Dept

Agencias Funerarias SA internacional@servilusa.pt International Dept. www.servilusa.pt Rua do Entreposto Industrial Tel: +35 121 470 6300

8-2 Esq, 2610-135 Amadora Fax: +35 121 470 6499 PoRTUGAL

ZEGA Roberto Funeral Home Cristina Zega – General Manager

Via Clelia, 26/28 cristina@zega.it 00181 Rome www.zega.it ITALY Tel: +39 06 78 40 300

Fax: +39 06 78 02 488

CATEGORY KEY Air Ambulance

Air Ambulance Interior

Aircraft Performance Solutions

Assistance Companies

Catastrophic Claims Specialist

Cost Containment

Claims Management

Claims Subrogation

Commercial Repatriation Specialists

Critical Care Patient Transport

Funeral Directors

Healthcare Clinics

Hospitals

Legal Services

Medical Escort on Commercial Airlines

Medical Provider

Medical Screening

Re-insurance

Travel Agents

Web & Design Services

www.itij.co.uk

45SERVICEDIRECTORYcall +44 (0) 117 925 5151 To make an alteration to a listing email: dave@itij.co.uk

HEALTHCARE CLINICSAmerican Medical Center Natalia oleinik – Insurance & Assistance Companies 26 build 6 Prospekt Mira info@amcenter.ru 129090 www.amcenter.ru

Moscow Tel: +7 495 933 7700 NEW

RUSSIA Fax: +7 495 933 7701

Luzdoc Dr Maria Alica Silva – Medical Director Rua 25 de Abril info@luzdoc.com 12 Vila da Luz www.luzdoc.com

8600-174 LGS Tel: +351 282 780 700 PoRTUGAL Fax: +351 282 780 709

Number one Health Group Dr Charlie Easmon – Director 1 Harley Street info@numberonehealth.co.uk London www.numberonehealth.co.uk

W1G 9QD Tel: +44 207 307 8756 UK Fax: +44 207 504 3758

HoSPITALSASIA

Bangkok Hospital Medical Center Judy Mitchell – Third Party Payor Services Bangkok International Hospital judy@bgh.co.th 2 Soi Soonvijai 7 www.bangkokhospital.com New Petchburi Road Tel: +66 2310 3000

Bangkok 10320 Fax: +66 2310 3105 THAILAND

Piyavate Hospital Intl. Health Care Dr. Tanatip Suppradit – CEO Piyavate International Hospital akanit@piyavate.net 998 Rimklongsamsaen Rd. www.piyavate.com (Rama IX Rd.), Bangkapi, Tel: +66 2625 6500

Huay Kwang, Bangkok 10310 Fax: +66 2625 6890 THAILAND

Privat Hospital Abhijeet Sachdev – Vice President DLF City-ll info@privathealthcaregroup.com M.G Road www.privathealthcaregroup.com New Delhi Tel: +91 9899 198 198

Gurgaon 122002 Fax: +91 124 235 3794 INDIA

Wockhardt Hospitals Pradeep Thukral – Head International Mrktg Mulund Goregaon pthukral@wockhardt.com, wockhosp@gmail.com Link Road www.wockhardthospitals.net Mumbai Tel: +91 9819015749 400 078 Tel: +91 22 26596502

INDIA Fax: +91-22-55994242

EURoPEAmerican Medical Center Natalia oleinik – Insurance & Assistance Companies 26 build 6 Prospekt Mira info@amcenter.ru 129090 www.amcenter.ru

Moscow Tel: +7 495 933 7700 NEW

RUSSIA Fax: +7 495 933 7701

Xanit Hospital de Benalmadena Dr. Juan Bosco Rodriguez Hurtado – Director Camino de Gilabert s/n xanit@xanit.net Benalmadena www.xanit.net 29630 Tel: +34 952 367 190

Malaga Fax: +34 952 367 191 SPAIN

NoRTH AMERICABaptist Health Int. Center of Miami Yohandra Fuentes – Finance Manager 8940 North Kendall Drive international@baptisthealth.net Suite 601-E www.baptisthealth.net/international Miami Tel: +1 786 596 2373 Fl 33176 Fax: +1 786 596 5979

USA

Jackson Memorial Hospital Int. Shai Gold – Vice President Jackson Medical Towers info@jmhi.org East Tower, Suite 829 www.jmhi.org 1500 NW 12th Avenue 24 hr: +1 305 355 12 12 Miami, FL 33136-9998 Tel: +1 305 355 5544

USA Fax: +1 305 355 5545

University of Miami Health System Jose Quesada M.D., M.B.A. – Dir Finance & Operations 1099 N.W. 14th Street ihcinfo@med.miami.edu Miami www.uhealthinternational.com Florida Toll Free: +1 877 442 8676

NEW USA Tel: +1 305 243 9100

Fax: +1 305 243 9101

LEGAL SERVICESPannone LLP Andrew Morton – Head of Travel Litigation 123 Deansgate law@pannone.co.uk Manchester www.pannone.com M3 2BU Tel: +44 (0)161 909 3000

NEW UK Fax: +44 (0)161 909 4444

MEDICAL ESCoRT oN CoMMERCIAL AIRLINES

AFRICAAMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org Langata Road www.amref.org PO Box 18617 Tel: +254 20 600 090

Nairobi Fax: +254 20 344 170 KENYA

AUSTRALASIACareFlight International Sue Robshaw – Co-ordinator Westmead Hospital Campus international@careflight.org PO Box 159 www.careflight.org

Westmead Tel: +61 1300 655 855 NSW 2145 Fax:+61 2 4751 2995 AUSTRALIA

Medic’Air International 每递安国际 Dr Huaqun Gao – Medical Director 885 Renmin Road operations@medic-air.cn Huaihai China Building www.medic-air.com Room 808 Tel: +86 2163 558289 200010 Shanghai Fax: +86 2163 558285

CHINA

Medical Wings Dr Sommart Somsiri – Medical Director 222 Room 3259 m.w@medicalwings.com

Bangkok Int Airport www.medicalwings.com Viphavadee-Rangsit Rd, Sikan Tel: +662 247 3392 Don Muang, Bangkok 10210 Fax:+662 535 4355 THAILAND

Mediflight Debra o’Brien – Operations Manager Royal Adelaide Hospital info@mediflight.com.au North Terrace www.mediflight.com.au

Adelaide Tel: +61 8 8223 6618 SA 5000 Fax: +61 8 8223 6340 AUSTRALIA

EURoPEAeroMed 365 Brian Brooker – Clinical Director

Worth Corner Business Cntr brian.brooker@aeromed365.com Turners Hill Road www.aeromed365.com

Pound Hill Tel: +44 8707 596 999 Crawley RH10 7SL Fax: +44 8707 559599 UK

EMC Meditrans Servé de Klerk – President Hoevestein 23 info@emc.nl Postbus 4190 www.emc.nl 4900 CD Tel: +31 162 496 000 Oosterhout Fax: +31 8 42 24 64 86

THE NETHERLANDS

Voyageur Aeromedical Travel Marc Lucas – General Manager Voyageur Buildings marc@voyageur.co.uk 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 BS1 5AX Fax: +44 (0)117 925 5940

UK

NoRTH AMERICAAeromedevac Air Ambulance Jesus Mendez – Provider Relations 681 Kenney Street flightrequest@aeromedevac.com Gillespie Field Airport www.aeromedevac.com El Cajon Tel: US: +1 619 284 7910 CA 92020 Tel: Mexico: 00 1-800-832-5087

USA Fax: +1 619 284-7918

Air Ambulance Network Kirk Pacheco – President 905 Martin Luther King Jr Drive inquiries@airambulancenetwork.com

Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276

Air Ambulance Worldwide Inc. Mark Jones – President 35246 US Hwy 19 North mjones31@tampabay.rr.com #210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198

Florida 34684 Fax: +1 727 786 0897 USA

American Care Air Ambulance Joel Reynolds – General Manager 8775 Aero Drive americancareair@aol.com Suite 120 www.americancareairambulance.com San Diego Tel: +1 858 627 0515

CA 92123 Fax:+1 858 627 0534 USA

Life Flight International Inc. Chris Connor – Operations Victoria International Airport info@lifeflight.ca Viscount Business Center www.lifeflight.ca

103-9800 McDonald Pk Rd Tel: +1 250 655 1630 Sidney, British Columbia Fax: +1 250 656 9394 CANADA

International Travel Insurance Journal

46 SERVICEDIRECTORY To have your company listed in the Service Directory email: dave@itij.co.uk

Trouser snake frightA tourist in Australia received a nasty reminder about the dangers of the local wildlife recently, when he was travelling by car to Cairns. It was a long trip, and he had to stop to relieve himself by the side of the road at one point, whereupon a highly venomous brown snake darted between his legs and bit him … how shall we put this … in a ‘sensitive area’. Emergency workers rushed to the scene, where they swiftly wrapped the appendage in plastic in case it had become infected with poison.The tourist, suffering from a painful wound, vomiting and stomach pain, was given the all clear after tests were performed that confi rmed the venom had not entered his bloodstream. One of the ambulance personnel told local reporters that the tourist was ‘lucky’ – something the tourist wouldn’t perhaps agree with. “It certainly had a swipe at him,” said the paramedic, “but it didn’t envenomate him. As it came through it must have got a bit of a shock.”

Chewing gum improves recoveryDoctors in the UK may soon be prescribing chewing gum after research found it helps patients recover faster from operations on their bowels.

People who endured bowel surgery and were then given chewing gum regularly were able to go home nearly two whole days earlier. The patients were asked to chew the gum for 30 minutes in the morning, afternoon and night in order to trigger their gastric hormones, thus stimulating their bowel functions, which allows the patient to resume normal eating habits.Consultant nurse Harriet Wright led the six-month study of 67 patients, and said: “We now recommend it after surgery to help bowels to recover quicker. Hopefully this will become practice now.”

Caught on cameraA man who allegedly photographed more than 3,000 women’s bottoms as they toured the sights of Venice has been arrested. The man was stopped by police who became suspicious of a large bag he was carrying as he followed several different women around the ever-popular St Mark’s Square. In the bag was a camera, which was taking snaps through a small hole he had apparently made in the lining.A video released by police shows a man in jeans and a hooded top walking closely behind certain women – all of whom happened to be wearing miniskirts. The Italian man would try to position the bag close to their legs and that when the women stopped or bent down to pick something up, the footage shows him lining the bag up under their skirts. After he had been arrested, the police found several DVDs and more than 3,000 images of women’s bottoms in his house. Although he has not been named by Italian authorities, it is known that he has a wife and two children, to whom he may well have some explaining to do.

GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

I

NE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

National Air Ambulance George Martinez – Mgr Flight Co-ordination 3495 SW 9th Ave inquiry@nationalairambulance.com Fort Lauderdale www.nationalairambulance.com

FL 33315 Tel: +1 954 359 9900 USA Fax: +1 954 359 9500

MedEscort International Craig Poliner – President 1730 Vultee Street medescort@fast.net Allentown www.medescort.com PA 18103 Toll Free: +1 800 255 7182

Tel (US): 610 791 3111 USA Fax: +1 610 791 9189

MEDICAL PRoVIDERAMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Wilson Airport emergency@flydoc.org Langata Road www.amref.org PO Box 18617 Tel: +254 20 600 090 Nairobi Fax: +254 20 344 170

KENYA

Atlantic Assist Adriano Gouveia – Operations Manager Rua da Alfandega 10-2.D info@atlanticassist.com PO Box 750 www.atlanticassist.com 9000-056 Funchal Tel: +351 291 214 200

Madeira Fax: +351 291 214 202 PoRTUGAL

DIARY DATES3-8 August

XVII International AIDS ConferenceMexico City, Mexico

www.eurolink-tours.co.uk

10-14 AugustTransplant Surgery Medical Congress

Sydney, Australia

14-16 August9th International Mental Health Conference

Holiday Inn, Gold Coast, Australiawww.gcimh.com.au/conference

6-9 SeptemberCasualty and Property Insurance Underwriters Annual Meeting & Seminar

Philadelphia, PA, USwww.cpcusociety.org

11-12 SeptemberMeasuring and Managing Mortality & Longevity Risk

London, UKwww.life-pensions.com

21-23 September9th China Rendezvous

Chinawww.asiainsurancereview.com/pages/conferences

24-25 September4th Insurance Executives’ Summit on Technology

Shanghai, Chinawww.asiainsurancereview.com/pages/conferences

2 OctoberLife and Pensions Italia

Milan, Italywww.life-pensions.com

12-15 OctoberGlobal Business Development Institute 10th Annual conference

Las Vegas, NV, USwww.gbdi-conference.org/8.html

14-17 October15th International Association of Insurance Supervisors

Budapest, Hungarywww.iais2008.org

30 OctoberSolvency II and Risk Management for European insurers

Brusselswww.life-pensions.com

Grapevine

MEDICAL ESCoRT oN CoMMERCIAL AIRLINES (CoNT) TRAVEL AGENTSVoyageur Aeromedical Travel Marc Lucas – General Manager Voyageur Buildings marc@voyageur.co.uk 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 BS1 5AX Fax: +44 (0)117 925 5940

UK

MEDICAL SCREENINGTravel & Medical Insurance Services Lara Suttie – Call Centre Manager 1st Flr Suite, West House sales@travelandmedical.co.uk 46 High Street www.travelandmedical.co.uk Orpington Tel: +44 845 058 8000

Kent BR6 0JQ Fax: +44 845 053 3000 UK

Travel Screen Sandra Howell – General Manager The Seedbed Centre info@travelscreen.co.uk Vanguard Way www.travelscreen.co.uk Shoeburyness Tel: +44 1702 587 007 Essex SS3 9QY Fax: +44 1702 584 731

UK

WEB & MEDIA ADVERTISINGV Creative Design Steve Annette – New Media Director Voyageur Buildings info@vcreativedesign.co.uk 43 Colston Street www.vcreativedesign.co.uk Bristol Tel: +44 (0)117 922 6600

NEW BS1 5AX Fax: +44 (0)117 925 2040

UK

47ONTHEMOVE

www.itij.co.uk

The Claimers illustrated by Chris Duggan, concept by Ian Cameron © Voyageur Publishing & Events Ltd

Grant chosen as group executiveMatthew Grant has been appointed to the position of group executive of global client development at Risk Management Consulting (RMS). Matthew joined the company in 1996 and since then has held various roles in the client development group, including senior vice-president of the RMS international region. Speaking at the announcement of his promotion, Matthew said: “The insurance industry is going through a period of change. Over 3,000 people are using RMS data, models and technology on a regular basis, many of whom have advanced qualifications in mathematics, science or engineering. I look forward to continuing to build a team that knows our partners and their businesses extremely well, and that has the skills and experience to ensure they gain long-lasting value from their relationships with RMS.” Matthew is taking over from Bill Keogh, who, after 12 years, has decided to leave the company to pursue other interests. Hemany Shah, CEO of RMS said: “Bill played a central role at RMS for over a decade. On behalf of my many colleagues at RMS we thank him for his dedicated services and wish him the best of luck in his endeavours.”Gould goes to

HiscoxBermuda-based Hiscox, the international specialist insurer, has announced that Michael Gould is to join the company in the position of chief operating officer. He will report directly to Bronek Masojada, CEO, and will be responsible for operations, IT and property services across the Hiscox group.Michael joins Hiscox from Aon, where most recently he held the position of chief operating officer for the business’s corporate division. Before this, he worked at American Express for 14 years in a variety of roles. Speaking at the announcement, Bronek Masojada said: “Michael’s understanding of customer experience as it relates to premium and corporate services combined with his leadership skills and knowledge of the insurance industry is the right mix for this role. His experience links in well with our ambition to provide flexible underwriting with superb customer service and will complement our existing management team.”

Mondial rewards successMondial Assistance has announced the promotion of Aimee Charlwood to the position of senior account manager for its corporate and travel sales department. In her previous position as business development manager, Aimee was responsible for the successful expansion of the easyJet travel insurance account. Commenting on the promotion was Ben Smart, head of business development for Mondial: “Mondial Assistance has played a key part in easyJet’s record profits for 2007, which soared by 48 per cent to £191 million. Aimee took the lead for this account, driving forward expansion of the travel insurance offering on a pan-European scale.”Aimee joined Mondial in 2003 and within two years was appointed as business development executive for the automotive team. In 2007, she made her move to business development manager for the corporate and travel division, and in her new role she will oversee the account management team, as well as continuing to focus on the easyJet and CSMA accounts. Speaking after the announcement had been made, Aimee said: “My new position offers me more exciting opportunities and reflects Mondial Assistance’s commitment to recognising and rewarding its staff. I will be able to drive the team forward and create new opportunities for the business across Europe.”

Griffin appointed at AmlinAmlin, the Lloyd’s insurer, has appointed Andrew Griffin to the post of class underwriter on the accident and health account, reporting to leading class underwriter Mark Clements. Andrew will join Amlin in the autumn from Ace Global Markets, where he held the position of product line head, responsible for overseeing the accident and health account there. Duncan Deal, interim joint divisional underwriter at Amlin, said of the move: “With Andrew’s appointment, we will be fielding two senior underwriters on an account where we believe there to be good development opportunities and where Amlin intends to cement its leadership position over the coming years.”

New CEO for Aon RückOn 1 July, Jan-Olivier Thofern took over as CEO and chairman of Germany’s largest reinsurance broker, Aon Rück, which is part of Aon Re Global. He replaces Holger Gaserow, who is retiring at the end of this year. Michael O’Halleran, executive chairman of Aon Re Global, said: “Our clients in Germany have come to expect the industry’s best in integrated capital solutions and services from Aon Re Global, and I am confident that Aon Rück, under Jan-Olivier’s leadership, will continue to give our clients our best. We are grateful for Holger’s leadership and vision and wish him well in his retirement.”In the 40 years he has spent with Aon, Holger has risen steadily through the ranks – initially employed in the reinsurance division of Hamburg brokers Jauch & Hübener, he was appointed to the board in 1989 and became a partner in 1997. Following Aon’s purchase of the company, Holger held the position of chairman of the reinsurance broker Aon Rück Hamburg. Jan-Olivier, meanwhile, has been with Aon since 1993, has been a member of the management board since 2005 and a member of the executive committee since 2006.

Wijngaarden to stand downING announced recently that Ludo Wijngaarden, chairman of the Dutch intermediary division, will step down on 1 August this year after 19 years of service to the company. At the same time, Ludo will also step down as board member of other ING companies. Ludo began his tenure as chairman of the intermediary division at the beginning of 2004 and since then has successfully guided the division through a number of milestones, including the improvement of customer experiences and increased operating efficiency. ING said it has already started the search for his successor.

E&Y chooses team leaderErnst & Young’s newly created insurance run-off team now has a lead partner – Kevin Gill has joined the firm in that capacity. Kevin will be based in the firm’s financial services’ transaction advisory services practice, where he is responsible for building up existing capabilities and growing the team.Prior to joining Ernst & Young, Kevin ran his own consultancy business, where he developed and advised underwriters and brokers on how to deal with their legacy business. Before this, he worked for PriceWaterhouseCoopers for 18 years, finally serving as a director of the company.Will Bridger, lead partner for Ernst & Young’s insurance transaction advisory services, noted: “I am delighted that Kevin is joining us to lead the dedicated insurance run-off team. He brings a wealth of experience, not just in dealing with underwriter legacy, but also in restructuring other financial services entities such as intermediaries.” On his appointment, Kevin said: “Changes in European Union regulations provide opportunities for European insurers to restructure their businesses to make better use of their capital. I am looking forward to further advising Ernst & Young clients on ways to restructure their businesses to ensure they get the best value from their capital.”

New manager at ChubbChubb Insurance has announced that Sarah Lidell has been appointed to the position of manager of the London casualty team. In this role, Sarah will be responsible for all aspects of management of the London team and for the continued growth and profitability of the portfolio. Her remit, said the company, would also include broker management and product development. Sarah’s appointment was in response to the recent promotion of Mark Roberts, who is now risk management and multinational underwriting manager for Europe. Tim Darley, UK & Ireland casualty practice leader and risk management manager at Chubb Insurance, said: “We are delighted to promote Sarah into this role. Her underwriting skills and knowledge of the London market make her the perfect candidate to move the portfolio to the next level.”

GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INE

• GR

AP

EV

INV

INE

GR

AP

EV

INE

• GR

AP

EV

I

NE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

GR

AP

EV

INE

• G

RA

PE

VIN

E •

Holger Gaserow

Ludo Wijngaarden

Aimee Charlwood

Matthew Grant