Page 24 Page 32

Page 30

Page 22

ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS JUNE 2009 • ISSUE 101 Italian cruise ship outruns pirates An Italian cruise ship, the MSC Melody, successfully used guns and a fi re hose to beat off an attack by pirates off the east coast of Africa, according to captain commander Ciro Pinto. Mandy Aitchison follows the latest attack

The ship, which was carrying its full capacity of 1,500 passengers and crew, was slightly damaged during the attack from gunshots issued by the pirates. The ship was 200 miles north of the Seychelles and 600 miles from Somalia when the pirates launched their offensive. Pinto described how the attack was carried out, saying that the pirates had at fi rst hit the ship with a barrage of gunfi re, at which point the decision was taken to equip security crewmembers with pistols. Pinto continued: “They [the pirates] tried to put up a ladder with hooks. They were climbing up, so we reacted, we started fi ring. When they saw us fi ring – we even sprayed them with water with the fi re hose – they gave up and went off.” Although deterred, the pirates then followed the MSC Melody for a further 30 minutes fi ring their Insurance gamble doesn’t pay weapons. “The passengers, meanwhile, were inside the cabin,” said Pinto, “There are no injuries, only two Britons who took an insurance gamble by failing through their EHIC card and eight per cent who held an their EHIC. The reason for the low renewal rate is people with scrapes; someone slipped and fell.” to check their European Health Insurance Card EHIC card failed to take out any other form of insurance that it is not well known that the cards each carry an Although the cruise ship successfully avoided capture (EHIC) are suffering the costly repercussions, after as they thought they were fully covered. expiry date of fi ve years after the date of issue, and the by the pirates, the actions taken by the captain and a survey by Sainsbury’s Travel Insurance found Sam Marrs, Sainsbury’s travel insurance manager, said: government does not notify holders of the cards when crew have been criticised by the East African Sea Farers that the EHIC did not cover the expenses of over “Many people wrongly overlook travel insurance because their renewal dates are looming. Steve Williams, head of Assistance Program (EASFAP). Andrew Mwangura, a half of Britons needing medical assistance abroad. they think their EHIC will cover them when they are travel insurance at aggregator site Confused.com, said that spokesman for the organisation, told Reuters: “Having Vicky McPhie reports abroad. But it will not cover you for private medical care, yet again, the importance of having comprehensive travel weapons on a passenger or merchant ship is dangerous. nor will it pay for you to be … repatriated to the UK.” He insurance in place had been emphasised, and added: They should have used other means to shake off the According to Sainsbury’s, cardholders paid an average added: “By not having travel insurance, many people are “Travellers should ensure they not only have the right pirates, like a loud acoustic device.” of £386 to settle their medical bills, with 51 per cent not taking on a great risk when they travel in Europe.” travel insurance for their circumstances, but they have being able to claim any of this back when they returned Criticism of the EHIC has continued in the British press, read the policy in detail – especially when claiming medical to the UK. Other results showed that 10 per cent of with fi gures from the Department of Health showing expenses. They might fi nd that if they do not follow the the 1,011 adults polled had received medical treatment that only one in ten Britons has remembered to renew procedures in their policy, their claim could be rejected.” Holiday activity trends call for insurance checks AXA has issued a warning to thrill seeking that those taking part in such pursuits should get their polices to ensure people are covered against new activity holidaymakers to check their travel insurance, insurance checked before rolling away as not all insurance trends like zorbing, holidaymakers could be putting following new trends in activity and experienced- providers will cover such extreme activities. themselves at a costly risk if they fail to take out the based holidays. Sarah Watson has the details John Dacey, the company’s lifestyle claims manager, correct level of insurance for their trip, with the average advised travellers: “Whatever activities you’re planning on cost of a UK medical insurance claim coming in at £744, Adventurous activities, such as zorbing – rolling down your holiday, make sure you tell your insurer. Many will according to AXA data. Dacey concluded: “Buying travel a slope inside a giant infl atable ball – are becoming be included on a standard policy, but it’s always worth insurance should be as essential as checking they’ve tied increasingly popular with vacationers, but AXA warns checking.” Although AXA has re-written its insurance the bungee rope to your foot before you jump.”

4

IN THIS ISSUE

REGULARS

News continued 6 Company brief 11 Insurance matters 12 Editorial comment 12 Health matters 17 Travel matters 18 Air ambulance news 20 IPMI News 37 Service directory 40 Grapevine 46 Diary dates 46 On the move 47 ITIJ CONTRIBUTORS FEATURES Milan Korcok is an award-winning freelance News analysis: health policy and economics writer who covers Mexican swine flu: A test of confidence? 22 travel insurance, public health, and medical The outbreak of swine flu in countries around the world has asked education issues in Canada and the US. He has several questions about the preparedness of the insurance industry to cope with a pandemic been writing about health fi nancing and policy issues in these countries since the 1960s and is The ITIC Review 24 a frequent contributor to leading North Ameri- Offering a round-up of the speakers, panel sessions and gossip that can professional journals and consumer media. took place in Oxford He lives in Fort Lauderdale, Florida.

Feature: Legal adventures 30 Jose Quesada is the director of fi nance The dangers of adventure holidays are often mentioned, but what and operations for UHealth International. He protection is in place for the tour operator? received his medical degree from Carabobo University, and a masters in business admin- World markets: Hungary 32 istration from IESA in Venezuela. He has held A country as diverse in its healthcare offerings as it is beautiful, several positions with healthcare providers in Hungary’s standard of care is put under the spotlight the US, Latin America and the Middle East. He has extensive experience in hospital opera- Profile: tions, revenue cycle management and fi nancial Dr Sutuspun Kajornboon, Bangkok Hospital Medical Center 36 planning.

ITIJ TEAM

Editor-in-chief: Ian Cameron Editor: Sarah Watson ITIJ Published on behalf of Voyageur Publishing & Events Ltd, Voyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK Assistant editor: Mandy Aitchison Copy editor: James Wallis Telephone: +44 (0)117 922 6600 The information contained in this publication has been published Staff writer: Vicky McPhie in good faith and every effort has been made to ensure its editorial dept: Ext. 3 Designers: Eli Butler accuracy. Neither the publisher nor Voyageur Ltd can accept Steve Annette advertising dept: Ext. 1 any responsibility for any error or misinterpretation. All liability US correspondent: Milan Korcok for loss, disappointment, negligence or other damage caused by editorial fax: +44 (0)117 925 2040 reliance on the information contained in this publication, or in Conference manager: Denise Clements the event of bankruptcy or liquidation or cessation of the trade of Production: Helen Watts advertising fax: +44 (0)117 929 2023 any company, individual or fi rm mentioned is hereby excluded. Kirsty Diclaudio email: [email protected] Advertising sales: David Fitzpatrick web: www.itij.co.uk Printed by Pensord Press, South Wales, United Kingdom James Miller design: V Creative Design Finance: Louise Goddard Copyright © Voyageur Publishing 2009. Materials in this Elspeth Reid WOULD YOU LIKE TO SUBSCRIBE? publication may not be reproduced in any form without permission INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522 Illustrations: Chris Duggan VISIT www.itij.co.uk

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

6 NEWS

Fraudulent claims Health checks could cause problems Thailand to insure on the rise A plan is afoot by the British Government tourists Figures from the Association of British Insurers (ABI) to offer free health checks to people The Thai authorities have approved the provision of have found that the number of fraudulent insurance over 40 years of age, but concerns over five billion baht in loans to help the country’s ailing claims has risen to a the plan have been voiced by one travel tourism industry, and has launched a special insurance record level, with 2,000 insurer, who believes that people who scheme that will cover travellers to Thailand. The such claims identified are diagnosed with a medical condition travel insurance scheme started on 1 May, and will across all sectors each could then find themselves underinsured run for six months. Cover is provided for accidents week. Last year, 4,300 when abroad. The government has and travel delays, including any costs that are incurred sham travel insurance estimated that more than two million by political unrest, up to US$10,000 per person. claims were detected, people will see a doctor for a free health Deputy finance minister Pradit Phataraprasit spoke to worth roughly £5 assessment each year, and insurer All a local paper about the scheme, and explained that it million. Clear is concerned that this could lead had been dreamt up as a direct result of foreign travel The research points to thousands of people heading off on insurance companies not covering claims related out that 20 per cent holiday without coverage for their pre- to the political unrest that has been seen in the last of people are willing existing medical conditions. Of course, few months in Thailand. Phataraprasit continued: to cheat on claims for those ‘in the know’ about insurance “Although we believe there will be no more unrest products such as holiday policies will go home following their in the country, we must have an insurance system, insurance, despite the risk diagnosis and check their policy wording since foreign travel agencies no longer guarantee the of getting caught. Nick to make sure they are still covered – but safety of tourists here. As a result, the government Starling from the ABI how many will not, and simply assume has to find an insurance company to cover foreign warned: “Cheating on their current insurance is still valid? tourists.” The budget for the scheme is reported to your insurance really Chris Blackman, head of product be around 200 billion baht, which the government does not pay – you development at All Clear, is worried that claims would insure about five million tourists. The will get caught, future the new health checks, which are for Ministry of Finance was appointed to the task of insurance will be more everyone aged between 40 and 74 in finding an insurance company. expensive and, along with England, will especially cause problems for people over credit, harder to obtain.” 65 years of age: “Whilst there are some companies Rise in Aussie arrests He added: “The only who specialise in covering the over-65s, and others thing you are likely to get who will cover some medical conditions, there are causes concern is a criminal record.” One only a small number that provide cover for people of the most prominent of any age and virtually any medical condition,” he The recent arrest of an Australian woman in Phuket, cases of fraud highlighted added. He also predicted that travel insurers will soon Thailand, has brought back into the limelight the issue by ABI was a ‘recovery be receiving more calls from the public who want to of how ignorant of local laws travellers are becoming. expenses’ claim by a ensure that the insurance they have is still suitable. Annice Smoel has since been set free after stealing a man, following an illness “Whereas on the one hand this might be viewed as AU$60 bar mat from a bar in Phuket, but her ordeal in West Africa, which a nice problem to have, travel insurers will need to has served as a reminder to travellers that ignorance actually turned out to be be prepared to cope with the extra demand, and in a of local law is not an excuse. ‘services’ at a local brothel. position to inform customers correctly.” The most recent figures made available by the Australian Department of Foreign Affairs and Trade (DFAT) show that in 2008 and so far this year, 970 Australians were arrested abroad, 507 of whom are serving time in foreign jails. In the first five months of 2009 alone, there were 790 arrests of Australians abroad, despite a warning on the DFAT website that states: “Every country has the sovereign right to Last-minute Brits determine its laws and penalties. When in another country, you are required to respect and abide by According to figures from AA Travel Insurance, that country’s laws just as foreigners are required more than 50 per cent of European single-trip travel to respect and abide by Australian laws when in insurance policies sold in the UK are bought within Australia.” It continues: “Australians are advised to three days of the traveller’s departure, often just learn as much as they can about the laws of the hours before boarding a ferry or aeroplane. Christian countries they visit. If they are arrested or jailed, the Young, director of AA Travel Insurance, has voiced Australian Government will do what it can to help, his concern that ‘last-minute Brits’ are indicative of but can’t get Australians out of trouble or out of jail.” a wider problem: “People who leave things to the As former Foreign Affairs Minister Alexander Downer last minute are inevitably going to have less time to pointed out: “Australian embassies are not travel be well organised, and insurance tends to be back of agencies, nor is it their job to provide free travel mind until it’s too late. They are even turning up at insurance.” Whether or not a travel insurance policy the travel terminal without their passports.” would be any use if a policyholder were arrested is The insurer also published figures demonstrating that down to the individual policy, but many would not the most common claim it receives is for medical offer cover if the insured had performed a criminal expenses, and Young reiterated the vital cover that act. Regarding Australians following advice offered travel insurance offers, saying: “Local doctors and to them, though, Downer said that thousands of hospitals will sort you out, but won’t send you home. Australians had ignored warnings about travel to Many will also charge for treatment, even if you have Lebanon in 2006, and when the fighting began remembered a European Health Insurance Card, between Israel and Lebanon, the Australian Embassy which should never be considered a substitute for had to repatriate 6,500 citizens at a cost of over travel insurance.” AU$32 million.

International Travel Insurance Journal

8 NEWS

Overpaying for travel insurance

Vacationers forced into holidaying more locally or approximately £25. Maxine Barker, travel insurance having a ‘staycation’, due to the biting recession, manager at moneysupermarket.com, added that could be overpaying on their travel insurance, while costs will be a priority when searching for according to a report by data provider Defaqto. The cover, it is worth sticking to certain minima, which report found that UK holidaymakers will commit include at least £2 million for medical expenses, £1 themselves to just one holiday this summer, with ‘the million for personal liability, £3,000 for cancellation, number of overseas trips showing a decline for the £1,500 for baggage and £250 for cash. first time in two decades’, said author of the Defaqto Findings from the report have also called for a review report Brian Brown. He explained that travellers of packaged accounts, which many people have bought may be better off purchasing single-trip insurance, as due to a deal for free annual travel insurance. Michael opposed to paying extra for annual cover, and stated: Taylor, money mentor with moneystatistics.co.uk, “Purchasing a single-trip policy makes more sense.” noted: “If you are paying £12.50 a month or more for Figures from Moneysupermarket.com seem to an account like this for the free annual travel insurance, support Defaqto’s analysis and reveal that a single- it may have seemed a reasonable offer. Once you can trip policy costs just £4.11, a massive decrease meet your travel insurance needs for as little as £5, the from a purchase of annual cover, which starts at scandalous over-charging becomes more obvious.”

Airline collapses call for correct protection Pre-existing problems continue International Passenger Protection Ltd (IPP) has predicted should consider if they are to be protected against Sainsbury’s Finance has released a report that has conditions – increasing pressure on household that financial failure protection will become an essential the potential liquidation of an airline, according to IPP found that around 500,000 Britons with medical finances has prompted some consumers to try component of travel insurance policies during the course director Paul McLean. conditions travelled abroad in the last year without and contain their insurance costs by not making a of this year, following continuous record losses within He stated: “There are huge chunks of the travel valid travel insurance – most of whom failed to full declaration. Chris Blackman, head of product the airline industry. Insurers like IPP are pushing travellers market which do not have government protection. inform their insurer about their pre-existing medical development at AllClear, noted: “Some travellers do to review their travel insurance policies to ensure they Although there is credit card cover under section condition. A survey performed by the company not understand the potential consequences of their include financial failure protection, which will cover 75 of the Consumer Protection Act, this will not estimates that around 267,000 people with a heart pre-existing medical conditions. And yet if they fall ill them in the event of an airline collapse, such as the high usually extend to include additional costs to get home problem failed to tell their insurer about their medical abroad and need to be repatriated, they could find profile failure of XL Airways in 2008. Scheduled Airline following a collapse.” McLean believes that travellers situation, while around 206,000 did not inform the themselves paying an enormous bill.” Failure, which will cover pre-paid sums in the event of are often ‘confused’ with the type of protection they company of their respiratory conditions. The insurers’ conclusions were drawn from a survey insolvency, including lost money and the cost of a return have in place when purchasing travel insurance and The main reasons for the non-disclosure were cited that showed 57 per cent of consumers bought the ticket home; and End Supplier Failure, which will extend said: “[Travellers] need to check with the retailer of as the fear of being refused cover all together if a cheapest insurance policy they could find, while 22 this cover to include end suppliers of holidays, such as their travel tickets to see what protection is in place person was to make full disclosure of their condition, per cent said they were looking for value for money. hotels and car hire companies, are sections that travellers and ensure it meets their needs.” and the need to find a cheaper policy in the As Blackman warned consumers, though: “Travel economic downturn. Also, some of those surveyed insurers share common issues with motor insurers. said they were embarrassed to discuss pre-existing Cheaper products often mean less cover, and conditions with an insurance representative. Sam policyholders only discover they are not covered at Marrs, travel insurance manager for Sainsbury’s the point that a claim is made.” Finance, told consumers that they were doing AllClear recently analysed its claim statistics over the themselves no favours in the long run: “Withholding past year, finding that some initially simple claims were key information such as any medical conditions could costing far more than originally thought. The claims mean your cover may be invalidated and in the worst data also showed that the insurer is paying out more of cases, this could mean facing large hospital bills or frequently to repatriate its customers once they have arranging your own repatriation.” undergone treatment abroad. One case in particular Recent research by travel insurer AllClear has that was highlighted was a traveller who broke their blamed the credit crunch for British holidaymakers ankle in Menorca and needed treating and taking back withholding information about their pre-existing to the UK – the bill for the claim came to £28,000. Effective fraud solutions A fraud detection system developed by CEGA Group Services has saved its clients in the travel insurance industry more than £2 million during the first year of its operation, according to the company. Sussex-based CEGA, which handled over 200,000 travel insurance claims in 2008, investigates hundreds of potentially fraudulent claims each month through its Special Investigations Unit using a cognitive interviewing process as one of its techniques. CEGA’s special investigations manager Simon Cook commented on the company’s methods: “Being office-based, our cognitive interviewing process offers an economical solution for a high volume of low value travel claims. It is complemented by assessments from our in-house medical staff, on site investigators and close communication with our claims management teams.” The company investigates claims on behalf of many household insurers and has cracked numerous fraudulent claims, including a staged car crash and a case of gold bullion that went missing from luggage. Despite figures from the Association of British Insurers indicating travel insurance fraud to be up 80 per cent at the end of summer 2008, systems such as that used by CEGA are helping the travel insurance industry to save significant amounts of money.

International Travel Insurance Journal NEWS 9

Recession hits Prime Travel Protection shut down insurance in Colorado American Express Insurance Services has released Prime Travel Protection Inc., a company run by Jerry Insurance if we receive documented a survey showing that as the recession continues to and Christine Watson, has been ordered to close complaints about their practices.” make its impact felt, the number of people considering down by the authorities in Colorado, US. Cameron In Colorado, the company has also stopping their insurance payments is rising. The survey Lewis, a spokeswoman for the Colorado Division of been known as Vacation Protection shows that 52 per cent of Britons who usually make Insurance, said around 200 people had purchased Services, Inc., Traveler Protection regular insurance product payments are thinking about travel insurance from the company, and complaints Services, Inc. and Universal stopping doing so in order to free up some money. about the service and cover they received have come Assurance Ltd. Colorado is the When the same survey was performed in 2008, the from as far away as Florida. As such, the company latest state to take action against number of people considering halting such payments has been issued with a ‘cease and desist’ order a company run or owned by the was 48 per cent. from the authority. Marcy Morrison, Colorado’s Watsons. See ITIJ 98, Prime Travel American Express broke down the results of its Commissioner of Insurance, said of the issue: “Travel Protection out of business; and ITIJ survey into different types of insurance products, insurance companies must prove they have adequate 99, America uncovered, for a full including identity theft protection, health insurance financial reserves to cover claims, for example. history of the company’s cease and and travel. ID protection saw the biggest increase in Licensed companies must answer to the Division of desist orders. the number of people considering stopping paying for the product, followed by health insurance with a nine-per-cent increase, and then travel insurance, which six per cent more people say they would consider travelling without. Chris Rolland, head of American Express Insurance Services, commented on the findings of the survey: “It is particularly worrying, with the summer holidays approaching, that the number of people who are thinking about cutting their travel insurance policies has increased. We strongly urge people to consider the financial implications should something go wrong while on holiday and to rest assured that money can be saved on travel insurance prices by shopping online.” Similar statistics from insurance provider LV have revealed that an alarming five million Britons plan to cut back on insurance policies this year, with as many as 22 per cent intent on giving up travel insurance. The company’s figures show that 69 per cent of vacationers holidaying within the UK could fail to take out any form of holiday insurance for their trip, which raises cause for concern since research accompanying the statistics indicates that Brits holidaying in 2009 are likely to save around £3 billion by exchanging overseas holidays for UK breaks. Emma Holyer, spokesperson for LV, advised: “It is important people remember that even though they are staying in this country, travel insurance is still important.”

Jersey launches new travel policy

Following the demise of the UK’s Reciprocal Health Agreement with the Channel Islands (see ITIJ 100, Insurance needed for Channel Islands), Jersey Tourism has launched a travel insurance policy for independent visitors to the island. The tourist board has collaborated with Rossboroughs, States Insurers and PJ Hayman to secure a policy that will provide cover for all who travel to the island. According to David de Carteret, Jersey Tourism director, there were growing concerns about the lack of insurance companies able to provide cover for visitors to the Channel Islands. He said: “A high proportion of companies define Jersey as part of the UK. Therefore, when the policy is used for travel outside of the UK, the Channel Islands are effectively excluded.”

www.itij.co.uk 10 NEWS

Diversion cost passed on to customer £90 million of holiday mishaps not covered

Jet2, a low-cost airline based in the UK, hit the the UK, the O’Briens then received a letter from the InsureandGo has estimated that Britons suffered medical problems. People don’t understand that when headlines recently after it attempted to charge one of airline, together with an invoice for £4,365 for ‘costs approximately £90 million worth of uninsured they go abroad, especially Europe, they’ll patch you up its passengers for the cost of a medical diversion. directly associated with medical diversion of flight’. holiday mishaps in 2008, a 38-per-cent increase but you won’t get a free ticket home.” Clare and John O’Brien were on their way back to The couple’s travel insurer has insisted the airline can on 2007. The company has revealed that medical the UK from a holiday in Tenerife when John was recover the loss from its own insurance company. problems accounted for the bulk of these missed taken ill and collapsed during the flight. The flight A consumer television programme in the UK picked claims opportunities at roughly 92,000, with 62,000 attendants gave him oxygen and found a doctor who up the story, and asked an aviation lawyer what he incidents of lost/stolen baggage and over 39,000 flight happened to be onboard, who prescribed aspirin. thought of the situation and demand from Jet2. James cancellations. Lost/stolen money and travel delays The pilot then emerged and discussed the situation Healy-Pratt responded: “I think it’s wrong morally, were also common amongst the estimated 236,000 with the doctor, telling the doctor that the plane was wrong legally and wrong commercially for Jet2 to incidents that could have been claimed for last year, in a suitable position to divert to a nearby airport if he seek to get four and half thousand pounds from the had the victims been insured. deemed it necessary. John, by this time, felt a great O’Briens for a decision that Jet2 made. Where there Although millions of British travellers managed to deal better and insisted he was fine to continue with is a medical diversion, the airline bears the cost or minimise unnecessary costs by having adequate the flight. However, as the doctor was unable to the airline’s insurance bears the cost.” Upon being travel insurance, around 14 per cent ventured guarantee that John’s condition would not deteriorate contacted by the programme, the airline quickly abroad without insurance. Perry Wilson, founder further, the decision was taken to divert the plane. backed down and made a statement to the media: of InsureandGo, noted: “Thankfully, most people The couple’s travel insurance policy covered the cost “Firstly, Jet2.com would like to make an unreserved get adequate insurance before they go on holiday, of the medical bills incurred in Spain and the price of apology to Mr and Mrs O’Brien. It was never our but there are still a significant proportion of us the new flights home, but once they had returned to intention that they should personally settle these going abroad without being insured. Issues like costs as we believed they should have been covered medical problems and lost baggage affect so many by their insurance.” It continued: “We do appreciate holidaymakers nowadays – and with average claims ABI urges double the distress that this situation has caused them and values rocketing they can be very costly.” we have taken the decision to cover the O’Briens’ Wilson is also urging travellers to prioritise medical cover checking costs ourselves. We have reviewed our policy in this above all other types of protection, and maintains it Malcolm Tarling, a spokesman for the Association of regard to ensure that all similar expenses are covered should be ‘the biggest point of call’ for anyone taking British Insurers (ABI), has warned British tourists that by us now and in the future.” out travel insurance. He advised: “The main crux of it is they should ensure they know exactly what their travel insurance policy covers them for before they agree to purchase the cover. The details of cover contained in the small print are vital, said Tarling, for Refunds offered for Mexican trips consumers to truly understand the exclusions applied to their particular policy. He continued: “[Customers] Sainsbury’s Travel Insurance has announced that it is However, if the travel agent refuses to offer either a should actually understand what they are covered for. to grant refunds to its customers who were scheduled refund or an alternative holiday, Sainsbury’s customers The essentials – what you would like to be covered to travel to Mexico between the 28 April and 6 May, can ring the insurer, which is dealing with claims arising for when you go abroad – are medical expenses and in light of the outbreak of swine flu. The supermarket from the swine flu outbreak on a case-by-case basis. loss of baggage and possessions.” has, however, advised its customers that they should For more details on the effects that swine flu has had first try and seek compensation from their travel agents, on the travel insurance industry, please see our news who may also offer a refund or an alternative holiday. analysis on p. 22. Freedom Direct falls Insurance as a victim to the crunch talisman UK-based online travel agent Freedom Direct has ceased trading, having failed to renew its Air Travel A new academic study undertaken in Canada has Organisers’ Licence (ATOL) in April. The Civil found that on some level, people think insurance Aviation Authority (CAA) estimated that around policies can act as talismans that can protect them 200 Freedom Direct customers were abroad when from harm. As the study authors say, for many the announcement was made that the company people, refusing to buy insurance is a way of had stopped trading, and there are around 9,000 tempting fate. further holidays booked. The company’s previous Eric Dolansky, a professor at Brock University in ATOL bond covered the company for £750,000, Ontario and one of the study authors, noted: “Based although it has been estimated that the total cost to on how superstitious someone is, they’re more the CAA’s Air Travel Fund could be up to £2 million. or less likely to connect having insurance to being A spokesman for the CAA noted that the case had protected against the (negative) event, rather than become more complex due to the fact that the the financial loss associated with the event.” company had continued to trade for three weeks The research was carried out by conducting after its ATOL licence had expired, meaning there experiments with 243 people that examined the are customers who purchased a holiday during this degree to which insuring a precious ornament period who are not would be seen as a talisman against breakage protected by the bond. during a shipping process. The results of CEO of Freedom the experiments showed that participants Direct Martin Jones consistently believed that if they did not insure said on the website: the ornament, it would be more likely to break. “We would like to The researchers indicated that such beliefs apologise for any could be the reason behind the rise in inconvenience uptake of travel insurance that has been caused to our seen in Canada in recent years. Vincent customers Beretta, CEO of insurer Walkaway and to thank Canada, noted that many people the many consider travel insurance that people includes cover for redundancy who have – in today’s uncertain climate, booked many would see this cover as holidays reassuring. Beretta continued: with us “Consumer debt has risen and over it leaves us in a situation where the we can’t even handle a minor last 12 adjustment in our income, let years.” alone a major one.”

International Travel Insurance Journal COMPANYBRIEF 11

Access America Improved Canada New ticket protection Passenger protection enhances cover product Travel Insured International has launched a new online Following the 2008 success of International Passenger Airline Ticket Protector plan with strengthened features Protection’s website ProtectMyHoliday.com, which Following in Canadian travel insurance provider Travel Insurance for leisure travellers and business travellers alike. The enables travellers to directly purchase financial failure the footsteps of Coordinators Ltd (TIC) has unveiled its newly new online plan covers airline tickets as priority, but insurance against the end suppliers of their holiday, several other travel improved Visitors to Canada product, designed includes trip delay and baggage loss as standard. It also an affiliation programme has been launched that insurance providers, to ease the process of understanding, selling and offers new value-added options for travellers in need of gives travel organisations the ability to link their site Access America has purchasing travel insurance for people visiting more comprehensive coverage such as cancel for any to protectmyholiday.com and earn a commission announced changes the country. TIC has introduced the product as reason, a combined emergency medical option, a flight on each policy sold. The programme is designed to to its Cancel Anytime a response to the sheer number of people that accident option and a car rental collision damage waiver. earn affiliates revenue while providing an important policy, raising venture to Canada each year, including tourists and The plan is designed to be a more cost-effective product to their customers, and will help cater for reimbursement for new immigrants, with the intention of meeting the option for travellers, with affordable base prices the expected collapse of airlines this year, following trip cancellation due specific needs of these visitors. starting as low as $16 per passenger, and has the demise of 30 airlines in 2008. to job loss from 80 Craig Spencer, director of product and underwriting increased available coverage on trip cancellation or The insurance policies are underwritten by a selection per cent to 100 for TIC, explained: “We’ve really listened to the trip interruption, which now cover up to $3,500 of insurers with a combined net worth of more than per cent of the cost marketplace … to capture the needs of both our instead of just $1,000. Additional new benefits are €100 billion and cover will protect travellers against of the trip. By increasing the reimbursement rate, partners and consumers. Just a few of the exciting a maximum $500 missed connection cover and the liquidation of un-bonded end suppliers, allowing the company says it is allowing customers to book new enhancements to our Visitors to Canada $1,000 for lost baggage and personal effects. lost money to be refunded if failure occurs prior to their trips with more confidence that they won’t find product are: clarified eligibility criteria, simplified travel, or cover the cost of a return ticket if failure themselves in debt should they lose their job. policy language, more competitive rates, and three occurs during the trip. It is said to be a simple and Mark Cipolletti, vice-president of communications follow-up visits to emergency care.” cost-effective method of adding the protection missing at the insurer, noted: “With the improvements to Results from the Canadian Tourist Commission revealed WTH alters cover from many travel insurance retail products. Paul Cancel Anytime’s coverage for job loss, Access that tourist spending in Canada reached $70.8 Mclean, director of International Passenger Protection, America continues its tradition of providing coverage billion in 2007, and foreign residents made US-based World Travel Holdings explained: “As more and more people continue to that’s relevant to the American traveller. It’s 17.8 million trips in the same year. Although (WTH) has announced it is to make their own holiday arrangements and book direct understandable that even financially secure families the figures for 2009 are slightly lower, enhance its travel insurance with airlines, there is usually no cover in place for and individuals might fear the unexpected in this Devanand Prashad, claims manager for TIC, policies so that consumers insolvency of the airline, for example, and therefore economic environment, but with Cancel Anytime, said that this doesn’t change the fact that vast booking various types of travel travellers are urged to check for cover with their travel there’s little reason to postpone booking a vacation.” quantities of people are still visiting the country can cancel their holiday for company or on their travel insurance policy.” The cover requires that the insured must have at least that need to be covered in case of medical reasons including job loss or Mclean said that only some 10 per cent of travel one year of continuous employment with the same emergency. He said: “Every year we see a furlough with a full refund. The insurance policies included cover during the XL employer and that the termination must be due to the number of visitors to Canada who end up addition to the policies was made collapse, but now it is expected that 70 per cent of all economic situation. Other unforeseen cancellations needing emergency medical care during their after the company saw a positive travel insurance polices sold in 2009 will include cover. will be reimbursed at a rate of 80 per cent cash back, stay. Some of the more routine occurrences response to the February launch He concluded: “Consumer protection has always been including job loss insurance for those who have not yet are the cases of minor food poisonings, of Cruise Assurance, a job loss unclear … and many people take for granted that they been in their current position for a year. broken bones due to common accidents, and cancellation policy rolled out are automatically covered. The fact is if someone books unexpected heart attacks or strokes.” by CruiseOne and Cruises Inc, a holiday independent of a package … they could face Brad Tolkin WTH The new product will also cover seniors up to the WTH’s cruise division. a lack of financial protection for the elements of their age of 69, will have no maximum number of family Brad Tolkin, co-chairman and co-CEO of WTH, holiday financially collapsing, such as the airline.” New Dubai members in the family coverage plan, and will said: “It is imperative that travel providers continue assistance office be especially beneficial to those visitors staying in revamping their insurance programmes so that as Canada for longer than the average tourist. One such we ride out this economic storm, consumers can CONNEX Assistance Middle East has announced the British mother’s three-month plan from TIC covered enjoy their right to book a vacation with peace of MSC agree with EA launch of a new branch office in the commercial area her $12,289 medical expenses when she had to mind. After rolling out Cruise Assurance, we saw an of Al-Qusais in Dubai. The business unit has been undergo emergency bowel surgery whilst staying immediate uptick in consumer confidence, realising Group developed as a response to the company’s growing with her daughter for a few months in Ontario. bookings from those who were on the fence.” demands by clients to handle larger volumes of MSC Cruises cases in the UAE and will act as a regional hub for all and the Europ activity in the Gulf. Assistance (EA) Lara Helmi, international network director, explained: Group have signed “It is of strategic importance for us to gain a solid FirstAssist wins ONE a global agreement foothold in the Gulf, and the expansion of our Dubai FirstAssist Insurance Services has won the contract to rated FirstAssist’s ability to tailor a flexible solution to to design and team and facilities is critical to ensuring the highest provide ONE Underwriting, part of the ONE Group, meet his company’s needs as ‘second to none’. launch a personalised worldwide international standard of service is continued in all our activities.” with travel insurance products and underwriting, Alistair Hardie, managing director of speciality travel assistance and insurance programme. The She added: “Having a team on the ground with over including their insurewithease and OUL Direct brands. insurance at FirstAssist, commented: “We are agreement, which is being managed and centralised a decade of experience will allow us to fill the gap Travel is a core part of the FirstAssist business and delighted to have been chosen to support ONE by the EA Group, will allow MSC Cruises to offer the for full-service assistance that is highly responsive, its comprehensive range of covers includes online Underwriting, and we look forward to building a complete range of products to its customers in 16 efficient and cost effective.” The new centre will medical screening, independent traveller, impaired life highly successful partnership with them. This contract different countries. The policies have been designed accommodate a state-of-the-art alarm centre, cover and scheduled airline failure insurance (SAFI). is a big win for us and … further strengthens our specifically on behalf of MSC Cruises and are tailored company executives and medical consultants. Chief executive officer of the ONE Group Paul Byrne position in this key sector.” to its needs and requirements.

www.itij.co.uk 12 INSURANCEMATTERS

June is an exciting month here at Voyageur, as it marks the first International Travel Insurance Conference (ITIC) Pacific event. This will take place in Thailand European insurers face tough year Insurers use more from 16th to 18th June, and promises to be an essential conference for Leading insurers across Europe have predicted that them to ride the rollercoaster and land safely on the predictive software anyone involved or potentially the next nine months will be challenging for the other side of the recession. involved in working in this part of industry as a whole, and have said that in order to In related news, the European parliament has According to the president and CEO of Arbitration the world – whether in the realm of offset large writedowns and depressed investment approved a deal with affected governments that should Forums Inc., a US-based arbitration service, insurers insurance, assistance or healthcare. income, they will be concentrating more on their see Solvency II rolled out across the European Union are increasingly using predictive analytics to identify With an array of speakers from local basic, ‘bread and butter’ business. It seems, though, by 2012. Approval was given to the plan that states subrogation claims, and turning to arbitration as a business, as well as international that 2009 could bring better news than did 2008 – one supervisor from an insurer’s home nation will means of settling disputes. Russ Smith, speaking at representatives with experience of Swiss Re has recently posted better-than-expected lead oversight of that company, replacing the current a National Association of Subrogation Professionals operating in this market, the panel first quarter earnings, showing it was making progress system whereby each of the company’s subsidiaries (NASP) conference, told delegates that 60 per cent and speaker sessions promise to in disposing of risky assets that made investors very must deal separately with regulators in each country. of subrogation professionals are making good use of deliver enlightening presentations nervous. The company said that it has cut the number Jose Manual Barrose, EU Commission president, said such software. He then claimed that the company and spark interesting debate for those of risky corporate bonds and complex structured the new rules would restore confidence in the market is making a big difference to the industry by saving with an interest in the APAC region. finance products it holds by Swiss F6.5 billion in the as well as shielding Europe’s economy from ‘a repeat the property and casualty industry more than $700 Meanwhile, this issue of ITIJ brings first three months of this year. Stefan Lippe, CEO of the disastrous excessive risk taking by financial million a year in litigation costs through programmes you the latest developments in the of the reinsurer, noted that it could take ‘some time institutions, including certain insurance operators, that that resolved around 498,000 claims in 2008. global travel insurance arena, with to reduce the asset risk’ in the company’s overall has contributed to the global crisis’. The deal, which Disputes leading to arbitration typically arise when features on topics including swine flu portfolio. Michael Huttner, an analyst for JP Morgan, was agreed at the end of April, did compromise on insurance or self-insured companies believe their and Hungarian healthcare reform. said the signs of recovery boded well for Swiss Re: one point, scrapping a proposal for ‘group support’ insureds are not at fault or due to disagreements We also have a comprehensive review “They are on track in reducing their exposures. You – it would have meant insurers setting aside enough over the percentage of liability or the amount of of the recent ITIC event in Oxford, feel confident that things are stabilising.” money to cover risk across their entire business. Now, damages. UK, and, in our news sections, Elsewhere in Europe, feelings are mixed. Henri de however, the capital requirements will remain as they analysis of the latest trends affecting Castries, chairman of AXA, announced a two-per- are currently – set separately by each nation where the international travel insurance cent fall in first quarter revenue compared to last the insurer wishes to do business. Charlie McCreevy, market. year, adding: “We expect the environment to remain an EU financial services official, was disappointed that difficult throughout 2009.” Both AXA and Zurich this had not been altered, but said that he hoped Friendly deal with I hope you enjoy this issue. Financial Services Group, though, have said they are it would be introduced at a later date, as it is ‘a key confident that their business strategies would allow element for modernising insurance supervision’. Tesco UK insurer Friends Provident recently announced an upturn in its fortunes through a new and exclusive deal with high street giant Tesco, while at the same time announcing first-quarter results that fell well short of expectations. The company’s management Sarah Watson team announced figures that show new business Editor sales dropped by 40 per cent compared to last year [email protected] to £148 million – analysts had been predicting a figure of over £200 million. Blame for such results was placed in the usual areas – a tough economic environment and falling investment income. channels is part of a move to combat the economic Friends Provident’s deal with Tesco, under which the situation, adding: “Since last year, Fortis has marketed supermarket chain will only sell Friends’ insurance its Real Life Cover via Asda, Bright Grey has products, will not bring in any revenue until the launched new products via The Idol and now Friends end of the year, according to chief executive Trevor Provident has struck a deal with Tesco. Insurers are Matthews. The deal agreed between the insurer clearly trying to improve distribution in challenging and the supermarket involves term assurance cover, market conditions.” which is already mostly sold through intermediaries, Trevor Matthews noted that the sea change in the and will be marketed directly to consumers through way the industry views such ventures has given Tesco’s personal finance website and through its the sector new and exciting opportunities: “A few thousands of stores. years ago, out intermediaries would have recoiled Industry experts say the latest deal between and in horror at this move. But this deal gives us critical insurer and supermarket is just another sign of the mass and an opportunity to increase our platform; it’s times – insurers need new markets to penetrate very significant.” and the huge volume of shoppers that Tesco can accommodate brings the companies a much higher level of visibility on the high street. Friends Provident has joined the list of other companies, such as Norwich Union and AXA, that ‘white label’ their insurance products and sell them through outlets that are more accessible to the public. Ben Heffer, principal consultant with Defaqto, said insurers expanding their distribution

International Travel Insurance Journal INSURANCEMATTERS 13

P&C insurers well capitalised despite troubles

Figures from the ISO and the Property Casualty $40.5-billion adverse swing from insurers’ $19.3 billion from some problems in the mortgage and financial of praise for the industry as a whole and its ability to Insurers Association of America (PCI) have shown in net gains in 2007. The combined ratio – a key guaranty sector, the P&C insurance industry emerged cope with financial crises such as the one currently that property and casualty (P&C) insurers operating in measure of losses and other underwriting expenses intact.” Intact, maybe, but not unscathed, as Murray being faced. He said of the figures: “That P&C the country remained profitable last year, despite the per dollar of premium – worsened to 105.1 per cent continued: “Insurers’ net income in 2008 would insurers remained profitable in 2008 and finished challenges facing the industry. last year from 95.5 per cent in 2007.” In spite of the have been the lowest in more than two decades the year with more than a trillion dollars available P&C insurance companies collectively earned $2.4 significant fall in net income, the PIC remains convinced if not for the net loss the industry suffered in 2001 to pay claims is a remarkable testament to their risk billion in net income after taxes in 2008, even as that the industry ‘remains well capitalised’. when terrorists destroyed the World Trade Centre. management and conservative approach. Unlike catastrophe losses, the recession and government Michael Murray, ISO’s assistant vice-president for Insurers’ 0.5-per-cent rate of return for 2008 was the banks and Wall Street icons brought down by bailouts caused chaos across the financial services sector. financial analysis, commented on the figures: “The their second-lowest full-year rate of return since the the financial crisis, and unlike some once mighty The figure is far below those of recent years and a long ‘perfect storm’ that beset the industry in third- start of ISO’s annual data in 1959 and 8.7 percentage industrial giants that have had to turn to Washington way off the $62.5 billion that was seen in 2007. quarter 2008 continued unabated in the fourth points below insurers’ 9.2-per-cent average rate of for financial aid, P&C insures have thus far been able The PCI said of the declines: “Insurers suffered $21.2 quarter, as the downturn in the economy gathered return during the past 50 years.” to continue servicing policyholders without skipping a billion in net losses on underwriting in 2008 – a momentum and financial markets tumbled. Yet, aside David Sampson, president and CEO of PCI, was full beat and without burdening taxpayers.”

GIC India to share profit

The national reinsurance company of India, General Insurance Corporation (GIC), has introduced a profit sharing scheme with other general insurers in order to encourage more prudent underwriting across the industry. The Hindu Business Line has reported that the scheme will become operational only if the reinsurance treaty proves to be profitable. The profit is to be calculated on an agreed formula, with allowances made for any expenses incurred by the reinsurers, and then a percentage of the profit paid to the insurers. The profit offered to the insurance companies would be in addition to the ceding commission that reinsurers already pay to insurance companies. GIC chairman and managing director Yogesh Lohiya told The Hindu Business Line: “We are ready to cede 10 to 20 per cent of the profits as long as the companies underwrite the risks properly. We have taken some strict measures to bring discipline to the market – we have reduced the ceding commissions by five and 10 per cent, as companies offer deep discounts, which in turn brings down their profitability.” In other news, a report by the Financial Sector Assessment Committee has found that the insurance industry in India is facing a severe shortage of skilled professionals in areas such as actuarial science and treasury management. Following the publication of the report, the body has urged the Insurance Regulatory and Development Authority (IRDA) to act fast if it is to enhance the current set of skills as well as retain those staff that are already trained. It recommends: “IRDA should put in place systems to ensure effective group-wide supervision by formalising the relationship through a memorandum of understanding with both home and foreign regulators.”

www.itij.co.uk 14 INSURANCEMATTERS

Increased risk for expats highlighted NEWSWIRE Clement International, a provider of insurance underestimated. According to the company, the are reported in the international press, as in most to expatriates around the world, has said that incidence of kidnapping has increased in Afghanistan, cases the ransom is paid and the victim released in a Fortis Insurance UK has announced strong the kidnapping of an American ship captain by Mexico, Pakistan, the Philippines and Venezuela in swift recovery. Bui warned international companies 2008 performance, with non-life profit before tax Somali pirates is a stark reminder that international recent years, while most occur in Latin America. that kidnapping is a threat they cannot simply ignore: and interest increasing to £76 million. The company organisations are increasingly at risk of kidnapping, Statistics from Clayton Consultants Inc., meanwhile, “Organisations cannot afford to deny the threat that is also in a strong capital position of £246 million. ransom and extortion. Yan Bui, a commercial show that at least 172 foreigners were kidnapped in kidnap and ransom poses to their operations and insurance executive with the company, said: Nigeria in 2007. employees. It is vital to ensure mechanisms are in China Life Insurance and other insurers “Kidnapping occurs more often than most realise. It is estimated that only 10 per cent of kidnap incidents place to safeguard against these risks.” are set for a bigger healthcare insurance market, There’s intense focus now on Africa and the Gulf following the unveiling of the central government’s of Aden since Richard Phillips, captain of US cargo ¥850-billion healthcare reform package. ship Maersk Alabama, was taken hostage and then freed by the US military; but this is certainly not a PICC Property & Casualty Co, China’s new problem, and international organisations and largest non-life insurer, has reported a 98-per-cent expatriates face other very real risks in the form of fall in net income for 2008, a year during which it kidnapping, ransom demands and extortion threats.” saw heavy catastrophe losses and the effects of the Figures from the International Maritime Bureau have credit crunch. shown that Somali pirates, in 2008, managed to seize over 800 crewmembers. Hiscox has announced that due to its recent Although Clements International noted that expansion in the US, the Group structure has been piracy is a very particular threat to the shipping reorganised along geographic lines and the US industry (although it would appear that cruise management team has been strengthened. Richard lines are also becoming targets), Bui said other Watson will now manage all US business. threats to international organisations should not be Maersk Alabama China Reinsurance has announced that it made a profit of ¥1.58 billion in the first three months of the year – a turnaround from last year’s Local ratings possible in Malaysia Profits plunge in results, which saw a ¥3.14-billion loss. Lloyd’s has said it will repurchase the local The senior vice-president and head of business locally, there would be an independent assessment of China currency equivalent of £102 million of its development of the Malaysian Rating Corporation, their abilities to meet the needs of local policyholders. China Life Insurance, Ping An Insurance and China outstanding debt securities, following its invitation Roza Shahnaz Omar, has told a local newspaper Unlike banks in the region, insurers do not currently Pacific Insurance, the three largest insurers in China, to holders to submit offers to sell their holdings. It that both local and foreign insurance companies have to be rated – it is a voluntary scheme run by the have all recently announced a serious fall in profits, has offered to purchase up to £100 million of the that operate in Malaysia should be rated separately Malaysian Rating Corp. Omar said the local ratings indicating that although the country’s economy is securities. to their international parents. Citing the current system would be similar to those seen internationally, protected, it is not immune from outside influences. economic situation as her main reason for pushing with the range spanning ‘AAA’ down to ‘D’ for the China Life announced a 45-per-cent drop in profits in Sompo Japan Insurance has said it expects the local ratings, Omar said that by rating insurers lowest rated companies. 2008 from 2007, blaming lower investment returns a bigger loss for the financial year ended 31 March, and foreign exchange losses. Total premiums, though, from ¥52 billion to ¥66.5 billion. rose by nearly 17 per cent on 2007 to 121.6 billion yuan. Yang Chao, chairman of the company, said in Aon’s first quarter revenue fell by three per a statement to the press: “This company’s operating cent to $1.9 billion, due to a 10-per-cent decline and development environment has become very from foreign currency translation and a 44-per- challenging,” adding that 2009 ‘is expected to be a cent decline in investment income. The decline in more difficult year full of uncertainties’ as economic revenue was partially offset by a seven-per-cent conditions elsewhere make sales more difficult. increase in acquisitions. Ping An Insurance, meanwhile, has announced that its annual profit fell in 2008 – the first time it has Mondial Assistance has been given ‘A’ and done so since 2004, when losses from Fortis and a ‘AA-’ ratings from AM Best and Standard & Poor’s slump in the local stock market had a similar effect confirming the strength of its outlook over the next on profit. Net income for Ping An fell by 98 per 18 months. cent to 268 million yuan in 2008 from 18.7 billion yuan in 2007. Again, Dutch group Fortis has been India’s four government-run non-life at least partly to blame for the recent figures – Ping insurers have forecast that the industry will grow by An had to write off 22.8 billion yuan last year on around seven or eight per cent in the 2009-2010 its stake in Fortis. China financial year. Pacific Insurance also saw a steep drop in profits – the The Investment and Financial Services company saw its net profit Association of Australia is urging its citizens to fall by 81 per cent in 2008 ensure they have adequate levels of life insurance to when compared to 2007, protect themselves from financial hardship. in spite of the fact that premium income rose by The life insurance industry in India saw new over 25 per cent to over business premiums fall by six per cent in the 2008- 94 billion yuan. 09 fiscal year, according to the Insurance Regulatory In other signs that the and Development Authority. It is the sector’s first industry is in need of a boost, the Chinese financial decline since it was liberalised. authorities have just introduced uniform pre-tax deductions for charges and commissions. The new Staff recruitment by insurers in Australia policy, launched by the Ministry of Finance and the has increased over the last year, despite the State Administration of Taxation, sets a ceiling on financial turmoil that has affected the investment insurers’ pre-tax deduction. For property insurers, earnings of the industry. the ceiling has been set at 15 per cent of the value of insurance premiums for the current year, less refunded Japanese insurers should buy more foreign premiums. For life insurers, the ceiling has been government debt, according to a report that cites lowered to 10 per cent. the country’s largest brokerage firm, Nomura China’s Finance Ministry has also shown it is not Securities. afraid to take direct action to try and minimise the effects of the recession – it has ordered pay cuts Lloyd’s of London broker Cooper Gay is for all the top executives of state-owned insurance said to be considering up to 12 potential and financial services firms, arguing that excessive acquisitions as it seeks to add to previous deals. remuneration has been paid in the past.

International Travel Insurance Journal

16 INSURANCEMATTERS

Tanzania passes Swine flu calls for business reviews Generali wins UAE

Insurance Act 2009 As a result of the recent outbreaks of swine flu, the matter. Other general concerns include: the absence licence New York-based Risk and Insurance Management of employees due to illness, disruptions in the delivery The National Assembly of Tanzania has passed a Society (RIMS) has issued recommendations to of goods/services, and the inability to perform business new Bill for The Insurance Act of 2009, which, businesses that call for them to review their insurance operations in flu-affected areas. among other stipulations, sets out a time frame in programmes, risk management systems and action RIMS advised: “If you have not already devised and which insurance companies must settle customers’ plans in the event of a pandemic. Cases of swine flu rehearsed a business continuity plan, keep in mind the claims. Before the recent amendment, insurers recently spread from Mexico to several other countries, key elements of your daily operations that are most were allowed 90 days to pay out on claims, but including the US, Europe, and Asia, which raised fresh likely to impacted by a widespread swine flu outbreak.” the updated Act only allows companies 45 days. In concerns that businesses may lapse under pressures RIMS also recommended that firms should keep addition, the Act states that the Commissioner of that could arise as a result of the rapid spread of a virus. up-to-date with news on the ever-changing outbreak Insurance has powers to examine circumstances RIMS is advising that companies should consider their situation as well as maintain regular communication in which an insurer has failed to keep to the new insurance offerings to see whether or not restrictions inside their own organisation. Although the current deadline and allow it further time to pay. apply in cases of infection, with workers compensation outbreak is subsiding, concerns still exist that a more Omary Yusuf Mzee, deputy minister for finance and and employee life/health policies at the forefront of the virulent outbreak will emerge in the Autumn. economic affairs, presented the Bill to Parliament and explained how the legislation would allow the regulator to impose a penalty on insurers that do not comply with the latest legislation. The Act, which Business increase for PT Prudential replaces the Insurance Act Cap 394, 1996, has included provisions that deal with loopholes left in The Indonesian subsidiary of UK-based Prudential, PT takaful business was responsible for 25 per cent of the first Act – the old law did not protect clients and Prudential Life Assurance, has experienced healthy PT Prudential’s total business in Indonesia (based on did not give any power to the Insurance Board that growth through its takaful business, with takaful annualised premium); it now accounts for roughly 20 Sergio Balbinot would enable proper supervision of the industry. premiums reaching IDR844 billion (US$79.4 million) per cent of the company’s new business premiums. The new Act also states that any foreign insurer last year. The robust increase comes from a boost Italy’s Assicurazioni Generali has successfully obtained wishing to begin operations in Tanzania must ensure in takaful demand and an expansion of its market a licence to sell life insurance in the United Arab that at least one-third of its shares are owned by distribution, which saw IDR821 billion of last year’s Emirates (UAE). In 2008, the insurance market in Tanzanians. Other sections of the Insurance Act 2009 total takaful premiums come from new business. PT the region rose by 30 per cent to US$4.7 billion of make provisions for an Insurance Appeals Tribunal, Prudential has also reported a 27.5-per-cent premiums, and Generali believes there is still plenty which will be responsible for handling appeals made overall rise in total premiums to IDR7.02 of potential left in the region, as chief executive by insurers and agents against decisions made by trillion, as well as a 15.8-per-cent leap in new Sergio Balbinot said: “With a number of high-earning the Commissioner of Insurance – under the old business premiums to IDR4.14 trillion in 2008. expatriates from Europe, the US and Asia, who law, such appeals were made directly to the finance The company, which offers regular and single represent 80 per cent of the population and who minister. The Commissioner of Insurance has also premium investment-linked products that feature have expanded 20 per cent in recent years, this been granted new powers and is now able to assess three Shariah-based underlying investment funds, market certainly still has potential to grow.” He and audit the financial and income statements of intends to focus on developing health and crisis cover added that Generali is currently seeking to develop insurers in order to safeguard the interest of its riders as well as long-term regular premium protection its Islamic insurance product offering through the clients; the financial statements will also be made products, including conventional and Shariah unit- introduction of takaful products that cater to locals. available to the public. linked product ranges. When launched in 2007, Top ten risks identified

Aon Corporation has announced the findings of flow; distribution or supply chain failure; third-party its 2009 Global Risk Management Survey, which liability and a failure to attract or retain top talent. was collated from the responses of over 500 Aon has noted that compared to the findings from the organisations in 40 countries. same survey in 2008, most organisations have acted Steve McGill, chairman and CEO of Aon Risk Services, to increase their overall risk preparedness, yet less said of the report: “This survey helps our clients stay than half are tracking and managing the total cost of abreast of emerging issues and learn how peers and their insurable risk. The insurer also highlighted that competitors are managing risks, overcoming challenges for three of the top ten risks – economic slowdown, and capturing opportunities in order to achieve damage to reputation and regulatory challenges – less sustainable growth, continuity and profitability. One of than two thirds of respondents had formally reviewed the benefits of having an unmatched global network is the risk or plan they already have in place. the ability to leverage Aon’s size and scope to create Analysing the results of its survey, Aon noted: “While the industry’s most comprehensive data reports and reputation risk has fallen from its top position in the better serve our clients.” firm’s 2007 survey, the importance of this threat is According to the results of the survey, the top ten not diminished. Reputation risks impact the public’s global risks facing the industry in 2009 are, in order: perception of the quality, integrity and intention of an the economic slowdown; regulatory challenges; organisation, influence a partner or customer’s decision business interruption; increasing competition; to do business with a firm and may affect a government commodity price risk; damage to reputation; cash or regulator’s decision to allow a company’s actions.”

Takaful operator numbers up According to the World Islamic Insurance Directory, the prominent position on the desk of every professional number of operators in the Islamic insurance and takaful involved in the booming global takaful market.” market has increased to 165 from 138 last year, an The directory has been put together through increase of over 19 per cent. The directory, which is input from Islamic insurance, takaful and retakaful only in its third year of publication, is collated by Takaful operators around the world, stemming from 23 Re and Middle East Insurance Review, incorporating countries. From a geographical standpoint, the Gulf figures from Global Takaful Group. The directory shows Cooperation Council (GCC) represents just over that total contributions to the market reached US$7.2 35 per cent of income for the takaful business, the billion 2007, up from $5.9 billion in 2006, and the Far East 12 per cent and Africa nearly four per cent. predictions are that 2008 will show further increases, The GCC is clearly shown to be the hotbed for despite the global economic situation. companies interested in starting takaful operations, as Chakib Adouzaid, CEO of Takaful Re, said at the the figures show that Iran alone accounts for nearly release of the information: “We are confident that the 50 per cent of the market and the number of players directory will serve as a useful source of information involved in the GCC market has risen from 39 to 72 and contacts in daily operations and will enjoy a in just over a year.

International Travel Insurance Journal HEALTHMATTERS 17

Meningitis hits India Yellow fever expands in Brazil

Since the beginning of this year, local health officials in cases, the CDC has recommended that preventive The Rio Grande do Sul and São Paolo states of vaccination for entrance to the country, although the India have reported over 230 deaths and 2,000 possible antibiotics should be used by people who have Brazil have been designated expanded areas of risk increasing intensity of its spread calls for vaccination as cases of meningitis in the northeastern states of Tripura, been in close contact with someone known to following confirmation of new human cases of yellow a precautionary measure before entering the country Meghalaya and Mizoram – all of which are in the part of have the infection. Such antibiotics include rifampin, fever within their boundaries. The in all areas of Acre, Amapá, Amazonas, India bordered by Bangladesh to the west and Burma ciprofloxacin and ceftriazone, the latter of which can outbreak demonstrates the intensity Distrito Federal, Goiás, Maranhão, to the east, indicating that spreading of the disease is be taken by pregnant women. of the virus in the southern part Mato Grosso do Sul, MinasGerais, highly likely. The US Centers for Disease Control and of the country, with an expansion Pará, Rondônia, Roraima, Tocantins Prevention (CDC) has advised travellers heading to of the virus’s transmission being and designated areas of Bahia, Paraná these parts of India to have a meningococcal vaccine at recorded since the beginning of Piauí, Santa Catarina Rio Grande do least 10 days before travelling. this year. Six sufferers of the 13 Sul and São Paolo. The bacteria that causes meningitis are spread confirmed cases of yellow fever The disease, named because of the by close, direct or prolonged contact with an died as a result of the viral disease in Rio Grande do jaundice-like symptoms that affect some patients, infected person through saliva, or respiratory or Sul and nine deaths have occurred from the 22 cases is spread by the bite of an infected mosquito so threat secretions. In order to prevent secondary reported in São Paolo since February 2009. travellers should also be reminded to take steps to Presently, Brazil does not require yellow fever prevent being bitten. Increased pertussis cases in Australia

Reports of an increase in the number of cases of pertussis (or ‘whooping cough’) in several areas of Australia has led to a call for all international travellers to be up-to-date on routine vaccinations that can easily prevent the effects of the illness. From early 2009 till April, more than 7,000 cases of pertussis have been reported across the country, with New South Wales accounting for more than 5,000 of these cases. It is believed that disease rates are higher in areas where vaccination coverage is low. Pertussis, which circulates worldwide, is a highly contagious respiratory infection caused by bacteria that is spread through coughing and sneezing, and its symptoms are often mistaken with those of the common cold. Although the disease is most severe amongst infants, two combination vaccinations – DTaP (acellular pertussis with diphtheria and tetanus toxoids) and Tdap (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis) – will protect against it.

Lassa fever diagnosed in London A case of Lassa haemorrhagic fever has been diagnosed in London in the case of an individual who died shortly after returning from Mali. The young British male, aged 24, was a volunteer with an NGO working in a rural area of the country, some 35 kilometres northeast of Manankoro, which nears the border with the Ivory Coast. After being evacuated in February from Mali to Bamako and subsequently repatriated to London for further treatment, the man died. This is the first symptomatic human case of infection by the Lassa virus caught in Mali to be diagnosed.

Dengue threat The UK’s Foreign and Commonwealth Office (FCO) has warned that the northern Argentine provinces that border Paraguay (notably Chaco, Corrientes, Misiones, Formosa, Salta and Jujuy) and Bolivia are the areas most affected by an outbreak of dengue fever. The FCO states that travellers could, however, be at risk in any part of the countries, as fatalities from dengue fever have been reported in Paraguay, and there is no vaccination or immunisation from the disease.

www.itij.co.uk 18 TRAVELMATTERS

The ‘AIG effect’ takes hold Zimbabwe seeks lost Iraqi tourism begins

Hoteliers have dubbed it ‘the AIG effect’ – the not placed on signs in the lobby directing delegates. tourists In the latest indication that security is improving in swift cuts that companies have made to corporate The US Travel Association has estimated that the Zimbabwe’s new coalition government may Iraq, the first Western tourists have now visited the travel allowances as a result of negative public hotel industry has, since the beginning of the year, be viewed with some suspicion by many in the country, courtesy of a British adventure travel agent. perception following trips made to conferences by lost nearly $1 billion through the cancellation of international community, but since President Robert Eight foreigners, including Britons and Americans, AIG executives. Starting back in September of last corporate meetings and conferences. The Association Mugabe and Prime Minister Morgan Tsvangirai took part in the first officially sanctioned tour of the year, hotel organisations around the world are still has thus lobbied both Congress and the White formed the unity government, hopes have been country outside the semiautonomous northern seeing the negative effects that public outrage about heightened that recovery Kurdish region since the US-led coalition invasion in AIG spending brought to the fore. In Las Vegas, for a country currently March 2003. One of the tourists, Tina Townsend the Mandalay Bay Resort and Casino has seen on its knees cannot be Greaves, told The Associated Press: “Sadly, we did around $131 million worth of cancellations since far away. Income from not have the chance to see the museum or any of the beginning of 2009, while the Four Seasons in tourism, a key currency the monuments, because they’ve been shut.” Los Angeles has seen its meetings business drop earner in the country, Although the group did not experience any major off by around 15 per cent. A knock-on effect of dropped off sharply when violence, it did have some difficulties navigating and curtailed corporate travel are the job losses in the violence dominated the passing through the many checkpoints that still exist hotel industry – according to the US Department of national elections and in and around Baghdad. The group visited such areas Labour, up to 200,000 travel industry jobs were cut economic turmoil saw as the International Zone in the heart of the capital, in 2008, and it is predicting a further 247,000 will be inflation rise beyond as well as Ctesiphon Arch, a Persian ruin near Salman lost throughout the course of 2009. control. Pak – once one of the country’s most dangerous Some hotel chains are doing their best to tempt Joyce Mujuru, vice towns. However, as Greaves pointed out, although corporate customers back through their doors president of the unity Iraq might seem a good deal safer for tourists, a through schemes that offer to give a certain government, said at a major influx is unlikely in the near future: “I think percentage of the cost of the conference to charity, recent tourism meeting maybe a few more of the sites need to be open to trying to show that not all corporations care solely in Harare that western tourists, because if tourists are going to come to Iraq, about profit. Hoteliers that are still receiving bookings House to ask them to relax rules on travel for those governments should lift the travel advisories they there has got to be things for them to see when they for conferences or meetings are saying that the companies that received government cash in the have in place at the moment regarding travel to get here.” cost of such events is falling thanks to the fact that bailout. The argument is that face-to-face meetings Zimbabwe in order to encourage tourists back there. conference organisers are trying to put on events bring better business results, while also showing that She added that it was time for all Zimbabweans ‘to more cheaply – a chicken main course, rather than the fall in travel is affecting lower wage earners, such take serious introspection to see to it that whatever duck, for instance. Laurence Geller, president of the as cleaners and waiting staff. Roger Dow, president of we say and do does not contribute to the negative firm that owns the Ritz-Carlton Laguna Niguel and the Association, said: “Our message is ‘Hey, let’s tone perceptions’ surrounding the country. “We are Islamic travel Hotel Del Coronado in San Diego, has noted that down the rhetoric. If you want to lose a million more here now, through our inclusive voice, asking the some firms are even asking that the company name is jobs, just keep talking’.” international community to please remove the travel demand remains warnings,” she continued. What Zimbabwe needs, she said, is more international flights, upgrading of According to the CEO of Dubai-based hospitality public utilities and improvements in telephone and firm Almulla Group, the Islamic hospitality industry Australians undeterred Internet systems that are hardly working at all at the now represents 10 per cent of the world’s moment. “Our visitors do not need to go through tourism market, and demand for Sharia-compliant Australian travel insurer AAMI has reported that said they were searching for good travel deals on the stress of failing to catch a bath in the morning accommodation continues to rise. Abdulla Almulla, the global economic downturn does not seem to the Internet, while 72 per cent also said they were or narrowly missing accidents on the roads … lest speaking to Arabian Business, pointed out: “UAE be enough to stop plenty of Aussies from packing travelling during off-peak seasons when hotels, flights we forget, potential tourists have alternative holiday travellers alone spend more than $4.9 million on their bags and heading off on an overseas holiday. and tours are all cheaper. destinations.” travel annually and the Islamic hotel product will be Research by the insurer has shown that instead James Merchant, AAMI operational services executive in high demand, certainly reaching 10 per cent in of not travelling at all, manager, noted that it would need more than an the short term.” The Almulla Group, which last year holidaymakers economic crisis to quell the Australian passion for launched the world’s first Sharia-compliant hotel from travel – but that holidaymakers are seeking ways to Business travellers portfolio, says it aims to have 30 additional properties Australia cut costs before and during their vacation. The survey up and running by the end of this year, with target are showed some reassuring results that contradict what beware destinations such as Saudi Arabia, Jordan and Egypt. looking several other questionnaires have said – 95 per cent The World Tourism Organisation (WTO) found last for of those surveyed said they would still be purchasing The British Foreign and Commonwealth Office year that travellers emanating from the Gulf region ways travel insurance before they head off on their trips. (FCO) has warned on its website of new dangers spend over $12 billion a year on leisure travel, to make As Merchant said: “Peace of mind goes a long way that have become apparent for business travellers with those from Saudi Arabia alone contributing their holidays more when holidaying. Travel insurance is the only way to heading to China. The organisation has cited recent $6.7 billion to the total. The WTO’s research affordable. When asked, ensure you’re covered for unexpected events when incidents of British nationals being detained showed that on average, each traveller from 73 per cent of those surveyed travelling overseas.” against their will by workers or hired gangs for the UAE spends $1,700 per holiday – a the specific purpose of extorting money or significantly higher sum than the average intimidating for other gains. The warning amount spent by a European traveller. states: “Typically, the British national is It is not just the Almulla Group that has Baltic tourism set to suffer threatened with violence and detained seen the potential of offering Islamic at a factory, hotel or private residence travellers Sharia-compliant hotels – Nadejda Popova, travel and tourism industry analyst sectors in the Baltic region – Estonia has been the until payment is negotiated and other companies involved in similar for Euromonitor International, has voiced the concern top choice for Finnish holidaymakers since 1999, delivered.” Although it goes on projects include the Rezidor Hotel from the Baltic tourism sector that the fledging tourism partly because the journey is so easy. It is a simple to say that violence occurs only Group, Shaza Hotels and Rotana industry in the region could suffer serious blows as 90-minute ferry trip from Helsinki to the capital of rarely, it is nonetheless a concern. Hotels. Sellim El Zyr, president and a result of the global economic crisis. Already, in Estonia, Tallinn. Since February this year, though, It also noted: “The police may be CEO of Rotana Hotels, said of terms of infrastructure development, behind its close Estonia has seen its international visitor numbers reluctant to act unless they have the future of the industry: “In this neighbours in Europe such as Turkey, countries like drop by four per cent compared to the same period specific evidence of an actual ever-changing world, individuality Latvia, Lithuania and Estonia have few differentiating in 2008, as even countries like Finland reign back assault taking place.” of choice is important to the tourism niches and a poor quality of accommodation consumer spending. Hotels in Latvia have reported Making reference to problems that traveller and some guests thanks to their Soviet history. Coupled with a general a nine-per-cent drop in the number of guests have already occurred, the FCO seek to reflect the wish among tourists to spend less but get more from compared to last year – the majority of the fall came added: “[Foreign] nationals doing values they hold in their holidays, and the Baltic region is in for a tough due to fewer numbers of international visitors. business in China should be aware the accommodation time in terms of winning foreign visitors. In order to try and tempt more international visitors that if they become involved in a they choose. We have However, all is not lost, according to Popova: back to the Baltic region, development projects business and/or civil dispute, and introduced the Rayhaan “Increasingly budget-conscious holidaymakers in to upgrade the region’s transportation system are the case actually goes to court, brand to Rotana’s hotel the region are changing their preferences from long already underway and the international airport in the Chinese government may and resort portfolio to short-haul holidays and a further decrease from Latvia is to receive a €300-million upgrade. Despite prohibit them from leaving China after considering short-haul holidays abroad to domestic holidays. the plans for improvements, Popova warned: “The until the matter is resolved. There the diverse needs This in turn has had a significant positive effect on lack of financial resources in the Baltic region, slowing are some cases of British nationals of our guests.” The domestic tourism.” foreign investments, increasing unemployment rates being prevented from leaving China Rayhaan brand caters Euromonitor’s figures show that for the past five and political tension will all have a negative impact on for months while their civil cases are specifically to Islamic years, tourism has been one of the strongest growth tourism growth throughout 2009.” resolved.” travellers.

International Travel Insurance Journal

20 AIRAMBULANCENEWS

New repat pact for high-risk areas Air ambulance closes runway

European Air Ambulance (EAA) and Remote Medical destination. The entire operation will be handled A Westwind II twin-jet air Solutions International (RMSI) have announced the by EAA’s Missions Control Centre (MCC), which is ambulance plane belonging to start of a new co-operation agreement that the available around the clock. EAA is promising too that Guam-based CareJet caused organisations say will make use of the best of each customers will receive a quotation from its MCC chaos in the Philippines recently, service to provide more efficient mission handling and within one hour for repatriation from Afghanistan or after its left landing gear caught less overall risk for customers. The intention of the Iraq. Once the quotation is approved, EAA and RMSI fire as it was approaching the agreement is that both EAA and RMSI will promote will immediately move into action, with the MCC co- take-off runway of Ninoy the quality and reliability of each other’s product to ordinators choosing the appropriate physician from a Aquino International Airport. the customer in order to highlight the advantages of pool of anaesthetists, neonatologists, gynaecologists The airport management co-operation in terms of improved communication and other specialists. was forced to close the main and established operational and medical processes EAA, formed from founding members Deutsche runway, which resulted in the between both parties. In particular, the agreement Rettungsflugwacht (DRF) and Luxembourg Air diversion of 14 flights to a will apply to repatriation from Afghanistan and Iraq Rescue (LAR), has a fleet of five Learjet 35As and one different nearby airport.

– high-risk areas in which RMSI provides medical Beechcraft KingAir 200. RMSI specialises in emergency The incident occurred just as N911GU, the aircraft involved in the incident CareJet evacuation. Under the agreement, RMSI will fly the medical response, support and retrieval solutions the jet was being lined up for patient to Dubai, where wing-to-wing transfer will for governments, non-governmental organisations take off – as it powered up to take place with an EAA aircraft already in position. and companies working in remote and/or hazardous gain speed, it was noted that smoke was emanating that are regularly used in the region – a Westwind EAA will then fly the patient back to the final environments, using Hawker 800 jet air ambulances. from the left wheel and brake assembly. The II is not one of them. He pointed out the aircraft, flight crew, Captain Charles Cooper and Captain which had been modified for medical transfers, has Toshihiro Shimo, immediately brought the aircraft to an extremely low profile for easy egress and ingress, a complete stop, jumped out and started to put out which has rendered the airport’s normal equipment the fire with extinguishers. Emergency workers from useless. Pneumatic lifting bags, which are usually Aeromedical boost for Australia the airport quickly arrived to help them smother the placed underneath the wing and then inflated to Phillip Dowler, general flames. Both flight and medical crew were unharmed. raise the plane, were too big for the Westwind II. manager of Australian Terry Habeck, president and CEO of Aviation A special axle jack was also too big for the aircraft emergency rescue service Concepts, parent of CareJet, explained what and was unable to fit underneath the wheels to be RACQ-CQ Rescue, has happened: “The aircraft had a long taxi and was lifted. Finally, the problem was solved by borrowing started up a new fixed-wing cleared for takeoff when smoke was observed a forklift truck from a nearby hangar – the forklift air ambulance service in emanating from the left wheel and brake assembly. was used to lift the plane, place it on skates and tow the country that aims to A small flame broke out in this area while still sitting it gently to the maintenance hangar. Following the complement the work done in the takeoff position. The crew, upon seeing the calamity, a local paper reported that an airport official by the Royal Flying Doctors smoke and flames, exited the aircraft with a fire has recommended that authorities purchase more Service. The service, called extinguisher and put out what remained of the aircraft recovery tools to lessen the time it takes Australian Aeromedical, will be flames, which was minimal at this point.” workers to dismantle and remove the debris of a based in Mackay, Queensland, and will be staffed by government to discuss funding for inter-hospital Recovery from the accident was hampered as the disabled plane. a team of 10 intensive care nurses from the Mackay transfers, adding: “The fixed-wing plane would be airport staff lacked the necessary equipment to lift the Habeck has confirmed that: “There was no patient Mater Hospital. cheaper to operate than CQ Rescue’s Bell 412 aircraft from its position on the runway, combined onboard at the time, as the medical portion of Dowler said the air ambulance service had been helicopter and would save CQ money by conducting with the fact that the left brake on the plane had the flight had been accomplished. There were no designed in order to help free up hospital beds as inter-hospital transfers.” seized, making it impractical to taxi the aircraft off injuries or additional damage sustained on the aircraft. well as to transfer critical patients in a faster, more The fixed-wing aircraft is on loan from Vincent the runway. Octavio Lina, assistant general manager CareJet has brokered flights to other operators in the efficient way – the company’s Beechcraft 1900D Aviation, a New Zealand-based firm that has entered for operations at the airport, noted that there are region during this interim period.” The aircraft was can transport up to three stretcher patients and the marketplace in order to diversify its business. some recovery tools available, but only for aircraft flying again on 5 May. five ambulatory patients at a time, along with three Vincent Aviation has fitted out the aircraft with the medical crew members. Dowler also noted that necessary medical equipment and is also responsible he is currently negotiating with the Queensland for providing the pilots and maintenance. Waypoint airshow and conference Challenger offers three-stretcher capacity postponed until 2010 Voyageur Publishing and Events has announced that to be confirmed. Voyageur managing director and Jet Executive has announced the Waypoint AirMed and Rescue airshow has been Waypoint editor-in-chief Ian Cameron explained the that its company-owned postponed to 2010. The inaugural event, which will postponement: “There has been a large amount of Challenger 600, D-BUSY, combine conference sessions, an indoor exhibition interest in the show; however, because of the current is now available in a triple- area and both static and live aircraft displays, will now economic climate, we felt that the show would be stretcher configuration for take place next year. The date and location are yet better served by postponing it until 2010” worldwide medevacs. The aircraft can be set-up in various configurations. In single-stretcher mode, with a CAMTS accreditation for Asia base full intensive care unit (ICU) medcrew onboard, it can AirMed International has announced that its Hong and a ‘seamless’ transport package to its customers accommodate up to eight further Kong-based subsidiary, AirMed Asia, has received in the region. passengers. With two stretchers accreditation from the Commission of Accreditation Jeffrey Tolbert, president and CEO of AirMed installed, five seats are available Jet Executive of Medical Transport Systems (CAMTS). AirMed Asia International, said the accreditation reflected the for accompanying passengers. When using the full capacities make for a cost-effective solution, with is only the fourth international programme to receive quality of the company’s staff and programme in capacity of three stretchers, the remaining four seats the Challenger’s pricing being approximately 1.75 this recognition, joining Ornge and STARS in Canada Hong Kong, adding : “We remain committed to can either be used for an extended medical team or for times the price of a Learjet 35. Therefore, said the and SOS Air Rescue Africa, South Africa. excellence no matter where we are on the globe.” accommodating up to two relatives of the patients. company, with two or three patients onboard, this AirMed Asia began operations in Hong Kong AirMed’s headquarters in Birmingham and its A company press release said that the aircraft’s will result in a cost saving for customers. in March 2008 with a US-registered Raytheon subsidiary in Honolulu, AirMed Hawaii, are also Hawker 800. The service provides specialty care CAMTS accredited.

A view of Hong Kong taken from the Kawloon peninsula Pauliyas

International Travel Insurance Journal AIRAMBULANCENEWS 21

RFDS expands Broken Hill base Size matters The South Eastern section of the Royal Flying Doctor Senior medical officer Dr Mike Hill noted: “Our Service has recently unveiled its brand new base and patient care areas have improved dramatically. When ITIJ asks AirMed International why bigger its fleet now includes three Hawker 800 aircraft – visitors centre in Broken Hill, which was officially critically ill patients are waiting to be transferred, we is often seen to be better when it comes to two in the US and one based in Hong Kong – as opened by the governor of New South Wales, her now have first-class facilities to tend to them. The air ambulance aircraft well as three Beechjet 400s, a Citation II, and four Excellency Professor Marie Bashir AC, CVO. Casting propeller jet King Air C-90s. These short-range a watchful eye over the entrance to the centre is a Alabama-based AirMed International started out King Air jets are used at the company’s Hawaii base four-metre high sculpture, designed by renowned with large, long-range jets. In 1989, with CEO for inter-island transports involving short distances artist Ron Gombok, called The Guardian. Jeffrey Tolbert as captain, the company’s Lockheed when a larger jet is not a practical solution. The RFDS has said that it is only through the JetStar circumnavigated the globe, performing the AirMed International’s aircraft were also the first generosity of supporters of the charity service world’s longest transport of a ventilator-dependent civilian medical aircraft in the US to be equipped that the base’s expansion was possible. A local patient from New York, US, to Manila in the with a medical liquid oxygen system. “The liquid philanthropist, Sir Michael Bishop CBE, gave Phillipines. The firm also flew the longest balloon oxygen system that we have custom built allows for $600,000; the figure was then matched by the pump (artificial heart) transport from Osaka, Japan, longer flights without having to replenish oxygen Federal Government. The new medical centre is in to Houston, Texas, US, in 1990, also in a JetStar. during the trip. Simply put, using the larger aircraft fact named after Sir Michael Bishop’s father, Clive

AirMed’s current flagship aircraft is the Raytheon allows us to carry more O2,” said the company’s Bishop, while the visitors’ centre commemorates Hawker 800. “Even though it cost more to executive vice-president Denise Treadwell, herself Bruce Langford.

a seasoned air transport nurse. The RFDS has had a base in Broken Hill since 1938, RFDS and for the past 22 years the service has operated from A question of power a converted airport hangar, but with the extension extra storage capacity for equipment gives us a more Another advantage that larger jets have is their and improvements undertaken in the last year, the efficient working environment too.” Judy Whitehead, ability to house an Auxiliary Power Unit (APU) infrastructure of the base has been transformed. The nurse manager of the base, added: “Direct access onboard. This creates total self-sufficiency for the medical centre now provides modern accommodation from the resuscitation/patient area to the tarmac, medical team and their care of the patient. “We’ve for both medical and allied health staff, including rooms with greatly improved stretcher bay, makes patient landed in some areas of the world with no ground for consultations, observation and resuscitation, as well transfers much more efficient. We now have a power supply to be found anywhere. Without our as a waiting room and facilities for medical and dental modern, user-friendly facility with space for training onboard APU, we would be unable to control the staff and students. sessions to be undertaken onsite.” temperature in the aircraft or power the medical equipment during technical/fuel stops or even while on the runway,” said Treadwell. From a pilot’s perspective, the APU is also crucial Swedish Government orders new SAS to a successful mission, because it provides power to the avionics, meaning no interruption to the AMAT system navigation and communication system during tech/ SAS Technical Services has received an order Six hours after a call, the SNAM system provides an fuel stops. “By keeping the aircraft powered up and from the Swedish Government for a second SAS airworthy and patient-safe environment for the air the temperature constant, the APU helps reduce Advanced Medical Air Transport System (SAS transport of six intensive care patients, six to twelve the length of tech stops and therefore reduces the AMAT System) shipset for the Boeing 737 NG. stretcher patients and approximately 23 walking amount of time the patient is on the aircraft,” said The SAS AMAT system allows the conversion of a wounded or relatives in each aircraft. Darby Wix, AirMed chief of operations, “Larger jets commercial airliner to transport multiple casualties. SAS Technical Services has developed and certified also have a more comfortable flight deck, which the SAS AMAT System as a flexible solution for helps reduce flight crew fatigue and adds to all- providing advanced intensive-care capability in fixed around safety and quality of service.” and rotary-wing aircraft with no requirement for It is not only international flights that benefit from prior modifications. Thanks to a modular design, the use of larger jets. Even a longer distance the SAS AMAT Systems can be adapted to meet cross-country transport benefits from the comforts the customer’s specific requirements ranging from

Dennis Keim a larger cabin affords, such as the closed-door customised installations on commercial airliners and lavatory and the ability to move about the cabin business jets to medevac capability for military aircraft. purchase and to operate this larger jet, we chose freely. Larger jets, such as the Hawker, would also The Micus AB’s mobile intensive care unit stretcher, the Hawker because this aircraft provides optimum normally have extra seating for a family member of SAS a key component in the SAS AMAT System, is patient care for long, over-water flights,” said the patient and space for small carry-on baggage, The new shipset is scheduled for delivery in designed to enable transport between different Tolbert. “It is also capable of carrying two critically something smaller aircraft cannot offer. “For these December 2009 and comes after the original SAS treatment facilities without having to switch ill patients, and the stand-up cabin is crucial for and many other reasons, we’ve found that our AMAT System shipset was successfully used on a between different stretcher systems and risking true, quality patient care, especially in the event of customers and large insurers in particular take European Union (EU) mission in November 2008 disruption in treatment. It features a self-contained a patient code or performing intubation or chest serious note of the benefits of larger jets over to repatriate EU citizens from Mumbai, India, after system with oxygen and electrical power for use compressions.” small. A large jet may not be at the lowest price the terrorist attacks in the city. when power and oxygen from external sources are Though the company has had many types of point, but it is the quality of care and service they With this delivery the Swedish Government will not available. The design also makes it suitable as aircraft, both large and small, throughout its history, seek for their transports,” concluded Treadwell. have two SAS AMAT System shipsets available for an advanced emergency medical treatment unit, in the Swedish National Air Medevac (SNAM) system. environments were this is required.

www.itij.co.uk 22 NEWSANALYSIS

Mexican swine flu: a test of confidence? After rattling travellers, tour operators and insurers, the dreaded swine flu has unquestionably tested the preparedness and resolve of those involved in the travel and insurance markets. Milan Korock investigates what he describes as a ‘wake-up call’ to the industry

The sudden eruption of swine flu out of Mexico not holidaymakers, honeymooners, backpackers and refund. Thomson offered refunds for a limited time policyholder wanted to cancel their trip because they only scored a heavy punch to a tourism industry business travellers sat disconsolate on their bags in and allowed customers to rearrange their plans at no didn’t feel safe and were worried about swine flu. already reeling from overcapacity and economic airports waiting to be repatriated, or to be given the extra cost – up to their original value. anaemia, but sent dazed travellers back to the news that their flights had been cancelled and they Montreal based Transat AT Inc., Canada’s largest Elusive solutions drawing board to struggle with fine print that was best check with their carriers, tour companies or travel tour operator, postponed flights to Mexico until 1 Much of the reaction from tour operators, airlines and sometimes contradictory, often obscure, and too often insurers for recourse. June, and sent equipment to pick up its customers travel insurers has hinged on the actions of their own inconsistent with what they were hearing from tour and staff as did Air Canada and Air Canada Vacations. governments in ‘advising’ their citizens about travel companies, air carriers, cruise lines and their own Covered or not? Air Canada told stranded passengers they would to certain countries. Many governments have tiered governments. In short, the message left by the highly Virtually all insurers would cover travellers for swine be allowed to rebook at a later date to different systems of advisories: cautionary, avoid certain areas, contagious flu, now given the upscale title of H1N1 flu symptoms and treatment contracted at their destinations, but would not receive refunds – a avoid all non-essential travel, and avoid all travel. virus (thanks to governments protective of their pig destination – so long as they didn’t travel there after common practice among other airlines. Normally, once the government warns against travel farmers), was caveat emptor and don’t expect to get their government had warned against it. But dealing In the US, most airlines cancelled flights to Mexico, to a given country (in this case Mexico because of your holiday money back without a struggle. with the prospect of rearranging thousands of dollars but full refunds were hard to come by, the airlines swine flu) certain protocols kick in – or are supposed When it first emerged, virtually overnight in April, worth of travel after their trip had been cancelled or offering rebooking to other destinations; not much to. But that does not mean adherence is universal. swine flu primarily hit holiday and business traffic Nathan LaFayette, executive vice president of Travel into and out of Mexico, but within days cases were Guard Canada, said that in the case of Mexico and confirmed throughout the United States and Canada, Will customers in future be satisfied with the swine flu, once Foreign Affairs and International the remainder of the Americas, as well as in the Trade Canada advised Canadians to avoid non- UK, Europe, Asia, and Australasia. Airlines promptly insurance products they are offered to protect essential travel to Mexico, coverage was available to cancelled flights and began handing out surgical masks, policyholders for cancellation or for costs to re-route travel insurers took to their websites posting warnings against such threats … How can they trust around the region, and if an insured were in Mexico about what would be covered should their customers when the warning was issued, the insurer would or their itineraries be disrupted by swine flu. Tour government advisories if vendors and suppliers pay to bring them back home. “No trip cancellation companies sent empty planes to repatriate vacationing coverage is available if the policy was purchased after clients, cruise ships wiped Mexico off their charts and put their own spin on how to interpret them? the warning was issued,” he clarified. Generally, that sent their boats to alternative ports; governments is the pattern followed by most insurers. posted advisories warning their citizens to avoid all interrupted, was not so straightforward. consolation for people who had Cancun, Cozumel Interviewed in the UK by ITIJ, marketing and PR ‘non essential’ travel to Mexico; border agents went Thomson, Thomas Cook and others in the UK or Acapulco firmly in their sights. American travel executive for Essential Travel Ltd Jennie Sheldon on heightened alert looking for sicker than normal immediately announced stoppage of trips to Mexico, insurers also rushed to get advisories on what was said: “Virtually no insurance policy will offer cover people. China even temporarily quarantined a group sent empty planes for those who wanted to return coverable vis-à-vis swine flu up on their websites, for travel to a country to which the FCO (Foreign of students suspected of carrying the flu from Canada and told their customers they could get credits for several making a strong pitch for customers to and Commonwealth Office) is advising against all (none of whom had been to Mexico but as Canada flights to different destinations. Thomson reported add Cancel for Any Reason or Change of Mind but essential travel. It now falls into the general was one of the primary vectors with numbers of it had approximately 2,500 customers in Mexico at supplements in future to their more standard exclusions section of our insurance policies and confirmed cases, they were suspect nonetheless). the time, Thomas Cook about 3,000. Thomas Cook interruption or cancellation policies. The cancellation we are unable to offer cover for anyone traveling China also banned the importation of Canadian said passengers due to fly within the next seven clauses of insurers such as CSA, Travel Guard, Travel there.” If, however, a vacationer bought a trip to pork, just as an afterthought. And throughout it all, days could re-arrange their travel but not claim a full Insured, and TravelSafe, however, did kick in if the Mexico several months ago, said Ms Sheldon, “We

International Travel Insurance Journal NEWSANALYSIS 23

advise them to speak to their airline, hotel, tour SARS. That might yet change, but to date this has operator or travel agent, who should be able to been more of a wake-up call than a raging fire. offer an alternative holiday or a refund. However, Will customers in future be satisfied with the our underwriter AXA has taken the decision to give insurance products they are offered to protect consideration, on a contingency basis, to cancellation against such threats, will they demand more, and will or curtailment claims from those customers who they accept airline assurances that they can trade in are able to demonstrate that despite exhaustive one location for another but overlook refunds? How attempts, they have been unsuccessful in seeking can they trust government advisories if vendors and redress from any of those other sources.” Note suppliers put their own spin on how to interpret the word ‘exhaustive’. Getting refunds out of cash them? And will they tolerate having to read pages strapped airlines or tour operators can be exhaustive and pages of fine print just to find that the liability indeed, but what about travel insurers? for covering them has shifted to another player Some of the best practical advice about applying somewhere down the food chain? travel insurance to swine flu and similar situations Can tour companies sustain many more of these wake- was issued in a press release by the Travel Health up calls? According to Price Waterhouse Coopers, Insurance Association of Canada, which urged between January and March 2009, 27 British travel travellers to always get ‘a clear, plain language companies collapsed compared to 11 in the same explanation of their trip cancellation benefits and period last year. Over the past 12 months, some 78 how they integrate with the benefits and exclusions companies have failed, up from 49 the previous year. It of their air carrier, tour company or cruise line’. warns that this coming September – when cash flows It further said that policies have limitations and slow following the peak summer period – will see exclusions so travellers need to understand where another rush of failures. That is the same month that they stand ‘should their trip to a given destination XL, Britain’s third largest operator, collapsed last year be suddenly cancelled, or should their destination affecting up to 300,000 holidaymakers. resort close down, or should their government issue In the UK, Which?, the consumer rights group, In the end, we may find that the Mexican swine flu an advisory warning them not to travel to a certain has accused some travel insurance companies of was but a blip on the world’s growing pandemic fear country or parts of it’. meter. But it has clearly left behind many questions The California Insurance Commissioner, on 30 April, acting unreasonably by refusing to compensate about how prepared the travel industry and its warned travellers that not all insurance policies will various components – including travel insurers – are fully reimburse trip cancellations due to the H1N1 policyholders for not travelling to Mexico after the in dealing with any repeats – big or small. flu outbreak. Steve Poizner said that ‘cancel for FCO warned against it any reason’ policies, which are available at an extra Following a decline in the number of cases in Mexico, cost, are the only types of travel insurance that the British Foreign and Commonwealth Office and will typically reimburse a policyholder for reasons Are travellers caught in the middle? and that policyholders should check with their insurer the US Centres for Disease Control and Prevention both lifted their travel advisories concerning the pertaining to the H1N1 flu. “Travellers should In the UK, Which?, the consumer rights group, to make sure of that. country at the beginning of May. educate themselves on their travel insurance options has accused some travel insurance companies of The lesson of swine flu is that this is not a ‘Mexican’ In a bid to repair the financial damage that swine and decide which, if any, travel insurance product acting unreasonably by refusing to compensate phenomenon but a generic one and it can happen flu has inflicted on Mexico, the Tourism Board in might be appropriate for them,” he said. policyholders for not travelling to Mexico after the anywhere, at any time. Though the WHO has the country is planning a revival package that could Cancel for Any Reason or Change of Mind policies FCO warned against it. Which? says there are too warned of a possible pandemic arising out of the include a 50-per-cent reduction in cruise tax. allow purchasers to pull out of a trip if they sense many impediments to claiming a refund on the cost Mexican flu variant, to date the repercussions have As ITIJ went to press, the total number of swine flu trouble on the horizon, but coverage is not absolute of a holiday, in that many insurers are only offering been quite modest, certainly not on the scale of cases worldwide reached 15, 510, with 99 deaths. and there are limitations. In Canada, Manulife Global to cover the cost of altering the holiday destinations states: “If you change your mind and decide not to offered by the travel company. travel for any reason before you leave home and you The country’s travel association ABTA said in a have booked your trip and purchased this insurance statement that it believes most travel policies won’t from the same travel agent, we will pay up to 50 cover policyholders for cancellations due only per cent of the covered amount for the prepaid to official government guidelines or to travellers portion of your trip that is non-refundable and non cancelling of their own will. The Association of transferable to another date. You must cancel your British Insurers, however, insists that most UK travel trip 16 days or more before your departure date.” insurance policies do cover this type of cancellation

American travel insurers also rushed to get advisories on what was coverable vis-à-vis swine flu up on their websites, several making a strong pitch for customers to add Cancel for Any Reason or Change of Mind supplements in future

www.itij.co.uk 24 ITIC REVIEW

INTERNATIONAL TRAVEL INSURANCE CONFERENCE

Conference Review 19th-20th May 2009 The RANDOLPH Hotel OXFORD • UK

Scheduled airline failure and This, obviously, is no longer the case, yet the law in forward such as SAF and credit card protection; or, learn how simple it can be to alter a complex policy the collapse of the travel the UK remains the same. finally, the industry could do nothing. Andrew offered and thus make it instantly more accessible to a higher Financial protection that is available in the UK, though, his preferred solutions to the issue, including for the percentage of the population. His top ten tips were industry includes ATOL, ABTA, the Association of short term a change in regulation to incorporate given using some excellent examples of very ‘unplain’ Independent Tour Operators and Travel dynamically packaged English, such as when he failed to find a bar of Michael Ward Trust Association. These, explained David, holidays and, in the long soap in a hotel room recently, and upon ringing Sales and marketing are all meant to be complementary, and all term, to meet consumer reception to ask for one, was told the ‘facial bar’ manager, International cover slightly different things. Most recently, expectations and put he had seen in the bathroom earlier was, in Passenger Protection the government has put in place an air a proper structured fact, just soap. travel trust fund to replace the ATOL bond protection scheme in Martin’s most vital recommendations to the Michael began by giving scheme as the primary level of protection place. insurance audience were: delegates an update on for passengers, but consumer awareness of - To keep average sentence length to under 20 the current state of the this scheme is somewhat limited, despite the Natalie Miles words; marketplace, including industry’s undertaking to promote guidance Head of group insurance, - To use familiar words and explain clearly any showing the statistic and awareness of it. The money for the fund TUI Travel that aren’t – there should be no assumptions that 2008 saw the will come from a £1 air passenger charge for made on the part of the insurer that the largest volume of airline each person on a flight. Natalie gave the audience consumer knows as much as they do; Natalie Miles collapses in the history of David then gave on overview of several an in-depth analysis of - To be concise, only using as many words as Michael Ward aviation, and according to future possibilities for the aviation industry, how the TUI Travel are necessary; PricewaterhouseCoopers, including an ‘all flights’ protection levy that is Group trades around the world, including mentioning - To use the active voice rather than the passive 2009 will continue this downward trend. Factors being considered by the European Union; a proposal the many subsidiaries that are part of the Group wherever possible – it is far easier to read affecting the slowdown, he continued, include the to increase the air passenger charge from £1 to £3; that are operating successfully, even in the midst of - To use clear, crisp and lively verbs; price of oil, exchange rate changes and low inflation. a government consultation on a recession. She explained that, as a result - To use vertical lists in order to break up large Michael then explained how costly airline failure can ATOL reformation; and it is of the company reducing capacity in 2009, swathes of complicated text; be, and the necessity of some form of protection, hoped that a definition of the the summer ’09 average selling price has - To make headings self- whether it be through credit card, travel insurance, term ‘package holiday’ will be actually risen by 10 per cent, and the public explanatory or predictive and the UK Air Transport Organisers’ License (ATOL) given. are showing their propensity for travel, even not to use bold as it dazzles or the Association of British Travel Agents (ABTA). when the budget is tighter than normal. the reader and they then When asked whether or not scheduled airline failure Andrew Cooper Thirty per cent of TUI Travel’s customers notice little else on the page; (SAF) should really be a risk travel insurers take on, Director general, Federation of are demanding package holidays, perhaps as - To proofread more carefully Michael pointed out that it will become one if it isn’t Tour Operators and Association a result of the collapses seen in the aviation (at this point some shocking already, thanks mainly to consumer expectation. of British Travel Agents industry throughout 2008 and continuing into examples of real policy He showed how certain aggregator websites have this year. wording were shown!) been using details such as SAF cover to illustrate the Andrew began by delving The impact that SAF has had on TUI is felt - Not to use continual differences between certain travel insurance policies, into the question of where indirectly through the cost of the new air capitals, as humans often and with high profile airline collapses such as XL the industry is currently going passenger charge of £1, which could be read a word by looking at in 2008, consumers will soon demand that such wrong, including long-standing hiked up to £3 if the government has its the shape of the letters, and coverage be in place. He predicted that by the end of overlaps in the different types of Andrew Cooper way. Concern in the industry, said Natalie, by using continuous capitals 2009, some 60 per cent of travel insurance policies cover, as well as the difficulties centres on the fact that the increased cost it makes it more difficult to available to the UK market surrounding the definition of the term ‘package could serve to distort the market as travel agents will digest; will incorporate some form of holiday’, which was created in the 1970s and have to include it in prices given to the customer, yet - Not to use initial (legal) Martin Cutts SAF insurance. hasn’t been altered since. The problem with low-cost carriers could get away with undercutting capitals for defined terms, or that, he continued, is that the marketplace the prices offered by agents. Natalie also reiterated any other inappropriate purpose: for instance, ‘Your David Moesli has changed dramatically, with the advent of a point that had been mentioned before, which is Policy protects You in the event of an Accident’. Deputy director, Consumer dynamically packaged holidays and independent that of consumer education – figures from the firm A quiz was then given to the audience, and there Protection Group, Civil travellers. For instance, in 1997, 96 per cent showed that more than 50 per cent of consumers were some rather red faces when the results Aviation Authority of leisure holiday sales were ATOL protected, believe they are protected when booking a flight only. revealed some delegates’ less-than-perfect yet in 2008, of the 47 million travellers who left Natalie then showed that TUI has taken action to knowledge of spelling and grammar. David explained in detail the the UK, just 24 million enjoyed the same cover. protect its customers from scheduled airline failure different types of financial The changing market can be attributed to the as it retains the credit risks of its dynamic package The European Gender protection that are available increase in low-cost carriers, second home holidays, so if an airline were to fail, TUI would be to UK holidaymakers and ownership, the Internet and the sales policies responsible for the cost of repatriating the customer. Directive highlighted the loopholes in of the large tour operators, who are catering to the ATOL scheme that leave customer demand with complex holiday plans. Policy wording – 10 top tips Mark Waterstone some tourists without any The average UK consumer, though, simply Obstetrician David Moesli form of compensation, should assumes they are protected, but little clarity is Martin Cutts the airline they are flying with being offered to them at the point of sale. Research director, Plain Language Commission As European insurers are no longer allowed to ask go into administration. The reason, he explained, Andrew then offered delegates some of the future a potential client whether or not they are pregnant that airlines are excluded from the ATOL scheme options for improving the situation, including Martin surprised the audience with his lively take on when assessing the risk, the problem of premature is an historic one – in the past, scheduled airlines government intervention through the possible hike of what some might deem a difficult topic – the humour births abroad could become increasingly important were usually part or fully owned by a country’s the air passenger charge; an improvement in public of the small print in insurance policies. Sceptics of in the industry, costing companies hundreds of government, meaning that they simply would not fail. awareness; reliance upon market solutions being put plain language, began Martin, might be surprised to thousands of pounds.

The welcome function The Welcome Function, sponsored by Baptist Health, was thoroughly enjoyed by all who attended. The volume of chatter in the room, combined with some serious faces, showed that both business and pleasure were on the minds of the delegates. A very successful function, ITIC would like to thank Baptist Health for providing the drinks for the evening.

International Travel Insurance Journal ITIC REVIEW 25

Mark gave an In order to try and work with the Directive, rather per day, and there are more phones than people in (broadband global area network), VHF radio and a overview of some of than against it, Daniel suggested ways in which the the UK alone. More than 50 per cent of the world’s local SIM card. The importance of communication in the complications that industry could still manage their risk. An insurer could population pay to use a mobile phone, he added, high-risk environments cannot be underestimated, travelling, and flying use dissuasive tactics, such as relying on a health and showing the potential market available. Due to concluded Travis – it can be a lifesaving tool. in particular, can bring safety warning about the dangers of flying for pregnant the advent of new technology, the travel insurance on or exacerbate in women, or alternatively the industry could work more industry has had to develop a multi-channel pregnant travellers, with airlines, asking them to be active in assessing approach, and using mobile technology is another and the costs that can pregnant travellers that seem to be near to term. sensible step forward, as it gives companies the be incurred when Daniel’s conclusion was that the consequences of opportunity to assist in most key touch points on a something does go non-compliance with the Gender Directive could customer’s journey. wrong abroad. He Mark Waterstone serve to be a very The advantages of using mobile technology to assist showed that between expensive mistake customers are convenience, the flexibility offered to two and eight per cent for an insurance both customer and company, as well as an enhanced of travel insurance claims that involved the provision company, and his overall customer experience. Importantly, though, of emergency assistance were for obstetric cases recommendation was the texting service must be complementary to and indicated that when a pregnancy does have that firms remove any other means of communication, not a replacement. Travis Vincent complications, they can happen very suddenly and and all references to However, on the other side, insurers must be be very dangerous to both mother and child. maternity, pregnancy or aware that there are some disadvantages to using Rob Malcolm One of the problems facing the insurance industry is transgender. text services, which include: some customers’ lack Vice-president, business development, MBLOX Ltd that pregnant women are given conflicting advice on of familiarity with mobiles; a discomfort among when it is and isn’t safe to fly – for instance, there is Scott Roberts the public that the document details are not ‘in Rob, a self-confessed ‘mobile phone geek’, offered an assumption that it is safe to travel in the first three Senior broker, Acumus writing’, therefore not legally binding; a belief that delegates further insight into the possibilities for months of pregnancy, when in actual fact it is a very Insurance the cost of such communication will be borne by improved business that mobile phones can give to unstable time for the baby and very dangerous. The the customer; and a misconception among the companies, from engaging more with customers Gender Directive could also result in more ‘tourist Scott discussed the public that the service to saving money. A key point of mobile phone obstetrics’, whereby a pregnant woman about to give impact and expense Scott Roberts replaces other means of technology, though, he continued, is that it must birth purposefully travels to another country in order that pre-term babies communication. both make and save a company money if it is to be to obtain a passport from that country for her child. have on the travel Moving onto future successfully instituted. Risks to pregnant travellers are numerous and can insurance industry as a whole, offering statistics on trends, Nicholas showed Mobile channels of communication that are already be serious, resulting in the worst case scenario in the how frequently premature births occur and the that other services, such on offer to the public include SMS, MMS, push email repatriation of a corpse – but even in the best case, likelihood that an insurer’s client will suffer from one. as dental surgeries, are (Blackberries etc.), instant messaging and Twitter. the care for a premature baby that arrived whilst the Pregnancy, as Scott pointed out, is an extremely using text services very Elsewhere, though, data applications are changing insured was on holiday in the US could effectively put emotive topic, and the last thing the insurance successfully as a way of the nature of mobile phones and driving the industry a travel insurer under huge pressure and seriously industry needs is bad publicity from denying a claim reminding patients of towards innovation and increased use of the Web affect the whole book of business it offers. It was for a premature baby – the media will be straight on their appointments. Such and WAP applications. pointed out that insurers now have no incentive to it and the insurer loses out again. schemes should increase Ways in which travel insurers could make use of offer travel as part of their business, as the unknown Scott’s statistics showed that seven per cent of customer trust in text mobile technology could include enabling the insured risk is simply too high. births in England and Wales are premature, which services, which will result Nicholas Thurlow to pay for cover through their mobile account, either is of concern to the industry. Generally, it was in more consumers instantaneously or through their monthly bill. In Daniel Scognamiglio demonstrated that a typical travel insurance claim expecting such services in the future. addition, for an assistance company seeking to locate Senior solicitor, Blake Lapthorne for a premature baby’s birth is settled for between a client in a country where there has been a security £80,000 and £250,000 – although one claims Travis Vincent alert, a mobile phone’s GPS signal could be used to Daniel began by company said that it had not witnessed a premature Regional security manager, International SOS determine whether the client is in any immediate asking delegates baby claim that reached over £11,000. danger. There are data protection problems with who among them There are several options open to travel insurers Travis explained how vital communication is in his this particular use of the technology, despite the clear had actually acted that can mitigate the effects of high worth claims, role of keeping clients safe in some of the most advantages it offers insurers and assistance firms. to change their continued Scott: reinsurance policies; lifestyle volatile regions in the world. There are three In the future, Rob policy wording screening and underwriting; policy wording changes; key considerations that should be made when a predicted that ‘sender since the Gender lobbying airlines to be more proactive in stopping company is deciding where to use technology to pays data’ technology Directive had come pregnant women over a certain number of weeks help businesses working remotely, and those are: the will become more into action – the travelling; reserving a more accurate amount of efficacy of the information provided; the operational popular – ‘sender pays absolute prohibition money for premature baby claims; working even procedures of the company; and the method of data’ is the technology on discrimination more closely with cost containment companies; and transmission and receipt of the information (i.e. the that allows a brand to on the ground properly explaining the dangers of travelling while type of mobile device being used). A company that offer data to its clients of pregnancy is pregnant to female clients. is considering introducing mobile technology to at the company’s own one the industry Finally, Scott urged the travel insurance industry to assist its workers should also carry out a travel risk cost, thus removing Daniel Scognamiglio must come to respond to requests from the Association of British assessment, and consider how the firm already keeps customer uncertainty terms with if Insurers for more information on claims statistics in regular contact with its remote employees. about the value of they are to be compliant. There is a lack of clarity relating to age in order to demonstrate the true Travis showed how International SOS keeps in the service. Smart about the Directive, explained Daniel, due to the nature of the claims, or else the impending Equality touch with its clients through its own technology, Pipe Enablers, said Rob Malcolm difficulty of whether to interpret the Directive Bill could end up being far worse for the industry. which can highlight problem areas around the world, Rob, will also rise in through a purposive or constructionist approach in including security or medical alerts, so the company popularity as they allow networks to be opened the UK. The insurance industry can also be found Mobile phone technology and is immediately aware of any risk facing the country. up to other companies that can further identify the to discriminate in both direct and indirect ways, Once aware, the company is able to check to see needs of the customer. More popular in the US at making it even more difficult for an insurer to make travel insurance if it has clients present in the affected area and can the moment, there is a move to utilise advertising- sure they are following the rules directly – especially take the necessary steps, if there are dangers to the funded messages to clients, so they receive an advert when solicitors are offering different advice, as many Nicholas Thurlow client, to contact and evacuate the person. It is vital, and the data at the same time. In conclusion, Rob are. Some are telling the insurers to take out of Director, Text2Insure continued Travis, that any communications system put indicated that as mobile phones continue to develop their policy wording any reference to maternity or in place be reliable, capable, robust, flexible, secure at an alarming rate, the penetration of smart phones pregnancy (and transgender clients), while others Nicholas began by offering his views on the role of and economical. In his opinion, the most critical will increase, offering customers richer applications are allowing the insurer to leave it in as long as it isn’t the mobile phone in today’s society, showing that communications tools available on today’s market are and further possibilities for those companies that can used in a discriminatory way. the average person sends nearly four text messages the quad band mobile phone, satellite phone, BGAN offer consumers what they want.

www.itij.co.uk 26 ITIC REVIEW

Age discrimination market of some products, it could become more Samantha O’Connor At the time of writing, – an update difficult to incentivise safe behaviour among insureds Head of business development, Columbus Insurance the World Health and there would be less diversity of Group Organization had product features. increased its threat Kate Carr Kate also gave delegates an update Sam offered delegates an insight into which providers level to phase five, and Assistant director, markets and on the current state of play with the are and are not providing cover without age Charlie predicted that regulation, Association of British European Union Equality Bill, which has limitation applied already, the latter being shown it would soon move Insurers some concerning features. The wording to be a very small proportion of providers on the up to phase six, due provided in the Bill does not yet provide market. On single trips, there were only a few to the prevalence of Kate gave a very detailed presentation sufficient protection to the industry, companies shown to not place age limits on their human-to-human on ‘the story so far’ in relation to the said Kate, and the ABI has asked for a policies, while for annual multi-trip insurance, that transmission and a UK Age Discrimination Bill, which has definition of ‘legitimate aim’ to be given figure came down even further. Sam presented higher death rate (0.8 been in the development process for before further action is taken. statistics showing that instead of the over-80s, the per cent) than was the last several years, and following As if coping with current UK and highest number of travel insurance claims came from seen with Severe seemingly endless proposals, European legislation were not difficult the 50 to 65-year-old age bracket, with 18 per cent Acute Respiratory Charlie Easmon consultations and reviews, is nearly enough, Kate reminded delegates that of all claims stemming from this age group, while Syndrome. Charlie ready for implementation. (For all the UK Age Discrimination Bill and over-65s account for just four per cent of claims. then gave delegates the latest information regarding the background on the legislation, Kate Carr European Equality Bill are coming into Sam indicated that in her opinion, age banding symptoms that employers should be on the lookout for, please see ITIJ 98, March 2009, action at different times. UK legislation is doesn’t really make sense – it could be made more as per government guidelines. Discrimination, the new regime.) slated to be introduced in 2012, while the European sensible and fairer by The insurance industry in general will feel the heat One particular issue that was highlighted by Kate legislation will be introduced in either 2013 or 2014. simply instigating a for the next several months through claims stemming was that of age banding – a particular problem for The cost of compliance with both pieces of legislation year-on-year increment from swine flu, predicted Charlie, as problems a division of the insurance industry that uses broad will be significant, and put the UK at a competitive for travel insurance with industry and the provision of public services age categories to quantify risk. If the Bill states that disadvantage with the rest of Europe. policies. In the future, will quickly become an issue if a sizeable outbreak age bands must be narrowed, Kate indicated that Industry action to try and counteract the effects of the it is hoped that all were to occur. Companies, then, should seek to this could bring higher costs for insurers and business Age Discrimination Bill include: offering ‘signposts’ to single-trip insurance mitigate the risk to their staff and their bottom line could become more complex for distributors, while customers when one insurer cannot offer cover, but policies will disregard through recognising the symptoms, then planning the cross subsidy used by many insurers could be knows another that can; making commercial deals age banding in favour and enforcing a business continuity plan should removed. If age limits are removed completely by between insurers to offer referrals to customers, and of more accurate staff become ill. Plans that companies have in place the Bill, this could mean total withdrawal from the the production of a good practice guide. risk assessments, but should include hygiene information, the organisation for annual policies, of ‘flu buddies’, limitations on staff travel and social the situation is distancing. more complex. The difficulties of mid- Samantha O’Connor term medical changes continue to plague the industry, and Sam issued a call to other industry personnel to help develop a way in which annual policies could become non age-banded. During the spirited debate that followed the session, it seemed most of the delegates were in agreement that age banding is passé and should be abolished in favour of offering more ‘signposts’ to customers about which insurers offer non-age limited coverage. There was also some concern voiced among delegates that the decision-makers behind the Age Discrimination Bill are not fully aware of the effects that the Bill will have on travel insurers.

Swine flu preparation Geoff Whiting

Charlie Easmon Geoff entertained the delegates just before the Managing director, The Number One Health Group conference drew to a close. Following on from Charlie Easmon’s presentation on swine flu, he Charlie’s presentation had everyone washing their lightened the mood significantly. Chatting about hands and covering their mouths soon afterwards, as topics as diverse as travel, customer service, football he showed that the world must prepare for a worst- and driving, the audience were soon chuckling case scenario with regards to the outbreak of swine along. Despite the fact that audience participation flu, despite hoping for the best. When considering was definitely what could happen next in the development of not on the cards, the disease and its progress across the world, Geoff managed processes of containment that have been used must to involve several be evaluated in their efficacy – social distancing, for delegates and kept instance, slows down the spread of the disease, but up an amusing will not stop it. Charlie predicted that in the next 12 patter that brought months, there will be three waves of outbreaks of the event to its swine flu, and could cause at least the same amount conclusion, and of damage as normal flu (economies already suffer got an enthusiastic when seasonal flu hits its annual peak). If those round of applause outbreaks were to coincide with an outbreak of from those in H5N1 bird flu and normal seasonal flu, the effects attendance. could be near disastrous for global industry. Geoff Whiting International Travel Insurance Journal INTERNATIONAL TRAVEL INSURANCE CONFERENCE

SHERATON HOTEL GRANDE BRETAGNE , GREECE

athens2-5 November 2009

Registration & conference details www.itic.org.uk/athens 28 ITIC REVIEW

Finale Dinner Set in the beautiful Rhodes House, the finale dinner was again voted by all to be a resounding success. The magician kept attendees entertained with some impressive magic tricks, while the band played jazz in the background before and during dinner. Also making the rounds was a caricaturist, who captured the essence of some of the delegates. The attendance at the finale dinner was once again a testament to the popularity of ITIC, and the dancing that followed in the club showed that once again, ITIC delegates know how to enjoy themselves!

The ITIC organisers would like to thank all the sponsors who helped to make the conference the success it was:

Welcome function Conference folders Baptist Health International Rowland Brothers

Oxford Maps United Health International Delegate lists V Creative design Delegate badges Euro-Center

International Travel Insurance Journal ITIJ AWARDS 2009 ONE READER – ONE VOTE!

After the phenomenal success of the Budapest 2008 ITIJ Awards, we are proud to announce that this year’s ceremony will once again provide the industry with an outstanding occasion that celebrates excellence and achievement in the global Travel Insurance industry.

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. 2009

The fi nalists’ presentations will be screened at the ITIC Gala Dinner awards evening in Athens on Thursday 5th 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) AWARDS 2009 • ITIJ marketing campaign of the year (judged independently) Athens 2009

2009

The rules: • One vote per category per subscriber to ITIJ • Votes/nominations must be received by 31st August 2009 to: [email protected] • 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 Friday 4th September and provided with the criteria and deadline for submitting their Visit www.itij.co.uk/awards for more information presentation

ITIJ AWARDS 2009 : : ITIJ AWARDS 2009 : : ITIJ AWARDS 2009 : : ITIJ AWARDS 2009 For further information advice contact us at: [email protected] or telephone the conference department on +44 (0)1179 22 6600 30 FEATURE Laws of adventure

In the fast-growing adventure tourism sector, the risk of injury and death is an unfortunate fact of life. Matthew Davies explores the difficulties a UK adventure travel company could face when a participant is injured on an expedition or adventure holiday overseas, and how combined planning by the operator’s insurer and the insured (adventure travel company) could reduce potential future legal complications.

Most liability insurers are familiar with the concept of early intervention or even third party capture as valid claims handling and mitigation processes, but what if the claimant is on the other side of the world? When dealing with an overseas investigation or an overseas coroner’s inquest, operators and insurers who fail to take control of a claim from the outset can damage their prospects of mounting a successful defence. Meanwhile, costs can easily spiral out of control. Imagine the scenario: an incident occurs on an expedition overseas where a British traveller is injured, perhaps fatally. As the tabloid media get wind of the story, the travel operator is vilified and the usual cycle of ‘more must be done to ensure safety in this sector’ begins to do the rounds. The outrage of the injured party or their family is fuelled by the press coverage, and the risk that a claim will follow will be magnified. It is with no little irony that a road traffic accident attracts little media interest, despite the fact that the number of people killed in road traffic collisions worldwide, on a daily basis, equates on average to the equivalent of ten jumbo jets crashing with no survivors. However, as the above example illustrates, public perception can often be based on unsubstantiated facts and wild media reports from unnamed sources that fail to materialise in any official or subsequent investigation. While this is something of an irritant, it has to be taken seriously by operators and insurers. Bad publicity for a tourist destination or operator can cause significant reputational , in the case of a fatality, by dependents of the estate damage for the insured and ultimately, if they fail the of the deceased. Of course, the number of incidents in the expedition adventure travel company’s insurers will not receive It is likely it was the local service provider or ground premiums from the insured in the future. handler that was running the activity at the time of industry is very small and most of the providers in Early intervention the incident. If that ground handler is unrepresented this sector operate excellent safety systems If an incident involves a fatality, an inquest will follow. whilst the family is not, the insured’s position (the In the example above, upon the body landing back insured may not be represented at all) may be in the UK, the UK coroner into whose jurisdiction damaged, particularly in light of the fact that the the deceased arrives, will open and immediately Package Travel Regulations 1992 will see a claim adjourn an inquest. Often, the UK inquest will being issued against the insured by the family of the be postponed until the outcome of the overseas deceased or by the injured person. inquest is know. And here’s the catch. Inquests are Given the legal time limits for issuing a claim form not always covered by the tour operators policy (three years from the date of incident for an adult or if they are, it is sometimes within the insurer’s and until the age of 21 for a minor), it is often discretion to fund the inquest if the outcome (whilst likely that much of the evidence will either have technically, the “verdict” at the inquest should not deteriorated (witnesses’ recollections) or that dealing with the issue of Civil liability) may impact on witnesses (particularly given the transient nature the Civil Proceedings to follow. The UK Coroner of employees in the travel service sector in many is likely to request a full copy of the file of papers of countries) will simply be untraceable. the overseas Coroner once the overseas inquest has Insurers should be notified under the policy as soon concluded, before conducting the UK inquest. as possible after the event – that will be a Condition The problem for insurers is that if they are not of the Policy. However, a letter of claim may not directing the proceedings from the earliest possible follow for many years – rest assured the Claimant moment, ensuring that the adventure travel will have collated all possible evidence at the earliest company insured are legally represented at the possible opportunity and will take all possible overseas inquest, problems may arise, from crucial advantage in the delay prior to issuing proceedings. evidence not being preserved, through to families Travel insurance cover? of the deceased uk citizen being represented at The injured party may have their own travel overseas inquests by Counsel and expert witnesses, insurance, taken out independently of the adventure with the insured operator often unaware of the travel package and this may have legal expenses workings of the process or potential implications insurance cover to fund the injured party in bringing arising from the inquest that could impact upon any a claim in the UK (pursuant to the terms and future civil claim brought by the injured customer or conditions of the holiday contract).

International Travel Insurance Journal FEATURE 31

Insurers I have spoken to have experience of claims being brought as a separate claim or as a bolt on to the personal injury claim

The task for brokers and insurers should be to go (including specialist health and safety courses for that one step further and encourage their clients companies on the sector such as Off Site Safety to seek the knowledge and tools that can help Management (Risk assessment, venture planning, them stay conversant with the risks they face in the legal liabilities, contingency planning, crisis response adventure travel sector. and management, media response) as well as vehicle Many insurers and brokers are now going one step safety assessment courses from our specialist Health further; encouraging insured’s to attend specialist and Safety Advisers. training courses. In association with a number of The old military adage that ‘Proper Prior Planning specialist brokers and insurers, we run two day Prevents Poor Performance’ is as relevant today as training seminars for the travel sector throughout it has ever been. Working together from the outset the year, including those specifically tailored to not only protects the insured’s and insurers’ position, the outdoor and adventure travel sector, covering it also confirms your sector expertise and client such issues as company formation, booking terms commitment to the insured. and condition, advertising, data protection, police response to incidents in the uk and overseas, Matthew Davies is coroners inquests, indemnity contracts with service a partner in the travel providers, Health and Safety Prosecutions, Liability and leisure team of issues in the UK and overseas, concluding in a international practice full mock trial with participants as witnesses. The Hill Dickinson LLP. He insurers and brokers involved encourage their is a fellow of the Royal Geographical Society and insured to attend, to minimise liabilities, ensuring that a solicitor advocate (all corporate structure and terms and conditions afford Higher Courts). Matt operators and insurers who fail to take control of a all possible protection to the insured (and thereby heads up the outdoor claim from the outset can damage their prospects of insurers). Similarly, the insured understand their activity and adventure potential liabilities and can respond appropriately to travel team at Hill Dickinson LLP and is a recognised leader in the field in Chambers and mounting a successful defence investigate when incidents arise. Ideally, insured’s Partners Legal directory. He has dealt with will have indemnity contracts with service providers numerous sector cases both within the UK If any subsequent claim were to succeed, then Had this been managed from the outset, even if the AND will have a copy of the valid and relevant and overseas. He also acts for tour operators the injured party’s solicitors would, if successful, ground handler has long ceased trading, any future insurance policy, making redirecting a claim far and expedition companies providing and have their costs, subject to court rules, paid by the claim could be directed to the insurer. Fail to do easier and therefore that any early investigation by delivering legal and crisis response services and safety training for clients as far afield as China. adventure travel company’s insurers in addition to so and the opportunity is lost, for once the ground insurers is likely to pay dividends and save the insurer He was a member of the core drafting team for the damages (compensation). handler has ceased trading your chances of securing money. Several of the insurers are contemplating BS:8848 – The new British standard for safety In terms of the repatriation costs, if the tour insurers’ details are virtually non-existent. Securing offering premium discounts to their insureds who in overseas expeditions. operator was at fault and the injured party’s own witness evidence early (perhaps by telephone using attend the future seminars in our programme travel insurance policy covered the costs of the teams with multi-lingual staff) can pay dividends, as repatriation, then that insurer may seek to recover can ensuring that evidence is collated early, supporting those costs. Insurers I have spoken to have the insured at the inquest and allowing an early and experience of claims being brought as a separate definitive denial of liability with such overwhelming claim or as a bolt on to the personal injury claim. evidence to avoid a claim being pursued. Taking action Of course, the number of incidents in the expedition The adventure company’s insurers may, in many industry is very small and most of the providers in cases, save significant sums by having a procedure this sector operate excellent safety systems and in place for cost effectively gathering evidence from emergency back-up procedures. Indeed, many overseas jurisdictions at the outset; dispatching of them work together to ensure safety standards investigators and specialist lawyers who understand – organisations such as the Expedition Providers’ the intricacies of the process as early as possible. Association and The Year Out Group – both of During this period, the relevant ground handlers which have their own safety standards. In addition, can be traced, statements obtained and, if possible, many of the industry bodies, along with experts in indemnities from their insurers. There is nothing the field and those representing consumers, have more frustrating than facing a claim many years down come together to develop the new British Standard the line, to find that the insured operator had no for safety on overseas expeditions/adventurous indemnity contract in place with their ground handler activities – BS:8848 (being the height of Everest in or that the insured did have such a contract, but did metres). This has been developed for adventurous not keep a signed copy and did not secure a copy activities abroad with the aim of reducing the risk of of the insurance policy required under the contract. injury or illness.

www.itij.co.uk 32 ASSISTANCE&HEALTHCAREWORLDMARKETS Hungary for change ungary’s healthcare system has its roots medical system functioned well. Hin the old socialist model, but is gradually The fall of the ‘Iron Curtain’ and the restoration privatising certain services. Dr Peter Felkai tells us of democracy made the information gap between how to get the best out of the current system East and West regarding medicine disappear altogether, but new ‘curtains’ have arisen, making Hungary, a landlocked country in central Europe, the management of healthcare for travellers to the has a population of just 10 million people; but it has country difficult. Besides the language barrier, the a rich cultural history and an enticing capital city in healthcare system is different from that in many Budapest, and as such is a popular travel destination other countries. These differences are based on the for vacationers to the continent. But do visitors to historical circumstances of the past 45 years and can Hungary know much about the level of medical care be summarised as follows: available in the country, and how the healthcare system operates? Well, no, because they don’t 1. Almost all the hospitals in Hungary are state-run expect to have to come into contact with the health (by central or local government), and hence they are service whilst on vacation, but it still surprises me run on a not-for-profit basis. They all have a service that some twenty years ago, when I began to treat agreement with the National Health Insurance Fund foreign tourists in Hungary, almost all US visitors (HIF), which is a separate administrative organisation carried a little package of sterile, disposable syringes, under the supervision of the Ministry of Health, as well as some basic antibiotics. I was completely Social and Family Affairs, whose main income is from shocked then, because I thought Hungary was public health insurance contributions. famous for its good quality medical care compared Hungary’s previous healthcare system relied on to other former socialist countries. But the tourists institutional care, where emphasis was placed on (probably upon the advice of their home doctor the development of large hospitals (with 1,500 to or travel agent) treated Hungary as a developing 2,000 beds) and university clinics. That has changed country. and there are currently 155 hospitals in Hungary, Still recently, however – five years after joining mostly owned by local governments. The national the EU, and one year after becoming part of the institutes (for cardiology, oncology, pulmonology, and Schengen Area – I get questions at international so forth) and rehabilitation centres belong directly medical congresses, which indicate a continued, to the Ministry of Health, and the country’s four general ignorance about medical care in my country, medical schools between them own five clinics. so it is with great pleasure that I take this opportunity The hospitals’ operational costs are covered by the to tell you more about the level of care available. HIF. Hospitals widely accept the European Health With the help of this article, doctors and assistance Insurance Card, which only covers the cost of companies providing pre-travel advice for their treatment for conditions needing urgent attention customers will be able to see that Hungary is a safe and only where the healthcare provider has a place to send their clients. contract with the ministry of health in the patient’s According to statistical data from 2007, some six home country. to seven per cent of total tourist expenditure was on ‘healthcare, medicine and sport’ (predominantly 2. The hierarchic structure of healthcare has meant spa treatments). There are no exact figures for the rigidity in the healthcare system. Until 1992, the morbidity rate of foreign tourists to Hungary, but Hungarian population could not choose their own generally some 30 per cent of visitors face some doctor and had to go to their local district physician; kind of medical issue during their trip, which often and if hospital treatment was needed, patients were involves having to seek medical advice or treatment. normally admitted to their district hospital. Today, repatriating ill travellers from Hungary is difficult. a hierarchy still remains in place whereby patients A little bit different needing specialist intervention will need to first visit This is, in large part, due to complicated regulations With the downfall of the socialist regime in 1989, their GP for a referral to hospital, where in turn they regarding payments Hungary transformed itself from an ‘unknown, far will be referred to a specialist consultant. away land’ into a popular tourist destination. But even under the socialist system, Hungary was a 3. The majority of Hungarian hospitals do not cover services (such as internal, obstetric, basic surgery, who establish the initial diagnosis – or by ambulance rather well organised country, often dubbed the all medical specialties. Municipal hospitals and those and so forth). The larger, county hospitals, however, staff in an emergency. In emergency situations, the ‘happiest barrack in the socialist camp’, and its in the capital city predominantly offer only basic usually cover the whole spectrum of specialties; ambulance staff will know which hospitals are running although out of almost 600 hospitals across the emergency wards on that particular day and will be country, this amounts to only 10 per cent of medical able to take the patient to an appropriate facility. establishments. Either way, those patients needing Meanwhile, if a foreign visitor goes to a hospital, in a specific treatment based on their diagnosis can be non-emergency situation, without a medical referral directed by their GP or the emergency doctor into (e.g. signed by a GP) he can expect a long wait in the a clinic with a suitable care structure. That’s why it reception area of what is probably an inappropriate doesn’t make sense for a foreigner to go directly to facility. To make the things worse, it is often hard the nearest hospital, as in a non-emergency situation, to find a receptionist, or any competent person, a different clinic may be more suitable. who can inform the foreign visitor what to do, or Outpatient clinics are predominantly state-run and where he should go, as generally hospitals have no offer a wide range of treatments as they are often reception ‘desk’, just a doctor on duty who would affiliated with hospitals, but private outpatient clinics be called upon if the ‘difficult’ situation of a foreign are becoming increasingly prevalent, offering mainly tourist arriving at the hospital arose. gynaecology and dentistry services, but also sometimes lab services, consultations, and sometimes ECG and 5. According to Hungarian medical regulation it is RTG. If any costly intervention or investigation is illegal to release medical information for anybody needed, private clinics immediately refer their patients without the prior consent of the patient, and into the state system for further treatment. telephone consultations are strictly prohibited. In any case, the extremely overburdened treating doctor 4. Most hospitals have failed to create emergency doesn’t generally have time to update insurance wards. Hospital admissions in Hungary are usually company representatives or assistance doctors by made by general practitioners or family doctors – telephone. In fact, to reach anybody in the hospital

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 33

providers, and to eliminate regional differences in part, due to complicated irregularities regarding new mechanisms have been established to allow the quality of services. To address these issues, the payments. For example, hospitals are often unable private physicians to act as independent contractors following measures are expected to be taken over to accept payment if their central office is closed; the next few years. First, outpatient services will be some hospitals stipulate that all payments must be to health agencies, and private companies are now privatised in stages. Second, the nature of the HIF made in cash; many hospitals offering differing pricing financing of healthcare services will be reviewed. structures have no instructions regarding when to providing many former inpatient services through Third, the system of co-payment will be extended, apply either one or the other. Generally, state-run home-care services increasing the role of households in financing hospitals are poorly prepared for paying customers. products and services. Each of these measures offers Furthermore, as standards of medical facilities are obvious opportunities to healthcare service providers uneven, with ill-defined separation of private and and related industries, including the insurance and public healthcare facilities, treating foreign patients assistance industries. has become a lucrative business. However, many In 1992, the Minister of Welfare's Decree created healthcare providers are eager to engage in the the Family Physician Service. Previously, the system treatment of foreign visitors, with or without a of ‘panel physicians’ required citizens to seek medical licence, and as such foreign insurance companies treatment only from designated district doctors. often experience difficulties finding reliable medical Now, individuals have the freedom to choose their providers in Hungary. own family physician. Family doctors refer patients In 2004, Hungary joined the EU, bringing many requiring more sophisticated interventions to benefits to the country; but as the Eastern boundary hospitals, outpatient clinics and/or diagnostic centres of the EU, Hungary saw the arrival of an ever- and labs for examinations and testing. larger number of migrants and refuges. This has Overall, the privatisation of various health services created many problems for the country’s healthcare has proceeded most rapidly in the pharmaceutical, infrastructure: while Hungary’s traditional medical dentistry and family physician areas, while private care system could hardly provide adequate care to sector development has been faster for ambulatory local inhabitants, the system has had to care for an and diagnostic services, but negligible for outpatient influx of migrants and refugees; and it certainly was and hospital care – areas where both costs and not prepared for caring for the many travellers who reimbursement mechanisms have thus far remained started visiting the country. largely within the public sector. However, new mechanisms have been established to allow private Recent developments physicians to act as independent contractors to health The main issue now facing Hungary is whether to agencies, and private companies are now providing create a multi-insurance model by combining the many former inpatient services, such as nursing, social insurance model with the advanced possibilities through home-care services. The production of private insurance provision. The maintenance and distribution of health aid products, such as or even potential rebuilding of the old medical disposables, wheelchairs, crutches and test kits, has facilities will require an enormous quantity of money, also been fully privatised. especially given the introduction of EU regulations With therapeutic protocols that are different to and standards into the country, which have required those in other countries, insufficient diagnostic more investment and have increased running costs; facilities, and ongoing language barriers, repatriating but the question is how to raise these funds. The ill travellers from Hungary is difficult. This is, in large government proposed sharing such expenses with

is a tough business: generally there is no bedside on a timely basis. But in 1993, new methods of telephone, and the telephone operator in the paying health facilities were introduced. Now, reception area speaks fluent Hungarian only. for inpatient care, payment is based on the DRG system as in the United States, while a German-style Coming of age ‘points’ system is used for determining payment for After the Second World War, as a result of the Yalta outpatient care based on a fee-for-service schedule. Treaty, Hungary belonged to the Soviet sphere of Accordingly, hospitals receive funding from the interest. As with the general state administration, the HIF on the basis of patient volume and types of healthcare system followed the Soviet model. The treatment offered, regardless of the length of time key ideology was – and remains – that taking care patients stay. Thus, physicians have been encouraged of inhabitants’ healthcare issues are exclusively the to shorten inpatient stays, which has in turn created task of the state. Then, as now, there was only one a growing need for outpatient and home-care social security insurance company, which was run health services. Moreover, the aim for politically by the state. The negative side of this model was induced centralisation yielded striking results both in the total control of all healthcare facilities (including organisational and in scientific fields of activity, where dental care, pharmacies, general practitioner’s decentralisation would have only caused parallelisms offices, hospitals, and nursing homes) by the state. in patient care or a pseudo-competitiveness at the The positive side was that all medical treatment was expense of the sick. free of charge for all, at any time and at any level. So, prior to the political and economic changes Even the price of medicines was heavily subsidised, in 1989/90, the government managed all aspects and sometimes free for poor people. Obviously, with of the country’s healthcare sector, but the Local such a limited budget, the healthcare system could Government Act (1990) transferred responsibility for not develop properly, and even everyday healthcare the ownership, management and provision of health/ was organised according to the Soviet model, with social services to local governments. Major capital no private care (except for a few dentists). However, investments are now financed by the owners (local following the privatisation of family doctor services, governments in most cases) or co-financed with the outpatient services began to be privatised in stages, Ministry of Health. All recurring expenditures are and doctors were offered the opportunity to financed and administered by the HIF. purchase specialist consultation rooms under closely According to a government report prepared in early specified conditions. 2000 for a European Union Commission, the major Furthermore, under the previous system, hospital tasks of the healthcare system for the immediate budgets were determined by bed occupancy rates. future are to improve public health, to increase Therefore, there was no incentive to release patients efficiency with regards to the financing healthcare

www.itij.co.uk 34 ASSISTANCE&HEALTHCAREWORLDMARKETS

treating foreign patients has become a lucrative business. However, many healthcare providers are eager to engage in the treatment of foreign visitors, with or without a licence, and as such foreign insurance companies often experience difficulties finding reliable medical providers in Hungary

private investors, but a referendum in 2008 refused care. Newly built hospitals have EU-standard patient the multi-insurance model and the privatisation rooms, with two beds and an en-suite bathroom. of medical facilities. The Hungarian people, who Nevertheless, private entrepreneurs have recognised generally have a low income, are afraid of the the huge demand for better conditions and faster potential rise in the cost of their medical treatment access to treatment, and have set up various types that might be caused by profit-oriented medical care. of private service, focusing on improving hospital The alternative has been for the government to decrease the cost of the healthcare and especially hospitals’ maintenance costs by centralising medical care. Thus, smaller hospitals have been affiliated into the nearest larger one or closed altogether. Still, there were recently 38 physicians and 80 hospital beds (60 acute beds) per 10,000 people in Hungary. The average for EU countries – where per capita budgets for healthcare are generally three times higher than Hungary’s – are 25 physicians and 70 beds (50 acute) per 10,000. But, as a result of the ongoing reform of Hungary’s healthcare, the number of hospital beds has been reduced by twenty per cent and will be reduced further. This work by the present government has, overall, helped lead to an increase in the quality of care available in Hungary, although hotel functions within public hospitals remain generally poor. Most hospitals try to offer extra beds for ‘VIP’ – or paying – clients, i.e. those who choose to pay out-of-pocket for better or faster treatment, and such facilities are not too expensive (nearly the same price as a bed in a three-star hotel) but ensure a comfortable hotel and catering service besides the high quality medical

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 35

TIJ spoke to Dennis Diokno, managing director of FirstMed, a private clinic in Budapest to find out his views on the progress of the private sector in IHungary. This is what he had to say: “Having been involved with the start-up and management of American-style clinics in Russia and China, I founded American Clinics International to meet the growing demand for international-standard medical services in central and eastern Europe, opening FirtstMed in 1999. The overwhelming majority of Eastern Bloc countries have extremely inefficient healthcare systems that were formed during the Soviet era. The fall of communism allowed countries to change their medical systems, but unfortunately healthcare was not a priority in most of the former Soviet bloc countries. Hungary is no exception. While Hungarian political parties always talk about the need for change, they never have the political will when elected to make the tough decisions to change the system. Thus, the healthcare system is in rapid decay. Over the last several years, the Hungarian government has closed numerous hospitals and clinics all over the country, and these closures have resulted in the further centralization of important medical services. The decay of the Hungarian medical system does not really affect tourists with basic or even somewhat urgent medical needs as there are private clinics that can provide adequate treatment. In fact, there are six or seven clinics that offer primary and some urgent care treatment in Budapest. As far as I am aware, the only two such clinics that are foreign-owned are FirstMed and Medicover. However, such clinics vary significantly in the level of customer services they can provide, as well as their English language capability. Those tourists or expatriates who are fortunate to find their way to foreign clinics such as the FirstMed Center benefit from a full range of services extending beyond those that can actually be provided on-site. For those cases that the clinic cannot handle, we use our extensive network of providers to coordinate treatment with local facilities. Again, the ability to refer such cases really varies from clinic to clinic. It is important to note that the level of quality and service can very dramatically within Hungarian hospitals, but many of our consultants play significant roles at their respective hospitals and departments. Furthermore, an important factor to consider is a clinic’s overall ability to communicate in the patient’s (and his/ her insurance/assistance company’s) language. Additionally, will the facility follow through with additional assistance after a referral?

Finding emergency services or wards is a problem that a tourist or even an assistance company can face. Hungary has a system of rotating emergency medical services. Thus it’s important to either know which hospital is providing emergency services on any given day or to call the EMS dispatcher directly.

accommodation and the quality of nursing – the groups of foreigners. Those qualifying as insured must more profitable aspects of medical care. prove entitlement to benefits of the Hungarian health Unfortunately, new and non-licensed medical insurance scheme by presenting their certificate of providers have also appeared, and there are not entitlement, or in other cases, in keeping with relevant enough officials to eliminate them, as along with the agreements (e.g. by presenting their passport). rationalisation of the healthcare administration came As in any country, if your client has medical problem, a decline in the monitoring and control of medical he should, where possible, call his assistance helpline facilities. Additionally, because providing medical in the first instance, as the company will surely have services to foreigners is a lucrative business, there are a license for referring the patient to hospital, and a huge number of blindfolding tricks directed at tourists they probably know the most appropriate hospital and expatriates that are used by unscrupulous medical facility available in the region. If the client does not providers. The first is to use misleading wording, such require inpatient treatment, outpatient treatment by as ‘private hospital’ to often mean nothing more than a a local correspondent doctor is more cheaply and simple nursing home that also offers perhaps a delivery more effectively carried out at the patient’s place suite and outpatient surgery, but within a luxurious of residence or accommodation. Moreover, this environment and with staff who speak several way the patient needs not face either the language languages, but which has no blood bank, advanced barriers often faced in hospitals, or the long wait time instruments or proven track record in safe medical prevalent in the public hospital arena or GP’s office. treatment. In such facilities, almost all the doctors are This said, where hospital treatment is needed, part-time employees, who run to the private facility visitors to the country should be encouraged to after their office hours in the state-run hospitals, use state-run facilities, as they provide good and where they have a full-time job. Another misleading professional care. Emergency services in Hungary are term is ‘clinic’, which in Western countries means a free of charge, and can be summoned by anybody medical facility for outpatient services, but until recently through telephone number 112, where operators in Hungary solely meant a university hospital. speak mostly English but sometimes German. Generally, prices are high in private facilities (compared with the services provided) and overcharging is not unheard of in some less scrupulous establishments. There have also been ITIJ AHWM rating reports of unnecessary testing, investigations and Healthcare Cost HHH repeat check-ups, and as a local supervisory doctor for many foreign insurance companies I can speak Access to emergency care HH from experience when I say I encounter such Overall quality of care HHH situations day after day.

Please note: Tools of our time These ratings are an overview of what ITIJ believes to be a Foreign nationals may stay in Hungary temporarily, or fair reflection of the general standards in the country, and live permanently in the country as an employee, retiree, do not represent any one hospital or service. ITIJ recognises student, dependent, refugee, asylum seeker or by that some individual facilities and services would receive different ratings than others, and to those shown in our having admitted status. From the point of view of health chart, should ratings of each be done separately. insurance, entitlement to healthcare differs by specific

www.itij.co.uk 36 PROFILE Man on a Mission Dr Sutuspun Kajornboon, director of Bangkok Hospital Medical Center’s (BMC) Aviation Medicine Department, spoke to ITIJ about his life and work in medicine and aviation and how his mission to set up a medevac unit has earned BMC’s HEMS service EURAMI accreditation

Where were you born, where did you How has BMC’s medevac service has become much more professional. Medevac was study, and where do you live now? developed since its instigation and how do not a core service of the hospital, but seeing as the I was born in Bangkok, Thailand and attended Elementary you see it develop in the future? hospital is a super tertiary care hospital, this has proved School in Bangkok before studying at junior high and Before setting up Bangkok Hospital’s Medevac to be a good idea, especially since most of the patients high school in Fairfax, Virginia, in the US. I went on to Service I needed time to increase my overall are usually critically ill or injured in the ICU and cannot complete a BS at Virginia Polytechnic Institute and State knowledge of aeromedical transportation. I not be transferred by just a simple ambulance, due to a University in the Thailand, and then an MD at Mahidol only established a medevac unit, but also organised deteriorating condition or too great a distance. University, training at Siriraj Hospital Faculty of Medicine. the complete medevac system, including a fit-to- I also completed my post graduate study and obtained fly evaluation process for patients who would be BMC’s HEMS service received EURAMI a Diploma in Aerospace Medicine at the School of travelling by air immediately after sickness or surgery, accreditation at the end of last year. Why Aerospace Medicine USAF, in San Antonio, Texas, as well and airman medical examinations. With the help of is such accreditation so important? as a Diploma in Aviation Medicine in the UK. three other flight surgeons, the Aviation Medicine Having a medevac HEMS team set up and having Department was finally set up in 2006. some medical equipment and standardised How did you come to work in the realm The medevac unit was initially established as an procedure does not mean that you have a good diagnosis, for instance myocardial infarction, I would of aviation medicine and in particular extension of the regular hospital services, and it medevac organisation. I always think in the back of put a cardiologist onboard with an intra-aortic balloon your role at BMC? remains so today. The difference today is that instead my mind, ‘Are we up to international standard and pump to stabilize any unstable cardiac cases. It is like During the last few years of communist insurgency in of a team of two crew members, we are a team of 30 can we do it better’? Having done several fixed-wing we are taking a specialist and a CCU to the patient. Thailand, I was working as a young flight surgeon in flight nurses and specialised physicians, and instead of air ambulance cases and commercial flight cases, The treatment would be started at origin whether it the Royal Thai Air Force and that was the beginning of minimum required training and experience, we now the HEMS were totally different, and we have done is a rural hospital or a primary health centre with no my experience in medical evacuation, treating critically have a fully functional training and education centre, only a small number of civilian cases. My experience cardiologist. Although roadside accident rescue is not wounded soldiers. I was stationed at a fighter air base for special care equipment and HEMS. Our organisation in moving patients in helicopters was from the possible at this time, it may be in the near future. the first three years and was fascinated by medicine and aviation. I was later trained as a flight surgeon with USAF. What is the nature of wider HEMS I knew then that the way of life as an aviation medicine My experience in moving patients in helicopters services in Thailand today? How many doctor was not like your ordinary hospital doctor. It was was from the military, so we decided to follow the other helicopters operate HEMS services in 1999, whilst I was working evenings as a part-time GP in the country? at the International Medical Service of Bangkok Hospital, guidelines recommended by EURAMI to ensure we In Thailand, this type of helicopter service had been when the hospital director offered me a full-time position limited to the police and military as the internal with the mission of setting up a medevac unit. had internationally recognised standards. security laws are very strict. We are working towards overcoming those barriers of understanding, and due military, so we decided to follow the guidelines to the Thai authority’s compassionate outlook on recommended by EURAMI to ensure we had people who are suffering and its recognition that lives internationally recognised standards. Shane Brooks, are on the line, they agreed to support our efforts. our medevac operation manager, was assigned to With their support we were able to cut down the process the accreditation that kept us on our toes. time of response from a seven-day-flight plan to a When we actually received accreditation, I realised 15-minute approval. that we had become a much more international operation. The Bangkok Hospital Aviation Medicine Did you find the recent ITIC event in Department and HEMS service that is now certified Budapest useful and productive from a by EURAMI may have increased the trust of insurers business perspective? and clients due to the quality commitment and high The ITIC was worthwhile from both a business safety standards. We understand it can be hard for networking and educational perspective. And as a companies or clients to know they are making the regional medical hub, I think the choice of Thailand for right decision about aeromedical transportation, but the ITIC Pacific in June 2009 is an excellent one. It will choosing a EURAMI-certified air medical service will also be a great opportunity to share information about make the decision easier. our country’s development and learn new ways to meet the needs of the travel insurance community. Is BMC’s helicopter utilized by international assistance clients? If so, What do you do in your spare time? could you tell us a little more about this? I love to play golf as it gets me outdoors and lets me How else is the HEMS service used? enjoy the pretty, natural scenery. I am lucky if I get Recently we have had a few international assistance in two rounds of golf a month. After the hospital, customers, and we certainly hope to develop this most of my remaining time is spent doing medical side of the business further. Our first HEMS case consultations for Bangkok Airways, for example enabled us to learn what we needed to do to assessing fitness-to-fly via MEDIFs. I also take care of improve our clients’ satisfaction. Resultantly, we the aircrew for Thai Airways International. improved templates for flight missions and improved our written standard operating procedures and What motivates you, and do you have a manuals, amongst other things; and we now have guiding philosophy? proper alarm codes, which we can activate and In Buddhism, there are many pathways to end all handle in seconds. Since we are the first dedicated of your suffering. Making good merit or doing good HEMS provider in Thailand, even the Thai Civil deeds will put you on the right path toward your Aviation Authority uses our knowledge to keep goal. So I go on in life trying to help other human themselves updated on operations. beings in every way possible to get these merits. To Our helicopter always takes off with two pilots and a help another person who is suffering from an illness/ team of one doctor and one nurse. It is fully prepared accident, or to be part of the process of getting them with all the critical care equipment fixed to the wall, to proper treatment, not only brings me merit but such as an oxygen supply ventilator, 12-lead ECG also provides me with the satisfaction of a successful monitor with external defibrillator and pacemaker, medevac mission or repatriation. The smiling, happy infusion and syringe pumps, suction pumps, and BP, and appreciative faces of the patients who have been pulse, oxygen saturation and capnometer. It is like we through such traumatic events are worth more than are bringing the ICU to the patient. If we know the any monetary gratification.

International Travel Insurance Journal IPMI NEWS 37

Worries over critical Struggling US hospitals focus on international patients illness American hospitals have taken a tough knock and deductibles. In addition, hospitals benefit in recent times. Jose Quesada sees inbound financially because reimbursement rates from these A recent survey by HSBC Insurance has found that medical tourism as one way for American commercial payers are usually higher than from more people in Hong Kong are worried about falling hospitals to make money again government-sponsored plans. ill than they are about job security and investment For many years, the US has been a leading losses, despite the economic gloom that is pervasive in The current economic crisis is affecting US destination for medical tourism, with hospitals many markets around the world. The survey showed hospitals on many different fronts, from a and physicians alike perceived worldwide to that 59 per cent of people in the region are most reduction in patient volumes to an increase in provide outstanding medical care with state-of- concerned about getting cancer or some other type of bad debt producing a negative effect on financial the-art technology. Regardless of stringent travel critical illness, while 38 per cent are most concerned results. Last year, according to Moody’s Investors requirements in recent years, patients continue to about their jobs, 21 per cent about investment woes Service, not-for-profit hospitals received 27 credit travel from all over the world looking for the best and 19 per cent say they are most concerned about upgrades versus 53 credit downgrades; this is the care at top hospitals for complex medical conditions accumulating sufficient income for retirement. largest number of downgrades since 2001. such as cancer, trauma, diabetes and cardiovascular Managing director of Insurance Business for Hong The rise in unemployment has worsened an problems. This trend will continue in the future; Kong at HSBC Jason Sadler commented on the already delicate situation regarding uninsured it might slow down under the current economic survey’s results: “Hong Kong people are clearly patients; from December 2008 to March 2009, climate, but it will definitely gain strength again once concerned about loss of health and the devastating more than 2.7 million people lost their jobs growth recovers. impact a major illness can have on them. What used bringing the total number of job losses to 5.3 International patients require a portfolio of logistic to be people’s worst case scenarios – critical illness, million in the last twelve months. Resultantly, it services while travelling abroad for medical care. losing a job and a lack of a financial safety net – are is estimated that the number of uninsured has Hospitals must have well-trained personnel to assist increasingly becoming a reality for many Hong Kong increased by 3.7 million in the last year alone, with visas, hotels, transportation and translation people … forcing them to recognise the importance surpassing more than 50 million or 16.7 per services. They should also provide timely access of planning for life’s unthinkable events.” cent of the total US population. Uninsured patients Tapping potential to physicians during scheduling appointments and When asked what action they had taken to mitigate delay elective medical care therefore misusing Inbound medical tourism, and the treatment of procedures. Similar services need to be provided for such worries, respondents to the survey showed a emergency rooms, which are costlier to operate. In foreign tourists, accounts for approximately $5 travellers on vacation or business who get injured or penchant for insurance. Sixty-seven per cent said they addition, these patients are unable to pay for care or billion dollars or 400,000 patients a year in the sick and require emergency medical services. had purchased a life insurance policy, 64 per cent had are covered by Medicaid or other public programs US, according to the Deloitte Center for Health US hospitals are well positioned to manage complex bought medical or critical illness cover, while 39 per designed for low income populations, increasing the Solutions. This represents an opportunity for US chronic medical conditions while providing excellent cent had saved more in the bank. Sadler added: “This financial burden on hospitals. A survey conducted in hospitals to diversify revenue; usually hospitals customer service; their international departments new focus on protection, March 2009 by the American Hospital Association with dedicated international centres generate five play a critical role in coordinating concierge, medical which had been derailed reported that 58 per cent of hospitals have seen to 10 per cent of total revenue from international and financial services for these patients. International by recent years’ market an increase in emergency department visits; it also patients, who come mainly from Latin America, the insurance products to access US healthcare providers exuberance, is important reported a 70-per-cent rise in uncompensated Caribbean, Europe and the Middle East. Some are are becoming an important feature for global not only as a short-term care as a percentage of total gross revenues. Thus, cash paying patients, usually wealthy people travelling insurers, with companies such as BUPA offering such response to the current during the calendar year 2009, US hospitals will have to US looking for high-tech care, but patients a product in several countries. Furthermore, strategic crisis, but as part of a long- lower revenues due to a shift from private payers with international insurance products represent relationships with international insurance companies, term financial planning to Medicaid for elective admissions and procedures the largest inbound group. The policies held by third party administrators and cost containment strategy.” and higher bad debt expense as a result of increased this sector generally cover most of the medical companies will boost revenues and contribute uncompensated and charity care. care they receive except for normal copayments positively to the bottom line of US hospitals.

AAR teams with Indian insurers ask for uniform charges The Business Standard of India has reported that the In related news, The Economic Times InterGlobal country’s General Insurance Council (GIC), which has reported that the health insurance InterGlobal Insurance Company has teamed up with represents non-life insurers, has asked that the industry increased in capacity by Uganda-based African Air Rescue to offer people Insurance Regulatory and Development Authority around 30 per cent year-on-year, in the region international health insurance. Mark (IRDA) regulate hospital charges. The newspaper thanks to a heightened awareness of Ochola, general manager for AAR, noted: “The Health reported that Mr G. Srinivasan, chairman and such products among the population Platinum Plan targets locals, expatriates and will be managing director of United India Insurance and and steadily increasing healthcare extended to the whole of the East African region.” The member of the GIC, feels that price regulation of costs. Hopes for the future of the scheme will be administered by InterGlobal, and will hospitals is necessary due to an absence of uniformity, sector remain high, with Antony Jacob, allow members to visit any public or private hospital which has meant the health portfolios of general chief executive of Apollo DKV, saying in the region and receive medical care without paying insurance companies are suffering. IRDA has recently that he predicts the business will grow any fees upfront. Ochola also noted that the scheme been investigating the performance and role of by between 30 and 40 per cent over would offer cover for a wide range of both in- and third-party administrators (TPAs) in the Indian health the course of the next financial year. out-patient procedures, including chronic medical insurance sector, with a report on the issue due out Despite the increased awareness conditions and terminal illness benefits, depending on soon. Industry experts have said that the expectation among the Indian population about low at just two per cent, so opportunities still abound the type of plan chosen. is regulation of TPAs as well. health insurance products, penetration remains very for the sector.

www.itij.co.uk 38 IPMI NEWS

Parkway Health launches all-in-one care South Korea seizes Opportunity knocks

One of Asia’s largest private healthcare companies, with 100-per-cent certainty that their hospital bill will opportunity in Australia Parkway Health, has recently unveiled a series of be what they expect (barring complications). The fi xed-price, all-in-one healthcare packages that cover price guarantee can be used only at those Parkway The Korean Tourism Organisation and Council for A golden opportunity seems to be arising for various surgical procedures. The announcement was hospitals that have received accreditation from Joint Korean Medicine Overseas Promotion have together providers of international private medical insurance Commission International recently launched a trial tour for cosmetic surgery (IPMI), as expatriates in Australia are hit hard by – East Shore Hospital, travellers from China through six Chinese travel increases to their ordinary private medical insurance Gleneagles Hospital and agencies, and have also recently sent a delegation premiums. Around 6,000 Britons reside in Australia, Mount Elizabeth Hospital, all to Tokyo in order to promote the country as a all of whom are required, as part of the conditions of which are in Singapore. destination for Japanese medical travellers. In order of their residency, not to become a burden on the The packages offer cover for to facilitate the country’s plans to offer healthcare state, meaning PMI is obligatory. However, thanks areas such as cardiology, ENT to 50,000 foreigners in 2009, 44 major hospitals, to swift rises in the price of cover, it is believed that surgery, gastroenterology, including Seoul National University Hospital, some expatriates are being forced to return to their obstetrics and gynaecology. Samsung Medical Centre, Asian Medical Centre countries of origin. Dr Lim explained: “The 34 and Yonsei Severance Hospital, have all agreed they Most expats present in Australia have a 410 visa, new healthcare packages will reserve fi ve per cent of their bed allocation for which allows the holder to own property, travel are arguably the most foreign patients. freely in and out of Australia and work for a inclusive and comprehensive Previously, hospitals and clinics in South Korea have maximum of 20 hours per week. Such visas are also to be offered to date by a been banned from directly advertising their services known as temporary residence permits, but many healthcare provider. These to potential patients, but following a change in the people with this type of visa only hold it because they fi xed-price packages include law on 1 May, many state-licensed facilities are could not meet the requirements of the permanent Gleneagles Hospital all costs relating to inpatient seeking to augment their revenues through attracting residency visa, which requires that 50 per cent of a made at the organisation’s Gleneagles Hospital in care, such as hospitalisation, nursing care, facility more patients from foreign climes, in particular couple’s children must settle in Australia. According Singapore, which is one of the hospitals where clients charges and doctors’ fees.” He went on to say that from China, Japan, Russia and Mongolia. Last year, to the vice-president of the British Expat Retirees can take advantage of the new packages on offer. the packages have been developed in response to fi gures showed that some 34 per cent of foreign in Australia (Beria) group, this is a sticking point as According to Dr Lim Cheok Peng, executive vice- the global recession: “These are tough times. We patients treated in South Korea came from the US, those on 410 visas pay much higher premiums for chairman, managing director, group president and hope that with these all-in-one packages, both local but it is hoped that an agreement with a large airline their health insurance than a permanent resident. CEO of Parkway Holdings, there are now more than and foreign patients will be encouraged not to delay company, Asiana Airlines, will bring more customers John Wittering told a national newspaper: “We feel 25 fi xed-price packages on offer to provide patients or put off much needed surgery.” from in and around Asia. as if we’re aliens in limbo. The only health insurance The moves and plans for the promotion of South we’re eligible for is visitors’ cover, which is almost Korean medical tourism have their detractors, with twice as expensive as residents’ cover.” some in the industry pointing out that there are still Further complicating the issue is the fact that many obstacles to residents’ healthcare Direct fl ights could increase patient numbers overcome before premiums are controlled by Following the launch of a daily fl ight between Texas number of Qataris have already undergone treatment the project is the government, but visitors’ and Qatar, Texas Medical Center (TMC) has said it is in the US, a fact confi rmed by an offi cial from the deemed a success premiums are not. Unhappy expecting even more patients from the Middle East nation Medical Center. Rosanna Moreno, TMC international – not least of which with the current arrangement, to seek treatment in the US. The fi rst fl ight took place on affairs advisory council chair, added: “TMC caters is the language Beria is to petition the 30 March and carried two patients to America for medical annually to over 14,000 international patients, barrier, as few government, asking it to give care, with another patient fl own out the following day. predominantly from the Gulf. We have [now] started medical staff speak long-term 410 visa holders Akbar al-Baker, CEO of Qatar Airways, noted that a receiving patients from Qatar.” fl uent English. permanent residential status.

IPMI SERVICE DIRECTORY

MedSave USA Expatriate Healthcare Karen Ann Bagni – Director of Operations & Customer Relations Lee Gerry – Healthcare Manager

390 Rabro Drive, Hauppage, NY 11788, USA 46-48 East Smithfield, London E1W 1AW, UNITED KINGDOM

tel: + 1 631 780 5006 email: [email protected] tel: +44 (0)870 428 5140 email: [email protected] INSURER fax: + 1 516 622 1742 website: www. medsaveusa.com fax: +44 (0)870 428 5141 website: www.expatriatehealthcare.com

Star Healthcare Baptist Health International Gigi Galen – President Yohandra Fuentes – Finance Manager 850 7th Avenue, Suite 803, New York, 10019, USA Suite 601-E, 8940 North Kendall Drive, Miami, FL 33176, USA

tel: + 1 212 581 8228 email: [email protected] tel: + 1 786 596 2373 email: [email protected] COST CONTAINMENT fax: + 1 212 581 8272 website: www.starhealthcarenet.com fax: + 1 786 596 5979 website: www.baptisthealth.net/international

Alliance International Medical Services Jackson Memorial Hospital International Bernadette Bretton – Managing Director Mario Mendez – MD - EVP/Managing Director Jackson Medical Towers, East Tower, Suite 829, Private Bag X5, Benmore Gardens, 2010, Johannesburg, SOUTH AFRICA 1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA PRIVATE HOSPITALS PRIVATE tel: + 27 11 245 5777 email: [email protected] 24hr tel: + 1 305 355 1212 email: [email protected] fax: + 27 11 783 9277 website: www.aims.org.za tel: + 1 305 355 5544 website: www.jmhi.org

Interhealth Technologies University of Miami Health System Kevin Thomas – Director - International Jose Quesada – Director of Finance & Operations P O Box 3058, Bedfordview, 2008, SOUTH AFRICA 1099 N.W. 14th Street, Miami, Florida 33136, USA

tel: + 27 11 622 8010 email: [email protected] tel: + 1 305 243 9100 email: fax: + 27 11 622 8264 website: www.interhealth.net fax: + 1 305 243 9101 website: www.uhealthinternational.com

Dr. Colin Plotkin Consulting CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Dr Colin Plotkin – Managing Director AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER 27-3088 Francis Road, Richmond, British Columbia, V7C 5V9, CANADA AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE tel: + 1 604 241 9677 email: [email protected] CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS fax: + 1 604 241 0733 website: www.plotkinconsulting.com COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES

International Travel Insurance Journal IPMI NEWS 39

Patent filed to fuse Military fails to ask for reimbursement tourism and insurance The US Pentagon is failing to bill American International were civilian contractors, creating a burden for staff that civilian contractors, resulting in delays of treatment. Group (AIG) for the medical care it is providing to should be treating wounded soldiers. The US Department of Defense is clear in its MRI Limited, a knowledge process outsourcing private contract workers in Iraq and Afghanistan. Following the publication of the report, US Senator statement that defence contractors should ‘ensure’ company, has recently branched out into the fields There are hundreds of thousands of civilians present Bernard Sanders has called on Senator Edward that the government is reimbursed for any medical of medical tourism and insurance. The firm has filed in the war zones, and when they are injured on the Kennedy, chairman of the Senate Committee on care that is given to contract workers in war zones. a patent with the US Patent & Trademark Office job, the medical care they receive should be paid for Health, Education, Labour and Pensions, to look at ‘the However, the report from the inspector general found (USPTO) for technology that enables the integration by insurers as part of the insurance purchased by the very costly and damaging problems that have resulted that there is no one agency responsible for carrying of a health insurance policy includes cover for government for workers employed by private contract from the inadequate oversight of billions of dollars’ out enforcement of the policy and, as a result, the medical tourism, which has been dubbed Offsurance. companies. However, an audit by the Pentagon’s that has been paid to AIG and other insurers over Pentagon is paying twice for the medical care of such Offsurance, says the company, incorporates a novel inspector general has concluded that the military is the years for medical cover for civilian contractors. It personnel – once through the insurance premiums method of underwriting and implementing low failing to demand fair compensation from AIG, CNA was discovered in 2008 that the insurance companies and again as it fails to bill the insurers for provision premium health insurance policies. According to the and others for the care it is giving to private individuals, involved charged the US government $1.5 billion of care. Due to a lack of record keeping, the report firm’s CEO, Dr Fazal Raheman, Offsurance is a ‘path- rather than the soldiers they are supposed to treat. in premiums and paid out $900 million in costs. A has stated it is impossible to know the true cost the breaking technology that can potentially reduce the US In one example cited by the report, it is said that at subsequent investigation by the Los Angeles Times, ABC situation has caused to the government, but it was healthcare expense by over 50 per cent’. He added: Bagram Air Base in Afghanistan, one third of people News and ProPublica found that insurers responsible noted that since the start of the wars, more than “There is absolutely no intellectual property precedence who were given treatment by army medical personnel for such cover routinely denied claims from injured 31,000 private contractors have filed injury claims. in this exponentially growing segment of insurance.” Regarding the predicted timeline for the new product, Raheman said: “Because Offsurance is the first and only pending patent, we target the grant of the patent within the next six to nine months under the USPTO’s new accelerated examination programme. With the speed with which we have developed the technology, we are quite confident of achieving our targets, not only of the timely grant of the US patent, but closing strategic alliance deals with corporate partners and investors for the product launch.” The aim of the product is to offer benefits to members of typical US health insurance plans that do not offer out-of-country care through reduced premiums – they would pay a low premium rate for the insurance, which would then cover them for both elective and essential surgery abroad. For foreign speciality hospitals, the benefits would be the provision of a steady stream of patients and guaranteed fees. However, MRI Limited must find potential investors and corporate partners with whom they can develop the project, before the predicted October 2009 launch date. Offsurance is a joint venture between UK-based MRI Limited and MRI FZE, a technology development and consulting firm based in Dubai.

Singapore doctor search site launched

The Singapore Tourism Board (STB), in collaboration with MedicaView International, Inc., has announced the launch of a new website offering information on Singapore as a destination for medical tourism travellers. Aimed in particular at American medical tourists, the site offers users a streamlined process to help them find, compare and choose medical providers in Singapore. John Linss, president and CEO of MedicaView International, said the number of US citizens expressing interest in medical care abroad is steadily increasing, but it is still hard for them to find all the information they require in one place. The site offers users a simple form to select doctors or hospitals in Singapore, based on the medical procedure required. Also available is information on accreditation of the facility and doctors’ credentials, along with the option of requesting a price estimate. In addition, the site offers a continuity of care programme that offers links between doctors in the US and doctors in Singapore to provide for electronic medical records to be accessible to both. Travel insurance that includes cover for surgical complications and the flights over to Singapore can also all be organised through the same website.

www.itij.co.uk 40 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Air Ambulance International ) Air Ambulance Worldwide Inc. Mr Peter Veazey – CEO Mark Jones – President P.O. Box 1044, Magnolia. Texas 77353, USA 35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA

tel: +1 832 934 2390 email: [email protected] tel: +1 727 781 1198 email: [email protected] (AFRICA) fax: +1 832 934 2395 website: www.airambulanceinternational.com fax: +1 727 786 0897 website: www.airambulanceworldwide.com

Air Ambulance Network CareFlight International AUSTRALASIA Kirk Pacheco – President ( Colin Robshaw – Co-ordinator AIR AMBULANCE AIR AMBULANCE 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA

24hr tel: + 1 727 934 3999 email: [email protected] tel: +61 1300 655 855 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +61 2 4751 2995 website: www.careflight.org

Air Ambulance Worldwide Inc. European Air Ambulance Mark Jones – President Patrick Schomaker – Director Sales & Marketing 35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA 175A, rue de Cessange, L-1321, LUXEMBOURG

tel: +1 727 781 1198 email: [email protected] 24hr tel: +49 711 7007 7007 email: [email protected] fax: +1 727 786 0897 website: www.airambulanceworldwide.com fax: +49 711 7007 7009 website: www.air-ambulance.com

AMREF Flying Doctor Service Goodmans Rescue 24 Hrs Ground & Air Ambulances Dr Bettina Vadera – Medical Director Dr Satish K Bhardwaj – Director Wilson Airport, LangataRoad, PO Box 18617, Nairobi, KENYA M-2 Greater Kailash-Part 1, New Delhi 110048, INDIA

tel: +254 20 600 090 email: [email protected] tel: +91 11 2923 1665 email: [email protected] fax: +254 20 344 170 website: www.amref.org fax: +91 11 2923 4665 website: www.goodmansrescue.com

European Air Ambulance Hope Ambulance Service Patrick Schomaker – Director Sales & Marketing Dr Charles Johnson – Medical Director 175A, rue de Cessange, L-1321, LUXEMBOURG 56 Upavon Road, Singapore 507745, SINGAPORE

24hr tel: +49 711 7007 7007 email: [email protected] tel: +65 6100 1911 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +65 6400 5254 website: www.hopeambulance.com

JET ICU JET ICU Mike Honeycutt – Vice President Mike Honeycutt – Vice President 17076 Helicopter Drive, Brooksville, FL 34604, USA 17076 Helicopter Drive, Brooksville, FL 34604, USA

tel: +1 352 796 2540 email: [email protected] tel: +1 352 796 2540 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com fax: +1 352 796 2549 website: www.jeticu.com

Netcare 911 Aeromedical Medical Wings Wayne Thomson – Flight Operations Manager Dr Sommart Somsiri – Medical Director 222 Room 3259, Donmuang Int Airport Moo 10, Viphavadee-Rangsit Rd, Sikan, Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA Don Muang, Bangkok 10210, THAILAND tel: +27 10 209 8387 email: [email protected] tel: +662 247 3392 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +662 535 4355 website: www.medicalwings.com

Skyservice Air Ambulance Mediflight David Ewing – VP International Market Development Chris Craft – Operations Manager YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, AUSTRALIA CANADA tel: +1 514 497 7000 email: [email protected] tel: +61 8 8378 6938 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +61 8 8423 3077 website: www.mediflight.com.au

) Air Ambulance International Ozevac Mr Peter Veazey – CEO Anne Mordey – Operations Manager P.O. Box 1044, Magnolia. Texas 77353, USA PO Box 299, Hampton, Victoria 3188, AUSTRALIA

tel: +1 832 934 2390 email: [email protected] tel: +61 409 537 333 email: [email protected] fax: +1 832 934 2395 website: www.airambulanceinternational.com fax: website: www.ozevac.com

Air Ambulance Network Skyservice Air Ambulance AUSTRALASIA ( Kirk Pacheco – President David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA CANADA 24hr tel: + 1 727 934 3999 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES South Pacific Air Ambulance Scotty Watson – Managing Director AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE NEW ZEALAND AUSTRALIA SINGAPORE AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER tel: +64 9256 9000 email: [email protected] INTERIOR SPECIALISTS fax: +64 9256 9111 website: www.spaa.co.nz AIRCRAFT PERFORMANCE CRITICAL CARE SOLUTION PATIENT TRANSPORT MEDICAL SCREENING ADAC-Ambulance Service ASSISTANCE FUNERAL DIRECTORS RE-INSURANCE COMPANIES Robert Glueck – Marketing & Sales Director CATASTROPHIC CLAIMS Am Westpark 8, 81373 Munich, GERMANY SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS tel: +49 89 76 76 52 85 email: [email protected]

WEB & DESIGN (EUROPE) COST CONTAINMENT HOSPITALS SERVICES 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 41

) Air Ambulance International ) JET ICU Mr Peter Veazey – CEO Mike Honeycutt – Vice President P.O. Box 1044, Magnolia. Texas 77353, USA 17076 Helicopter Drive, Brooksville, FL 34604, USA

tel: +1 832 934 2390 email: [email protected] tel: +1 352 796 2540 email: [email protected] EUROPE EUROPE

( fax: +1 832 934 2395 website: www.airambulanceinternational.com ( fax: +1 352 796 2549 website: www.jeticu.com

Air Ambulance Network Mayoral Executive Jet Kirk Pacheco – President Paulo Vassar – Commercial Director AIR AMBULANCE AIR AMBULANCE 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA Dominguez Toledo S.A., 118 La Orotava, Malaga 29006, SPAIN

24hr tel: + 1 727 934 3999 email: [email protected] tel: +34 952 048 609 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +34 924 048 612 website: www.mayoralexecutivejet.com

Air Ambulance Worldwide Inc. Med Call GmbH Mark Jones – President Michael Diefenbach – CEO 35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA Black and Decker Str. 1-3, 65510, Idstein, GERMANY

tel: +1 727 781 1198 email: [email protected] tel: +49 61 2695 3708-0 email: [email protected] fax: +1 727 786 0897 website: www.airambulanceworldwide.com fax: +49 61 2695 3708-11 website: www.medcallgmbh.com

Air Medical Ltd Medic’Air International Glenn Salt – Flight Operations Manager Dr Herve Raffin – General Manager Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE

tel: +44 1865 842 887 email: [email protected] tel: +33 141 72 1414 email: [email protected] tel: +44 1865 370 642 website: www.airmed.co.uk fax: +33 148 57 1010 website: www.medic-air.com

AirMed International LLC Skyservice Air Ambulance Jeffrey T Tolbert – President David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA CANADA tel: +1 205 443 4840 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: +1 205 443 4841 website: www.airmed.com fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

Augsburg Air Ambulance Swiss Air Ambulance / REGA Roland Schoberth – Director Walter Stunzi – PR / Marketing Manager Roseggerstr 17, D-86368, Gersthofen, GERMANY PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND

tel: +49 821 299 1020 email: [email protected] tel: +41 333 333 333 email: [email protected] tel: +49 821 299 2030 website: www.ambulanzflugdienst.de fax: +41 44 654 3590 website: www.rega.ch

Euro-flite Air Ambulance Juhani Missonen – Coordinator Helsinki International Airport, PO Box 187, FIN-01531, Vantaa, FINLAND

tel: +358 20510 1900 email: [email protected] fax: +358 20510 1901 website:

European Air Ambulance Patrick Schomaker – Director Sales & Marketing 175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: +49 711 7007 7007 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com

FAI – rent-a-jet AG Volker Lemke – Director Sales & Marketing Flughafenstrasse 100, D-90268 Nuremberg, GERMANY

tel: +49 911 36009 31 email: [email protected] fax: +49 911 36009 59 website: www.rent-a-jet.de

German Red Cross Air Ambulance Service Andreas Speich – Managing Director Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY

tel: +49 228 2300 23 email: [email protected] fax: +49 228 2300 27 website: www.grcairambulance.de

IFRA Dr Christian Steindl – Director Bahnhofplatz 13/5, POB 160, 3500 Krems, AUSTRIA

tel: +43 2732 825 610 email: [email protected] fax: +43 2732 851 01 website: www.ifra.at

Jet Executive International Charter Günter Krahé – Marketing & Sales Mündelheimer Weg 50, D-40472, Düsseldorf, GERMANY “Homebase FRA & MUC” tel: +49 211 602 7775 email: [email protected] fax: +49 211 602 77766 website: www.jetexecutive.com 42 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

) Tyrol Air Ambulance AIMS Jakob Ringler – Managing Director Bernadette Breton – Managing Director PO Box 81, A-6026, Innsbruck Airport, AUSTRIA Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA

tel: +43 512 224 220 email: [email protected] tel: +27 11 245 5777 email: [email protected] (AFRICA) EUROPE

( fax: +43 512 288 888 website: www.taa.at fax: +27 11 783 9277 website: www.aims.org.za

Advanced Paramedic AMREF Flying Doctor Service Stephen J Woodburn – CEO Dr Bettina Vadera – Medical Director AIR AMBULANCE Hangar #18 - Peace River Airport, P.O. Box 7320, Peace River, NEW Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA Alberta T8S 1S9, USA tel: + 1 780 624-4911 email: [email protected] tel: +254 20 600 090 email: [email protected] fax: + 1 780 624-4577 website: www.advancedparamedic.com fax: +254 20 344 170 website: www.amref.org ASSISTANCE COMPANIES ASSISTANCE Aerojet Interhealth Technologies Stuart Hayman – President Kevin Thomas – Director - International

(NORTH AMERICA) 4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: +1 954 730 9300 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +1 954 485 6564 website: www.aero-jet.com fax: +27 11 622 8264 website: www.interhealth.net

Air Ambulance International Netcare 911 International Assistance Mr Peter Veazey – CEO Brenda Durow – International Assistance Manager P.O. Box 1044, Magnolia. Texas 77353, USA Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA

tel: +1 832 934 2390 email: [email protected] tel: +27 10 209 8387 email: [email protected] fax: +1 832 934 2395 website: www.airambulanceinternational.com fax: +27 10 209 8405 website: www.netcare911.co.za

Air Ambulance Network West African Rescue Association Kirk Pacheco – President Florian Zagel – Managing Director 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA Klotey Cresent 6, North Labone, Accra, GHANA

24hr tel: + 1 727 934 3999 email: [email protected] tel: +233 244 312 496/7 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +233 21 781 259 website: www.westafrican-rescue.com

Air Ambulance Professionals, Inc. Asia Medical Assistance India Brian L. Weisz – President Abhijeet Sachdev – Group VP Ft. Lauderdale Executive Airport, 1535 South Perimeter Rd, Hangar 36B Ft. DLF City-ll, M.G Road, New Delhi, Gurgaon 122002, INDIA Lauderdale, Florida 33309, USA tel: +1 954 491 0555 email: [email protected] tel: +91 9899 198 198 email: [email protected] fax: +1 954 491 6114 website: www.airambulanceprof.com fax: +91 2440 147 28 website: www.asiamedassist.org

Air Ambulance Worldwide Inc. Asia Medical Assistance Nepal Mark Jones – President (AUSTRALASIA) Bikash Gurung – General Manager 35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA 35 Pyukha Marg, PO Box 156, Katmandu, NEPAL

tel: +1 727 781 1198 email: [email protected] tel: +977 980 366 4163 email: [email protected] fax: +1 727 786 0897 website: www.airambulanceworldwide.com fax: +911 244 014 728 website: www.asiamedassist.org

AirMed International LLC Asia Medical Assistance Thailand Jeffrey T Tolbert – President Jane Bailey – CEO 50 Soi Sukhumvit, 19 Sukhumvit Road, Klongtoey Nau, Wattana, Bangkok 10110, 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA THAILAND tel: +1 205 443 4840 email: [email protected] tel: +91 9899 198 198 email: [email protected] fax: +1 205 443 4841 website: www.airmed.com fax: +66 225 822 77 website: www.asiamedassist.org

European Air Ambulance Assistance Online Patrick Schomaker – Director Sales & Marketing Bertrand Guichoux – CEO 175A, rue de Cessange, L-1321, LUXEMBOURG Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA

24hr tel: +49 711 7007 7007 email: [email protected] tel: +86 21 6104 9500 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +86 21 6104 9484 website: www.assistanceonline-china.com

JET ICU Customer Care Pty Ltd Mike Honeycutt – Vice President Janine Benson – Operations Manager 17076 Helicopter Drive, Brooksville, FL 34604, USA Level 3, 60 Miller Street, North Sydney 2060, NSW, AUSTRALIA

tel: +1 352 796 2540 email: [email protected] tel: +612 9202 8222 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com fax: +612 9202 8220 website: www.customercare.com.au

Life Flight International Inc. Global Assistance & Healthcare Chris Connor – Operations Mario Babin – Chief Executive Officer Victoria International Airport, Shell Aero Center, 104-1962 Canso Road, Jalan Pattimura, 15 Kebayoran Baru, Jakaita, 12110, INDONESIA North Saanich, British Columbia V8L 5VF, CANADA tel: +1 250 655 1630 email: [email protected] tel: +62 21 725 8115 email: [email protected] fax: +1 250 656 9394 website: www.lifeflight.ca fax: +62 21 725 7961 website: www.global-assistance.net

Skyservice Air Ambulance South Pacific Air Ambulance David Ewing – VP International Market Development Scotty Watson – Managing Director YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, NEW ZEALAND AUSTRALIA SINGAPORE CANADA tel: +1 514 497 7000 email: [email protected] tel: +64 9256 9000 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +64 9256 9111 website: www.spaa.co.nz call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 43

ADAC-Ambulance Service Save Assistance France Robert Glueck – Marketing & Sales Director Franck Molinier – Director of Business Development Am Westpark 8, 81373 Munich, GERMANY 19 rue de Provence, 78310 Maurepas, FRANCE

tel: +49 89 76 76 52 85 email: [email protected] tel: +33 13062 6752 email: [email protected] (EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance 24 tel: +33 13062 1122 website: www.saveassistance.com

ARC Europe SA SOS International

(AUSTRALASIA) Hans Biekmann – Network Director Helle Drager Sandahl – Communications & Marketing Manager Avenue des Olympiades 2, 1140 Brussels, BELGIUM Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: +32 2 706 6660 email: [email protected] tel: +45 7010 5055 email: [email protected] fax: +32 2 706 6601 website: www.arceurope.com fax: +45 7010 5056 website: www.sos.eu ASSISTANCE COMPANIES ASSISTANCE ASSISTANCE COMPANIES ASSISTANCE Assistance Plus ASISTUR Liana Absaliamova – General Manager Emilio Guevara – Managing Director 6th Floor, 19 Zhukov Proezd, Moscow 115054, RUSSIA Prado 208, e/ Colon y Trocadero, Habana Vieja, Ciudad Habana 10100, CUBA

tel: +7 495 748 8735 email: [email protected] tel: +537 8664499 email: [email protected] fax: +7 495 748 8741 website: www.assistplus.ru fax: +537 8668087 website: www.asistur.cu

CNAS CONNEX Assistance Middle East Carole Luisy – Managing Director Lara Helmi – International Network Director 80 rue des alliés, 38100, Grenoble, FRANCE Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE NEW

tel: +33 438 49 83 49 email: [email protected] tel: +97 14 257 82 84 email: [email protected] fax: +33 438 49 83 40 website: www.cnas-assistance.com fax: +97 14 257 82 85 website: www.connexassistance.com

Global Voyager Assistance (MIDDLE EAST) Goral Assistance Costas Danilenko – CEO Marcel Kadoche – International Network & Development Manager PO Box II, 125124 Moscow, RUSSIA Corex House, P.O. Box: 12815, Herzeliya Pituah 46733, ISRAEL

tel: +7 495 775 0999 email: [email protected] tel: +972 9 957 9930 email: [email protected] fax: +7 495 775 0998 website: www.gvassistance.com fax: +972 9 957 9931 website: www.goralassist.com

Global Excel Management Dr Colin Plotkin Consulting Michael Drew – Vice-President Sales Dr Colin Plotkin – Managing Director 73 Queen Street, Sherbrooke, QC J1M 0C9, CANADA 27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA 17548 Deer Isle Circle, Winter Garden, FL 34787 USA tel: +1 866 566 1130 email: [email protected] tel: +1 604 241 9677 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca fax: +1 604 241 0733 website: (AMERICAS) Medex Assistance Corporation To have your company listed in our service directory

Linda McGee – SVP of Sales CATASTROPHIC 8501 LaSalle Road, Suite 200, Baltimore, MD 21286, USA contact the sales department now:

tel: +1 410 453 6300 email: [email protected] CLAIMS SPECIALISTS [email protected] or telephone: +44 (0)117 922 66 00 fax: +1 410 453 6301 website: www.medexassist.com

On Call International AIMS Michael J. Kelly – President & CEO Bernadette Breton – Managing Director One Delaware Drive, Salem, NH 03079, USA Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA

tel: + 888 289 0567 email: [email protected] tel: +27 11 245 5777 email: [email protected] fax: +1 603 328 1770 website: www.oncallinternational.com fax: +27 11 783 9277 website: www.aims.org.za

OneWorld Assist Interhealth Technologies Taka Katsube – Director Assistance & Cost Managment Kevin Thomas – Director - International COST CONTAINT 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: +1 604 303 2113 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +1 604 276 4593 website: www.oneworldassist.com fax: +27 11 622 8264 website: www.interhealth.net

SelectCare Worldwide ChargeCare International Jacques LeTual – Director of Business Development Christiane Burniston – Managing Director #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

tel: +1 416 340 7265 email: [email protected] tel: +44 1865 400 007 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com fax: +44 845 003 9923 website: www.chargecare.co.uk

Cardinal Assistance CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES Alberto C. Chapur – President Av. Cordoba 890 7° piso, (C 1054AAU) Capital Federal, Buenos Aires, AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON ARGENTINA COMMERCIAL AIRLINE tel: +54 11 4129 7514 email: [email protected] AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER fax: +54 11 4328 3822 website: www. cardinalassistance.com INTERIOR SPECIALISTS AIRCRAFT PERFORMANCE CRITICAL CARE MEDICAL SCREENING med con team GmbH SOLUTION PATIENT TRANSPORT ASSISTANCE Michael Weinlich – Managing Director COMPANIES FUNERAL DIRECTORS RE-INSURANCE Gerhard-Kindler-Str.8, 72770 Reutlingen, GERMANY CATASTROPHIC CLAIMS SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS tel: +49 7121 433 660 email: [email protected]

(EUROPE) WEB & DESIGN fax: +49 7121 433 619 website: www.medconteam.com COST CONTAINMENT HOSPITALS SERVICES 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Medical Claims International Spain SelectCare Worldwide Fatima Guillen Grande – Managing Director Jacques LeTual – Director of Business Development C/Ciudad de Aguilas No.2, Local 2A, Madrid 28030, SPAIN #1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: 00 34 913 016 145 email: [email protected] tel: +1 416 340 7265 email: [email protected] fax: 00 34 913 016 160 website: www.mcimanager.com toll free: +1 866 261 6718 website: www.selectcareworldwide.com

Capone & Associates, Inc Star Healthcare Virginia S. Capone – President Gigi Galen – President

(NORTH AMERICA) 100 Springhouse Drive, Suite 103, Collegeville, PA 19426, USA 850 7th Avenue, Suite 803, New York, 10019, USA

COST CONTAINMENT tel: +1.610.831.5580 email: [email protected] tel: + 1 212 581 8228 email: [email protected] fax: +1.610.831.5581 website: www.caponeassociates.com fax: + 1 212 581 8272 website: www.starhealthcarenet.com CLAIMS MANAGEMENT

Global Excel Management Medsave USA Michael Drew – Vice-President Sales Karen Ann Bagni – Director of Operations & Customer Relations 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA 390 Rabro Drive, Hauppauge, NY 11788, USA 17548 Deer Isle Circle, Winter Gdn, FL 34787 USA tel: +1 866 566 1130 email: [email protected] tel: +1 631 780 5006 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca fax: +1 516 622 1742 website: www.medsaveusa.com

Global Medical Management To have your company listed in our service directory Raija Itzchaki – COO 7901 SW 36th Street, Suite 100, Davie, FL 33328, USA contact the sales department now: tel: +1 954 370 6404 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00

fax: +1 954 370 8613 website: www.gmmusa.com CLAIMS SUBROGATION

Medsave USA MedEscort International Karen Ann Bagni – Director of Operations & Customer Relations Craig Poliner – President

390 Rabro Drive, Hauppauge, NY 11788, USA REPAT. 1730 Vultee Street, Allentown, PA 18103, USA

tel: +1 631 780 5006 email: [email protected] US tel: +1 610 791 3111 email: [email protected] fax: +1 516 622 1742 website: www.medsaveusa.com fax: +1 610 791 9189 website: www.medescort.com SPECIALISTS OneWorld Assist Voyageur Aeromedical Travel Taka Katsube – Director Assistance & Cost Managment Marc Lucas – General Manager 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK COMMERCIAL tel: +1 604 303 2113 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected] fax: +1 604 276 4593 website: www.oneworldassist.com fax: +44 (0)117 925 5940 website: www.voyageur.co.uk

SelectCare Worldwide Lufthansa Medical Services Jacques LeTual – Director of Business Development Doris Ehring – Manager Sales & Marketing Lufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Frankfurt/Main, GERMANY tel: +1 416 340 7265 email: [email protected] tel: +49 (0)69690-20904 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com fax: +49 (0)69690-58147 website: www.dlh.de

Star Healthcare ADAC CRITICAL CARE Gigi Galen – President Christoph Ullrich – Director of Purchase / International Network 850 7th Avenue, Suite 803, New York, 10019, USA Am West Park 8, 81373 Munich, GERMANY

tel: + 1 212 581 8228 email: [email protected] tel: +49 89 7676 2912 email: [email protected] fax: + 1 212 581 8272 website: www.starhealthcarenet.com TRANSPORT PATIENT 24hr Alm: +49 89 7676 5005 website: www.adac.de/ambulance

United Health International Funeral Home AURIGA Ltd. Philip Brun – Director of Business Development Helen Pradova – Chief of International Department 15500 New Barn Road, Suite 200, Miami Lakes, FL 33014, USA B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC

tel: +1 305 594 9291 Ext.3312 email: [email protected] tel: +420 724 257 899 email: [email protected] fax: +1 305 594 9201 website: www.hygeia.net fax: +420 416 735 800 website: www.funeral-assistance.cz

Global Assistance & Healthcare Funeralcare International Nathan Hannah – TPA Manager Asia / Pacific Roger Waddington Jalan Pattimura, 15 Kebayoran Baru, Jakaita, 12110, INDONESIA 221 Upper Richmond Road, Putney, London SW15 6SQ, UK

tel: +62 21 725 8115 email: [email protected] FUNERAL DIRECTORS tel: +44 20 8788 5303 email: [email protected] fax: +62 21 725 8951 website: www.global-assistance.net fax: +44 20 8788 2525 website: www.co-operativefuneralcare.co.uk

Global Excel Management Global Networks Funeral Assistance Michael Drew – Vice President of Sales Cristina Almudi – Managing Director 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA 23 Blindmans Lane, Cheshunt, Hertfordshire EN8 9DR, UK 17548 Deer Isle Circle, Winter Gdn, FL 34787 USA tel: +1 866 566 1130 email: [email protected] tel: +44 1992 640 066 email: [email protected]

CLAIMS MANAGEMENT fax: +1 819 566 8335 website: www.globalexcel.ca fax: +44 1992 785 030 website: www.gnfa.info

Interhealth Technologies John Allison Monkhouse Co., Ltd (Thailand) Kevin Thomas – Director - International Apple Kaewprasert – General Manager President Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton P O Box 3058, Bedfordview 2008, SOUTH AFRICA Klongtoey, Bangkok, THAILAND tel: +27 11 622 8010 email: [email protected] tel: +66 2382 5345-7 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +66 81 584 5942 website: www.monkhouse.com.au call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 45

KCH Repatriation Specialists AMREF Flying Doctor Service Emerson De Luca – General Manager Dr Bettina Vadera – Medical Director 83 Westbourne Grove, Bayswater, London W2 4UL, UK Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +44 20 7313 6920 email: [email protected] tel: +254 20 600 090 email: [email protected]

fax: +44 20 7313 6999 website: www. kchrepatriation.com (EUROPE) fax: +254 20 344 170 website: www.amref.org

Rowland Brothers International Voyageur Aeromedical Travel Melanie Walkling – Partner Marc Lucas – General Manager 299-305 Whitehorse Road, West Croydon, Surrey CR0 2HR, UK Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

FUNERAL DIRECTORS tel: +44 20 8684 2324 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected] fax: +44 20 8684 8000 website: www.rowlandbrothersinternational.co.uk fax: +44 (0)117 925 5940 website: www.voyageur.co.uk

Servilusa Air Ambulance Network Vanda Castro – Manager International Department Kirk Pacheco – President Agencias Funerarias SA, International Dept. Rua do Entreposto Industrial, 8-2 Esq, 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA 2610-135 Amadora, PORTUGAL tel: +35 121 470 6300 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected] fax: +35 121 470 6499 website: www.servilusa.pt fax: + 1 727 937 0276 website: www.airambulancenetwork.com

Xanit Hospital de Benalmadena Air Ambulance Worldwide Inc. Dr. Juan Bosco Rodriguez Hurtado – Director Mark Jones – President (NORTH AMERICA)

Camino de Gilabert s/n, Benalmadena, 29630 Malaga, SPAIN AIRLINES COMMERCIAL ON ESCORT MEDICAL 35246 US Highway, 19 North, #210 Palm Harbor, Florida 34684, USA

tel: +34 952 367 190 email: [email protected] tel: +1 727 781 1198 email: [email protected]

(EUROPE) fax: +34 952 367 191 website: www.xanit.net fax: +1 727 786 0897 website: www.airambulanceworldwide.com HOSPITALS HOSPITALS Baptist Health Int. Center of Miami Life Flight International Inc. Yohandra Fuentes – Finance Manager Chris Connor – Operations Victoria International Airport, Viscount Business Center, 103-9800 McDonald Park 8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA Road, Sidney, British Columbia, CANADA tel: +1 786 596 2373 email: [email protected] tel: +1 250 655 1630 email: [email protected]

(AMERICA) fax: +1 786 596 5979 website: www.baptisthealth.net/international fax: +1 250 656 9394 website: www.lifeflight.ca

Integrated Healthcare Services MedEscort International Brenda Escobar - Int. Services Manager Craig Poliner – President 450 E. Las Olas Blvd., Ft. Lauderdale, Fl 33301, USA NEW 1730 Vultee Street, Allentown, PA 18103, USA

tel: + 1 305 222 6750 email: [email protected] tel: +1 610 791 3111 email: [email protected] tel: + 1 305 222 6751 website: www.hcaeastflorida.com fax: +1 610 791 9189 website: www.medescort.com

Jackson Memorial Hospital International AMREF Flying Doctor Service Mario Mendez – MD - EVP/Managing Director Dr Bettina Vadera – Medical Director Jackson Medical Towers, East Tower, Suite 829, Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA 1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA 24hr tel: + 1 305 355 1212 email: [email protected] tel: +254 20 600 090 email: [email protected] tel: + 1 305 355 5544 website: www.jmhi.org MEDICAL fax: +254 20 344 170 website: www.amref.org PROVIDER

University of Miami Health System Travel Screen Jose Quesada M.D., M.B.A. – Director Finance & Operations Sandra Howell – General Manager 1099 N.W. 14th Street, Miami, Florida 33136, USA The Seedbed Centre, Vanguard Way, Shoeburyness, Essex SS3 9QY, UK

tel: +1 305 243 9100 email: [email protected] tel: +44 1702 587 007 email: [email protected] MEDICAL

fax: +1 305 243 9101 website: www.uhealthinternational.com SCREENING fax: +44 1702 584 731 website: www.travelscreen.co.uk

CareFlight International Voyageur Aeromedical Travel Sue Robshaw – Co-ordinator Marc Lucas – General Manager Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK TRAVEL TRAVEL

tel: +61 1300 655 855 email: [email protected] AGENTS tel: +44 (0)117 927 3554 email: [email protected] fax: +61 2 4751 2995 website: www.careflight.org fax: +44 (0)117 925 5940 website: www.voyageur.co.uk

Medical Wings V Creative Design Dr Sommart Somsiri – Medical Director Steve Annette – New Media Director 222 Room 3259, Bangkok Int Airport, Viphavadee-Rangsit Rd, Sikan, Don Muang, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK Bangkok 10210, THAILAND tel: +662 247 3392 email: [email protected] tel: +44 (0)117 929 4636 email: [email protected] fax: +662 535 4355 website: www.medicalwings.com fax: +44 (0)117 925 2040 website: www.vcreativedesign.co.uk ADVERTISING WEB & MEDIA MED. ESCORT ON COMM AIRLINE (AUSTRALASIA) Medic’Air International 每递安国际 CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES Dr Huaqun Gao – Medical Director MEDICAL ESCORT ON 885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA AIR AMBULANCE CLAIMS SUBROGATION COMMERCIAL AIRLINE tel: +86 2163 558289 email: [email protected] AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER fax: +86 2163 558285 website: www.medic-air.com INTERIOR SPECIALISTS AIRCRAFT PERFORMANCE CRITICAL CARE MEDICAL SCREENING Mediflight SOLUTION PATIENT TRANSPORT ASSISTANCE Chris Craft – Operations Manager COMPANIES FUNERAL DIRECTORS RE-INSURANCE Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, AUSTRALIA CATASTROPHIC CLAIMS SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS tel: +61 8 8378 6938 email: [email protected] fax: +61 8 8423 3077 website: www.mediflight.com.au WEB & DESIGN COST CONTAINMENT HOSPITALS SERVICES 46 REGULARS

• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPEVINE • GRA PEVINE GRAPEV INE Letter to the editor Diary Dates 16-18 June Dear Editor, Grapevine International Travel Insurance With reference to your feature in the last issue (ITIJ Conference 100), I agree that the past decade has seen dramatic Mandarin Oriental Bangkok, Thailand changes to our sector and undoubtedly standards TV tips help has used an advertisement that shows a beautiful across the marketplace have improved. In the UK, beach – the problem is that the beach in question 1-4 July both internally and externally, General Insurance backpackers is really in the north of England. A promotional Global Risk Conference Standards Council self regulation and then Financial video for the province, made by PR firm Calder Cardiff University, UK Services Authority statutory regulation have pushed us Three Brits who were Bateman, shows a clip of a boy all to focus on customer outcomes where previously backpacking across Malaysia and girl running through sand 7-9 July the market was perhaps guided by the fact that only had a close call recently, dunes and tall grass on Bamburgh National Conference of Insurance four per cent of customers ‘use’ the product each year. when they become lost in the beach, Northumberland. Legislators However, whilst acknowledging these positives, I am jungle with only memories The anomaly was spotted by a Philadelphia, Pennsylvania, US guarded towards the future because of a potentially of a far-distant television Canadian boat enthusiast who damaging skills gap in terms of talented travel show to help them find their saw the video on the Internet 16-18 July insurance professionals coming through the ranks – way out. Chiara Maddocks, and liked the look of the coastline Independent Insurance Agents most worryingly at the insurer level. her brother Rory, and Rachel Hodson, said they enough to attempt to pinpoint its exact location. Conference For as long as I can remember, the UK travel insurance relied on memories of an episode of Ray Mears’ Following numerous emails to tourism officials in Wisconsin, US market has been driven by a number of notable Survival Guide about how to follow a watercourse Canada, he was told that the beach he wanted insurer figures capable of knowledgeable, stimulating downstream to find a way out of the jungle and was not as accessible as he first thought. 22-23 July debate on the full gambit of industry topics and towards the coastline. Sheelagh Caygill, marketing executive for 3rd Asian Conference on related disciplines. I am unsure that the next 10 The tourists, wearing only shorts and flip flops, Northumberland Tourism, said: “We think it’s quite Microinsurance China years will benefit from the same level of professional were visiting the island of Langkawi when the funny, a landlocked province in Canada presenting expertise cajoling, agitating and provoking the market incident occurred. Having followed a steep trail an image of itself as an island. But Northumberland stakeholders into more innovative, effective solutions. uphill for several hours, they turned back, but Tourism is really thrilled that a picture of a beach 11-13 August Many modern insurers now compartmentalise the found the descent too difficult and abandoned the in our area is being used for the Alberta campaign.” Vermont Captive Insurance guide rope in the search for a better way down. Olga Guthrie, manager of the brand initiative for Association Meeting underwriting role into all sorts of professional sub-sets. Burlington, VA, US Pricing, finance, IT, claims and the dreaded compliance As night fell, the three adventurers took shelter Alberta’s public affairs bureau, said: “This [image all get their say in the underwriting life cycle and a by in a clearing they found using the lights from their of the beach] represents Albertans’ concern for digital cameras. Chiara said: “It was terrifying, the future of the world. There is no attempt 29 August-1 September product of this, in my opinion, has been some chaotic Chartered Property Casualty processes and unfortunately the erosion of the co- we had no food or water and knew we couldn’t to make people think that the place pictured is Underwriters Society Meeting ordinated skill set of the specialist class underwriter. survive for long. We hadn’t told anyone we were actually Alberta.” St Johns, Newfoundland, Canada This is of course only an opinion, and a greatly going on the trail, so no one was searching for simplified one at that. There remain some very us. But Rory remembered watching a Ray Mears 13-16 September effective travel underwriters out there, writing very programme about surviving in the wilderness. Naked ramblers Canadian Risk and Insurance successfully but as I look around there are certainly far That was the turning point that led us to safety.” Management Society fewer of them and those that remain seem limited by When morning came, they followed the course banned St Johns, Newfoundland, Canada colleagues with a fraction of their skill. Everyday my of a stream in the hope they would be led to the Nude tourists have been banned from entering life is punctuated by poor customer outcomes caused coast. After trekking all day and navigating a 50- the small Swiss canton of Appenzell Inner Rhodes 13-16 September by non-underwriters underwriting – normally with the foot waterfall they finally reached a beach. They after residents voted overwhelmingly to impose the International Union of Marine expert looking on shaking their head in disbelief. Over then thought they spotted masts in the water and ban, with a fine of £120 for those who choose to Insurance conference the next decade, we must guard against the demise started to swim towards them (Mears did not ignore it. The local government recommended the Bruges, Belgium of this wonderful, rare underwriting creature as they advise this course of action!), but in fact found the ban after people objected to encountering hikers are the second most important element of our market ‘masts’ were fishing markers. The two girls ended wearing nothing but their socks and boots, which 14-16 September ecosystem … second only to that magnificent beast, up clinging onto rocks in the bay, while the young was unacceptable, according to a statement: “The Argus de l’Assurance the broker! man climbed up on a rock and passed out. They reactions of the population have shown that such Cannes, France Yours sincerely, were all later rescued by a fisherman. appearances over a large area are perceived as Phil Denman thoroughly disturbing and irritating.” A similar move 20-23 September Managing Director – Healix Insurance Services Ltd is expected in the neighbouring canton of Appenzell Society of Insurance Research Canadian province Outer Rhodes. Orlando, Florida, US Dear Mr Denman, German websites that promote nude hiking Thank you for your letter and your observations. borrows UK beach describe the activity as ‘a special experience of 20-23 September Here’s to keeping up standards in the industry. In its latest bid to attract more tourists to the nature, free and healthy’ – not so free if they get National Association of Mutual Sarah Watson region, Alberta, a land-locked Canadian province, caught in Appenzell. Insurance Companies Convention Editor ITIJ • GRAPEVINE G RAPEVINE GRAP EVINE Atlanta, Georgia, US GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE

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

International Travel Insurance Journal ONTHEMOVE 47

JLT expands UK Groupama appoints New CEO for Apollo introduces team key account manager Travel Guard Francis

UK-based JLT Benefit Solutions Ltd (JLT) has The UK’s Groupama AIU Holdings’ Travel Guard unit has named Dean Apollo Medical Holdings has announced the doubled its investment team with a number of key Insurances has chosen Silvey as its new president and chief executive introduction of Kyle W. D. Francis as its new appointments, following the company’s continued Louise Welsh as key officer. Silvey succeeds the company’s founder John executive vice president of business development success in investment. Consultants Vanessa Wakefield account manager for Noel, and joins from Orbitz where he was senior and strategy. Francis has over 10 years experience of Mercer and Nnamdi Odozi of KPMG are two the North East region. vice president and chief operating officer for its in the financial and transactional sectors and served of the names to have joined JLT in its Leeds and This further boost to business and alliance marketing sector. for nine years as member of the Healthcare Services London offices. Groupama’s frontline John Doyle, president of AIU’s property casualty Investment Banking Division of Oppenheimer & Co. Steve Barker, head of investment, employee benefits at account management group, believes that Silvey’s extensive travel and and CIBC World Markets. JLT, said: “In the current economic climate, clients are team will see Louise technology experience, combined with various Warren Hosseinion, chief executive officer of very focused on making the right investment decisions. managing relationships senior management positions within Atlas Travel Apollo Medical Holdings, commented on Francis’s Whether they are changing a scheme or reviewing their with the company’s Technologies, Rosenbluth International, Neon appointment: “Kyle has a long and distinguished Louise Welsh benefits, understanding investment decisions and their brokers from Sheffield Systems and VerticalNet Inc., will take the track record in structuring successful ventures as well repercussions is a key part of the process. These new up to the south of Scotland. organisation to ‘new heights’. Silvey commented: as successfully directing mergers and acquisitions appointments demonstrate our continued success in Louise joins Groupama from RSA – Global Division, “This is an opportunity for me to join a company in the healthcare services industry,” adding “I am investment, both working solely on investment advice where she was responsible for developing a that has established an outstanding reputation in the delighted to add this world-class talent to the senior to clients or as part of larger JLT teams working across panel of brokers in Manchester and Glasgow. She travel industry … I look forward to working with management team.” employee benefits requirements.” commented: “This appointment will allow me to Travel Guard’s first-class management team.” Elsewhere, the company has appointed James Lewis use my knowledge, skills and expertise to the full to as a senior sales consultant working across JLT’s maximise business opportunities and build upon the administration services in London. A former client strong relationships Groupama has already formed Promotion at services director for Aon Consulting, James looks with partner brokers in the North East.” She added: forward to driving this area of business forward, and “Groupama’s steadfast focus on the broker and JCI names Middle Penningtons noted: “JLT already has a well established position in intermediary market was critical to my decision to East MD Penningtons Solicitors has administration [and] whilst 2009 may be a challenging take this role.” announced that Mark Lee, year for clients, this will only serve to highlight the Anne Harrison, regional business development Joint Commission International (JCI) has named Dr specialist in international importance of working with the right administration manager for Groupama said: “We are delighted that Asharf Ismail as managing director of its Middle East travel litigation, has been provider and … will emphasise JLT’s ability and Louise has joined our team … 2009 is going to be office in Dubai, United Arab Emirates. The founder promoted to partner expertise.” a challenging year for brokers but the local expertise of the Egyptian Society for Quality in Healthcare after joining the company Malcolm Reynolds, commercial director at JLT, offered by key account managers like Louise is brings with him a wealth of experience in hospital last October as head of concluded: “I am really pleased to welcome James to designed to provide the support they need – right on accreditation, healthcare quality management, its travel group. Mr Lee, the team. He is a key appointment that will cement their doorstep.” performance improvement and development of who is a member of our position in this market.” human resources, and Karen Timmons, president the Travel and Tourism Mark Lee of JCI, is ‘pleased to have him’ as the leader of Lawyers Association, the the company’s Middle East operations. She said: Association of Personal Injury Lawyers, the British Vanbreda appoints “Dr Ismail’s experience and relationships with key Spanish Lawyers Association and the Pan European De Luca chosen by healthcare leaders in the Middle East will strengthen Organisation of Personal Injury Lawyers, has new head of relations our existing alliances, offer opportunities for new represented clients on cases in over 30 jurisdictions Kenyon partnerships and help bring a foundation for worldwide, advises tour operators on their terms/ Vanbreda International has appointed Joris Smets as improvements in quality and patient safety.” conditions and potential liability to consumers, and Kenyon Repatriation Ltd has announced the the new head of its Provider Relations Department, Dr Ismail has previously served as a consultant on JCI assists travel insurance policyholders in a defendant appointment of Emerson De Luca as general where he will be responsible for managing, accreditation preparation and in this new post he will capacity when required. manager; he has been with the company for over improving and extending the company’s network of represent JCI in the Middle East and India, providing Pennington’s chief executive, David Raine, commented four years working on corporate development in-and-outpatient healthcare providers. expert counsel on performance improvement, on the appointment: “It further strengthens [the firm’s] and social responsibility projects, finance and also Smets will continue to raise the company’s patient safety and JCI accreditation for a variety of travel team and confirms our commitment to extending assisting with repatriations worldwide, including being awareness with in-network and out-of-network healthcare organisations. the range of services that we offer to clients in this field.” involved in the Spanish air disaster of August 2008. providers, while also Emerson has a Masters in Globalisation, has a focusing on optimising managing and counselling background, and speaks its own network by five languages. He has travelled to most parts of adapting it to the needs the world on behalf of the company, giving the firm of various clients. Prior Addition to FirstAssist’s travel team the confidence to assure its clients that the service to this new position, FirstAssist has announced the appointment of Darren and development. it is offering is of the highest standard. Chairman Dr Smets acted as account Jennings to its travel management team. Jennings Jennings’ 15 years as a specialist broker, including positions Barry Albin Dyer has said he is pleased to welcome manager of ExpatPlus, joins the company as its new travel portfolio manager, at Aon, Primary Group and Acumus, has helped cement Emerson to head the team and looks forward to where he was in and is to work alongside the head of travel sales and his place at FirstAssist. Managing director Alistair Hardie challenging new projects that will take the company charge of sales and strategy to continue the company’s growing portfolio. believes the new appointment will ‘further strengthen’ the forward in 2009. Joris Smets distribution. He will also be responsible for product management company’s position in the travel sector.

www.itij.co.uk