In Africa, public healthcare is generally characterised by poorly resourced medical facilities and a lack of skilled healthcare professionals, mainly located in urban areas. Private healthcare is available in most territories but it is very expensive and payment is often demanded upfront.

Faced with this challenge, multi-national companies looking to expand their footprint in Africa, need to exercise a “duty of care” when it comes to providing healthcare services to mobile employees and their families.

With the expat population rising worldwide and now representing 3.1% of the total global population, many products and services are available to globally mobile employees.  Navigating these to find what best suits your company’s health and wellness strategy and the diverse needs of your employees can be a headache! Not all expat health insurance policies are equal and while your benefits budget may be attracted to the policy with the lowest price tag, as with any other rewards benefit, you will only get what you pay for.

In this article we share a few key points which we feel are the most important for multi-national companies to consider when buying an international health insurance policy.

Insurer reputation and financial standing

The cheapest health insurance cover is not always the best approach to take. It is wise to do some research into the reputation and financial standing of the insurer, to have peace of mind that your chosen insurer will provide good service and will settle your employee’s claims in an efficient and timely manner.  A healthcare broker skilled in international health insurance is best placed to help the company align its health benefits with other benefits (retirement and risk) and to evaluate the most appropriate insurer to partner with.

Area of cover

When choosing a health insurance provider ensure that the area of cover chosen is appropriate for your employees’ home and host country. Full global cover for expats who are only regionally located in Africa can be an unnecessary expense.

Medical underwriting

Depending on the number of employees to be covered, insurers may individually underwrite. This means that the insurer may impose partial exclusions or total exclusion from cover (refusal of cover) on individual employees and/or their affected dependants for health conditions that already exist. With the help of your healthcare broker the company may be able to negotiate an additional premium in lieu of a benefit exclusion, for these employees. If not, they may need to seek additional coverage for their condition.

Benefit waiting periods

Again, depending on the size of the membership, at the start of a cover policy, be aware that some benefits may have upfront waiting periods. Importantly, if an employee is pregnant or is planning to have a baby while living abroad as an expat, carefully investigate the maternity benefits of the insurer. While most insurers cover pregnancy and natural childbirth, elective caesarean deliveries are generally excluded and a 10 to 24 month waiting period may apply before the employee can access the benefit. Also, rider (optional) benefits like dental and vision may also carry waiting periods, especially for major restorative dentistry.

Payment of claims

Direct claims settlement is a vital requirement, especially in Africa where private healthcare is very expensive and up-front payment is often required. Direct payment means any hospital or doctor’s medical fees will be settled directly by the insurer, without the employee needing to pay and then claim the money back later.

Medical evacuation

With access to health facilities of an international standard being a challenge in many African territories, medical evacuation to the nearest centre of medical excellence, in the event of treatment not being available locally, is essential as a standard policy inclusion. Equally, it is important to interrogate the credentials and capability of the outsourced evacuation provider network as reliable and prompt response times are an absolute necessity.

Customer service and digital engagement

Customer support is also vital. With different time zones between territories, mobile employees need a health insurer that offers round the clock support, 365 days a year. They also need to be able to quickly and easily speak to someone in their language especially when emergencies occur. Insurers with digitalised web and mobile app solutions provide mobile employees with on-line access to provider searches, claims submission and tracking and personal and benefit information.  This level of support greatly reduces the management time involved for companies.

At Axiomatic we are confident in our ability to help multi-national companies navigate the complexities of the Africa benefits market and construct a sustainable and optimal health insurance solution for mobile employees. One that not only drives a company’s competitive advantage, but which also fulfils the company’s obligation of delivering “duty of care” by ensuring that employees and their families are optimally covered.

For more information please contact Anthea Towert on +27 11 305 1970 or