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ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS DECEMBER 2009 • ISSUE 107 Educating People Manulife Client non-disclosure is an issue that haunts bags broker travel insurers, but a recent case in the UK has prompted one member of parliament to say that Canadian fi nancial services group Manulife has the duty should be placed on the insurer to ask the purchased Pottruff & Smith Travel Insurance right questions. Mandy Aitchison has the full story Brokers Inc., a leading broker and third-party administrator of travel insurance across the country. A member of parliament (MP) in the UK is asking travel Charlotte Hodgman has the details of the buy out insurance companies to take responsibility for checking that the potential client has given all possible medical With the announcement of the transaction comes information to the insurer, after another case of claim the realisation that Manulife Affi nity Markets has denial based on non-disclosure of medical information become one of the largest providers of travel led to a holidaymaker being stranded in Turkey in insurance services in Canada. intensive care. The case concerns Jean Edwards, who Paul Rooney, president and chief executive offi cer suddenly became ill while on holiday in Bodrum with of Manulife Canada, commented on the purchase: her daughter and son-in-law, and needed life-saving “With this acquisition, we are well positioned to surgery. However, her insurer, EHIC Plus, refused serve even more Canadians to meet their broad the medical claim on the grounds that she had failed range of travel insurance needs. This strengthens to properly declare her existing health complaints our existing travel insurance operations and provides when she bought the policy online. The company, momentum to move our fast-growing Affi nity whose travel insurance is underwritten by the Watkins Markets business segment to higher levels.” Syndicate, said that although she ticked a box to say Meanwhile Gary Pottruff, founder and majority she suffered from heart and breathing conditions and owner of Pottruff & Smith, added: “We are very gave details of her medications, she did not properly pleased to conclude this transaction with Manulife, declare all of her illnesses. which has had a long-standing relationship with Mrs Edwards was treated in a private hospital in our company. This purchase will further develop a Bodrum for six weeks, much of it on a life support dynamic team with the expertise and size to meet machine following continued on page 8 Canadians’ broad travel insurance needs.” Air ambulance in deep water? A critically ill patient was rescued from the sea following that the pilot had been remiss in his fl ight company rules in place that require the aircraft to after the Carefl ight International jet in which preparations, and the Civil Aviation Safety Authority take enough fuel to reach a different airport only if they were fl ying was forced to land in the waters (CASA) in Australia has since said it is considering there are any doubts about whether or not it will around Norfolk Island, Australia. Mandy Aitchison examining Pel-Air’s fl ight planning practices regarding be able to reach its intended destination – the policy reports on the incident ensuring enough fuel is carried on an aircraft to differs from international aviation rules, which state reach an alternative destination. An Australian that aircraft should always carry supplementary fuel. The jet, which was operated by Pel-Air Aviation, was newspaper has also reported that Pel-Air has since Davies then seemed to explain why the plane had scheduled to land at Norfolk Island for refuelling, but tightened its policy concerning fuel, so that it now not been carrying enough fuel for an alternative stop: after several unsuccessful attempts at landing on a requires all planes fl ying to remote islands to carry “One of the factors that we had in mind is quite often fog-bound runway, the pilot Dominic James made enough fuel so that they can reach a different airport these fl ights are urgent, particularly if you’ve got a a controlled landing into the sea off the island. The if they are unable for any reason to land at their critically ill patient. So what we’ve said is that, until we patient, her husband, two members of the medical planned destination. Jim Davies, managing director understand what happened … it doesn’t matter the crew and both pilots evacuated safely and were of Regional Express, Pel-Air’s parent company, told urgency, you must carry enough fuel no matter how rescued by boats launched from the island. The Australian that the fi rm’s current policy did not many extra fuel stops that requires.” Although initially the incident was reported in mandate an alternative destination if the weather In further criticisms of the operator, questions have a positive light, it was suggested in the days conditions were good enough. However, there are been raised about continued on page 8 Manulife’s headquarters 22 NEWS

ITIJ CONTRIBUTORS IN THIS ISSUE

Tatum Anderson is a freelance internation- REGULARS al health and technology business writer with a decade of experience. Her specialist subjects include emerging markets, business, health, News continued 4 and public health policy. She has written for a Editorial comment 8 variety of publications, including The Econo- Company brief 10 mist, Guardian Weekly, Nature, BBC News On- line, Wall Street Journal Europe, New Scientist, Insurance matters 12 Daily Telegraph and the Financial Times. Travel matters 16 Health matters 18 David Craik has been working as a freelance Air ambulance news 20 journalist for the past six years and writes IPMI News 22 for national newspapers and magazines. This Cross-border care 24 includes shifts on the Daily Express City and Service directory 39 Business desk where he covers market reports including the insurance sector. He has expe- Grapevine 46 rience writing news and features on a wide Diary dates 46 range of subjects including insurance, aviation, On the move 47 transport, recruitment, IT, personal fi nance and small business. FEATURES

News analysis: Cancer care 26 High-street insurers are in the spotlight again for their inadequate cover Feature: Is this the future? 28 Outsourcing continues to be the way forward for some companies, but not others – we weigh up the pros and cons Feature: Delhi belly 30 The incidence and cost of travellers’ diarrhoea continues to rise – we evaluate by how much Assistance and Healthcare World Markets: Viva Cuba 32 Medical facilities in Cuba vary widely; but where is best to send a traveller in need?

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

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

4 NEWS

Winter sports Acquisition for Rock Travellers at risk from insurance cutbacks cover warning Rock Insurance has gained its third acquisition within a Post Office Travel Insurance research has found medical advice for their children during their year, after the company added online insurance broker that UK travellers, including those with children, holiday abroad, Post Office travel insurance is also AA Travel Insurance in the UK has voiced its concern 24drtravel.com to its diverse portfolio. 24DrTravel, are not taking out appropriate travel insurance encouraging travellers to take out comprehensive that millions of Britons heading for the snow this which aims to provide in order to save money, placing themselves and travel insurance to protect their family’s health. winter will be doing so without the protection of travellers with reliable their families at risk from unforeseen costs. The The research found that over a quarter of parents travel insurance. With an ever-increasing number health and destination research showed that 23 per cent of travellers have had to deal with a sick youngster on holiday, of severe ski and snowboard accidents, The Good information, believes consider not taking out travel insurance to keep with £666 being the average cost of a medical care Ski Guide, a popular ski magazine in Europe, told its that the move to Rock holiday costs down, despite the fact that increasing claim for children. readers it is ‘vital’ to obtain winter sports cover. will take the company numbers of UK holidaymakers are heading to Ear infections, costing £291 on average, were the Christian Young, chief executive officer of AA “to the next level,” more exotic travel destinations and are opting to most commonly claimed for medical expense, Travel Insurance, said: “We expect an increase in according to brand participate in more adventurous activities. with cuts and scrapes making up for the second- winter sports claims. There’s no doubt that skiing director Tony Sheridan, Related statistics found that 3,000 UK travellers largest number of claims at £258. Commenting and snowboarding are becoming more and more who will be staying were hospitalised last year while they were on the findings, Croft said: “With many household popular; therefore it is inevitable there’ll be more on to oversee the overseas in India, Thailand and Australia, according budgets being squeezed, skimping on travel accidents on the slopes this coming season.” Editor business. Commenting Antony Martin of the magazine John Hill added: “There has been on the merger, he said: steady rise in the number of people choosing skiing “Joining forces with Rock Insurance is a logical move … and snowboarding holidays for the past 10 years I am looking forward to seeing the brand grow in new and this is continuing in spite of the recession. With directions over the coming months.” more people enjoying the sport, the pistes are For Rock Insurance, the recent purchase is a becoming more crowded and, therefore, accidents strategic move that further diversifies the firms are on the increase.” existing portfolio, which includes Rock Insurance Innovation, Supplier Failure Cover, Insurefor.com, MRL Insurance and AIS. “24DrTravel is an exciting addition to the Rock group and a strong brand in its own right,” said Rock’s managing director Antony Martin. “Tony Sheridan has established a loyal customer base since he established the company more than 10 years ago and he will be an invaluable asset to the team,” he added.

to research from the Foreign Commonwealth insurance can seem like an appropriate way of Office. “All travellers should make sure they have saving money on the cost of a holiday. However adequate insurance in place – no matter where … having comprehensive travel insurance is their destination may be,” warned head of Post important [and] parents without travel insurance Office travel insurance Rachel Croft. could face considerable medical bills if their As one in 10 parents surveyed sought professional children fall ill on holiday.”

‘Best buy’ for Insurefor

Insurefor’s Premium annual travel insurance trip policy travel requirements. The insurer was product has been voted as a ‘Best Buy’ by UK particularly recognised for its low-cost policies consumer magazine Which? after the organisation with high offerings, including medical cover at £2 completed an audit of travel insurance providers million, £1,500 cover for lost baggage and £3,000 and policies and found the insurer to be one of cancellation or curtailment cover. the most competitive in the market. The magazine “We’ve always known our products offer good value found that Insurefor was one of the best suppliers for money for all travellers no matter what their age,” of high-quality, low-cost travel insurance that said the company’s managing director Antony Martin, offered a wide range of products, and which who added “this most recent vote of confidence covered all ages for a variety of annual and single from Which? simply proves this.”

UstiA urges cover uptake

The US Travel Insurance Association revealed that 50 per cent of (UStiA) has suggested that, with Medicare recipients may not be impending healthcare reform on the covered abroad at all, and in cases cards, US travellers should evaluate where they are covered, benefits their health insurance policy to see were normally limited to 80 per what out-of-country coverage is cent of the emergency treatment on offer. The suggestion has been cost, with a $250-deductible. prompted by research undertaken Mike Ambrose, president of the by the consumer organisation, which UStiA, has thus urged travellers to showed that the majority of domestic seek alternative cover: “Travellers health insurance plans place strict whose main concern is the and low limits on medical expenses unforeseen possibility of a health that occur out of the US, have high emergency while overseas should deductibles, and do not cover medical consider medical travel or other evacuation. Tellingly, the survey Mike Ambrose types of insurance.” International Travel Insurance Journal NEWS 5

Canadian travellers protected

Canadian Airlines and Canada’s second airlines and those who operate ‘public conveyances’ that travel insurance covers injury, cancellation due to largest online travel site Flightnetwork should make it easier for travellers to re-book their illness or any travel advisories against a destination.” are supporting new H1N1 travel flights, with the purchase of travel insurance being the Budhdeo also mentioned that while it is important guidelines that have been issued by best way to handle H1N1-related trip cancellations, for every traveller to make their own health-related the Public Health Agency of Canada, according to airlines and Flightnetwork. decisions, travel insurance is “available at a fraction of which will allow Canadians to easily Commenting on the matter, Flightnetwork president the cost of your trip [and] it’s the best way to protect re-book travel plans if they get ill with Naman Budhdeo recommended that every Canadian you and your family.” Supporting Budhdeo’s views, the virus. Set out by federal health should invest in travel insurance for any forthcoming director of business development at AMA Travel minister Leona Aglukkaq, the H1N1 trips, since it “remains the best way for consumers to Andrew Hopkins added: “You should always have travel guidelines request that travel companies, protect their financial and health interests considering insurance, and H1N1 is no different than anything else.”

Sainsbury’s winter warning

UK provider Sainsbury’s Finance has warned holidaymakers heading away from home for some winter sunshine that they must buy adequate travel insurance before they leave, after research showed that over 11 million summer holidaymakers did not take out any form of cover. The research, which was undertaken by Sainsbury’s, indicates that those under the age of 34 are the most likely not to buy travel insurance. In the 16-to-24 age group, 39 per cent of respondents said they would not take out insurance for their holidays, while in the 25-to-34 age band the figure stood at 43 per cent. Of those aged between 35 and 44, 32 per cent said they would not take any cover with them, while the 45-to-54 age group was slightly worse with 37 per cent admitting to not taking out cover. For those aged over 55, 36 per cent of respondents said they would not buy travel insurance. According to Sainsbury’s, the most common reason for people not taking out travel insurance was because they felt they did not need it, with just over two million people agreeing with this statement. A further 1.9 million people who did not take out cover said it was due to cost restrictions, which could be a reflection of the financial pressure many families are feeling at the moment. Sam Marrs, travel insurance manager for Sainsbury’s, said of the research: “It is very worrying that many people feel that they do not need travel insurance, as no one can guarantee a hiccup-free holiday. We are

very concerned by our research findings and would strongly urge winter holidaymakers to purchase a good quality policy before they go, as winter breaks, especially those involving skiing and snowboarding, can often lead to more claims than summer vacations.” There were also some disparities in terms of which parts of the UK contain the most daredevils who don’t take out travel insurance, with the highest proportion of non-takers living in the East Midlands, from where an estimated 1.34 million people will travel uninsured this winter. Those most likely to take out insurance live in the north of England, where a mere 28 per cent of the population said they would not take out cover.

www.itij.co.uk 6 NEWS

US industry standard set

New travel insurance policies that pay up to US$1 conceived new product to our customers.” million in medical bills for Americans who become Michael Hartung, chief product development ill or injured overseas are setting an industry officer for HTH Worldwide, said that loopholes standard, according to insurance comparison website such as unexpected co-insurance, deductibles and Squaremouth.com. Chris Harvey, chief executive of sometimes large gaps in coverage under private the Internet-based comparison company, said the medical insurance policies, combined with the fact gap shown between the more traditional medical that Medicare benefits do not extend outside the US, trip benefits and the recent introduction of HTH are among the main reasons that more Americans Worldwide’s TripProtector proves that American are buying specialist travel insurance cover. He added consumers now have access to the ‘vastly improved’ that long-term international travel insurance policies medical protection they have been demanding. designed for professionals on expatriate assignments Extended travel Phuket jet-ski Harvey added: “There’s definitely a growing appetite have always featured higher limits, but this has for this kind of turbo-boosted trip medical coverage, not traditionally been the case for the normal trip policy rise operators covered so we’re thrilled to begin offering such a well- cancellation/interruption benefit policies that make up the majority of the US 1Stop Travel Insurance has reported a 42-per-cent Phuket jet-ski operators are now required by marketplace. increase in the number of travellers taking out the Thai government to sign up for one of According to Harvey, the holiday insurance policies for 35 days or more in two mandatory insurance schemes for their $1-million medical benefit comparison to the same time last year. While there machines. The decision comes after a series on the TripProtector policy is no one specific reason behind the increase, a of claims revealed that tourists were being is a significant leap upwards 1Stop spokesperson commented: “It could well be scammed over jet-ski ‘damage’ by operators, for the market, and is a that people are just becoming more adventurous who demanded large sums of money in strong indicator of a new and looking to branch out further in their travels, in compensation. trend emerging in the US. which case the numbers opting for extended travels Jet-ski operators now have to get one of He added: “For places abroad may continue to rise at the rates we have two compulsory insurance arrangements, like Canada and the UK, experienced over the past 12 months.” provided by public insurance company $1 million in coverage Another speculation is that the current economic Saiwalee Sakornjit of Ayudhya Insurance. is nothing. In America, climate has played a significant part in the extended Under the first policy, a premium of 13,500 products are getting better travel rise, with 2009 graduates opting to travel baht (US$404) per year will insure a jet-ski and better, and this is the before pursuing their chosen career in the presently hirer for up to 40,000 baht of hospital biggest leap we’ve seen in saturated job market and cash-strapped employers’ expenses. For the second policy, a premium medical coverage so far.” methods to secure the best graduates by offering of 9,400 baht a year will insure the hirer for them work opportunities after a 12-month gap, up to 20,000 baht in hospital cover and 50,000 baht perhaps being some of the reasons behind the boost. for damage to the machine. Workers who were made redundant this year and Both polices will provide cover for most outcomes, Insurance protects against quarantine chose to go on an extended career break rather excluding loss, theft, or wear and tear, and the than jump back into the job market, may have also insurer will pay the first 1,000 baht if a claim is made Jim Grace, president and chief executive officer quarantine is provided “by most insurance companies, contributed to the rise. under either insurance scheme. of US online insurer InsureMyTrip has told the some companies provide quarantine benefits only if American public that the only way to protect their you are sick, while others provide benefits if you are holiday investment against possible quarantine not sick but singled out because you were travelling measures for swine flu is to buy travel insurance. with, or near to, someone who is ill.” “Quarantined travellers stand to lose a lot unless Consumers have been becoming more aware they’re properly insured,” said Grace. “The time of the need for travel insurance as a result of the you spend in quarantine means time lost enjoying emergence of swine flu, said Grace: “Over the past your trip, unused hotel reservations, missed pre-paid few months, InsureMyTrip’s customer care centre has planned activities and, possibly, a future one-way been inundated with a host of consumer questions ticket home.” about travel insurance coverage for H1N1 influenza, He warned, though, that travellers must check the including options to cancel trips to areas impacted by small print of their policy because, while coverage for the virus before departure.”

Pickpocket threat

Travellers should be more alert when venturing abroad, according to online provider etravelinsurance, after a survey commissioned on behalf of the company found that 18 per cent of travellers had been subject to pickpocketing whilst away. The 2009 survey, conducted by TripAdvisor, confirmed that pickpockets were drawn to areas with a high concentration of tourists, with Barcelona topping the list of pickpocket hot spots. But, while tourist destinations such as Rome, Prague, Paris and Florence were also found to be prevalent pickpocket areas, all travellers heading away from home are being advised to regard the survey’s findings as a stark warning not to be complacent about the potential threat posed by pickpockets, especially when holidaying in unfamiliar locations. “If you don’t want your holiday to be completely ruined in the event of having something stolen it’s imperative that you buy travel insurance cover whenever you travel,” said a spokesperson for etravelinsurance. “A good insurance policy gives you the reassurance that even in a nightmare situation like having your belongings stolen you will be able to make a claim for your losses,” they added. While travel insurance can offer some reassurance not carrying large quantities of cash or valuables, against the threat of pickpockets, other precautions keeping bags closed and generally being vigilant in that travellers are being advised to take include their surroundings.

International Travel Insurance Journal NEWS 7

NEWSWIRE Top of the class Financial failure demand surges Global rating agency Fitch Ratings has awarded The collapse of budget airlines and other travel is credited to the policy also having no excess charges InsureandGo has seen a 17-per-cent rise Europaeische Reiseversicherung AG (ERV) an Insurer industry failures have prompted a sharp rise in for customers with pre-existing health conditions. in annual travel insurance policies sold in October Financial Strength (IFS) rating of A+ with a stable the uptake of financial protection insurance by Jonathan Buttery, director of Voyager, commented: 2009 compared to October 2008. outlook. According to ERV, the IFS rating reflects holidaymakers in the UK, according to travel “Although the number of UK residents’ visits abroad group support from ERGO and Munich Re and insurance specialist Voyager Insurance. The continued decreased by 13 per cent between August 2008 The UK’s foreign secretary has launched incorporates ERV’s ‘strong market position within collapse of low-cost carriers throughout 2009 and 2009, that still equates to over 61 million trips this year’s delegation to provide medical and the niche of travel insurance’. ERV is a wholly owned has contributed ‘significantly’ to a huge increase in made by UK nationals overseas. So, despite the consular support to British nationals performing the subsidiary of ERGO Insurance Group, which controls demand that Voyager has seen for its WEBroker impact of the downturn on the travel sector, people annual Hajj pilgrimage. The delegation includes the primary insurance operations of Munich Re and travel insurance product, which includes holiday do still want to travel and, due to the industry’s a chief medical adviser, seven doctors and three had a 41.1 per cent market share in the Germany’s financial protection as standard. The product’s difficulties, more and more are seeking protection consular staff. travel insurance market in 2008, said the company. popularity has risen by 87 per cent – part of the rise with financial insurance.”

World First Travel Insurance has advised customers taking short breaks that the purchase of an annual travel insurance policy would be far more economical. The company says some families could save 20 per cent of the cost of several single-trip policies.

A British couple have died while on holiday in Kenya. The Foreign Office said that they died after being attacked during an attempted robbery; two people have been arrested.

Gocompare.com has advised the public that travelling to their second home without insurance could be more dangerous than they thought, indicating that in a worst-case scenario, they could have to sell the holiday home to pay for medical care.

Two British tourists drowned in Spain in October after finishing a night out at the Eastern Spanish resort of Salou with a swim in rough Mediterranean waters. Spanish emergency services said the bodies were recovered within an hour.

UK-based travel failure specialist ProtectMyHoliday.com has warned travellers to be cautious with their festive travel plans over Christmas, as the industry continues to be hit with large losses.

Online travel insurance broker in South Africa TravelInsurance123 has reported that record numbers of travellers are purchasing insurance for their trips. The website offers information about the cover travel insurance offers, as well as the chance to compare quotes.

Luggage cover urged As Christmas approaches and the number of travellers heading off to visit far-flung family members increases, AA Travel Insurance has issued a reminder to travellers about taking out insurance to protect their luggage in case it is lost in transit. The Air Transport Users Council has predicted that up to 70 million bags could be going missing on an annual basis in 2019, based on the predicted number of travellers, but in spite of such statistics, research has shown that there are still plenty of uncovered travellers out there. A spokesman for AA Travel Insurance also warned consumers that the protection offered by airlines is not quite what they would have thought: “Airlines are only required by law to pay a specified minimum amount of compensation for any baggage they lose, regardless of how much the contents might actually be worth.”

www.itij.co.uk 8 NEWS

Warning against Specialist cruise cover ignored

cheap cover With the cruise season in full swing, it has been Other loopholes in ordinary travel insurance policies highlighted that many travellers still do not understand that could catch out the unwary tourist include a lack Travel insurance provider PJ Hayman has warned the importance of taking out the right policy when of cover for cancelled shore excursions or missed UK consumers against opting for a travel insurance they set sail, according to British insurer All Clear and ports due to severe weather, or simply a change As always, November saw the annual gathering policy based solely on its cost, despite price being the Association of British Insurers (ABI). A statement in the itinerary of the ship. And then there is the of the good, the bad and the cost containment the most influential factor for consumers when it on the ABI’s website leaves little doubt as to where increasing risk on cruise ships of contracting some people – this year in Athens, at the ITIC comes to purchasing travel insurance. Research the organisation stands: “Insurance is as important sort of stomach infection, which spreads quickly conference. It’s an awesome sight to watch 500 conducted by the company found that 20 per on a cruise as on any other holiday, especially as among passengers. Blackman said: “There have been people attempt to book and counter book each cent of the 1,300 Brits surveyed said that cost you’re likely to be visiting several different countries, a few cases recently where a number of passengers other for a business meeting. Everything from a was the most important factor when deciding on all of which may have slightly different approaches to have fallen ill while on a cruise, and have had to pre-breakfast meeting (a what?), to a post-dinner which travel insurance policy to purchase, although healthcare and how it’s paid for.” be quarantined in their room for days on end. But and drinks-early-morning meeting (or is that just PJ Hayman advised that cheap cover does not Chris Blackman, head of product development at without a policy that is tailored specifically to a cruise, a ‘persuading the barman to give you another necessarily mean comprehensive cover and that All Clear, added: “A drink’ meeting?). Whatever… it all appeared to travellers should be wary when selecting a policy surprising number of have been a rip roaring success. based purely on its cost. people seem to rely Oh yes, then there’s the case of the Pel-Air air With just 38 per cent of the UK population on the basic medical ambulance flight that ditched in the Pacific just actually reading their travel insurance policy details provision onboard cruise off Norfolk Island, after having run out of fuel. thoroughly, according to the survey, company ships. However, in all but There are all sorts of machinations and questions director Peter Hayman cautioned: “Travellers must fairly minor emergencies, about that, which will be raised elsewhere in ITIJ. ensure their policy cover is comprehensive to avoid this may not be But what really tickled me were the life jackets. having to pay any extra costs in the unlikely event sufficient.” A case in There were only three that were actually put on that anything should go wrong abroad.” point would be if there (although Pel-Air claim there were at least six on The same survey also found that 27 per cent of was a serious accident board).The two medics managed to don them, people were of the belief that those who suffer onboard and a tourist as did the patient’s relative. That, of course, left from a pre-existing medical condition, such as without insurance could need to be airlifted to shore you may never be compensated.” Some passengers the two pilots and the patient without. This is epilepsy, diabetes or high blood pressure, would – at their own expense. According to the company’s who were taken ill onboard a Thomson Spirit cruise the patient whose condition was considered struggle to obtain travel insurance, with the fear of research, around 34 per cent of British holidaymakers in May of this year found that out the hard way, and serious enough to warrant an air ambulance. not being able to get cover prompting 11 per cent do not take out a cruise-specific insurance policy are now facing a potentially lengthy and costly court Treading water (presumably) with the others for of Brits to lie about any pre-existing conditions, even before leaving UK shores. case against the cruise line. 90 minutes: without a life jacket. And can you though travel insurance can be obtained for all the imagine the conversation in the water during that aforementioned conditions. time? The mind boggles. Priceless… “There are common misconceptions surrounding Educating people continued from page 1 Merry Christmas! what conditions you can and cannot travel abroad with,” said Hayman, who reassured the public: an operation to remove a blockage from her bowel. away. We are glad at least that our help enabled the Ian Cameron “The majority of people with a pre-existing medical After six weeks, she was transferred to a state hospital family to get Mrs Edwards home. We would like to Editor-in-Chief condition can obtain travel insurance for their holidays in Istanbul, but reportedly the family has yet to pay the stress that there was no insurance cover.” [email protected] … and we have developed a range of specialist private hospital bill, which is an estimated £100,000. Medical insurer AllClear has also followed the case, policies to ensure they can travel with full cover.” For eight weeks, the Edwards family battled with the and has since warned consumers about the dangers insurer, who eventually made a ‘humanitarian’ payment of taking out low-cost travel insurance cover – Mrs of £30,000 to help with the cost of the repatriation. Edwards paid £38 for her policy from EHIC Plus. Sadly, Mrs Edwards died around 10 hours after being Chris Blackman, head of product development at repatriated to the UK. the insurer, noted: “Cheaper products often mean Following the case was Jim Dobbin, MP, who helped less cover, and policyholders only discover they are in part to raise awareness of the incident. He has now not covered at the point that a claim is made. Budget said that he wants to see changes in travel insurance to policies that rely heavily on the use of European ensure no other families have to endure such hardship. reciprocal agreements can prove to be a false The responsibility of disclosure, he says, should lie with economy, because when people fall ill abroad the the insurer, who knows the common pitfalls in the decision about their care and treatment is often taken policy and should highlight them to consumers. “We out of their hands in the heat of the emergency, want to see the duty to ask the right questions and and this can mean medical costs not covered by the make sure there is complete disclosure going back on insurance or EHIC are left to the patient to settle.” the insurers; we want to see them making sure the Commenting on Dobbin’s intentions to take the up clients understand the deal and the form is completed the case of making insurers responsible for making properly. Sometimes not all the information about sure full disclosure is given, Blackman said: “As Mr policies is easily accessible – I’m talking about the small Dobbin says, complete disclosure to the insurer is print, and this is a major issue.” a must. The problem is often that customers fail to EHIC Plus issued a statement about the incident: “We see the relevance or connection between medical are very sad to hear that Mrs Edwards has passed conditions or simply forget some altogether.”

Air ambulance in deep water? continued from page 1

why the plane continued on its journey when the and to an alternate aerodrome. The alternate island was fogbound; in response, the company said aerodrome must not be located on a remote that the weather forecast had been fine at the time of island.” The website also noted several occurrences departure from Western Samoa, and the crew failed over the years of weather reporting from Norfolk to realise how badly it had deteriorated until after Island not being ‘sufficiently reliable on some they had flown past the point of no return. occasions to prevent pilots from having to carry CASA is currently referring all questions about the out unplanned diversions or holding’. The island’s incident to the Australian Transport Safety Bureau meteorological office is not staffed around the clock, (ATSB), which is investigating the accident and is and pilots were warned by the ATSB: “A delay of interviewing the pilots. A spokesman for CASA one hour or more can exist between a change did say that legal requirements for Australian air occurring in the weather conditions and advice of operators to carry enough fuel to undertake a flight that change reaching the pilot.” A convoluted series safely do exist, and according to the website of the of connections must be made between bad weather ATSB: “In August 1999, Civil Aviation Order 82.0 on the island and reports of that weather reaching was amended to require all charter passenger- an incoming pilot, and it is the pilot’s responsibility carrying flights to Norfolk Island and other remote to request that information before he reaches the islands to carry fuel for the flight to their destination point of no return.

International Travel Insurance Journal NEWS 9

British couple take Kenyan market expands legal action According to those involved in the industry, the insurance, as well as the compulsory aspect of corporates still sending people out for conferences, travel insurance market in Kenya is growing as you have to have it in order to get a visa.” Milne training particularly, which is why we have not seen A British couple whose honeymoon was left in tatters demand for the product is rising among the general said that although he was unable to comment on a fall. If anything, we have seen a growth.” after they were both struck down with a severe population. John Milne, managing director of other insurance companies’ experience, his own He also mentioned that the violence seen in the gastric illness so serious it landed them both in a Heritage Insurance, was quoted in the local press as firm had seen a 50-per-cent rise in the number country, following the elections last year, had affected Turkish hospital, are now to take legal action against saying that insurance companies are now recording of travel insurance policies sold. Sales had been the industry but that, due to ‘the resilience of the tour operator Thomas Cook. Ewan and Leah Gurr a leap in the underwriting of travel insurance policies boosted, at least in part, by the fact that despite Kenyan people’, the industry was able to pick itself up were staying in the Hotel Tuana in Side, near Antalya, as more people move to comply with the global the global economic conditions, people still had again almost immediately. “They [Kenyans] realised when they fell ill a few days after arriving. best practices requirement. to travel, especially for business and, therefore, there was a need to get back to business as soon as Among the problems the couple listed with the hotel He explained: “People are travelling more regularly travel insurance has not become a casualty of possible and I think the private sector had a lot to do were undercooked food, rotting dairy products and a and they recognise the need to have travel the recession. He added: “We’ve seen a lot of with that,” he remarked. variety of animals and insects around the eating area, as well as a swimming pool with dirty water. Travel litigation firm Irwin Mitchell has taken on the case for the couple to investigate their claims. Allegedly, both parties suffered from a severe bout of gastroenteritis as a result of these problems, with symptoms so bad that they were admitted to hospital for three days, running up a £2,000-bill, at which point they ran out of money and stopped receiving treatment. Mrs Gurr commented: “We didn’t even get to speak to our tour rep to complain – she was only there every other day, and when she did come after the symptoms had kicked in, we were already in hospital.”

Take-up rate still low

One in 10 British holidaymakers are still not taking out travel insurance before leaving UK shores, according to a survey of over 2,000 tourists by Opinion Matters. The survey also revealed the types of people least likely to buy insurance for their holiday and women, it would appear, are more likely than men to forego the purchase. Sixty-six per cent of women interviewed said that they do not buy insurance, while 26 per cent of people aged between 35 and 44 – the worst age group – admitted that they did not buy travel cover. However, despite such a casual attitude to travel insurance, 40 per cent of respondents to the survey said they had experienced food poisoning, an accident, a burn or a bacterial infection whilst on holiday. The public was also asked about the reasons why they claimed on their travel insurance, the most frequent responses included treatment for insect bites, skiing injuries and stomach infections. Other slightly less common reasons given were an accident at a railway toilet (sadly, no more details were given about this claim!), a window falling from a building and hitting the insured person, and a helicopter evacuation. Consumers were also questioned about their fraudulent tendencies, with some revealing results. Two per cent of the 2,000 people surveyed admitted dishonestly claiming that they had contracted food poisoning during their stay abroad. Some people, according to Check Safety First, were even ‘boasting’ that they commit travel insurance fraud on a regular basis. Harrington commented: “It is worrying to think that some people think it is okay to make fraudulent claims against hotels. But, unfortunately, we are living in a claims culture where some people will always chase a fast buck.”

www.itij.co.uk 10 COMPANYBRIEF

BIBA includes Variety is the spice of travel financial failure US-based Travel Insured International has introduced a Among the eight available plans, two of the most programme of eight short and long-term international popular so far, according to the company, are medical insurance and life insurance plans, which have the Atlas Travel Series and StudentSecureSM, been geared specifically towards customers travelling designed for students heading abroad for their outside the US for between five days and one year. studies. Other international plans available include In addition, most plans offer options for renewal or CitizenSecure SM, an annually renewable medical extension online. Travel Insured offers the programme insurance plan with optional term-life insurance. in partnership with Indianapolis-based HCC Medical Also on offer is Atlas Professional, which provides Insurance Services, which administers each of the plans international medical insurance for business offered under the programme. travellers who take multiple trips abroad each year. Steve Foulsham Liberty partners The British Insurance Brokers’ Association’s (BIBA) own travel insurance policy, BIBA Protect, has been extended with red24 to protect independent travellers in the UK against the risk of airlines and end suppliers going into liquidation Liberty International Underwriters (LIU), a division of before or while they are travelling. The policy provides the Liberty Mutual Group, has expanded its product protection for travellers who are not currently covered recall crisis management contract with red24, a by the government’s Air Travel Organisers’ Licence global security assistance company, to give brokers (ATOL), which only covers those who have purchased and their clients access to an experienced kidnap, their holiday through an ATOL operator. ransom and extortion (KRE) consulting and response Steve Foulsham, BIBA technical services manager, said: team. As a result of the expanded deal, LIU KRE “In situations such as Sky Europe [an airline that failed policyholders will have access to red24’s services recently], BIBA policyholders would have been able lead by Jack Cloonon, a retired FBI special agent. to claim their lost monies on their travel insurance, so Lou Lubrano, LIU’s senior vice-president of global that they could continue with their arrangements. If crisis management, said: “Around the world, kidnaps the clients were overseas then the policy would have for ransom are becoming increasingly violent and covered their increased cost to return home.” The ransom demands are skyrocketing. With access policy is provided by Tokio Marine Europe Insurance to world-renowned specialist Jack Cloonon as Limited, which itself has entered into partnership with their kidnap and ransom team leader, LIU KRE International Passenger Protection Limited to provide policyholders will have an edge in preventing and the financial failure cover. responding to these frightening trends.”

Five star products ProfitPlus revealed Travel Select on offer Older driver policy

Holidaymakers in the UK who choose Travel Travel Guard recently unveiled ProfitPlus+, a suite Mondial Assistance in the UK has marked its launched Counsellors for travel insurance can now rest of technology solutions for travel agencies that help entry into the employee benefits market with the assured, as both the company’s Premier and agents to select the appropriate travel insurance plan introduction of its Travel Select insurance policy, Older travellers who wish to go on a driving holiday, Premier Plus travel insurance products have received for customers at the point of sale, based on data which allows staff members to select the level of or just drive to their intended destination, are a five-star rating from financial services analyst, heuristics from its patent-pending Factor-Based Pricing cover that meets their individual requirements. Ben now being offered international driving policies by Defaqto. The rating follows the development of the technology. The platform also provides expert-based Smart, sales director in the corporate, travel and online provider Insurance4CarHire. The company new products for Travel Counsellors by Mondial electronic communications to the end user, which health department of Mondial Assistance, said of has recently launched dedicated European and Assistance, which is also the underwriter and is delivered through Travel Guard’s proprietary the new offering: “Through Travel Select, we have Worldwide policies for those aged between 75 administrator of the policies. E-management system. created a complete, one-stop solution, increasing and 85. The company said: “With a large majority Travel Counsellors managing Dean Sivley, chief executive the efficiency and seamless management of overseas of senior citizens travelling on a restricted budget, director Steve Byrne said: officer of Travel Guard, said of assistance and associated sometimes the excess “Working with Mondial the new product: “Throughout repatriation work. Policy insurance charges can Assistance, we designed the past year, our message to cover levels can be adjusted, look extremely scary our travel cover with the our travel agency partners is if required, to meet different in the light of a mishap. Defaqto ratings in mind. This that ‘travel comes first’. We’ve business expectations and However, both Europe meant that we didn’t have focused on ways to help our needs.” and Worldwide policies to make any enhancements partners strategically grow The cover can be tailored to cover excess on damage to reach the high standard their travel business, while include activities such as scuba to the rental vehicle, set by Defaqto, confirming also providing them with the diving, golf and business travel including the roof and our reputation to provide enhanced tools they need to as standard, and also offers staff undercarriage, excess our customers with the best successfully convert more travel the choice of whether or not on theft, and damage to quality products.” insurance sales opportunities.” they have winter sports cover. windows and tyres.”

International Travel Insurance Journal

12 INSURANCEMATTERS

£1.6 million crash Customer service training slashed NEWSWIRE scam man jailed The Institute of Customer Services has issued a cut costs, since there exists more competition for stark warning to organisations, including insurance customers in today’s current climate. A man has been sentenced to jail for four-and-a- organisations, after a 2009 poll found that one in Commenting on the situation, Causon said: “Investing UK-based Prudential is considering a half years, after admitting to playing a key part in three slashed customer service training in a bid to in your people is a key differentiator in business separate listing in Hong Kong or Shanghai in a a £1.6 million ‘crash for cash’ conspiracy at the survive the recession. This ‘slash and burn’ approach today. An organisation that emphasises customer move that could raise capital and underline its UK’s Manchester Crown Court. The court found to cost cutting may damage relationships with service through training and development goes a regional ambitions. The company is conducting Mohammad Patel guilty of causing a minimum of 93 customers at a time when competition is fierce long way to retaining staff – which motivates them a preliminary assessment of the likely benefits of car crashes within three years, each costing insurers and customer satisfaction levels are key to industry to satisfy customers.” With Christmas looming and listing on either bourse. in the region of £17,000, after he admitted to being survival, said the Institute, which found 30 per cent the prediction of a ‘flat Christmas’ Causon added: at the heart of the conspiracy. of the organisations surveyed have cut investment in “Our advice is to embrace a strong customer services In response to the threat of climate change, Twenty-four-year-old Patel was named responsible customer service training. It also found that 21 per culture to keep customers satisfied” Insurance Australia Group has started to make flood for numerous low speed crashes that mainly cent had laid-off customer-facing staff this year. cover an automatic part of its customers’ policies, occurred at roundabouts. It was thanks to the sharp While one in five organisations did increase according to the Sydney Morning Herald. eyes of office workers who overlooked the A34’s investment in customer service and a fifth said that Eden Point roundabout at Chead Hulme in Stockport the recession had no effect on their business plans, American International Group has agreed to – a favoured scam location for Patel – that they were the institute’s chief executive Jo Causon stated that sell its Taiwan life insurance unit to a group led by able to recognise that it was the same person driving it was dangerous to see training as the place to Hong Kong-based Primus Financial Holdings for the lead vehicle each time. The staff then alerted the US$2.15 billion. rear drivers to the fact that they may have been a ‘victim of fraud’. Allianz Taiwan Life Insurance posted a Patel pleaded guilty to one count of conspiracy to Proposed levies on insurance NT$5.06 billion first year premium in September, defraud, six counts of dangerous driving and four and expects this figure to improve over the rest counts of driving whilst disqualified. The conspiracy Hinting at a change of levies on insurance, Australia’s insurance policies in Victoria and New South Wales, of the year in the atmosphere of an improving earned him around £46,000, which funded his Treasure Secretary Dr Ken Henry and his panel are which has led to the increased cost of insurance economy, according to the Taipei Times. luxurious foreign holidays and expensive cars, said planning to look into ways of broadening the states’ and resulted in many people either deferring from prosecuting lawyer William Baker, although the cost revenue base after he described state taxes on insurance purchasing cover or being underinsured. Aviva plc. 92 per cent owner of Delta Lloyd, to the insurance industry was much larger. as ‘highly insufficient’, during a speech on tax reform. Dr While Dr Henry’s panel are looking at ways to is looking to raise upwards of €1 billion by offering Henry said in his speech that the burden of taxes falls broaden the states’ revenue base – including the up to 40 per cent of its shares in the Dutch more heavily on those who are more disenfranchised, possibility to levy their own income, his tax review will company in order to free up capital for other including: “Those who bear risk where they would also consider a plan to give state governments a share possible acquisitions and growth opportunities. prefer to be insured but aren’t because of tax,” and said of income tax/other government revenue, in exchange that new tax reforms were needed to make the tax for the government scrapping taxes on insurance Saudi Arabia’s Al Alamiya Co-operative system simpler, more equitable and more broad-based. sales, car sales, or property conveyance transactions, Insurance Company has successfully completed An example of this is related to the wildfires that for instance. “If it is a meaningful reform, it means that its initial public offering, raising SAR449.2 million have affected the country, whereby Australian prices will change so that people have more incentive (US$120 million) after it was 748 per cent insurers have long argued against the fire services to do things that improve their own lives and those of subscribed. levy that was imposed at state level on home others in the community,” he said. Australia has begun preparing more than 1,000 fire refuges and will recast its national alert system to warn of catastrophic bushfires as the new Regulator puts fire season threatens to be even worse than the one data online seen earlier this year. Prospects for higher insurance penetration in Asia remain positive despite the economic slowdown, according to Tan Sri Dato’ Seri Dr Zeti Akhtar Aziz, governor of the Bank Megara Malaysia.

Gross insurance premiums in the Jordanian market had increased by seven per cent to US$389.4 million by the end of September, compared to $364 million recorded in the same period last year, according to the Insurance Commission of Jordan. Dr. Amarnath Ananthanarayanan

Samples of transaction-level data on motor and health German reinsurer Munich Re has extended insurance are to be published by the Indian Insurance its partnership with Abu Dhabi-based National regulator IRDA in a bid to help insurers price their Health Insurance Company, Daman, until 2019. products appropriately. The regulator has decided to publish the information on its website to facilitate Qatar Financial Centre Regulatory Authority research on non-life insurance, after it discovered that has authorised SEIC Insurance and Reinsurance Co non-life insurance companies who failed to share their LLP and Chedid & Associates Qatar LLC to carry on data were contributing towards underwriting losses. activities in or from the Qatar Financial Centre. Commenting on the publication of this new data, Bharti Axa’s chief executive officer Amarnath Australian insurers have attributed a recent Ananthanarayan said: “Data-sharing will certainly round of price increases for home owners to years improve underwriting,” but also stated that of an unusually high frequency of large natural competition between insurers, which force some disasters, which culminated in this year’s bushfires. insurers to drop prices ‘below the loss ratios’, and ‘discounts on premiums’ are the real cause of the The Insurance Council of Australia has problem. “Profitability has come down by 80 per cent reiterated that economic efficiency and welfare in the last three years for the entire general insurance would be improved if states were to alter their tax industry,” he said, adding: “While premiums have gone mix away from transaction taxes, such as stamp up, claims have gone up at a higher rate, which means duties, and replace them with a more enhanced pricing is not right. Non-life insurance companies are payroll tax system. not doing the right tasks.” IRDA has collected its data from insurers and third-party Lloyd’s of London is examining the amount administrators, although the regulator warned that it of catastrophe-related insurance being taken on by would not be held responsible for any inaccuracies or its members and is likely to ask some to reduce their omissions in the data published: “IRDA is not obliged to exposure or stump up more capital, according to give any clarification on the sample data,” it said. market insiders.

International Travel Insurance Journal INSURANCEMATTERS 13

China to become FAIR prepares insurers for unstable times

‘major peak zone’ Risk management and co-operation were stressed management practices, greater alignment between at this year’s 21st Federation of Afro-Asian Insurers business strategy and risks, and more appreciation by According to specialist insurance provider Lloyd’s of and Reinsurers (FAIR) conference in Malaysia, as key boards and senior managements would be a sound London, China’s expanding economy and increased factors that will help the insurance industry remain way of keeping the industry more stable during these insurance take-up will increase the value of the resilient in facing the uncertainties of the world’s uncertain times. country’s assets that are at risk from natural hazards. economy. The governor of Bank Negara Malaysia Mr Anuar Mohd Hassan, chairman of the 21st FAIR Many insurance experts think that China will become Tan Sri Dato’ Seri Dr Zeti Akhtar Aziz, said at the organising committee, echoed Dr Zeti’s sentiments a major ‘peak zone’ in a matter of years with major conference, which was themed ‘Insurance and as he encouraged FAIR members to be more cities exposed to typhoons and earthquakes. Reinsurance Environment in the Afro-Asian Region in committed to working closely together to face Milan Simic, managing director of AIR Worldwide, the Wake of the Economic and Financial Crisis’ that, potential solvency challenges. “What happens in one said that he felt the two most costly scenarios would while there are significant prospects for growth within region will definitely affect the other region either be a typhoon making landfall in Shanghai or an the insurance industry, solvency and its influences on directly or indirectly,” he said, adding: “The thinking earthquake impacting Beijing. Flooding, he felt, is countries like Malaysia is a challenge that needs to be and working in the regional spirit would create the least costly peril from an insurance perspective reinforced. She proposed that improvements in risk mutual benefit to everyone.” as it mainly affects rural areas. He said: “If insurance Andrew Moss penetration were to increase in Asia and specifically in China, you could easily see the country becoming India sees new Sompo-Nipponkoa Aviva remains a peak zone for many insurance and reinsurance companies.” James Few, managing director of Aspen disclosure standards to focus on Japan positive Re, added: “China is vulnerable to just about every type of peril you can think of. With so much value, India’s insurance regulator, IRDA, has issued The intended merger of Sompo Japan Insurance Despite a downturn in sales of 25 per cent, Aviva’s so many people and a growing economy, you would disclosure standards for insurance companies that and Nipponkoa Insurance is to go ahead in the chief executive Andrew Moss said that 2009 has naturally assume that insurance penetration rates are are in line with the standards set by the International New Year, according to a joint statement from the proved to be a strong year for the company, going to rise in the five-to-10-year timeframe.” Association of Insurance Supervisors (IAIS), in a move two companies. In its release, it was stated that according to the firm’s third-quarter management to lay the groundwork for insurers to raise funds the enlarged company, Sompo-Nipponkoa, will statement. The drop in sales was explained by in the capital market. Under the new standards, place the main focus of its business in Japan itself, customers close to retirement delaying the purchase insurers are now required to make available data for as it seeks ‘to provide high-quality services and of annuities, while pension savers have either the last four to five years as well as make quarterly, security to customers’. According to the plan, the reduced or halted their monthly contributions. half-yearly and annual disclosures to the public for two insurers and their various subsidiaries are to Industry analysts have been buoyed by the news investors and other stakeholders to assess their be structured as one under the newly established that the group’s capital surplus has risen from around financial health. This information includes insurers’ firm, NKSJ Holdings, which has a capital stock of £3 billion to over £4 billion, combined with a rise in investment profile, solvency, liability valuations and 100 billion yen. margins on pensions and life products. Much of the business statistics. Current president and chief executive director of capital boost has stemmed from the £400-million sale Mr A Gridhar, an IRDA executive, said of the changes: Nipponkoa Makoto Hyodo will be both chairman of Aviva’s Australian arm and the £1-billion listing of a “The idea is to let policyholders, whose money is at and co-chief executive director of the merged minority stake in Dutch insurer Delta Lloyd. On the stake, know how the companies are faring. At present, firm, and he will be joined in both of those roles downside, though, life and pensions sales fell by 11 per insurers disclose most of their business statistics and by Masatoshi Sato, currently president and chief cent to just over £24 billion, while sales in the previously investment details to the regulator yearly.” executive director of Sompo Japan. fast-growing US business have fallen by 25 per cent.

Philippines faces typhoon aftermath ING transfers US business Following initial assessments of the damage caused Based on estimates by the Philippine Insurers and by tropical storm Ketsana, non-life insurers in the Reinsurers Association (PIRA), insurers estimated Dutch financial services provider ING Group Philippines are now charging premium rates of 0.5 that they would receive property claims of about has announced that it has reached an agreement per cent for insurance against flood and other natural PHP11 billion (US$234 million) and motor vehicle to transfer its US group reinsurance business, disasters. In addition, President Gloria Macapagal- claims of PHP1 billion as a result of the two disasters. ING Reinsurance US, to Reinsurance Group of Arroyo has directed the National Insurance However, police have warned insurers to be wary America (RGA). Tom McInerney, chief executive Commission (NIC) to facilitate the immediate of false claims submitted by typhoon victims, after for ING Insurance Americas, said of the deal: payment of all insurance claims of victims of the reports of a rise in the number of stolen vehicles “This transaction fits within ING’s Back to Basics two typhoons that struck in late September and in Metro Manila, which turned out to be bogus strategy to simplify our structure and focus on our early October – at present the law mandates that a claims made by those looking to cash in on their US insurance operations on retirement services life claim be settled 30 days from filing the proof of loss. comprehensive car insurance policies. insurance, and rollover annuities.” He continued: “Although ING Reinsurance is not part of ING’s core businesses in the US, it is a solid, well-run, and client-focused business that will complement Costs of super typhoon a company that considers reinsurance its core business. We believe that RGA will be an excellent Boston-headquartered catastrophe risk modelling estimated its incurred losses from Typhoon Melor Tom McInerney owner of ING Reinsurance.” firm AIR Worldwide has estimated that super will amount to 12.36 billion yen ($136 million). typhoon Melor, which struck the Japanese island In a statement, the company said that, as of 19 of Honshu on 9 October, could cost insurers October, incurred losses for marine and transport between 75 billion yen (US$835 million) to 130 insurance totalled 5.93 billion yen, 3.96 billion yen Swine flu concerns prompt insurance rush billion yen ($1.5 billion). for fire insurance and a further 2.46 billion yen for Dr Peter Sousounis, principal scientist at AIR automobile insurance. Many businesses in Japan, faced with the prospect 2009 were 40-per-cent higher than they were Worldwide, commented: “In the regions most Sompo Japan Insurance, which is the country’s third of mass absences from workplaces as a result of during the same period a year earlier. affected by Typhoon Melor, wood frame homes largest non-life insurer by market share, has reported the increasing number of swine flu cases in the Global insurance broker Marsh said that businesses dominate residential construction. Many estimated insured losses of 4.41 billion yen as a result country, are seeking help from the insurance should treat the pandemic as a ‘truly catastrophic have heavy, clay tile roofs, meant to of Typhoon Melor. At the end of October, the industry, according to media reports. The Japan event’, as opposed to ‘manageable disruption’, and prevent damage from wind.” insurer announced incurred losses for Times has reported that because there has never has thus urged companies to establish committees He continued: “At Melor’s fire insurance of over three been a major outbreak of flu, some companies that will develop a plan of action should the wind speeds, these homes billion yen, followed are struggling to understand exactly how their pandemic cause severe business disruption. These are expected to have minor by 650 million yen businesses will be affected, and are thus turning to teams, continued Marsh, should be supported by roof damage and little or for marine and 550 insurance policies to mitigate the risk. real budgets and should prioritise critical products no structural damage.” million yen for car Sompo Japan Risk Management has said that it is and services and prepare to protect them. Meanwhile, Tokio insurance. currently receiving between 40 and 50 enquiries Businesses should also consider the aftermath Marine & Nichido a month from companies that are concerned of a pandemic, and should estimate and plan Fire Insurance, a about their crisis management ability. From these accordingly for post-infection changes, such as subsidiary of Tokio enquiries, sales have risen significantly – sales of changes in demand patterns and the availability and Marine Holdings, has flu-related insurance during April to September morale of staff and infrastructure.

www.itij.co.uk 14 INSURANCEMATTERS

E&Y highlights Direct insurers gain lessons learnt independence

A new report from Ernst&Young (E&Y) entitled Lessons Following the implementation of the country’s new from change, regaining the balance in the insurance insurance law, direct insurance companies in China industry, has shown that while the insurance sector are now able to choose their own reinsurer. The has been less directly impacted by the recession in liberalisation of the market is in line with China’s comparison to other financial services businesses, commitment to the World Trade Organisation when, most insurers were still surprised by the depth and in 2006, it promised to totally commercialise the magnitude of the downturn. Recommendations reinsurance sector. As a result of the market opening, made in the report include urging insurers to focus on China Reinsurance Group Corporation – the evaluating and assessing potential exposure to extreme country’s only local reinsurer – looks set to lose its risks if they are to ‘better anticipate, manage and previously privileged position. respond to future stress events’. Meanwhile, in another sign that the previously Peter Porrino, global insurance leader from E&Y, closed Chinese market is opening up, British insurer commented on the findings of the report: “For Prudential’s new chief executive Tidjane Thiam has the past year, progressive insurers have been announced the possibility of a public offering in either responding to the pressure of an evolving economic Shanghai or Hong Kong in order to raise funds for landscape. Speaking to our clients, we have heard the company. Asia already represents Prudential’s Forex exposure concerns how companies around the world are deploying largest single business region by premium volume, approaches to manage credit exposures and ahead of Europe and US, although sales are spread Reuters has reported that Japan’s largest life insurance In contrast, Nippon Life Insurance has announced regulatory capital, as well as focusing on re-designing across several Asian countries. Currently, the companies, whose investments in local and global that it is considering cutting its shares in domestic and re-pricing certain products.” Chinese Insurance Regulatory Commission is said markets total some US$1.6 trillion, are making companies by around one trillion Yen, or between The report also highlights a number of lessons that to be formulating rules that would allow foreign a concerted effort to minimise their exposure 10 and 20 per cent of its current portfolio, over insurers have learned from the crisis, including the companies to list in mainland stock exchanges. to currency volatility through focusing on buying the course of the next five years. At the end of fact that: “Most insurers have learned to secure a domestic rather than international debt. The move March this year, the company managed 44 trillion capital buffer over and above what is predicted by has been prompted by the Japanese Yen rising in Yen of assets, around 12 per cent of which was in economic capital models. It’s equally important to value to a 13-year high, which has moved some of domestic companies. The insurer, though, does plan develop actionable strategies for moving capital from the top nine life insurers to dispose of some of their on continuing with its strategy of buying long-term one legal entity to another during a crisis.” It was also uncertain foreign investments and replace them with Japanese Government bonds and corporate debt as noted that some insurers are re-evaluating the size domestic ones. they form the ‘core assets’ of its portfolio, according and shape of their business, and that those companies Iwao Matsumoto, Sumitomo Life’s deputy general to Tomiji Akabayshi, general manager of Nippon that responded most quickly to the crisis were usually manager of the investment planning department, Life’s finance and investment planning department. the most nimble. Insurers are also divesting certain commented: “We are keeping our cautious stance in He added that the decision to cut domestic shares businesses or product lines and are re-investing their currency movements as there is a risk of future falls has also been prompted by a government plan to core businesses for future growth. in the dollar. We remain cautious about investment in tighten rules on evaluating the financial health of Lex van Overmeire, insurance leader for Europe, unhedged foreign bonds.” insurance companies. the Middle East, India and Africa, commented: “The insurance industry has done well to emerge relatively unscathed from the downturn but we are now entering a new and changing world. Insurance leaders able to demonstrate ingenuity, the courage to make tough decisions and the foresight to apply lessons from change will guide their companies to Pandemic building success in the sector.” closure cover offered

Insurance broker Aon has created a standalone RIMS report insurance policy to reimburse companies for wages, fixed costs and extra expenses if they are unable to released access their company building as a result of it being officially closed due to the swine flu pandemic. The Risk and Insurance Management Society Inc. The insurance policy was created when, in the (RIMS) has released its executive report, A Practical wake of the April outbreak, both the Mexican and Guide to Insurance Broker Compensation and Argentinean Governments shut their central business Potential Conflicts of Interest for the Risk Manager, districts, public buildings and educational institutes which calls for ‘complete transparency and full in an effort to prevent the spread of infection. disclosure of all revenue streams associated with If the UK Government were to follow in their the placement of insurance products and serves footsteps, Aon warned that companies may not be as a guide to assist risk mangers’. According to able to rely on their standard business interruption the company, its ultimate goal in publishing the insurance policies, which traditionally restrict cover report is to ‘heighten members’ awareness of the to disruption caused by physical damage or notifiable potential pitfalls surrounding the insurance purchase disease, which swine flu is not. transaction’ to empower them to press for The broker believes its policy is the first of its kind to transparency in their negotiations with brokers. be made available to all industry groups, rather than Deborah Luthi, director of RIMS External Affairs just the hospitals and healthcare industry. The sectors Committee and director of enterprise risk most likely to be most affected by any government- management at Matheson Inc., said: “In ideal mandated closures, according to Aon, will be retail, settings, insurance brokers and risk managers are transport and manufacturing as they rely on public working very closely toward a common goal – access and staff on site. marketing the insured’s coverage to achieve optimal Matt Harvey, senior wordings technician/broker at results within the commercial insurance market.” Aon for the UK and Europe, commented: “Imagine She continued: “However, because the industry Oxford Street is quarantined in the run-up to has yet to mandate full disclosure, risk managers Christmas. This could lead to massive losses in must be diligent in their broker selection process. the retail sector, winter is looming and companies This report gives them the tools they need, not across the board are working on business continuity only to successfully make that selection, but to plans, identifying everything that could go wrong and drive a higher standard of conduct industry-wide.” looking for ways to protect their business.” He went The report also stressed that, in order to ensure on to explain that the new policy complements such brokers act solely in the interest of clients, any continuity plans and will help companies recover compensation to the broker from insurers must the fixed costs of running the business in the face of either be transparent or eliminated altogether. lower revenues.

International Travel Insurance Journal INSURANCEMATTERS 15

NEWSWIRE Disaster management AIG drops Japanese sales plans team planned American International Group has dropped its its was shown that chief financial officer of AIG David intended plan to sell two of its three Japanese Herzog was paid $1 million, while chief executive of At the recent East Asia Summit held in Thailand, subsidiaries, according to The Wall Street Journal the company’s property-casualty division Kristian Moor Aviva has announced a substantial 10 ASEAN nations and their six dialogue partners – – previously, the group had planned to sell all received $1.6 million. restructuring of its European operations after a Australia, China, India, Japan, South Korea and New three of its units in the country. It was reported While it is known that several other executives thorough review of the insurer’s 12 continental Zealand – known as the ASEAN +6 – have agreed that the change of heart stemmed from the belief also received payments, AIG did not disclose the business by Andrea Moneta, who became chief to improve co-operation between each other in that AIG will eventually receive more value from identities of any other recipients. In a letter to AIG, executive of the division just over a year ago. order to respond more effectively to natural disasters holding on to the other two companies for at least the US Treasury said it decided the three named in the Asia Pacific region. a while longer. Slowly but surely, it seems AIG is executives should be paid the retention awards in In its recently published strategic review, According to an official statement, the new group of emerging from the crisis that saw it bailed out by the order to keep them at the company. However, it Fortis has confirmed its intention to streamline its co-ordinated emergency responders are tasked with American Government in September 2008, and the went on to state that it would consider the amounts current portfolio against certain criteria. Thus, it has exploring “the possibility of establishing a regional immediate need to sell off various subsidiaries has of the awards when ‘determining an appropriate decided to discontinue its activities in Russia. network of disaster response contact points, through slowed, allowing the group to hold onto AIG Star reduction in proposed 2009 cash salaries for these existing regional frameworks and mechanisms in Life Insurance and AIG Edison Life Insurance for the employees’. The payments were promised to the Prudential plc has announced a robust nine ASEAN. Japan proposes an initiative to build a time being, although there are still plans to sell the executives in 2008 even as the company teetered months of group-wide sales of over £2,000 million. disaster resilient society in East Asia and Australia and third entity, Alico Japan. Robert Benmosche, chief on the brink of insolvency, to halt the rush of Retail sales in the US rose by 66 per cent and Asian also suggests a regional disaster response network executive officer of the insurer, told the newspaper: employees to the door. AIG’s latest chief executive sales by four per cent. and a regional funding pool as part of the efforts to “I have come to believe that we can obtain the officer Robert Benmosche has sent a memo to all enhance disaster response co-ordination.” greatest value of AIG Star and AIG Edison by of the company’s employees reassuring them that Admiral has stepped up its efforts to Recent natural catastrophes in the region have served continuing to operate and grow these companies as Feinberg’s jurisdiction was confined to the firm’s replicate its successful UK online price comparison to raise awareness among consumers of disaster part of AIG.” most senior executives, but warned that such pay insurance business in Spain, launching a television insurance, but insurers must raise the prices of such In related news, Alico Japan has admitted that it restrictions could hurt its ability to retain and motivate advertising campaign that stars a basset hound policies, according to the Indonesian Insurance Bureau. has identified over 18,000 cases of credit card data its best-performing employees. dressed as Sherlock Holmes. Mr Isa Rachmatarwata, chief of the Insurance Bureau, leakage, in what is becoming one of the largest told insurers at the 16th Indonesia Rendezvous: “The data leaks seen in the country. According to the AIG has announced its largest divestment insurance market has not reached equilibrium for the insurer, policyholders’ credit card since its rescue last year, with the announcement of cost to the industry. Insurers must raise rates and better details were stolen by an employee the $2.15-billion sale of its Taiwanese life assurance manage catastrophe risks and reduce concentration of of a third-party contractor, but the business to buyers based in Hong Kong. exposures.” Penetration in the Indonesian market is still company has covered any costs very low, at just 1.3 per cent, and while year-on-year that were incurred as a result of the Hardy Underwriting, the Lloyd’s of London gross written premiums are increasing, there is still details being stolen. Following the issue, insurer, has announced a joint venture to write plenty of scope for development. Alico has improved its security systems and reinsurance in the Middle East and North Africa as investigative abilities in order to prevent a it seeks to expand and diversify its business. similar situation in the future. Meanwhile, the insurer has said that it is to pay $12.1 Aviva has improved the terms of its critical million in retention awards to some of its top executives illness cover, but has yet to offer premium after Kenneth Feinburg, the government’s pay czar, reductions for customers if an exclusion is placed on gave the payments the green light. In a regulatory filing, their policies.

RSA Insurance Group published its third- quarter interim management statement, with CEO Andy Haste commenting on ‘another robust performance’. Liability development AXA PPP has launched two new medical insurance options – one for corporate firms and the in China other for individuals who have received a cancer diagnosis. According to a report from Swiss Re, although China’s property and casualty (P&C) industry is still A rise in global temperatures could in the early stages of its development, the country’s lead to more expensive and harder to obtain liability sector is evolving ‘with some interesting property insurance in the UK and throughout and encouraging trends’. Ms Feifei Ford, part of the the world, according to a new report from the company’s casualty underwriting team in Beijing, said Association of British Insurers. new product innovation is just one of the strengths that is pushing the industry forward. Aviva is said to be ‘keeping an eye on’ the The report continued: “As more foreign subsidiaries break up of ING to asses the situation and wait to and foreign insurers entered China over the past few see if it will yield any acquisition opportunities. years, bringing with them experience and expertise, a variety of new products including professional indemnity, European non-life insurers are struggling to medical malpractice, directors’ and officers’ liability hike prices to offset a rise in claims during the and pollution liability, has gradually been introduced to recession as cash-strapped policyholders put up stiff the country. These add to the three traditional liability resistance, according to Insurance Broadcasting. insurance products: employers’ liability, public liability and product liability.” It was also noted that despite the Dubai Islamic Insurance and Reinsurance penetration of insurance remaining low, insurers are company has made AED26.3 million in net profit making progress in improving their technical capabilities for the first nine months of 2009, a rise of 326 per and are attracting more potential insureds to liability cent over the same period last year. products – a trend that has increased the level of reinsurance required in the country’s market. Ms India’s insurance regulator is considering Ford added: “As domestic insurers venture into new allowing life insurers to invest part of their funds in lines of business, they need strong technical support equity derivatives. If the green light is given, insurers from prominent international reinsurance partners in will be able to hedge their equity exposure and terms of policy wording, rate setting, underwriting, risk protect the returns of policyholders. management and claims handling.” Two major roadblocks remain that are hindering the Fitch Ratings agency has announced that continued development of the liability industry in China, its outlooks for the French life and non-life though, said Ms Ford. The first is that demand for insurance sectors remain negative. Profitability insurance products remains low from society in general, and capital adequacy of the sectors are unlikely to while the other is the limited distribution channels on offer recover to good levels in the near term. to insurers, resulting in higher-than-usual acquisition costs.

www.itij.co.uk 16 TRAVELMATTERS

Viva Las Vegas Light at the end of the tunnel

Las Vegas is the destination of High speed Channel Tunnel passenger rail service Continent. The increase has been credited to the choice for those British travel Eurostar, which operates the service between impact of an advertising campaign that encouraged insurance customers looking to France and London, has reported a marginal sales UK-based travellers to buy return fares for just £59. escape the financial worries and recovery during the third quarter of the year. Brown added: “Today’s figures show that despite poor weather at home, according Overall, its sales revenue was 6.8-per-cent higher tough times, people are increasingly realising the to research conducted by the Las than it was during the same period last year. Vegas Convention and Visitors However, sales and revenues for the year- Authority (LVCVA). The research, to-date are down slightly, and the business which was published shortly travel environment remains ‘challenging’. The after British Airways launched company put the third-quarter improvement the UK’S first direct route to the down to the impact of the fire on a shuttle Nevada city because it believed in the Tunnel in September last year, which it had ‘real opportunities for depressed results for that quarter. growth’, revealed that Las Vegas Richard Brown, chief executive of the firm, businesses obtain more cash from said that while the economic climate in the British tourists than those from UK remains difficult, there are signs that the any other nation. business travel market has reached its nadir and Cathy Tull, senior-vice president could be improving again: “In recent weeks, a of marketing at LVCVA, believes number of our major corporate clients have that the appeal of a three-to- eased their business travel restrictions. Although it is great benefit of travelling with Eurostar. These five mile strip of night clubs, early days, this may be a sign of an upturn.” individuals are part of what we call the ‘Eurostar restaurants and casinos provides According to figures from Eurostar, there was an Generation’, travellers who, over the past decade- millions of Britons “with much 11-per-cent increase in the number of passengers and-a-half, have experienced significant changes to needed respite from their day-to- travelling outbound from the UK and an increase the way they live, work and play as the network of day pressures at values that meet of seven per cent in the number travelling from the high-speed rail services steadily grows.” a variety of budgets.”

US offers diversity to tourists Online confusion Retail sales fall Research by eDigital Research has revealed that Mark Hudson of PricewaterhouseCoopers advised The US is a popular tourist destination due to its size things to do and places to visit. “From the picturesque holiday websites that lead to third-party portals delegates attending the Association of British Travel and diversity, according to the online travel portal scenery of its National Parks, to the glitz and glamour can often cause confusion amongst those making Agents (ABTA) Travel Convention that the recession Expedia. Jonathan Cudworth, director of product of the Strip,” added Cudworth, there is something for the bookings. Director Michelle Fuller explained has had ‘a dramatic impact on consumer behaviour’, placement for Europe, Middle East and Africa for the everyone, and at the moment there are a number that sites such as Lastminute.com, which send with retail sales of holidays falling by between 15 company, noted that the ‘sheer size and diversity’ of package deals on offer, which could tempt more customers through to third-party websites, often and 20 per cent in the past 12 months. Hudson also of the country gives visitors a much wider range of travellers in difficult times for the tourism industry. leave consumers wondering where their cash is revealed research that demonstrated that 86 per going. She said: “Travel can be very complex and cent of consumers who had traded down on their it is often the case that the holiday the customer holiday felt they had got the same value for money is trying to book is not available online and they as they had in previous years, while 34 per cent said need advice from a customer service agent to they felt they had received better value for money. tailor their travel.” Dermot Blastland, managing director of Thomson and The research comes after online customer experience First Choice UK, said that the majority of his customers company Tealeaf revealed that 53 per cent of the wanted to maintain the standard of the holidays they UK’s adult population are conducting more business take, but had traded down from 14 nights to 10 or online than they did in the past. In addition, more than 11. Meanwhile, Andy Coslett, managing director of half of those who tried to resolve an online problem InterContinental Hotels, said more people had stayed at over the phone did not have the problem resolved home this year, but was hopeful that they might revert and 77 per cent felt the person they spoke to was not back to old holiday habits if the experience had not knowledgeable enough. been as enjoyable as hoped.

Travel fraud spikes

A survey commissioned by Kroll and undertaken by the Economist Intelligence Unit of more than 700 senior travel executives has found ‘a dramatic spike’ in the level of fraud detected, leading companies in the travel, leisure and transportation sectors losing an average of US$10.2 million. The survey showed a 75-per-cent rise on fraud levels from 2008, although there was no one dominant type of fraud detected. In the past three years, 47 per cent of respondents to the questionnaire had experienced a theft of physical assets, while 32 per cent faced internal financial fraud and 30 per cent had seen regulatory or compliance breaches. The Kroll Annual Global Fraud Report revealed that overall, fraud activity worldwide across many different industries remained fairly steady in 2009, although companies did lose an average of $8.8 million to fraudulent activities. Investigations practice, said: “Our report highlights It was noted that although the travel industry is how motive and opportunity for committing crime addressing the issue through greater spending on have effectively cancelled one another out in the past anti-fraud devices, software and training, efforts year, but this apparent steady rate of fraud may be are inconsistent and have also been stymied by the a false dawn. As we emerge from recession, both recession. In fact, 25 per cent of those companies businesses and investors should be extra vigilant as surveyed admitted that efforts to save money we are likely to witness a different set of motivations, had resulted in weakened internal controls and, with the corporate saviour replaced, once again, consequently, an increase in fraud vulnerability. by the activities of sophisticated criminals starved of Richard Abbey, managing director of Kroll’s Financial opportunity in recent times.”

International Travel Insurance Journal TRAVELMATTERS 17

Iberia plans revamp Rule change for international students Tsunami aftermath

In a sign that the troubled airline industry is looking also a new travel security and information officer on Roger Allnutt reports on the devastation caused towards the future and possible economic recovery, site, whose job it is to oversee emergency response by the recent tsunami and the efforts to re-build Spanish flag carrier Iberia has announced a revamp of preparedness. New guidelines are also being put in tourist destinations on the islands of Samoa its domestic and European flights. The airline, which is place that aim to streamline communications between planning a merger with British Airways, is to replace its students and their home universities, ease financial Nature has been cruel to many parts of the Asia current programme with a new and as yet unnamed tractions and institute mandatory training for faculties Pacific region in the past year with natural disasters airline, which will operate as a wholly owned taking students abroad. encompassing floods, typhoons and earthquakes subsidiary. From 2011, the new airline will connect Aside from Amanda Knox, UW has seen several with considerable damage and loss of life. On 29 Madrid with those European cities where travellers episodes where its students studying abroad have September a massive earthquake off the coast of need to fly to Spain to then catch a long-haul flight, encountered a dangerous or unique situation and Western Samoa triggered a tsunami, the waves of usually to South America. The airline explained: “Given needed help – in August 2007, eight of 17 students which crashed into the southern coast of Upolu, the the difference in the performance and competitiveness on exchange in Ghana fell ill with mosquito-borne main island of Samoa, causing over 140 deaths and of Iberia’s long-haul business in contrast to the short illnesses and had to be evacuated from the country by the destruction of some resorts and tourist facilities and medium-haul routes, the company is proposing In a move that mirrors many others already taken ambulance and chartered planes, paid for through the on this popular holiday destination. two well-defined strategies that allow it to be larger across the US, the University of Washington (UW) is university’s travel insurance. Just weeks afterwards, a The properties affected by the tsunami were while simultaneously cutting losses.” overhauling how its students and professors interface group of 13 students in Greece had to be evacuated Coconuts Beach Club, Sinalei Reef Resort, Salani Surf, Other cost-cutting moves started by the firm include with foreign countries – the rule change is a reaction to from an area that was being threatened by wildfires. In Maninoa Surf, Boomerang, Sea Breeze and the all the plans to sack all cabin staff over the age of 55, the continuing case of an American student, Amanda November 2007, Amanda Knox was arrested. beach fales at Lalomanu and neighbouring villages. replacing them with younger, less experienced staff. Knox, who is being held in Italy charged with alleged Taso Lagos, the internal communications professor I visited a few weeks after the tsunami and it was A company-wide pay freeze in the next two years murder. As a result of the ongoing murder case, at UW, said pressure had been building at the very sad to see the destruction the waves has done is also on the cards, as is the possible expansion of international education officials across the US are more International Exchanges and Programs Office, even to these resorts. The battering to the dreams and the current redundancy plans to cover around 200 closely tracking who, where and what study-abroad before Amanda Knox was arrested. He added: “The aspirations of the owners must have been devastating. ground employees. programmes involve, with rules at UW now stating more students are involved the more likely it is to However, even in the short time after the tsunami, a that the department chair must sign off an international have problems, so it is good that the rules are being huge amount of cleaning up has already taken place study-abroad scheme and travel health insurance is streamlined with structures and communication in and massive piles of rubble removed. There were mandatory, as is a mobile phone. As students returned place so that if something happens, programme even signs of rebuilding; at the end of October a Egypt as bargain to their campuses in September, at UW there was directors are prepared to deal with it.” group of about 60 gathered at the ‘bar’ at Maninoa Surf and celebrated what they had achieved. holiday choice Already Sinalei has been able to open to partial operation and plans are underway to have Coconuts Egypt emerged as a top destination for bargain autumn Recovery on the horizon? Beach Club return to business by February or March breaks, after October’s half-term holidays to Sharm El 2010. Although it will take time for the hardest-hit Sheikh increased by 142 per cent, according to findings The United Nations World Tourism Organisation Second World War period, in tourism too there are areas to recover and rebuild, the friendly people from The Co-Operative Travel, based on over 1,000 (UNWTO) has said that stronger prospects for a signs that confidence is returning and that demand is of Samoa are there to welcome you to their island bookings. The rise is believed to have coincided with a recovery in the tourism sector in 2010 are evident, improving for both business and leisure travel.” paradise, to show you their culture and attractions drop in the cost of holidays to the Red Sea resort, which including macroeconomic upward revisions from Highlights of the UNWTO report indicate that with and offer a holiday experience to remember. averaged around 20.7 per cent for a family holiday, and the International Monetary Fund and preliminary the exception of Africa, all regions recorded a drop in Contrary to the impression given by some media ties in with the weakness of the pound in comparison to international travel figures. International arrivals declined reports, the other parts of Upolu and the euro, said the company. by just four per cent this July, a relative improvement the other main island of Savaii were Last year’s most favoured Spanish holiday destination, when compared to decreases of between seven and 10 untouched. For a country highly Majorca, dropped to fourth in the ranks, a result of the per cent as seen in May and June, according to figures dependent on the tourist dollar for pound falling to a six-month low of 1.0628 euros to from the organisation. Many destinations showed a its economic wellbeing, it is vital that the pound, although Tenerife, whose prices have risen similar pattern of slow but defined change for the better, tourists return to help the country by 14.7 per cent, ranked as the number one family with particular improvements noted in Asia, Europe recover from the this devastating act holiday destination. Commenting on the findings, retail and the Middle East. In absolute terms, the number of nature. distribution director Trevor Davis said: “Destinations of international tourist arrivals worldwide reached 500 Samoa offers a large range of like Tenerife will always be popular in October as million in the first seven months of 2009, down from holiday options from upmarket they offer good weather with relatively short flight 540 million in the same period of 2008. resorts to the most basic beach times. However … with the euro still high, families Looking to the future, the UNWTO stated: “As fales. What makes each so special are looking further afield for value for money. Resorts decline rates are anticipated to ease during the is the wonderful friendliness of the such as Sharm El Sheikh … benefit from having a large remainder of 2009, international tourism is forecast people, huge smiles, a genuine selection of all-inclusive hotels, so families can budget to decrease within a range of four and six per cent interest in their visitors and a for their holiday before they travel.” this year. And though many sub-regions might return arrivals for the first seven months of 2009. In Europe, relaxed lifestyle, so much so that you are quickly into While the weakness of the pound against the euro to growth in the last months of 2009, this will not be where visitor numbers have dropped by eight per Samoan ‘mode’. continues to affect the choice of holiday destination enough to compensate for the losses felt so far.” cent overall, there are signs of improvement with just The tsunami also caused damage to American for UK-based travellers, findings from the company Taleb Rifai, secretary general of the organisation, a four-per-cent fall in July. Results have improved in Samoa, a group of five small islands to the east of also found that 82 per cent of families would opt for noted: “As the latest economic data and prospects Asia as well, where some destinations, such as the Western Samoa. Most damage and over 40 deaths European holidays, simply because they are worried indicate that the world economy may be starting to Republic of Korea and Malaysia, have bucked the occurred in and around the capital Pago Pago on the about the complications of travelling with children. emerge from its most severe recession of the post trend with significant increases in visitor numbers. main island of Tutuila.

www.itij.co.uk 18 HEALTHMATTERS

Flood victims face new danger National emergency declared in US

Survivors of the two powerful storms that wreaked in the area have already said that disease and poor On 24 October, President Barack Obama officially official added: “It’s important to note that this is havoc across the Philippines at the beginning of sanitation could affect large numbers of people. “It’s declared the 2009 H1N1 swine flu pandemic a a proactive measure – not a response to a new October are now facing a new threat in the form of a perfect storm because there’s standing water,” national emergency. The declaration will make it development. H1N1 is moving rapidly, as expected – potentially life-threatening diseases. Charity workers said Dr Sean Keogh, emergency health assessor for easier for medical facilities in the US to handle the by the time regions or healthcare systems recognise Merlin, a UK-based medical relief agency. “There’s surge in patients by allowing them to waive some of they are becoming overburdened, they need to cholera, leptospirosis is endemic in the population the requirements of Medicare, Medicaid and other implement disaster plans quickly.” and there’s a disease called dengue which is spread federal health insurance programmes, as and when So far, swine flu has killed more than 1,000 people by mosquitoes.” they need to. According to the latest figures from in the US and more than 20,000 have been Health officials say that as many as 1.7 million the US Centres for Disease Control and Prevention, hospitalised. The Department of Health and Human people living in and around Manila risk exposure to swine flu is now widespread in 46 of the 50 states, Services has said that although it is trying to deliver leptospirosis, a waterborne disease that has already which is on a level comparable to the peak of the vaccines, production of the immunisation is falling killed more than 96 people. According to the ordinary winter flu season, but has happened far short of projections because companies are having National Centre for Disease Prevention and Control, earlier than expected. trouble coping with demand. the disease, which can lead to kidney failure if A statement released from the White House said Despite the pronouncement of a national emergency, untreated, has infected more than 1,300 people and the official declaration was intended to prepare the it seems many in the US are not curtailing their travel 1.3 million people deemed to be in high-risk areas country in case ‘of a rapid increase in illness that may plans in response to the swine flu virus.The Salt are to receive antibiotics. overburden healthcare resources’. An administration Lake Tribune spoke to a local nurse working in the Keogh said: “Most people are getting some clean Salt Lake County Health water, but the problem is that people are using the Department’s Travel Clinic, standing water as a toilet and children are swimming who said that almost all through it.” He continued: “All these things are of her patients are asking coming together. There’s another storm coming. questions about the virus, There’s standing water, endemic disease and people but are not cancelling their walking through the water, which has all sorts in – plans. Local travel agents petrol, human waste –­ it’s a complete mess. This is a concur: “I have not had a communicable disease disaster in the making.” client who has specifically changed plans or cancelled because of swine flu,” said Doug Andersen of Cruise Dengue epidemic in Cape Verde and Travel Masters, “a lot of their attitude is that we Since October, more than 12,000 cases of Dengue Maio, Brava and Fogo. The situation is being carefully are in cold and flu season fever have been reported, with 9,000 cases being monitored on account of the islands’ proximity to anyway and its standard reported in the first two weeks of November alone, Senegal and the numerous tourist and business ties year after year.” according to the health authorities throughout the the two countries share. Visitors to the islands are Cape Verde archipelago. The entire string of islands being advised to adopt maximum precautions against appears to be affected, but with a higher number of mosquito bites and to avoid particularly unhealthy cases appearing on the islands in the south: Santiago, districts and crowded areas such as markets. Rabies precautions Chikungunya in Bali increase in Asia

The US Centers for Disease Control and Prevention Continued cases of chikungunya fever in Asia and (CDC) has advised travellers venturing to Bali to the Indian Ocean region mean that travellers need avoid close contact with the animals there following to take extra precautions in areas such as Thailand, a 2009 report by the Indonesia Ministry of Health, Malaysia and Réunion, where it has recently been which confirmed 15 deaths caused by rabies. reported, says the US Centres for Disease Control While most cases of rabies have been sited near (CDC). popular tourist destinations on the southern tip of Thailand’s Ministry of Public Health has documented Bali, the CDC is warning all visitors to the island to over 42,300 cases in 50 provinces, while the Ministry take precautions and avoid touching/playing with of Health in Malaysia has confirmed over 3,185 cases the animals there and spending a lot of time in rural of chikungunya fever. Three cases of the fever have areas, where there lies an increased chance of also been reported on the French island of Réunion, coming into contact with them. with all cases occurring in the Saint-Gilles-Les-Bains Rabies kills around 50,000 people each year and area of the island. is usually spread via the bite of a rabid animal, with To avoid obtaining the disease, which is spread the primary sources of infection coming from dogs, by the bite of infected mosquitoes, the CDC has foxes, mongeese and bats, although the deadly recommended that travellers should wear an insect disease can be spread when rabid animal saliva repellent that contains a higher concentration of comes into direct contact with broken skin. active ingredient, such as DEET, picaridin (KBR The CDC has cautioned travellers holidaying in 3023), Oil of Lemon Eucalyptus/PMD, or IR3535, to the area to get vaccinated before they go as a repel mosquito bites for longer. precautionary measure and has advised those who Since 2006, reports of chikungunya fever activity get bitten or scratched to wash the wound well with have increased and forced several countries to soap and water, before seeking immediate medical heighten surveillance for the disease, which has no attention from a doctor and then informing their medications or vaccines to prevent a person from own doctor when getting sick. While they return home. there is also no specific Recent findings treatment for the from travel- disease, the CDC has related illness data advised that medical collection network care should still be GeoSentinel also sought as a doctor revealed that may be able to help the number of treat some of the requests for rabies symptoms, which can postexposure include joint pain, chills, prophylaxis from headache, nausea, travellers returning lower back pain, from Bali has vomiting and a rash, increased since May and last in excess of 2008. two weeks.

International Travel Insurance Journal

20 AIRAMBULANCENEWS

Kokoda challenge needs rescue helicopter Is there a doctor in the onboard? A search and rescue helicopter equipped with a medical evacuations. She said: “I’ve seen trekkers medical team may be required for Australians who come off in a helicopter screaming in pain, needing Dr Paulo M. Alves, vice-president of aviation and How ‘sudden’? attempt to take on the infamous Papua New Guinea treatment … operators are not using bona fide maritime health at MedAire, discusses the issues Necropsy studies of onboard deaths show Kokoda Track, after two Australians died within a medevac services and it’s dangerous.” raised for medical escorts on commercial flights different causes of expiration bearing no relation week of each other when trekking through the rough Phillip Brunskill, of Sydney, was the most recent when a passenger suffers cardiac arrest to the flight at all. Many are not necessarily 96-km terrain. ‘sudden’ by definition – for example, a terminally Since 2001, six Australians have lost Imagine that you, as a flight nurse, are travelling ill patient seeking medical treatment or simply their lives on their pursuit through the on a commercial jet to meet a patient you will returning home to die. Some passengers, Owen Stanley Range and Jan Sheehan, escort back next day on a repatriation mission. understandably, won’t disclose and may even flight nurse manager for PNG’s The case is simple and you are not carrying any disguise their condition, afraid of being denied International SOS medical rescue team, special drugs or equipment. En route, you hear an boarding. said that something must be done: “I just announcement asking for a medical volunteer. You Flight attendants are trained to perform don’t think Australians are fully aware of alone step forward and there you see a passenger lifesaving procedures such as CPR, but having an what the Kokoda challenge is and that’s in cardiac arrest with flight attendants performing experienced medical person onboard is always why we are seeing all sorts of incidents,” CPR (cardiopulmonary resuscitation). What do welcome in critical situations. As a flight nurse, she said. you need to know about sudden cardiac arrest you may be asked to step forward to assist a Sheehan explained that a SAR helicopter (SCA) in-flight? What tools will be available? passenger other than your own. equipped with an onboard medical SCA is an overwhelmingly emotional situation The advent of automated external defibrillators team, similar to that of Australia’s Westpac Rescue trekker to die while attempting the Kokoda challenge in the aircraft environment, particularly for carried by many airlines, along with enhanced helicopter, was needed for evacuating injured and the fourth life to be taken by it this year. The relatives of the victim and crew handling the medical kits, has changed the way airlines cope trekkers, but went on to express her concerns that 55-year-old died after suffering from a suspected event. Fortunately, in-flight SCAs are relatively with an unexpected in-flight cardiac arrest. insurance companies may try to cut costs by using heart attack when he began struggling less than one rare. Providing in-flight medical advice to nearly Contents vary, but most medical kits onboard regular helicopters for trekking incidents that require hour into the trek. 90 airlines over the past eight years, MedAire commercial carriers now have at least adrenaline Inc. is in a position to estimate that an average (epinephrine), atropine and a resuscitation bag of one in-flight death occurs in every 5.7 million and mask. Emergency therapeutic oxygen is also passengers, or 0.08 per billion for each kilometre available. As a result, people today have a much Skyline Aviation partners International SOS a paying passenger is carried (‘revenue passenger greater chance of surviving in-flight SCAs. kilometres’). But considering the number of flights Having a nurse onboard is an invaluable resource New Zealand-based Skyline Aviation Ltd has required. The announcement of this partnership at any given moment, the absolute numbers are to help crew directly. You can establish IV lines announced a new partnership with global assistance today confirms we absolutely have confidence in not exactly small. MedAire is involved in precisely while working under the direction of a ground- company, International SOS, to provide the company Skyline Aviation Ltd.” 5.6 cases per month, which represents the based medical support team, a service that more with specialist medical aircraft resources that can be Van de Klundert then espoused the benefits of average over a period of nine years. and more airlines are consulting. The end result called upon at any time, if required. Michael Toogood International SOS’s specialist medical outfitting, At cruising altitude, the vast majority of healthy could be a life saved. said of the deal: “I have huge regard for International saying: “It [Skyline Aviation Ltd’s turboprop King Air SOS and the work they do around the world. To with two stretcher ‘Lifeport systems’] has a huge partner them is both significant from a commercial cargo door and specialist lifting devices for ease of Having a nurse onboard is an invaluable and credibility perspective.” Meanwhile, Jeremy van transporting stretchered patients. It really is a great de Klundert, general manager of International SOS, asset for International SOS to call on.” He continued by added: “The arrangement we have entered into confirming that the aircraft would be flown by two pilots resource to help crew directly with Skyline Aviation Ltd is essentially about saving and has a flight-cell satellite telephone system, allowing, peoples’ lives or removing them from a situation “International SOS’s call centres and clinical teams based where they are medically or physically at risk. We around the world to communicate with the pilots and must have complete faith in our business partner’s medical teams onboard, relaying vital medical history ability to be able to complete the necessary tasks that is essential to the safe treatment of patients.”

Air ambulance service shake-up raises concern

The Scottish Air Ambulance Service (SAS) is to near Glasgow, in a move that has raised concerns transfer the co-ordination of air ambulance medical amongst staff. Despite Scottish Ambulance chiefs transfer requests for the north of the country insisting the switch will improve efficiency, staff are from Raigmore Hospital, Inverness, to a new unit concerned that adding another link in the chain of command, combined with a lack of local knowledge, could cause delays. A spokesman for the SAS said that calls received in Inverness would now be relayed to a new ‘inter-hospital transfer team’ in Cardonald, Glasgow, which ssengers can tolerate a cabin pressure of 6,000 will then dispatch an aircraft from the to 8,000 feet. However, cabin pressure can be Dr Paolo M. Alves is vice-president of service’s fleet of planes and choppers. a problem for those with cardiac or pulmonary aviation and maritime health at MedAire. He He said: “We are setting up a new team conditions, particularly borderline risk factors. is responsible for providing technical guidance dedicated to managing our inter-hospital Events leading to an in-flight SCA may begin well regarding medical case analysis and product road and air service across Scotland. It before the flight. Many air travellers have to walk development. A company spokesperson, he is will make better use of our resources to longer distances and carry more weight than they a frequent speaker at industry associations such provide a better service for everyone.” are accustomed to. They also may be in a hurry, as the International Air Transport Association, adding psychological stress to the equation. The Airlines Medical Directors Association, bottom line is: passengers can easily cross their Aerospace Medical Association and National safety limit if they already have, knowingly or not, Business Aviation Association. Red Crescent to launch a subjacent health condition. The Saudi Arabian Red Crescent Authority was set to four and six medium-range fixed-wing aircraft in order officially launch its air ambulance service this year. Dr to offer air ambulance coverage across the country over Muwaffaq Al-Byook, executive director of the Self- the course of four years. The first stage begins very Kuwait to lease air ambulance services Operation Project at Red Crescent, spoke to The Saudi soon, with the purchase of several fixed-wing aircraft Gazette newspaper at the end of October, and said that will be located in the Central Region near Riyadh The Kuwait Health Ministry is to consider the option would save time and lives and be particularly useful in that the aircraft were expected to arrive within days, and the Western Region, Makkah. The Authority also of leasing air ambulance services that would aid in the the case of traffic accidents, where it can sometimes be and the air ambulances would officially be launched has plans to set up an academy that will offer training to quicker transfer of severe medical cases to hospital, difficult for ground medical teams to reach casualties. The soon afterwards. candidates interested in aeromedical care. Each aircraft according to Health Minister Hilal Al-Sayer. Health Minister also mentioned that hiring air ambulance At a press conference, Al-Byook said the Authority was will have a crew of between eight and 10 people, Al-Sayer told the Ministry that he believes the aircraft services would be less costly than purchasing them. in the process of securing 28 helicopters and between according to Al-Byook, in addition to the pilots.

International Travel Insurance Journal AIRAMBULANCENEWS 21

RFDS responds to contract loss NEWSWIRE Royal Flying Doctors South Eastern Section (RFDS is too early at this stage to confirm whether we will definitely behind the RFDS retaining the air ambulance SE) has lost its contract to run Air Ambulance simply stop serving the region or implement an RFDS contract. We continue to receive many letters and Jet Rescue Air Ambulance, based in Arizona Victoria when the current arrangement ends in primary health service. However, the move by the emails of support and I do understand that the in the US and Guadalajara and Toluca in Mexico, 2011. ITIJ spoke to Clyde Thomson, executive Victorian Government to contract Air Ambulance Victorian Government has been besieged by much is in the process of gaining accreditation by the director of RFDS SE, on the wider implications of Victoria to an overseas-based company will definitely correspondence also. European Aeromedical Institute (EURAMI). The the contract loss have ramifications to our remote servicing of the area. award would signify the first time EURAMI has given ITIJ: If the RFDS loses both contracts, how will the accreditation to an air ambulance company based ITIJ: If the NSW contract charity cope moving forward? Will the charity’s in Latin America. were to be lost to Pel-Air fundraising efforts have to be stepped up and as well, what knock-on become more innovative, or is the current funding Germany-based FAI saw a 13-per-cent rise effect would this have model for RFDS, whereby money from one state’s in missions in August 2009 compared to the same on the remote medical contract helps medical services in that state, going period last year, and a 57-per-cent higher volume in and dental services RFDS to have to change so that money from other state’s September 2009 in contrast to 2008. The company provides there? contracts can be shifted into other states in order expects a 10-per-cent growth of activity overall by CT: Should the NSW to provide continued medical services? Would the the end of the year. Government move the NSW public be happy with this? Air Ambulance contract to CT: The Reverend John Flynn, in 1928, had a Pelair, ramifications on the dream of bringing healthcare to people isolated in ability of the RFDS to service outback communities. His vision was to provide ‘a NSW rural and outback mantle of safety’ for all Australians. Since the news Rio Tinto teams communities will be significant the RFDS may be losing the Victorian and NSW due to the loss of economies contracts, RFDS support through cash donations with air ambulances of scale. However, the RFDS from many individuals, partnerships and companies (SE Section) is in negotiations and support for the ‘doctor’ has grown to the extent The Royal Flying Doctors Service in Western Clyde Thompson with the Commonwealth it will, together with additional support from the Australia (RFDSWA) has purchased and launched Government to provide Commonwealth Government, replace any additional its first medical emergency jet, a Hawker 800X, ITIJ: How much does the RFDS SE rely on additional funding to enable RFDS Primary Health costs experienced through the loss of both contracts. which will service the whole WA region. The aircraft, government contract cash to keep up its remote services to continue should the NSW Air Ambulance However, it should be noted, we are still very hopeful named the Rio Tinto Life Flight, was purchased in rural medical services? What proportion of a A$70- contract be lost. of retaining the NSW Air Ambulance contract. partnership with mining company Rio Tinto and can million contract would be invested in such schemes? The RFDS provides what we call a ‘mantle of safety’ Today, the RFDS [provides] not only 24-hour carry three clinical staff and three stretcher patients. Clyde Thomson: State Government contract income for over the region. However, with the assistance of our emergency aerial retrieval, but also inter-hospital Tim Shackleton, spokesman for the RFDS, said the the South Eastern Section amounts to $26 million per individual and corporate donors, every effort will be transfers, general practitioner clinics, primary care plane can reach any destination in WA in three hours year from operations of the air ambulance services in made to retain our services. nursing, remote consultations, ‘fly around’ clinics, the or less, and that it will also be used to repatriate Victoria, Tasmania and New South Wales (NSW). The rural women’s general practitioner service, [as well injured Australians from overseas. He added: “The jet cash ‘surplus’ from contracts (as above) amounts to $3.1 ITIJ: Victoria Premier John Brumby was quoted as] health services: indigenous, mental and dental. has the capacity to fly from Perth to any capital city in million. In addition, the RFDS SE receives funds from as saying it was a decision that had been based The RFDS will continue to move forward, and fund- Australia without requiring refuel, so it has very long donations & bequests ($11.5 million), State grants ($4.8 on money – but given the service that RFDS raising activities will increase and continue their path range, and its conceivable that on the odd occasion, million), Commonwealth grants ($7 million) and several has provided over the years, do you believe the of innovation wherever required. if there’s a major emergency somewhere within our other origins totalling some $3 million. government should take more ‘human’ aspects into region, this jet may be able to respond to that.” The expenditure of the RFDS SE is as follows: primary account? Sam Walsh, Rio Tinto chief evacuations ($3.4 million), inter-hospital transfers CT: It is a short-sighted approach by the Victorian executive of iron ore, said the ($27.6 million), primary health clinics ($3.7 million), Government to take the actions they have taken, with partnership with RFDS reflected medical and dental programmes ($2.7 million) and the awarding of this contract to a foreign commercial a strong commitment to the fundraising/merchandising expenses of some $1.7 company. The RFDS is a transparent organisation with regional and remote communities million. In addition, an amount in 2008 was allowed for all profits from the Air Ambulance operation being in which most of the company’s devaluation of aircraft and depreciation of $10.8 million. directed to improving health services for rural and employees lived and worked: remote Australians as we have for the last 81 years in “We are proud to support ITIJ: Will RFDS have to scale back remote medical Australia. Australia’s first and only RFDS- operations as a result of losing the Victoria contract? Australia is not in a recession – technically. We do operated jet, which will help Is the RFDS simply going to stop serving the area in not know the taxpayer would be paying more with deliver faster and more effective 2011 once the contract comes to an end? continued air ambulance operations by the RFDS. The services to critically ill people living CT: The loss of the air ambulance contract in Victoria mandate of any commercial enterprise is to maximise in regional and remote WA. We will reflect adversely on services to remote Australia its profits for its shareholders. Surely any person, let believe that it will provide a life- in NSW and Victoria, based on the loss of economies alone a government, would understand that continued saving service and demonstrates of scale these operations bring to the South Eastern and expanding profitability is foremost on the minds of our genuine commitment to the Sections operations. The Air Ambulance Victoria any commercial enterprise. well-being of the communities in contract with the RFDS will expire 30 June 2011. It The taxpayer in Victoria, along with the media, is RFDSWA medical director DR Stephen Langford boards the jet Rio Tinto/Ross Swanborough and around our operations.”

www.itij.co.uk 22 IPMI NEWS

Compass launched for expats Insurer posts WR announces

Cigna International has launched Cigna Compass provide needed information to the expatriate improvements record growth SM, an interactive Web-based tool that gives employees, can be challenging due to the nature of expatriates and their families ready access to their international regulations and customs,” said Keith Data released by the independent non-profit benefit information, and provides guidance to keep Vaughn, senior vice president for Cigna International organisation the National Committee for Quality themselves healthy. The tool combines on-screen Expatriate Benefits. “Cigna Compass provides Assurance (NCQA) shows that CIGNA plans text and audio-video features, making it easy for key information in a user-friendly online format. continue to post gains in healthcare quality which, users to find a doctor anywhere in the world, or No other international benefits carrier offers a according to CIGNA analysis of the data, shows year- to seek a second opinion on a medical condition. comparable advantage.” over-year improvements in more than 80 per cent of Through Compass, everything measures tracked by NCQA. expats need to know about Dr Jeffrey Kang, chief medical officer for CIGNA, their healthcare coverage or said: “We are proud of the difference that CIGNA’s the status of their health claims programmes continue to make in helping our instantly pops up on a computer customers receive quality care and enjoy better screen and is accompanied by a outcomes that improve quality of life, promote good voiceover. Pod casts and other health and reduce costs.” He continued: “NCQA’s digital technology complete the data underscores just some of the many ways that Compass experience. quality-orientated heath service organisations bring “Cigna Compass sets a new additional value to the healthcare system.” industry standard for international According to the company, the analysis indicates that service and communications. CIGNA ‘continues to exceed the national average and Without [it], getting international the averages of its national competitors in a significant employers’ necessary information number of these measures’. CIGNA also states, in a timely manner, so they can through its Quality Value Model, that improved quality saves clients nearly US$400 per person, per year. Goodhealth Worldwide renamed

Aetna has announced that it has renamed official integration of our global business operations International expatriate insurance provider William Goodhealth Worldwide, the company that Aetna strengthens our position as a key player in the Russell has reported a growth of 647 per cent purchased in late 2007. All products and services international marketplace. Now, under the Aetna for 2008, despite the downturn in the global will now be sold as Aetna Global Benefits (AGB), umbrella, our stakeholders worldwide will benefit economy. The company puts its success down the organisation’s international business segment from the experience, healthcare expertise and to the fact that it joined with local insurer, Dubai that has over 400,000 clients around the world. financial stability of a powerful brand that’s been Insurance Company, to sell their international Martha Temple, president of AGB, noted: “The respected for over 150 years.” health, life and income protection insurance plans to individuals and employers in the United Arab Emirates (UAE). In fact, William Russell states that sales in the last 12 months have out-performed the previous five years combined. InterGlobal launches ‘buy online’ Colin Ward, business development manager for the company, said: “William Russell’s collaboration International private medical insurer InterGlobal with Dubai Insurance provides our members has introduced a new transactional capability on with the assurance that their worldwide policies its website that will allow clients and brokers to CIGNA expands team are underwritten by one of the leading and most purchase international private medical insurance respected insurers in the region, combined plans online. The ‘buy online’ enhancement is CIGNA Healthcare of California has appointed with William Russell’s global reputation for high being rolled out in stages, with intermediaries and Emile Bayle III as the new sales manager for existing standards of service.” expatriates wishing to buy InterGlobal’s individual business for the Orange County and San Diego Abdellatif Abuqurah, general manager, Dubai Ultracare and International Student Plans being able markets. Bayle is responsible for helping CIGNA’s Insurance Company, commented: “We are to purchase them online. current clients design medical, dental, behavioural extremely pleased that we have increased our InterGlobal’s private medical insurance products and pharmacy benefit plans that keep employees share of the international insurance marketplace can now be purchased easily and in a completely healthy and productive as well as helping to control so dramatically. William Russell’s niche products secure online environment, according to group a system with an easy-to-use layout and industry- costs. Christopher De Rosa, president and general and service ethos bring global standards and marketing and Ecommerce manager Matt leading security with 3D Secure.” manager of the company, said: “CIGNA is committed worldwide cover to expatriates, local residents and Wilkinson. Commenting on the launch, he said: The website capability also offers direct processing to providing the individuals and businesses we serve small-to-medium sized employers in the UAE.” “When people buy online, they expect a reliable, to the firm’s back office system, without the need with excellent service, strong client management and In addition, William Russell has also topped the straightforward buying experience coupled with for re-keying any data entered, which the company top-of-the-line wellness programmes. We’re please April Medibroker Insurer Survey in both the total security of their personal information and believes will increase the ‘accuracy and speed’ of to have Emile on board. He brings extensive market ‘Service to Customer’ and ‘Service to Independent records. We have therefore focused on delivering processing for its members. knowledge to our team.” Broker Advisors and Intermediaries’ categories.

International Travel Insurance Journal IPMI NEWS 23

Medicare International offers advice Sheerin appointed at WR

Global expatriate healthcare provider Medicare country. There International is responsible for the overall management International has issued healthcare advice is also a mild risk expatriate of the company’s international customer to expats living in or planning to move to, of contracting insurance provider care operations, which services new health, Singapore. According to the company, expats dengue fever William Russell life and income protection plan applications planning to relocate to the country who have and Medicare (WR) has added and renewals from both consumers and ‘good health insurance and [take] sensible recommends to its customer intermediary partners. Previously, Sheerin precautions, [should] usually have very little that travellers service team in worked for Standard Life Healthcare as risk of developing a serious medical condition seek medical the UK through customer service team manager. through infection’. advice before the appointment Inez Cooper, managing director of WR, said The advice covers the topic of swine flu, stating travelling to the of Jamie Sheerin of the appointment: “We are delighted to that Singapore’s government takes the risk of country and that as customer welcome Jamie to WR. Jamie brings with him people transmitting the virus very seriously and all appropriate service manager. 10 years of qualified experience as a team confirming that, as of 30 September 2009, there vaccinations are In his new manager dedicated to the deliverance of the have been 18 swine flu-related deaths in the up to date. role, Sheerin highest standards of customer care.”

Bupa steals the show

Expatriate health insurer Bupa International has been named ‘Best International Medical Insurance Provider’ by brokers for the fourth year running at this year’s Health Insurance Awards – the ninth time the company has won the award since 1999. Commenting on the award, Tim Slee, sales director for Bupa International, said: “We work with excellent brokers on a global level and appreciate their continued support. We are delighted to have received the accolade from the brokers as best provider of international private medical insurance for the fourth consecutive year, which highlights why Bupa International is the number one choice for expats wherever they are in the world.” He added: “This accolade is testament to the hard work and dedication of everyone at Bupa International and recognises our desire as a company to lead the industry in terms of our product range and dedication to customer service.” Bupa UK also enjoyed success at the awards ceremony, winning ‘Health Insurance Company of the Year’ and ‘Best Group Private Medical Insurance Provider’. In other news, Bupa has appointed Steven Zuanella as its group e-commerce director, with responsibility for Bupa’s online presence globally. Steven joins the company from Prudential, where he headed up the online and e-commerce division. Alison Platt, group development director, said of the appointment: “Steven brings to Bupa an impressive track record in the online and e-commerce space. He will play a crucial role as e-commerce director in driving forward Bupa’s web experience and integrating all the international web platforms across Bupa to enable growth and support our business priorities.”

Mike Sims (left) and David Nuttall Two step up at BHSF UK-based health and benefits insurer BHSF has announced that Mark Chapman, the company’s human resources and quality management director, is retiring after nearly nine years with the business. He joined after a lengthy career with Lucas Aerospace and in his time with BHSF has accomplished a great deal, including seeing the business awarded ISO 9001:2000. From January, David Nuttall is to be the new HR and operations director; he joined the firm upon its acquisition of The Health Scheme in 2001 and has grown the business since his appointment. At the same time, Mike Sims is to become IS and quality director. Mike has international IS experience, having run his own computer consultancy. He joined BHSF in 2003 and adds the quality management role to his busy IS and business improvement portfolio.

www.itij.co.uk 24 CROSS BORDER CARE

Heathbase partners with German hospital Thai growth continues Piyavate on the up

US-based medical tourism provider Healthbase has added Mohahasundaram, who mentioned that the The Tourism Authority of Thailand (TAT) and the Bangkok’s Piyavate Hospital saw its profits rise for partnered with a Joint Commission International geographical location of the hospital means that flight Department of Export Promotion have estimated the first time in four years and can now expect (JCI)-accredited German hospital to bring wider times for patients travelling from Europe and North that around two million tourists took advantage of its revenue to increase by 10 per cent this year, options for medical tourists seeking affordable, timely America will be reduced. Thailand’s healthcare services over the course of according to hospital’s chief executive officer Dr Nithi and high quality dental treatments. The partnership The new German provider will be able to offer 2009, giving the medical tourism industry a growth Mahanonda. The non-listed private hospital expects has increased Healthbase’s network to over 100 orthopaedic, spinal and bariatric treatments at a rate that rate of 14 per cent year-on-year. According to a its revenue to approach one billion baht, thanks to healthcare and dental providers spread across 18 is 50 to 70 per cent lower than those in the US, and recent Research and Markets report into the topic, the continual profits over the past five months. This countries, meaning increased choices and convenience it will offer a faster access to service compared to that country cared for the highest number of international sum betters last year’s revenue of 800 million baht, for Europeans, Americans, Canadians and others. offered by healthcare systems in the UK and Canada. medical tourists compared to any other Asian nation. and there has been a significant improvement in the “With growing demands from our consumer base Joint replacement procedures, spinal procedures and The type of procedure patients are heading to hospital’s losses, which stood at 300 million baht in for a quality tertiary medical care centre in Europe, weight-loss procedures are among some of Thailand for varies widely, according to TAT. 2008 and will come in at a much lesser 40 to 50 we are excited to have our newest Germany-based the hospital’s treatment Procedures range from general health check-ups million this year. healthcare provider onboard,” said Healthbase’s offerings. and routine dental maintenance, to cosmetic According to Dr Nithi, an increase in Piyavate’s chief executive officer Saroja Mohanasundaram. surgery and angioplasties. In further confirmation profits was down to better credit standing with “We have carefully chosen our German of the country’s status among medical tourism lenders, a benefit gained from the hospital’s major provider after a rigorous selection process providers, a new book: Patients Beyond Borders: shareholder, Chaleo Yoovidhya – Red Bull energy keeping in mind all aspects of affordable, Thailand Edition, features an in-depth overview of drink tycoon and Thailand’s wealthiest man, who safe and top quality medical tourism care,” the country’s private hospitals, selected health travel raised his stake in the hospital from 40 per cent to 90 agents, nearby recovery and guest accommodations per cent. “With the help of Mr Chaleo’s credibility, and area travel information. we were able to seek loans at a very low interest rate, which lowered our costs by 20 per cent and Medical tourism helped with our cash flow,” said Dr Nithi. While Piyavate is known for its heart, orthopaedic on the mend Mexico calling and cancer treatments, its revenue is expected to Economic recovery may help to encourage grow by a further 14 to 15 per cent in 2010 due a 35 per cent annual growth rate for the The US-based medical travel division of one of to the introduction of doctors specialised in general medical tourism industry by 2010, according Mexico’s private hospital networks, Angeles Health practice, obstetrics and paediatrics. This will increase to a report released by the Deloitte Centre International (AHI), is encouraging US patients to its team of 30 full-time doctors to between 40 and for Health Solutions at this year’s World Medical travel to Mexico for various medical, surgical and 50 and help the hospital to accomplish its goal of Tourism and Global Health Congress held in dental care options available in its hospitals. Paulo becoming one of the top five private Thai hospitals, Los Angeles, California. The report showed Yberri, chief executive of AHI, said: “Medical care in in terms of treatment and research, over the next that the recession dramatically slowed the Mexico is both high quality and affordable, with the four years. “Currently the process of improvement growth rate of medical tourism by 13.9 added benefit of allowing patients to spend some is 80 to 90 per cent complete,” said Dr Nithi, who per cent from 2007 to 2009 by forcing time in a beautiful, welcoming place during and after added: “What we will get is a hospital that is known consumers to put off elective medical their treatment.” He continued: “We have treated for its specialisation, but which can also offer all the procedures. Over 750,000 Americans … 4,000 American travellers in the past three years. basic services.” 150 billion baht will also be invested travelled abroad for outbound medical care We treat an average of five American patients per for hospital renovation and medical supplies over in 2007, but this figure decreased by 20 day in the areas of bariatric surgery, orthopaedics, the next five to six months to help with the hospital’s per cent in 2008 to just 540,000 and growth cardiology and organ transplant, amongst others.” advancement. decreased by a further 10 per cent in 2009, despite the number of travellers increasing to 648,000. Top Still, the report projected that outbound medical tourism could reach upwards of 1.6 million patients destinations revealed by 2012, “Barring any tempering factors, such as WorldMed Assist signs industry-first contract supply constraints, resistance from health plans, UK specialist travel insurance and medical tourism increased domestic competition or government insurance provider PJ Hayman has revealed the An industry-first contract has been signed between “represents the first contract with an association policies,” said Deloitte Center for Health Solution’s world’s cheapest countries medical tourists can fly medical tourism facilitator WorldMed Assist and US of its kind for the medical tourism industry,” said executive director Paul Keeley. to for cosmetic surgery. Having selected the top five non-profit organisation the International Association WorldMed Assist chief executive officer Wouter According to Keeley, medical tourism is likely to cosmetic procedures for both sexes, the company of Benefits (IAB), which will allow IAB members Hoeberechts, looks set to be beneficial for IAB recover in 2010 because medical quality is becoming calculated the cost of these procedures in various to choose a discounted and fully-facilitated medical members. Commenting on the contract, Danny better defined and consumers may be more willing countries – taking into account flight costs – and journey to one of WorldMed Assist’s overseas Grey, vice president of IAB operations, said: “We’re to test it out to explore ways of saving. “With identified the cheapest countries to visit. partner hospitals. With the two firms in partnership, confident in the quality of care [WorldMed Assist] will healthcare costs increasing at the rate of six per cent It emerged that women were best placed to fly further IAB’s focus of providing individuals and families deliver to our members … [and adding] a medical per year for the next decade, and medical tourism afield and take advantage of the warmer climes of with affordable access to benefits, including savings travel option to their benefits lets our members offering savings of up to 70 per cent after travel Brazil or India. Even after flight costs had been taken on medical services that are only usually available select from among the world’s best doctors.” expenses … we expect to see an increase in medical into account, Brazil topped the table for the cheapest to large groups, can be further tourism pilots and involvement by employers, country to visit for all five procedures, with Hungary accomplished. Thanks to the insurers and physicians to help create a backdrop for and India ranked as second and third cheapest break-through contract with sustainable, healthy growth in this sector,” he said. respectively. Meanwhile, countries closer to the UK WorldMed Assist, IAB members Presently, the American Medical Association (AMA) has cost over triple the amount – including Greece, France can now save even more money developed a set of nine guidelines on medical tourism and Spain. When looking at the cost comparison for on healthcare by having certain for employers, insurance companies and other entities popular procedures for men, it was found that Brazil medical procedures done that facilitate medical care outside of the US, and ranks as the least expensive option, while Hungary overseas at five-star facilities and at several health insurers have already launched medical retained its second position and Poland came in third. a significantly reduced cost. tourism pilots as part of their health benefit plans. Peter Hayman, director of PJ Hayman, noted: “As With insufficient signs of reduced Despite the impact of the prolonged recession on long as consumers have thoroughly researched their healthcare costs in the US, patients’ ability to afford medical care, and therefore chosen clinic, are confident in the procedures that medical tourism has become an medical tourism, the report revealed that 40 per they offer and have taken out appropriate travel attractive option for many and cent of respondents would travel outside of their insurance, they should not be wary about travelling this new contract with IAB, which immediate area for care if their physician advised it. abroad for surgery.”

Korean revenue surges Singapore rises in popularity Foreign visitors spent more than US$60 million health-related travel expenditure recorded a drop According to medical tourism company, year and aims to receive one million patients by in South Korea on medical treatments during of 35 per cent, reaching $69 million. The medical PlanetHospital, more Americans are travelling to 2012. According to PlanetHospital, patients who the first nine months of 2009, according to the tourism industry in the country has continued its Singapore for healthcare as well as for tourism travel to Singapore are usually those with no Bank of Korea. The bank said that revenue from rapid development and has undergone several reasons – the company stated that it expects to be medical insurance who can save as much as 70 medical tourism between January and September improvements in quality of care provided, but at the able to send up to twenty patients to Singapore per cent on medical and travel bills. Many travel this year increased by 29 per cent compared to same time the Korean won weakened against other every month in 2010. The country is currently for heart, cancer, obesity and knee replacement- the same period last year, while at the same time currencies early on in the year. visited by around 40,000 medical tourists every related surgery.

26 NEWSANALYSIS A difficult partnership Travel insurance and cancer have never been the easiest of bedfellows and that difficult relationship is once again in the media spotlight. This time, according to those who see an inherent unfairness in the way travel insurers treat cancer patients, the industry is going to have to make changes. David Craik investigates

he most recent furore began with Coutts his son Trevor challenged the decision on the grounds Ombudsman Service (FOS), said he is unable customer Ron Phillips. He paid for that they expected the policy to provide cover for to provide breakdown figures for cancer-related Ta holiday using his Coutts gold card unforeseen events, and that it was unfair for the insurer disputes as opposed to other types of disputes. But, but before taking his trip was diagnosed with to amend the terms of a policy mid-term, Coutts was he said, one recent case is a typical example of the cancer. In keeping with the terms of his policy, forced to reinstate full cover. complaint it receives in this area. “The customer was Phillips contacted the bank to inform them But, the bank then said it would rewrite the diagnosed with cancer only a few weeks after taking of the change in his circumstances. terms and conditions of its travel insurance out insurance,” he said. “It was not until three days The bank advised Phillips that it would policy so they could be changed if a future before he was due to depart that he was well enough exclude cover for his condition. client falls ill after they have booked a trip, for his doctor to declare him fit to travel. He called When Phillips and but before departure. The Phillips could his insurer to check that he would be covered for any have revelled in their victory but, instead, problems linked with his cancer while he was away. they have taken up the fight for cancer It was not until the afternoon before he was due to patients who have faced similar difficulties. set off that he was told the insurer would not cover They have set up a website, which is partly him. He then spent several hours ringing around aimed at chronicling these concerns, and insurers to find cover. He asked for compensation for which has had 14,000 hits to date. the distress and inconvenience this had caused him, “The experience of people with cancer and but he was refused.” The complaint was upheld as travel insurance is terrible,” said Trevor Phillip. the FOS said the customer could not ever be “certain Respondents to the site include a gentleman who exactly what cover was available under their policy. had held a multi-trip policy with a company for 18 We did not consider this to be fair”.

The normal online box ticking applications process leaves absolutely no leeway for someone who has survived [cancer]

years. However, when he was diagnosed This case and the comments on the Phillips website with cancer he was told there would don’t surprise Macmillan Cancer Support. The charity be no cover for anything related to conducted a survey in 2007, which found that a his condition. “He got neither third of over 1,000 cancer patients had been offered explanation nor offer to premiums two or even three times the normal rate. renew.” “People living with cancer find it difficult to obtain Even cancer survivors have travel insurance that covers their cancer diagnosis struggled. “Since pulling because of high prices, being refused cover for their through two operations I cancer and having to spend time shopping around,” have the utmost difficulty said Mike Hobday, head of policy and campaigns in finding satisfactory travel at Macmillan. “We want to ensure cancer patients insurance. The normal online do not have to choose between inadequate travel box ticking applications process insurance cover and extremely high premiums. We leaves absolutely no leeway for also want the travel insurance industry to develop someone who has survived and, insurance products that meet the needs of people as in my case, is in better health living with cancer.” than I was for many years before,” Hobday said cancer treatment is improving all the one respondent said. time and for the two million people living with a Another said: “My cancer is no cancer diagnosis today their state of health and longer there. I was advised by well-being is ‘a lot better’ than it was 10 years ago. my oncologist to take a holiday “As people’s health improves we want the price of somewhere hot. I was shocked travel insurance to come down in a way that reflects that no one would insure me. I people’s better health,” he said. “We are working felt very upset at all the questions. with insurance companies to show them where they After a horrendous 12 months I can reduce their prices.” have come through and now feel fine. But I feel discriminated against Industry response because I was unfortunate to get So, what do the travel insurers say? Do they need to cancer.” Others said they are paying rethink their approach to cancer? ITIJ contacted 12 up to £600 cover for a two-week companies for comment on the cover they provide break. for cancer patients, but only three replied. A basic website check of major insurance providers, Are these complaints likely to be a common starting point for cancer patients, typical? provides some clues, but the word cancer is rarely Paul Bicknell, mentioned. Generally the websites state that the press officer at insurers cover a range of pre-existing medical conditions the Financial but it needs to ask the customer a ‘few simple’ questions

International Travel Insurance Journal NEWSANALYSIS 27

a third of over 1,000 cancer patients had been offered premiums two or even three times the normal rate

first. If a customer’s health changes after the start date of their policy and the date their travel tickets were issued, they must telephone the insurer’s customer helpline to make sure their cover is not affected. Walter De Angeli, founder of Travel Insurance Australia, did respond: “Cancer is not covered. I think the public fails to look at insurers in the following chilling light that they are bookmakers betting the odds that you will not claim on them. Thus, if you have a terminal illness they won’t take the bet. Why should a non-affected person pay exorbitant premiums to cover a person who could forseeably die?” Paul Beven, director of the Healix Group, said: “This is an emotive issue. Insurers need to ensure objectivity and fairness in their dealings with cancer patients. I believe considerable thought goes into practical ways to allow the maximum number of people access to cover.” He said it is ‘prudent’ of insurers to ask ‘pertinent The Association of British Insurers said the cost mid-term underwriting. People’s health can change questions’ about the nature of the risk and act of cover needs to be reviewed if the risk changes “If the risk is low meaning the underwriter is faced with a material accordingly: “Some cancers are eminently treatable between the date of the policy being taken out and change in risk.” and can be considered cured after a period of the date of travel. It says it is key that customers tell enough cover at Phillips concludes by appealing to the industry’s time. Others are rapidly fatal. Others follow a their insurer about any changes. This allows them to pocket. “The majority of cancers are discovered in long and sometimes unpredictable course. Travel reassess the risk and obtain medical information such standard rates is later life. These are cash-rich people who want to go insurance claims related to cancer may, as a result of as medical reports. on holiday and medically can do so. The industry is emergencies occurring overseas, be very expensive.” Kingaby added: “Most travel insurance policies often available.” missing out on a huge market.” He added: “I believe most UK travel insurers adopt provide cancellation cover for events that weren’t a fair and reasonable approach in that they will not known about before the policy was purchased. In automatically decline an applicant with cancer but the Phillips example the cancer was diagnosed after try to establish the relevant facts about the disease. purchase of the policy therefore most insurers will The way they ask their questions and the loads cover all the costs of cancellation.” that attach to the answers are regularly reviewed by medical staff.” He continued: “If the risk is low enough, cover at standard rates is often available. For greater degrees of risk, insurers will quote “I think the public fails additional premium to provide full cover where they can but, not unreasonably, most insurers to look at insurers in will deem significantly high risks to be beyond the scope of their standard products.” He argues that the following chilling higher-risk travellers still have a range of products to choose from offering cover, with as few restrictions light that they are as possible. “Unfortunately, the way risk equates to price means that some people may be unable, or bookmakers betting unwilling, to pay for the cover and are understandably aggrieved about it.” the odds that you will World Nomads policies do not cover pre-existing medical conditions. Graham Kingaby said: “Because not claim on them.” it is easy to rack up tens of thousands of pounds worth of medical expenses in a foreign hospital, most travel insurers exclude medical conditions that you know about before you actually travel. Discriminatory tactics or missing a trick? Ron Phillips, like a lot of people, was offered travel Trevor Phillips says he has received legal advice stating insurance through his bank or credit card and, that insurers who cancel cover without assessing obviously, the terms and conditions were not medical risk such as getting a doctor’s report could properly considered by either party. It is better to go be in breach of the Disability Discrimination Act. “I to a specialist travel insurance company than a bank believe the insurance industry has not caught up with or supermarket where you are more likely to deal the DDA revisions in 2005. They have to assess on with people who actually work in this part of the a case by case basis,” he said. “We aim to approach industry and can offer alternatives if your particular and challenge the insurance industry on this. They issues aren’t dealt with by a standard policy.” have to get in line with medical improvements and InsureCancer, a specialist insurance provider which not have a one-size-fits-all approach.” underwrites each individual case, said it is the What of Coutts? A spokesperson said: “All policy customers of the major high-street banks and credit terms and conditions are reviewed by our legal team. card companies who are most likely to experience a Any proposed changes are in line with what we are denial of coverage. Director Krish Shastri said: “The legally entitled to do. We try and extend cover for practice is so prevalent that we have had to devise a those people whose health changes during the life of special gap cover policy to help the customers of the the policy either for no extra cost of for an additional major high-street banks who have been denied cover premium. Customers need to fully understand their for their recent diagnosis.” obligations under travel insurance particularly with

www.itij.co.uk 28 FEATURE

Is this the future?

Katie Hughes spoke to several different Offshore or onshore? And, says the UK Business Process Management the internal resource or capability to do this.” insurers to assess whether outsourcing But should customer service centres, such as those Journal, outsourcing can be as much about saving Smith, of Travel Claims Services, adds: “A good travel insurance claims is the way offering claims management, be sent offshore? Emma opportunity costs as reducing financial outlay, through claims management company will have a niche forward for the industry Holyer, speaking for LV= in the UK, thinks not: “We its potential to release key employees from non-core understanding of the diversity of a client’s product firmly believe that UK-based companies are best placed or administrative processes and allowing them to and this is particularly important in the travel sector. It’s no secret that the rising cost of claims is hitting the to offer a much higher standard of customer care than invest more time and energy in building the firm’s Without the expertise you won’t make the savings.” travel insurance industry. Hard. Last year, according companies that are based outside of the UK.” Hart core business. CEGA’s Upton encourages clients to look beyond a to the Association of British Insurers (ABI), claims in of the NOA agrees, arguing: “Using an outsourcing But what about customer service, the pivot on supplier’s initial fee for savings: “Establish the ability the UK cost the sector £392 million – up £40 million partner in the same country … means that cultural which effective claims handling turns? Julie Smith of a claims administrator to manage and reduce on the year before. The rising tide of fraud and the hurdles and language problems are avoided and legal of Travel Claims Services maintains that customer the total claims spend, through the application of attendant disputes symptomatic of recession are also and technical processes will all be familiar.” service can be improved by using an onshore third specialist systems and expertise to tackle issues such putting pressure on insurers. “The level of fraud in And it’s not just customer service that compels party: “There can be a sense of complacency when as fraud, recoveries and medical cost containment, the UK generally has risen by about 24 per cent companies to look onshore for their outsourcing companies use in-house resources, because there and then judge the true value being provided within over the last two years,” says Malcolm Tarling of solutions. The recession is creating a wave of is very little comeback when service levels are not the context of this total spend.” the ABI. “When times are tough, people look for patriotic outsourcing in the US, dubbed the reached.” Holyer, of LV=, says: “We would tend to Aviva’s claims fraud manager Andrew Buck gives an easy money.” ‘Bangalore Backlash’. This has seen businesses such use an outsourcing company if they were in the best example of this by illustrating the savings made by a It seems, therefore, that the need for extended as Sallie Mae ‘back shore’ job, citing “a desire to position to provide a good service to our customers third-party fraud team, saying: “The value of fraud savings hours of claims operations, together with robust contribute economically to the communities in which – rather than specifically to cut costs and make detected on travel claims has risen from £1.5 million in investment in technology and expertise has never the company operates.” financial savings.” 2007, to £1.9 million in 2008 – a rise of 27 per cent been greater. But this is challenged by the financial against a three-per-cent smaller volume of claims.” constraints of the recession and the potential Why outsource? Niche services distraction from insurers’ core competencies. The fee-for-service basis on which most outsourcing “Outsourcing claims management is all about Bespoke solutions So, how can the efficiency of claims handling be companies operate “helps a company respond accessing specialist services from a pedigree company Tailor-made travel claims services may also include improved without compromising customer service? to changes in required capacity and does not that does it for a living.” says Rick Ware, sales and support for new products, business continuity plans Many have turned to outsourcing for the answer. require them to invest in assets, thereby making marketing director for Axa Assistance in the UK. and crisis management, but it is the ‘white labelling’ Business process outsourcing is a rapidly expanding the company more flexible,” says the US Journal of “Currently we have delegated authority on a of a brand that draws most on the expertise of a sector with an addressable global worth of US$122 Management. With claims volumes that fluctuate small number of specific programmes. By using third party administrator. “The ability to fully white- to $154 billion (last measured by the McKinsey in line with seasonal and economic events and specialists in their field we are able to concentrate label a service on behalf of another brand is a highly Global Institute in 2006). Of this, between $25 round-the-clock operational requirements, could on maintaining a high level of customer service skilled process that demands the seamless integration and $35 billion could be attributed to the insurance the travel claims industry benefit from such flexibility, and growing our business,” adds Monique van der of expertise in technology, telephony, training, industry as a whole. “The recession has meant that particularly in a recession? “The outsourcing of claims Linden, UK & Ireland claims manager for Chubb marketing and client management,” said Upton. “A private and public organisations have been looking to management can offer clients the potential to transfer Insurance Company of Europe. bespoke claims service involves taking on the client’s reduce overheads and minimise any negative impact risk by giving them access to advanced technology, Holyer from LV= supports this: “The overseas culture and branding in every area – from medical on the bottom line,” says Martyn Hart, chairman of solid business continuity plans and highly skilled contacts that our UK supplier has means they are screening to assistance,” adds Julie Smith of Travel the UK’s National Outsourcing Association (NOA). staff, whilst avoiding large capital expenditure on IT, in a good position to assist our customers with Claims Services. Monique van der Linden of Chubb “Outsourcing has therefore increased in popularity as training or HR,” says Rob Upton, director of sales a wide range of emergency situations they may highlights the importance of this ability: “We work a cost saving business strategy.” and marketing for UK-based CEGA Group Services. find themselves in overseas. We would not have with a limited number of third party administrators,

International Travel Insurance Journal FEATURE 29

highlights the importance of rigorous procedures “We work closely with the third party administrator Katie Hughes is a freelance journal- when appointing a third party to handle claims, saying to make sure that they handle the claims in line ist and public relations consultant. that outsourcing “may affect a firm’s exposure to with our philosophy and we will do regular audits,” operational risk through reduced control over people, says Monique van der Linden of Chubb. Upton She has more than twenty years' processes and systems.” Can a third party really avoid of CEGA agrees: “In our experience, the most experience of writing on a range of this risk? Rick Ware thinks so: “We would take on a successful relationships are built around trust and subjects, including insurance, finance, client’s brand promise, agree service levels and have open communication. Agree the goals and meet IT and travel. She makes contribu- regular audits and training sessions. We have systems regularly to track progress.” Monique van der Linden tions to the national press and sup- that measure what we deliver and our clients have concludes: “Our selection is based on companies that ports the corporate communications free access to us. We’re completely transparent.” are able to offer first class service and the required Holyer of LV= says: “The claims handling company technical expertise for the programme.” of blue chip companies. should have a clear understanding of the culture of the company it is working for, so it is able to reflect and Is this the future? enhance the service it provides to their customers.” Finding and working with the right third party “Choose a company that can mirror the philosophies which are medium sized and are flexible enough to and standards of your own brand,” says Rob Upton. provide a bespoke service.” “Then agree on measures that are most important Upton is an advocate of developing the tailor-made to the success of your business; be it customer approach still further, at a strategic level. He urges satisfaction, analysis of claims spend, increased clients to “take a holistic view of outsourcing by fraud detection rates, third party recoveries or integrating the specialist service provider into the management of large losses.” business process and product development cycle, so Julie Smith added: “Talk to a number of companies to that it can complement and add value to core skills.” see if they fit your culture and have a proven record Martyn Hart adds: “Many organisations have of achieving service level agreements. Third parties advanced their sourcing strategies to examine should work strictly to service level agreements that are whether or not a supplier can actually complement agreed up front – and it is in their interest to get it right.” their overall business strategy, rather than just reduce Rick Ware thinks that three main criteria set claims costs. It is this search for innovation and strategic management companies apart from one another: partnership that has driven significant advances in “Speed: how quickly they settle claims. Leakage: how outsourcing relationships.” effectively they control costs on behalf of the insurer, “We want to be seen as an integral partner and work and customer satisfaction: how fairly and efficiently with our clients strategically,” adds Rick Ware of Axa customers are treated and paid for their claims.” Emma Assistance. “We also need to be mindful of our role Holyer of LV= says: “We conduct a rigorous interview as a supplier and our need to be innovative and and tender process to ensure the company we choose competitive.” to work with is able to offer the same high standards of customer care. Should this standard fall at any time we The challenges of outsourcing would review the contract.” Is outsourcing always the right solution, though? But how can service level agreements be structured “Whilst access to specialist skills may be one of its key to preserve such standards? “We would include advantages, firms need to assess the skills slippage telephone statistics, complaint levels and claims that can result from outsourcing,” says Martyn Hart. leakage targets,” says Rick Ware, “we would also “To retain core competencies in-house is vital, as ensure that the insurance is fair to the customer.” employees’ skills are a factor that is crucial to a firm’s success.” But many organisations simply do not have the time or resources to take a holistic view of their More information: operations and assess their outsourcing need. “An The UK National Outsourcing Association exploratory venture can avoid the need for major www.noa.co.uk The European Outsourcing Association investment whilst drawing on the expertise and www.e-oa.net advice of a specialist third party”, says Rob Upton. International Association of Outsourcing This, he says, can be of particular benefit for new Professionals (US trade organisation) products or inherited schemes. www.outsourcingprofessional.org A Financial Services Authority (FSA) spokesman

www.itij.co.uk 30 FEATURE

Delhi belly

Robert Steffen of the University of Zurich people annually will confront TD problems – that is A variety of drugs have been considered for details the incidence and increasing costs 40,000 travellers per day. prevention of TD. These include probiotics, bismuth However, milder associated with treating one of the most Due to acquired immunity, the risk of illness is much subsalicylate (the active ingredient found in Pepto- common travelling ailments less in those living in areas with high endemicity. In Bismol, which is only available in certain countries, forms of TD may contrast, those groups who are at particularly high risk including the US) and antibiotics. Only the latter group It’s no secret that diarrhoea is a frequent health of illness include infants, young adults, and persons offers satisfactory protection, reducing the incidence also result in problem in developing countries. Most importantly, with an impaired gastric acid barrier. Recently, it of TD by 80 per cent or more. Quinolones (mainly it still is a very relevant cause of death, mainly among has been demonstrated that there is also a genetic ciprofloxacine) and rifaximine (a non-absorbed incapacitation, as infants and children – in the year 2000 alone, 2.1 susceptibility to TD. It has also been noted by antibiotic that, therefore, has a profile of adverse million people died from diarrhoeal diseases. Similarly researchers that TD often has a particularly severe and events similar to placebo) are those most often the patient cannot to these children, travellers visiting third-world long‑lasting course in small children. considered. This is controversial: While in North destinations are non-immunes with respect to the The risk of TD also depends on the selection of America such prophylaxis is frequently prescribed, predict how the many gastrointestinal pathogens occurring there, since hotel. In Jamaica, for instance, TD incidence rates in European doctors are more restrictive and would, for they have never, or not recently, been exposed to 18 hotels visited by at least 40 clients for one week the most part, consider it only for high-risk groups, illness will evolve them and have thus been unable to gradually develop varied between 0 and 33 per cent – a highly significant such as for patients with pre-existing illnesses in whom immunity or remain immune. difference. When visiting these places, food hygiene dehydration subsequent to TD may be dangerous Travellers Diarrhoea Travellers’ diarrhoea (TD) is usually defined as three experts realised that this statistic mirrors the hygienic (e.g., those with a history of stroke or transient Ian Gilmour, The ONE Group Chief Operating or more unformed stools per 24 hours with at least conditions. Already in previous studies, it had been ischemic attacks, inflammatory bowel disease, insulin- Officer comments: one accompanying symptom, such as fecal urgency, demonstrated that five-star hotels tend to have a dependent diabetes mellitus, chronic renal failure, or “Looking back around ten years, the travel abdominal cramps, nausea, vomiting or a fever. slightly higher TD incidence rate as compared to many AIDS), or persons who are particularly prone to suffer insurance industry did experience problems with However, milder forms of TD may also result in three or four star hotels. This is plausible, considering TD, be that for genetic reasons (rare) or due to a lack Spanish hospitals when it came to traveller’s incapacitation, as the patient cannot predict how the that food items are more frequently prepared with the of the gastric acid barrier. Such prophylaxis may also diarrhoea, as many admitted patients under the illness will evolve. Dysentery is usually pragmatically assistance of fingers in the more refined places. be considered for VIPs during short trips. diagnosis of gastroenteritis, keeping them in defined in travellers as TD that has invaded the TD is usually caused by fecal contamination of food Currently, no vaccine offers satisfactory protection hospital with the consequent cost implications intestinal mucosa, resulting in systemic disease with and beverages. The pathogens responsible for TD are against TD. Typhoid vaccines are specific against for insurers. This was particularly true of the fever and/or blood admixed to the stools. primarily bacteria, such as enterotoxigenic and other typhoid, which is not characterised by diarrhoea. The private clinics, and provoked heated debates TD mainly results in great frustration at times types of E. coli, Salmonella, Shigella, Campylobacter. only cholera vaccine available in a limited number of about moving patients from private to state of highest expectations – both for tourists or Viruses are infrequently detected in adults; parasites, countries (not in the US) offers some limited cross- facilities which, from the patient’s perspective, was people travelling on business. TD is hardly ever such as Entamoeba histolytica or Giardia lamblia, are protection against enterotoxigenic E. coli (ETEC), but seemingly only for cost reasons. Some insurers life threatening – on average the symptoms the cause of TD in less than five per cent of sufferers, the estimated efficacy against TD of all causes is limited took draconian measures, such as excluding spontaneously disappear after four days. However, but they may persist for a longer period upon return to between five and 23 per cent. A skin-patch vaccine private medical treatment in their wordings, in one per cent of patients they persist for over home. against ETEC is currently being tested. which made life challenging to say the least for one month. In more than 10 per cent, TD may be assistance companies. followed by an Irritable Bowel Syndrome (IBS). Is prevention possible? Therapeutic options The risk of infection depends strongly on the Avoidance of potentially contaminated food and As described above, it is nearly impossible to avoid “During this time, the many assistance cases destination, the type of travel (accommodation), beverages along the rule ‘boil it, cook it, peel it – or TD by clever behaviour, medication or vaccines. originating from Spain were for gastroenteritis and and other individual host factors. Travellers from forget it’ has been shown to drastically reduce the Therefore, therapy plays a dominating role and, for many cases resulted in four to six days inpatient industrialised countries journeying to developing risk of TD in one prospective study. However, less reasons explained below, self-treatment is important. admission. According to our most recent figures, countries are at the highest risk (between 20 and than five per cent of tourists strictly adhere to these The leading principle in the management of TD is however, most gastro cases are now treated as 66 per cent) during the first two weeks of their stay recommendations, and the majority of travellers to avoid dehydration. In healthy adults, an adequate outpatients with only a few requiring 24hrs IV (Figure 1), thus TD still is the most frequent illness in select, for instance, salads from attractive buffets fluid and electrolyte balance can be maintained with for rehydration. Also, Spanish GPs now hand out this population. If we conservatively estimate that 50 or accept ice cubes in their drinks. Organisms in tea with sugar (fluids without sugar are not well forms to gastro suffers on self treatment rather million travellers visit a developing country every year contaminated ice will survive concentrations of alcohol absorbed by the infected gastrointestinal tract), bottled than admit them, and prescribe special drinks [World Tourism Organization, unpublished data], and found in drinks mixed with tequila and whisky. On the soft drinks (no cola, as that contains caffeine, which designed to restore electrolyte balance. Naturally that overall, 30 to 40 per cent of these travellers will other hand, almost all enteropathogens are killed at increases intestinal motility and thus diarrhoea), juices, this has had a significant cost benefit to insurers.” develop TD, we can conclude that 15 to 20 million 100°C and most food items served at 60°C are safe. soups and crackers etc., to replace electrolytes. International Travel Insurance Journal FEATURE 31

doctor. A recent study conducted in Phuket (Thailand), Goa (India) and Mombasa (Kenya) illustrated that some physicians caring for patients at tourist hotels use obsolete antimicrobials or combinations, which are not recommended in industrialised nations. Additionally, many have now set up their private clinics in the vicinity of the hotels and increasingly hospitalise TD patients (some 80 per cent of the TD consultations) there overnight for antimicrobial infusion therapy – that results in costs amounting to several hundred US dollars, which the patients must then try to get reimbursed from their insurances upon return. Lastly, in some more remote areas there is concern about nosocomial transmission, mainly of the hepatitis B virus, and occasionally also of other pathogens.

Travellers’ diarrhoea persisting upon return While at most destinations in developing countries, no state-of-the-art laboratory investigation on the origin of TD is feasible, this may become a necessity upon return. In the initial phase, priority will often be given to stool analysis for parasites, particularly considering that most patients had already received antibiotics. However, ultimately a colonoscopy may be indicated as, rarely, TD symptoms may be the expression of a yet undetected malignancy in the gastrointestinal tract.

Professor Robert Steffen heads the Division of Epidemiology and Prevention of Communicable Diseases at the University of Zurich and is the Director of the World Health Organization collaborating centre for travellers’ health. He is also Adjunct Professor in the Epidemiology and Disease Prevention Electrolyte-containing oral rehydration solutions, such lead to rapid symptomatic improvement; the most situations. Therapy with lactobacilli or other probiotics Division of the University of Texas School as those formulated by WHO, will neither diminish dramatic reduction in the duration of illness is achieved has not been shown to be effective in modifying the of Public Health in Houston, Texas and the amount, nor duration, of diarrhoea, but they are by a combination therapy – two thirds of patients are course of travellers’ diarrhoea, although it appears that Honorary Fellow of the Australasian paramount in infants, children or senior TD patients free of symptoms within four hours. early therapy is slightly more effective. College of Tropical Medicine. in whom dehydration may much more rapidly have In adult TD patients, loperamide (up to 16 mg every Some with concerns about self-therapy have devastating effects. Because of damage to the intestinal 24 hours) may be used, but such high doses often recommended that TD patients should consult a local Literature is available from the author upon request lactase-producing cells by enteric pathogens, dairy subsequently result in constipation; also loperamide products should be avoided during illness, otherwise should really be avoided during bouts of dysentery, no diet is indicated. unless used in combination with an antibiotic. Most experts agree that travellers to TD risk Quinolones, and in Southeast Asia azithromycin, have destinations should carry an antimotility agent (usually become the antibiotics of choice for self-treatment. loperamide) and an antibiotic for self-treatment. Many Studies have shown single-dose therapy and three- studies have shown that both types of medication to five-day courses to be equally effective in most

Avoidance of potentially contaminated food and beverages along the rule ‘boil it, cook it, peel it – or forget it’ has been shown to drastically reduce the risk of TD

Figure 1 : world map with four zones of TD risk Incidence rates of travellers’ diarrhoea per two-week stay

www.itij.co.uk 32 ASSISTANCE&HEALTHCAREWORLDMARKETS

The Cuban Dream

Cuba’s faded and decaying grandeur, with its form the largest proportion iconic 1950s American cars and Caribbean of its tourists, but Europeans beaches, is as much of a pull to tourists as its from the UK, Spain, Italy, Patients from over 90 countries turbulent political history and revolutionary Germany and France largely icons. Tatum Anderson evaluates what make up the rest. More worldwide – including famous facilities are on offer to tourists who need recently, however, Cuba has medical help begun to market its tourist industry to Argentina, personalities such as Diego Brazil, Spain, Portugal, Bulgaria and Russia, and is With an indigenous population of over 11 million, also understood to be working on China, a large Maradona – have reportedly Cuba receives a further boost of around two potential market. million international visitors a year. Canadians The largest of the Caribbean islands, Cuba is visited Cuba for treatments International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 33

Major resort areas run international clinics that handle more complex medical conditions with permanent teams of doctors and nurses

actually an archipelago that sits between the Gulf of services, but luxury hotels Mexico and the Caribbean Sea. Many tourists head for and beaches where patients can the resort areas along the north and south coast at Pinar del recuperate from treatments. It even Río, Varadero, Trinidad, Cayo Coco and Playa, Santa Lucía, and offers sightseeing tours for recovering Santiago de Cuba. Concurrently, however, Cuba is establishing another patients. Thus, there is a great incentive for type of tourism industry – health tourism. Patients from over 90 countries Cuba to provide world-class health services if it is worldwide – including famous personalities such as Diego Maradona – have to attract patients from the rest of the world. That’s reportedly visited Cuba for treatments. good news for tourists and assistance companies alike. Health tourism generates an income of approximately US$50 million each year, according to experts, and almost 10,000 people have already visited Cuba Universal healthcare to receive a range of services from plastic surgery or drug rehabilitation to Cuba is essentially capitalising on a reputation it has built orthopaedic surgery and treatments for vitiligo, psoriasis and alopecia. in healthcare. It is a poor country, one of the poorest in Most patients come from Europe and Canada, but some the Caribbean, but it has still pursued the principal of health tourists will travel from the US, despite legal free universal access to healthcare for all inhabitants. restrictions. The island offers not only health As such, public health experts see its system as a

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model, particularly for other developing countries. Cubans enjoy an integrated, free system of care led by the Ministry of Public Health or Ministerio de Salud Pública, which is composed of a family doctor system, municipal health centres or polyclinics, public hospitals and pharmaceutical and research institutions. By 2005, its primary healthcare (PHC) comprised some 31,000 physicians and nurses, organised in a network that encompassed 442 polyclinics, 64 rural hospitals and some 22,000 GP clinics, according to Pan-American Health Organisation (PAHO), a division of the World Health Organization. The healthcare system has grown up amidst a revolution, which saw half of the country’s doctors flee a decades-old US government trade embargo and the dramatic collapse of the island’s economy when the Soviet bloc disintegrated. Cuba lost over

Cuba can claim to have eliminated some infectious diseases that typically blight poor countries

80 per cent of its foreign trade in the 1990s and the loss of income took its toll on the health of the population. The country’s most significant health reforms took place during the 1970s and 1980s. Other countries have made similar changes more recently, in the 1990s, say public health experts. For instance, the 1980s saw the introduction of the family doctor system, which embedded a small doctor- and-nurse team within communities, sometimes in nearby flats or houses. Although not necessarily well-equipped, these teams were able to promote family health and disease prevention amongst a few hundred families in their areas, link to other services and maintain good health monitoring records. The country has also placed great importance on training new doctors and now has an enormous workforce too. Cuba had 70,594 physicians (62.7 per 10,000 people) in 2007. Indeed, there are

so many medical graduates, that Cuba has been exporting thousands to Africa and Latin America since the 1970s, who provide free medical services to these communities in what is seen as an exercise in soft diplomacy. Over 28,000 Cuban health professionals were serving abroad in 2006, says Medical Education Cooperation with Cuba (MEDICC), a non-profit organisation promoting US, Cuban and global health collaboration. Therefore, with an enormous healthcare workforce, good health surveillance systems and a burgeoning domestic drug and vaccine manufacturing industry, Cuba can claim to have eliminated some infectious diseases that typically blight poor countries. Indeed, declining mortality and fertility rates on the island means that its population’s entire demographic has shifted. Citizens are increasingly facing health problems seen in rich countries instead – chronic disease and old age. As a result, its healthcare system has been forced to alter health priorities to try and keep pace. Chronic health problems are treated at the appropriate level of care according to PAHO. Cuba’s National Cardiology and Cardiovascular Surgery Network tracks surgical procedures performed nationwide and provides follow-up care. Indeed its Hemodynamics and Interventional Cardiology Section had performed 5,008 diagnostic procedures and 1,354 major surgeries with a medium to high level of sophistication by 2005, it says. Some of those treatments included highly complex repairs

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 35

of congenital malformations and heart transplants. Cubans cannot use them. This segregation has organises health tourism services at specialist centres aimed at the rural population also offer basic care. But, while malaria and other poverty-related extended to healthcare too. Tourists are serviced and runs health spas and a network of drugstores and That said, medical facilities in Havana are generally diseases may have been effectively eliminated, by a separate system that is largely managed by the opticians too. better than those available elsewhere in the country, some infectious diseases such as diarrhoeal illness Ministry of Tourism. Here, patients are expected to Major resort areas run international clinics that handle says the UK government. persist. This exposes large health inequalities among pay for treatment although, just like Cuba’s licensed more complex medical conditions with permanent However, even at public hospitals, travellers are often the provinces in Cuba and probably reflects the hotels and restaurants, the tourist health system teams of doctors and nurses. These clinics are equipped treated in dedicated tourist wards. The Frank Pais differences in sewage, water supply and general is run by the government. The health system is to offer emergency medical attention too, according Orthopedic and Scientific Compound, a specialist living conditions, say academics. managed by Cubanacan Turismo y Salud (CTS), a to CTS. There are such CTS clinics in Pinar del Rio, orthopaedic centre, says it offers 677 beds for Cuban As with many parts of life on this Caribbean island, subsidiary of the Cubanacan Group, which oversees Havana, Varadero, Cienfuegos, Trinidad, Cayo Coco in patients, plus a special section exclusively reserved tourists are generally kept at arms length from most Cuba’s finest hotels, luxury resorts and restaurants. Ciego de Avila, Playa Santa Lucia in Camaguey, Santiago for treating foreigners. In Havana, however, many residents, often visiting different hotels, restaurants Cubanacan Group is a state-run corporation of tourism de Cuba and in Baracoa, plus CTS-linked doctors in 100 travellers are sent to Cira Garcia Central Clinic, and even shops. This is primarily the result of a dual and international trade, which markets and operates hotels across the islands. There are also stand-alone which is owned by CTS. The hospital has 39 private currency system. Cubans are paid, and can buy Cuban hotels at home and abroad. It boasts 70 hotels CTS clinics that are not in the major resort areas, but rooms – including suites – that offer surgical, intensive staples and non-luxury items, in Cuban pesos (CUP) and 15,000 rooms, and even runs partnerships with are, instead, within hospitals. and intermediate care, as well as scanning and while tourists use a currency called the Convertible international hotel chains. CTS runs different types of laboratory facilities. Peso (CUC$). Goods and services priced in CUC$ health services for tourists. It operates international In emergencies, tourists can be treated at other are usually more expensive, so many ordinary clinics that offer primary healthcare services to tourists, Tourists are serviced types of Cuban institutions, such as the polyclinics used by ordinary Cubans. Typically, these have no by a separate in-patient facilities, although there are up to eight beds, and a maximum stay of eight hours is allowed. system that is largely The polyclinics often boast maternity staff, dentists, ambulances and laboratories too. In fact, experts say that around 80 per cent of specialist services in Cuba managed by the are provided by polyclinics. Asistur, an official Cuban assistance firm, provides Ministry of Tourism services to over 200 foreign assistance and insurance companies worldwide, says Cira Garcia is Emergency care well-equipped to deal with tourists. Emilio Guevara, Tourists can be referred to specialist public hospitals managing director of Asistur, says that, like other if more serious conditions cannot be treated at CTS CTS clinics, it is more likely to have multilingual staff, clinics or in the medical emergency rooms located at can process invoices and deliver medical reports some hotels. CTS says it has a network of specialised required by assistance firms. “Cira Garcia is used, vehicles to transport patients to Cuba’s national not only because of the good services it provides, health service, although the state also runs a road but because of the very good administrative ambulance service. performance,” he says. With at least one public hospital in each of Cuba’s 14 In contrast, there is little administrative infrastructure provinces and several facilities in Havana, the nation’s dedicated to invoicing at polyclinics. That said, in capital, the island is home to around 270 hospitals. an emergency, tourists are treated regardless of They provide general, clinical, surgical, paediatric, and their ability to pay or whether they are insured, say gynaecological and obstetric care. Over 60 hospitals experts. However, foreign governments warn visitors

www.itij.co.uk 36 ASSISTANCE&HEALTHCAREWORLDMARKETS

foreign governments warn visitors that healthcare can be expensive

The country has also placed great importance on training new doctors and now has an enormous work force … there are so many medical graduates that Cuba has been exporting thousands to Africa and Latin America since the 1970s

that healthcare can be expensive – a basic hospital equipment can be out-dated; there is poor choice stay can cost as much as £200 per day plus medical and essential drugs (especially those priced in Cuban expenses, says the UK Foreign and Commonwealth pesos) are frequently non-existent. The FCO, Office (FCO). Patients requiring medical treatment for instance, advises its citizens to bring adequate will often be expected to pay in hard currency. quantities of their own prescription drugs because of Asistur agrees that medical assistance at CTS clinics frequent shortages. and in provincial hospitals is usually invoiced directly The US embargo and Cuban rules that restrict to tourists, but invoices can also be sent to assistance imports both contribute to the shortage, says companies if visitors are covered by a policy it MEDICC. Asistur insists, however, that for tourists, recognises. Repatriation is usually organised via the drugs and supplies are guaranteed in clinics and airlines that regularly fly to Cuba, such as Iberia, Air hospitals, and are invoiced directly to tourists or France or Air Canada. However, there are no air through the assistance firm if recognised by Asistur. ambulance companies in Cuba, so critically ill patients Some drugs can also be bought in pharmacies must be transported using firms from Canada, Puerto located at some hotels and in Cuba’s largest cities, Rico, Mexico and, occasionally, the US and Europe. says Guevara. Indeed, CTS boasts a network of Special arrangements are essential before such outlets in major locations across the country selling transport is permitted to land in Cuba, however. Cuban-made drugs and cosmetic preparations. “We arrange landing clearance for air ambulances MEDICC agrees that Cuba’s resources are stretched and co-ordinate immigration and transport – especially with so many of its doctors working arrangements for the arriving crew,” says Asistur’s abroad – and that it faces serious challenges and Guevara. European foreign affairs departments will have to refurbish and re-equip its hospitals. In advise their nationals that medical evacuation can be 2004, around 444 community polyclinics and 52 expensive too. hospitals and tertiary institutes were earmarked for an upgrade. A few have been completed, such Standards vary as Hermanos Ameijeiras Hospital, Pando Ferrer Reports on the state of the nation’s hospitals Ophthalmological Institute and the Enrique Cabrera vary, however. Reports describe some facilities as Clinical-Surgical Hospital in Havana, it says. The well-equipped; others state that in many parts of success of the national refurbishment project is key Cuba, doctors are badly paid; poor facilities are rife to Cuba’s continuing reputation as a public health with many buildings in a poor state of repair; that model and, ultimately, as a health tourism centre.

International Travel Insurance Journal

38 PROFILE Nursing with Netcare ITIJ spoke to Brenda Durow, head should be no need to send visitors out of the Netcare started with just four hospitals services and assistance services are provided through country for care. However, should the need arise, in 1996, and now runs 49 hospitals, along Netcare 911. Casualty and specialist hospital care is of international assistance for Netcare’s international assistance desk has extensive with around 50 Medicross clinics, and the provided by our Netcare Hospitals, and finally we South Africa’s Netcare 911 experience in international repatriation! Emergency Services and Aeromedical are able to ensure the patient reaches home safely South Africa has hosted a number of major events division, Netcare 911 – how do these three with the evacuation and repatriation services of Where did you grow up and where were in recent years, which have served as preparation separate entities support one another? Netcare 911. you educated? for the 2010 event. Netcare and Netcare 911 have I believe Netcare is unusual in that it has the ability to Our family moved around South Africa quite a bit in been involved in providing medical care for the World provide an end-to-end solution to an individual or a How have Netcare hospitals and Netcare the early years, from Empangeni on the KwaZulu Summit on Sustainable 911 been coping with the current swine Natal north coast, to Durban and then Pretoria. We Development in 2002, flu pandemic – both regarding locals and eventually settled in Dundee, a mining and farming for instance, as well as travellers? community in Northern Kwa-Zulu Natal. I attended the Rugby World Cup, We have world-class infection control protocols in the local schools, and matriculated from Dundee the Grand Prix and place across all business units and within all hospitals. High School. I spent four years in Durban studying the Superbike Series. We have followed the World Health Organization Clothing Design and Technology at the Technikon, Granted, none of these advisories, and all staff are well informed. While before changing to Nursing in 1992. I completed can compete with the we have seen some panic and strain placed on my Diploma in General and Community Nursing, Soccer World Cup in the pathology services, we have had few major with Midwifery and Psychiatry at Greys Hospital terms of size, but they problems. We have had confirmed cases among in Pietermaritzburg. After qualifying we moved to have given us valuable our workforce, particularly in the call centre where Durban, where I worked in the Neonatal ICU of experience. people are working in close proximity to one another. Addington Hospital. But education, provision of disinfectant hand gel and Do you encounter other measures have ensured we are in control of the How did you come to be involved in the any persistent situation. Tamiflu is readily available on prescription private hospital industry, and with Netcare problems in from a doctor, at all major pharmacies and at hospitals. 911 in particular? your dealings In 2000 I joined the Netcare 911 Call Centre on with assistance There is a high incidence of serious road the Nurseline. Netcare 911 was established in companies? If so, accidents in South Africa that inevitably 1998 as a primary paramedic response to support how could these be increase the pressure on A&E units. What the government ambulance services and provided rectified? A&E provision does Netcare offer? a call centre with response cars and a few private One of the most All Netcare hospitals have excellent A& E units, ambulances in Gauteng, Durban and Cape Town. The frustrating problems capable of stabilising victims of both trauma and Nurseline provided a value-add service to clients and is when an insurer or medical emergencies. We have A&E units that are a support service to the crews on the road. The job assistance company equipped with state-of-the-art equipment and are involved assessment of emergency calls, pre-arrival pays suppliers directly, considered among the best in the world. Netcare 911 instructions such as telephonic CPR and telephonic when Netcare 911 is the largest private emergency service in South Africa medical advice. At the time, Nurseline was relatively has been authorised and possesses a fleet of more than 200 response new to South Africa, and it was definitely new to me. to guarantee and vehicles and ambulances. It also has an air wing with After returning to hands-on nursing for two years in settle payments. This two helicopters and six fixed-wing air ambulances that the medical and cardiac unit at Netcare Sunninghill results in a double manage evacuations throughout Africa. The division hospital, I accepted the role of international assistance payment to the supplier undertakes commercial repatriation of foreigners to co-ordinator in 2004 and have been fortunate to with the subsequent their country of origin. Netcare 911 also has the only grow within this exciting part of the business. administrative nightmare 24-hour helicopter emergency service in South Africa, of proving the error which is based in Gauteng. Treating foreign visitors is an important and requesting refunds. part of Netcare’s work. How have you Regular, relevant What are you most proud of – both established and improved your relationship communication and personally and professionally? with international assistance companies in feedback should rectify On a personal level I am very proud of our two recent years? this. wonderful, talented, beautiful daughters. I am grateful Netcare 911 joined the International Assistance to have had the support and opportunities that have Group in 2004; this membership has allowed us to Cost containment is allowed me to combine a meaningful and challenging have a global presence while maintaining our local an important issue career with a relatively balanced home life. identity. We do inbound work with international for insurers. How insurers and assistance companies who have does Netcare 911 How do you relax at the end of a heavy day? patients in the Netcare Hospitals, as well as work work with assistance I am not big on routine, and there is no set pattern with local insurers to provide outbound assistance companies/insurers to our days. I enjoy cooking – but something quick to South Africans. Netcare 911 did not actively to ensure the and healthy such as wraps, pasta or a stir-fry. I try market its international assistance services initially, most appropriate Netcare 911 did not actively market to get to the gym three times a week and swim in but established some key relationships that allowed treatment is given at summer. As a family we play board and card games us to grow into the industry. We are seeing a steady the best price? its international assistance services together rather than just watching TV. I love reading increase in the number of companies dealing with Netcare Group has and gardening when time allows. us, and attribute this to our willingness to tailor our national standard tariffs initially, but established some key offering to meet the specific needs of each client. that apply to daily Do you have a guiding philosophy that ward rates, theatre relationships that allowed us to motivates you in either your career or at Talking about foreign visitors, how ready are time, etc; the variable home? you for the influx of soccer supporters that costs are in the length grow into the industry My grandfather was a headmaster and lay-minister will be heading your way for the FIFA World of stay, treatment and had several maxims by which he lived. The most Cup, which kicks off on 11 June 2010? prescribed, and other succinct was in Afrikaans – ‘Aanhouer Wen’. This I am proud to say that Netcare is well placed to service provider costs. translates into long-winded English as ‘the one who cope with any medical emergencies – our footprint Legislation and regulation of the pharmaceutical company’s healthcare needs. Each division is aligned perseveres will win’. So long as you keep on trying mirrors almost exactly the footprint of the World industry controls the pricing on medication with with the same guiding values and strategic focus. your best you still have the potential to succeed. It Cup. We have hospitals and Netcare 911 services single exit pricing ensuring costs are controlled. Policy is set at group level, but each business is run is only when you give up that you have truly failed. I close to all the stadia except in Polokwane. For Netcare 911 has negotiated competitive tariffs for as a separate entity with authority and accountability am fortunate to work for a company whose values example, our Netcare Christiaan Barnard Hospital is our clients within the Netcare Group, which allows resting with the managing directors of the business. I am able to embrace and live by. Netcare values practically on the doorstep of the new Greenpoint insurers access to all 49 Netcare Hospitals at the Netcare provides integrated solutions – from care for our staff and the dignity of our patients, we stadium. Private hospitals such as the Netcare same tariff, and through the single entry point of occupational and primary health through Primecure value truth in all one does, and value passionate Group facilities offer world-class care – there Netcare 911. and Medicross. Pre-hospital emergency medical participation in order to affect positive change.

International Travel Insurance Journal CATEGORY KEY CLAIMS MANAGEMENT INSURERS AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 40 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Air Ambulance International ) CareFlight International Mr Peter Veazey – CEO Colin Robshaw – National Manager Westmead Hospital Campus, PO Box 159, Westmead, P.O. Box 1044, Magnolia. Texas 77353, USA NSW 2145, AUSTRALIA tel: +1 832 934 2390 email: [email protected] tel: +61 1300 655 855 email: [email protected] (AFRICA) fax: +1 832 934 2395 website: www.airambulanceinternational.com fax: +61 2 9689 2744 website: www.careflight.org

Air Ambulance Network European Air Ambulance AUSTRALASIA

Kirk Pacheco – President ( Patrick Schomaker – Director Sales & Marketing AIR AMBULANCE AIR AMBULANCE 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA 175A, rue de Cessange, L-1321, LUXEMBOURG

24hr tel: + 1 727 934 3999 email: [email protected] 24hr tel: +49 711 7007 7007 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +49 711 7007 7009 website: www.air-ambulance.com

AMREF Flying Doctor Service Flying Doctors Asia Dr Bettina Vadera – Medical Director Prithpal Singh – CEO , Director 313 Old Bird Cage Walk, #01-15/02-16, Seletar Airport, Wilson Airport, LangataRoad, PO Box 18617, Nairobi, KENYA SINGAPORE tel: +254 20 600 090 email: [email protected] 24hr tel: +65 9297 7757 email: [email protected] fax: +254 20 344 170 website: www.amref.org fax: +65 6483 5407 website: www.flyingdoctorsasia.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 – President Mike Honeycutt – 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

AirMed International LLC South Pacific Air Ambulance Jeffrey T Tolbert – President Scotty Watson – Managing Director 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA NEW ZEALAND AUSTRALIA SINGAPORE

tel: +1 205 443 4840 email: [email protected] tel: +64 9256 9000 email: [email protected] fax: +1 205 443 4841 website: www.airmed.com fax: +64 9256 9111 website: www.spaa.co.nz

CareFlight Group ADAC-Ambulance Service Medical and Tasking Centre Robert Glueck – Marketing & Sales Director PO Box 5078, Robina Town Centre, Queensland, 4230 AUSTRALIA Am Westpark 8, 81373 Munich, GERMANY

24hr tel: +61 7 5553 5955 email: [email protected] tel: +49 89 76 76 52 85 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com (EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance

CATEGORY KEY CLAIMS MANAGEMENT INSURERS Air Ambulance International AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER Mr Peter Veazey – CEO AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING P.O. Box 1044, Magnolia. Texas 77353, USA ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS tel: +1 832 934 2390 email: [email protected] COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES fax: +1 832 934 2395 website: www.airambulanceinternational.com call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 41 ) Air Ambulance Network ) Mayoral Executive Jet Kirk Pacheco – President Paulo Vassar – Commercial Director 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] EUROPE EUROPE ( fax: + 1 727 937 0276 website: www.airambulancenetwork.com ( fax: +34 924 048 612 website: www.mayoralexecutivejet.com

Air Medical Ltd Med Call GmbH Glenn Salt – Flight Operations Manager Michael Diefenbach – CEO AIR AMBULANCE AIR AMBULANCE Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK Black and Decker Str. 1-3, 65510, Idstein, GERMANY

tel: +44 1865 842 887 email: [email protected] tel: +49 61 2695 3708-0 email: [email protected] tel: +44 1865 370 642 website: www.airmed.co.uk fax: +49 61 2695 3708-11 website: www.medcallgmbh.com

AirMed International LLC Medic’Air International Jeffrey T Tolbert – President Dr Herve Raffin – General Manager 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE

tel: +1 205 443 4840 email: [email protected] tel: +33 141 72 1414 email: [email protected] fax: +1 205 443 4841 website: www.airmed.com fax: +33 148 57 1010 website: www.medic-air.com

Augsburg Air Ambulance Skyservice Air Ambulance Roland Schoberth – Director David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, Roseggerstr 17, D-86368, Gersthofen, GERMANY CANADA tel: +49 821 299 1020 email: [email protected] tel: +1 514 497 7000 email: [email protected] tel: +49 821 299 2030 website: www.ambulanzflugdienst.de fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

European Air Ambulance Swiss Air Ambulance / Rega Patrick Schomaker – Director Sales & Marketing Peter Meierhans – Director of Sales 175A, rue de Cessange, L-1321, LUXEMBOURG PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND

24hr tel: +49 711 7007 7007 email: [email protected] tel: +41 333 333 333 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +41 44 654 3590 website: www.rega.ch

Euro Link Air Ambulance Tyrol Air Ambulance Dr. Frederich Renner – Medical Director Jakob Ringler – Managing Director Putzbrunner Str. 114, 81739, München, GERMANY PO Box 81, A-6026, Innsbruck Airport, AUSTRIA

24hr tel: +49 89 613 72103 email: [email protected] tel: +43 512 224 220 email: [email protected] fax: +49 89 613 72106 website: www.FlyEuroLink.de fax: +43 512 288 888 website: www.taa.at

FAI – rent-a-jet AG Advanced Paramedic Volker Lemke – Director Sales & Marketing Stephen J Woodburn – CEO Hangar #18 - Peace River Airport, P.O. Box 7320, Peace River, Flughafenstrasse 100, D-90268 Nuremberg, GERMANY Alberta T8S 1S9, USA tel: +49 911 36009 31 email: [email protected] tel: + 1 780 624-4911 email: [email protected] fax: +49 911 36009 59 website: www.rent-a-jet.de fax: + 1 780 624-4577 website: www.advancedparamedic.com

German Red Cross Air Ambulance Service Aerojet Andreas Speich – Managing Director Stuart Hayman – President (NORTH AMERICA) Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY 4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA

tel: +49 228 2300 23 email: [email protected] tel: +1 954 730 9300 email: [email protected] fax: +49 228 2300 27 website: www.grcairambulance.de fax: +1 954 485 6564 website: www.aero-jet.com

Greek Flying Doctors Air Ambulance International Dimitris Kanellis – Manager Mr Peter Veazey – CEO NEW 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE P.O. Box 1044, Magnolia. Texas 77353, USA

tel: +30 210 674 0600 email: [email protected] tel: +1 832 934 2390 email: [email protected] fax: +30 210 674 0634 website: www.greekflyingdoctors.gr fax: +1 832 934 2395 website: www.airambulanceinternational.com

IFRA Air Ambulance Network Dr Christian Steindl – Director Kirk Pacheco – President Bahnhofplatz 13/5, POB 160, 3500 Krems, AUSTRIA 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA

tel: +43 2732 825 610 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected] fax: +43 2732 851 01 website: www.ifra.at fax: + 1 727 937 0276 website: www.airambulancenetwork.com

Jet Executive International Charter Air Ambulance Professionals, Inc. Dennis Stoffel – Ground Operations Manager Brian L. Weisz – President Mündelheimer Weg 50, D-40472, Düsseldorf, GERMANY Ft. Lauderdale Executive Airport, 1535 South Perimeter Rd, “Homebase FRA & MUC” Hangar 36B Ft. Lauderdale, Florida 33309, USA tel: +49 211 602 7775 email: [email protected] tel: +1 954 491 0555 email: [email protected] fax: +49 211 602 77766 website: www.jetexecutive.com fax: +1 954 491 6114 website: www.airambulanceprof.com

JET ICU AirMed International LLC Mike Honeycutt – President Jeffrey T Tolbert – President 17076 Helicopter Drive, Brooksville, FL 34604, USA 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA

tel: +1 352 796 2540 email: [email protected] tel: +1 205 443 4840 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com fax: +1 205 443 4841 website: www.airmed.com 42 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

European Air Ambulance Cardinal Assistance Patrick Schomaker – Director Sales & Marketing Alberto C. Chapur – President Av. Cordoba 890 7° piso, (C 1054AAU) Capital Federal, Buenos Aires, 175A, rue de Cessange, L-1321, LUXEMBOURG ARGENTINA 24hr tel: +49 711 7007 7007 email: [email protected] tel: +54 11 4129 7514 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +54 11 4328 3822 website: www. cardinalassistance.com (AMERICAS) Global Jetcare, Inc. Emergency Assistance North America Inc. Bart Gray – President Jaime Perez – Operations Manager AIR AMBULANCE

(NORTH AMERICA) 16479 Runway Drive, Brooksville, FL 34604, USA 93 South Jackson Street, Suite #27490, Seattle, Washington, USA

tel: +1 352 799 7771 email: [email protected] tel: + 1 604 922-4443 email: [email protected] fax: +1 352 799 7776 website: www.globaljetcare.com fax: +888 572-9956 website: www.eanorthamerica.com ASSISTANCE COMPANIES ASSISTANCE JET ICU Global Excel Management Mike Honeycutt – President Michael Drew – Vice-President Sales 73 Queen Street, Sherbrooke, QC J1M 0C9, CANADA 17076 Helicopter Drive, Brooksville, FL 34604, USA 17548 Deer Isle Circle, Winter Garden, FL 34787 USA tel: +1 352 796 2540 email: [email protected] tel: +1 866 566 1130 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com fax: +1 819 566 8335 website: www.globalexcel.ca

Life Flight International Inc. Medex Global Solutions Chris Connor – Operations Mark Hall – SVP of Sales Victoria International Airport, Shell Aero Center, 104-1962 Canso Road, 8501 LaSalle Road, Suite 200, Baltimore, MD 21286, USA North Saanich, British Columbia V8L 5VF, CANADA tel: +1 250 655 1630 email: [email protected] tel: +1 713 430 7300 email: [email protected] fax: +1 250 656 9394 website: www.lifeflight.ca fax: +1 713 430 7318 website: www.medexassist.com

Skyservice Air Ambulance On Call International David Ewing – VP International Market Development Michael J. Kelly – President & CEO YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), One Delaware Drive, Salem, NH 03079, USA H9P 1A2, CANADA tel: +1 514 497 7000 email: [email protected] tel: + 888 289 0567 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +1 603 328 1770 website: www.oncallinternational.com

AIMS OneWorld Assist Bernadette Breton – Managing Director Taka Katsube – Director Assistance & Cost Managment Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA

(AFRICA) tel: +27 11 245 5777 email: [email protected] tel: +1 604 303 2113 email: [email protected] fax: +27 11 783 9277 website: www.aims.org.za fax: +1 604 276 4593 website: www.oneworldassist.com

AMREF Flying Doctor Service SelectCare Worldwide Dr Bettina Vadera – Medical Director Jacques LeTual – Director of Business Development Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: +254 20 600 090 email: [email protected] tel: +1 416 340 7265 email: [email protected] fax: +254 20 344 170 website: www.amref.org toll free: +1 866 261 6718 website: www.selectcareworldwide.com ASSISTANCE COMPANIES ASSISTANCE

Interhealth Technologies TMCA - Travel Medical Casualty Assistance Kevin Thomas – Director - International Margaret Wharton – VP Travel Division P O Box 3058, Bedfordview 2008, SOUTH AFRICA 217 Broadway suite 600, New York NY 10007, USA

tel: +27 11 622 8010 email: [email protected] tel: +1 212 964 8580 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +1 212 406 1520 website: www.tmcatravel.com

Netcare 911 International Assistance Asia Assistance Partners Brenda Durow – International Assistance Manager Siriporn Wongurai – International Operations Director 184/235 Forum Tower, 36 Flr Ratchadapisek Rd Huaykwang, Bangkok 10320, Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA THAILAND tel: +27 10 209 8387 email: [email protected] tel: +662 645 3733-5 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +662 645 3732 website: www.aapartners.net

West African Rescue Association Asia Medical Assistance India (AUSTRALASIA) Florian Zagel – Managing Director Abhijeet Sachdev – Group VP Klotey Cresent 6, North Labone, Accra, GHANA DLF City-ll, M.G Road, New Delhi, Gurgaon 122002, INDIA

tel: +233 244 312 496/7 email: [email protected] tel: +91 9899 198 198 email: [email protected] fax: +233 21 781 259 website: www.westafrican-rescue.com fax: +91 2440 147 28 website: www.asiamedassist.org

ASISTUR Asia Medical Assistance Nepal Emilio Guevara – Managing Director Bikash Gurung – General Manager Prado 208, e/ Colon y Trocadero, Habana Vieja, Ciudad Habana 10100, CUBA 35 Pyukha Marg, PO Box 156, Katmandu, NEPAL

tel: +537 8664499 email: [email protected] tel: +977 985 1111 366 email: [email protected] fax: +537 8668087 website: www.asistur.cu fax: +911 244 014 728 website: www.asiamedassist.org

CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES Asia Medical Assistance Thailand AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Jane Bailey – CEO AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER United Tower 7/1, 333/13 Sukhummvit Soi 55 Klongtan Nua, Bangkok, 10110, AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING THAILAND ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS tel: +66 (0) 2712 88934 email: [email protected] fax: +66 (0) 2712 6684 website: www.asiamedassist.org COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 43

Assistance Online med con team GmbH Bertrand Guichoux – CEO Michael Weinlich – Managing Director Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA Gerhard-Kindler-Str.8, 72770 Reutlingen, GERMANY

tel: +86 21 6104 9500 email: [email protected] tel: +49 7121 433 660 email: [email protected]

fax: +86 21 6104 9484 website: www.assistanceonline-china.com (EUROPE) fax: +49 7121 433 619 website: www.medconteam.com

Customer Care Pty Ltd Save Assistance France

(AUSTRALASIA) Janine Benson – Operations Manager Franck Molinier – Director of Business Development Level 3, 60 Miller Street, North Sydney 2060, NSW, AUSTRALIA 19 rue de Provence, 78310 Maurepas, FRANCE

tel: +612 9202 8222 email: [email protected] tel: +33 13062 6752 email: [email protected] fax: +612 9202 8220 website: www.customercare.com.au 24 tel: +33 13062 1122 website: www.saveassistance.com ASSISTANCE COMPANIES ASSISTANCE ASSISTANCE COMPANIES ASSISTANCE First Assistance Savitar Mary-Jo McDonald – General Manager Lydia Semchenkova – Business Development Manager NEW PO Box 17-310, Greenlane, Auckland, NEW ZEALAND 25/1, 7th Floor, Trubnaya Str., Moscow, 127051, RUSSIA

tel: +64 9 356 1650 email: [email protected] tel: +7 495 987 1775 email: [email protected] fax: +64 9 525 1278 website: www.firstassistance.co.nz fax: +7 495 987 1776 website: www.savitar-gr.com

Global Assistance & Healthcare SOS International Mario Babin – Chief Executive Officer Helle Drager Sandahl – Communications & Marketing Manager Jalan Pattimura, 15 Kebayoran Baru, Jakaita, 12110, INDONESIA Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: +62 21 725 8115 email: [email protected] tel: +45 7010 5055 email: [email protected] fax: +62 21 725 7961 website: www.global-assistance.net fax: +45 7010 5056 website: www.sos.eu

South Pacific Air Ambulance TBS Team 24 d.o.o Scotty Watson – Managing Director Edvard Hojnik – General Manger NEW ZEALAND AUSTRALIA SINGAPORE Ljubljanska Ulica 42, 2000 Maribor, SLOVENIA NEW

tel: +64 9256 9000 email: [email protected] tel: +386 2618 2301 email: [email protected] fax: +64 9256 9111 website: www.spaa.co.nz fax: +386 2618 5800 website: www. tbs-team24.com

ADAC-Ambulance Service CONNEX Assistance Middle East Robert Glueck – Marketing & Sales Director Lara Helmi – International Network Director Am Westpark 8, 81373 Munich, GERMANY Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE

tel: +49 89 76 76 52 85 email: [email protected] tel: +97 14 257 82 84 email: [email protected] (EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance fax: +97 14 257 82 85 website: www.connexassistance.com

ARC Europe SA EAST) (MIDDLE Goral Assistance Hans Biekmann – Network Director Marcel Kadoche – International Network & Development Manager Avenue des Olympiades 2, 1140 Brussels, BELGIUM Corex House, P.O. Box: 12815, Herzeliya Pituah 46733, ISRAEL

tel: +32 2 706 6660 email: [email protected] tel: +972 9 957 9930 email: [email protected] fax: +32 2 706 6601 website: www.arceurope.com fax: +972 9 957 9931 website: www.goralassist.com

Assistance Plus Dr Colin Plotkin Consulting Liana Absaliamova – General Manager Dr Colin Plotkin – Managing Director 6th Floor, 19 Zhukov Proezd, Moscow 115054, RUSSIA 27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: +7 495 989 1120 email: [email protected] tel: +1 604 241 9677 email: [email protected] fax: +7 495 989 1130 website: www.assistplus.ru fax: +1 604 241 0733 website:

CNAS To have your company listed in our service directory Carole Luisy – Managing Director CATASTROPHIC 80 rue des alliés, 38100, Grenoble, FRANCE contact the sales department now:

tel: +33 438 49 83 49 email: [email protected] CLAIMS SPECIALISTS [email protected] or telephone: +44 (0)117 922 66 00 fax: +33 438 49 83 40 website: www.cnas-assistance.com

Global Assistance a.s. AIMS Petr Bold – General Manager Bernadette Breton – Managing Director Dopraváku˚ 749/3,184 00 Prague 8, CZECH REPUBLIC Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA

tel: +420 266 799 770 email: [email protected] tel: +27 11 245 5777 email: [email protected] (AFRICA) fax: +420 266 799 797 website: www.1220.cz fax: +27 11 783 9277 website: www.aims.org.za

Global Voyager Assistance Interhealth Technologies Costas Danilenko – CEO Kevin Thomas – Director - International PO Box II, 125124 Moscow, RUSSIA P O Box 3058, Bedfordview 2008, SOUTH AFRICA COST CONTAINMENT tel: +7 495 775 0999 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +7 495 775 0998 website: www.gvassistance.com fax: +27 11 622 8264 website: www.interhealth.net

Greek Flying Doctors ChargeCare International Dimitris Kanellis – Manager Christiane Burniston – Managing Director 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE NEW Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

tel: +30 210 674 0600 email: [email protected] tel: +44 1865 400 007 email: [email protected] fax: +30 210 674 0634 website: www.greekflyingdoctors.gr fax: +44 845 003 9923 website: www.chargecare.co.uk 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Medical Claims International Spain Interhealth Technologies Fatima Guillen Grande – Managing Director Kevin Thomas – Director - International C/Ciudad de Aguilas No.2, Local 2A, Madrid 28030, SPAIN P O Box 3058, Bedfordview 2008, SOUTH AFRICA

tel: 00 34 913 016 145 email: [email protected] tel: +27 11 622 8010 email: [email protected]

(EUROPE) fax: 00 34 913 016 160 website: www.mcimanager.com fax: +27 11 622 8264 website: www.interhealth.net

Capone & Associates, Inc SelectCare Worldwide Virginia S. Capone – President Jacques LeTual – Director of Business Development 100 Springhouse Drive, Suite 103, Collegeville, PA 19426, USA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: +1.610.831.5580 email: [email protected] tel: +1 416 340 7265 email: [email protected] COST CONTAINMENT fax: +1.610.831.5581 website: www.caponeassociates.com toll free: +1 866 261 6718 website: www.selectcareworldwide.com CLAIMS MANAGEMENT

Global Excel Management Star Healthcare Michael Drew – Vice-President Sales Gigi Galen – President 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA (NORTH AMERICA) 850 7th Avenue, Suite 803, New York, 10019, USA 17548 Deer Isle Circle, Winter Gdn, FL 34787 USA tel: +1 866 566 1130 email: [email protected] tel: + 1 212 581 8228 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca fax: + 1 212 581 8272 website: www.starhealthcarenet.com

Global Medical Management MedEscort International Raija Itzchaki – COO Craig Poliner – President 7901 SW 36th Street, Suite 100, Davie, FL 33328, USA 1730 Vultee Street, Allentown, PA 18103, USA

tel: +1 954 370 6404 email: [email protected] US tel: +1 610 791 3111 email: [email protected] fax: +1 954 370 8613 website: www.gmmusa.com fax: +1 610 791 9189 website: www.medescort.com SPECIALISTS Olympus Managed Healthcare Voyageur Aeromedical Travel Steven Jacobson – CEO Marc Lucas – General Manager 777 Brickell Avenue, Suite PH70, Miami, Florida 33131, USA NEW Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: +1 305 530 8600 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected] fax: +1 305 530 0766 website: www.omhc.com COMM. REPATRIATION fax: +44 (0)117 925 5940 website: www.voyageur.co.uk

OneWorld Assist ADAC Taka Katsube – Director Assistance & Cost Managment Christoph Ullrich – Director of Purchase / International Network 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA Am West Park 8, 81373 Munich, GERMANY

tel: +1 604 303 2113 email: [email protected] tel: +49 89 7676 2912 email: [email protected] fax: +1 604 276 4593 website: www.oneworldassist.com 24hr Alm: +49 89 7676 5005 website: www.adac.de/ambulance TRANSPORT 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] fax: +49 (0)69690-58147 website: www.dlh.de toll free: +1 866 261 6718 website: www.selectcareworldwide.com PATIENT CARE CRITICAL

Star Healthcare ANUBIS International Repatriation Gigi Galen – President Fabrice Kana – Development & Quality Manager 850 7th Avenue, Suite 803, New York, 10019, USA Tour Pleyel, 93200 Paris, Saint Denise, FRANCE NEW tel: + 1 212 581 8228 email: [email protected] tel: +33 149 195 960 email: [email protected] fax: + 1 212 581 8272 website: www.starhealthcarenet.com fax: +33 149 471 901 website: www.anubisgroup.org

UnitedHealth International Funeral Home AURIGA Ltd. Philip Brun – Vice President of Sales & Service Helen Pradova – Chief of International Department 3100 SW 145 Avenue, Miramar, FL 33027, USA B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC

tel: +1 954 378 0694 email: [email protected] FUNERAL DIRECTORS tel: +420 724 257 899 email: [email protected] fax: +1 954 378 0771 website: www.uhgi.com fax: +420 416 735 800 website: www.funeral-assistance.cz

Global Assistance & Healthcare Funeralcare International Mario Babin – Chief Executive Officer Louisa Killen – Repatriation Specialist 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] 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

CLAIMS MANAGEMENT tel: +1 866 566 1130 email: [email protected] tel: +44 1992 640 066 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca fax: +44 1992 785 030 website: www.gnfa.info

CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES John Allison Monkhouse Co., Ltd (Thailand) AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Apple Kaewprasert – General Manager AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING President Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton Klongtoey, Bangkok, THAILAND ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS tel: +66 2382 5345-7 email: [email protected] fax: +66 81 584 5942 website: www.monkhouse.com.au COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 45

KCH Repatriation Ltd Medic’Air International 每递安国际 Emerson De Luca – General Manager Dr Huaqun Gao – Medical Director 83 Westbourne Grove, Bayswater, London W2 4UL, UK 885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA

tel: +44 20 7313 6920 email: [email protected] tel: +86 2163 558289 email: [email protected] fax: +44 20 7313 6999 website: www.kenyonrepatriation.com fax: +86 2163 558285 website: www.medic-air.com

Lutece International Mediflight Zouhaier Hertelli – Repatriation Specialist (AUSTRALASIA) Chris Craft – Operations Manager 56 rue Olivier de Serres, 75015 Paris, FRANCE NEW Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, AUSTRALIA

FUNERAL DIRECTORS tel: +33 1 56 08 00 23 email: [email protected] tel: +61 8 8378 6938 email: [email protected] fax: +33 1 56 08 00 43 website: www.pflutece.com fax: +61 8 8423 3077 website: www.mediflight.com.au

Rowland Brothers International (AFRICA) AMREF Flying Doctor Service Melanie Walkling – Partner Dr Bettina Vadera – Medical Director 299-305 Whitehorse Road, West Croydon, Surrey CR0 2HR, UK Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +44 20 8684 2324 email: [email protected] tel: +254 20 600 090 email: [email protected] fax: +44 20 8684 8000 website: www.rowlandbrothersinternational.co.uk fax: +254 20 344 170 website: www.amref.org

Servilusa Greek Flying Doctors Vanda Castro – Manager International Department Dimitris Kanellis – Manager

Agencias Funerarias SA, International Dept. Rua do Entreposto Industrial, 8-2 Esq, AIRLINES COMMERCIAL ON ESCORT MEDICAL 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE NEW 2610-135 Amadora, PORTUGAL

tel: +35 121 470 6300 email: [email protected] (EUROPE) tel: +30 210 674 0600 email: [email protected] fax: +35 121 470 6499 website: www.servilusa.pt fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

Xanit Hospital de Benalmadena Voyageur Aeromedical Travel Dr. Juan Bosco Rodriguez Hurtado – Director Marc Lucas – General Manager Avda. Los Argonautas, Benalmadena, 29630 Malaga, SPAIN Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: +34 952 367 190 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

(EUROPE) fax: +34 952 367 191 website: www.xanit.net fax: +44 (0)117 925 5940 website: www.voyageur.co.uk HOSPITALS HOSPITALS Baptist Health Int. Center of Miami Air Ambulance Network Yohandra Fuentes – Finance Manager Kirk Pacheco – President

8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA (NORTH AMERICA) 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689 USA

tel: +1 786 596 2373 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected]

(AMERICA) fax: +1 786 596 5979 website: www.baptisthealth.net/international fax: + 1 727 937 0276 website: www.airambulancenetwork.com

Integrated Healthcare Services Life Flight International Inc. Brenda Escobar - Int. Services Manager Chris Connor – Operations Victoria International Airport, Viscount Business Center, 103-9800 McDonald Park 450 E. Las Olas Blvd., Ft. Lauderdale, Fl 33301, USA Road, Sidney, British Columbia, CANADA tel: + 1 305 222 6750 email: [email protected] tel: +1 250 655 1630 email: [email protected] tel: + 1 305 222 6751 website: www.hcaeastflorida.com fax: +1 250 656 9394 website: www.lifeflight.ca

Jackson Memorial Hospital International MedEscort International Mario Mendez – MD - EVP/Managing Director Craig Poliner – President Jackson Medical Towers, East Tower, Suite 829, 1730 Vultee Street, Allentown, PA 18103, USA 1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA 24hr tel: + 1 305 355 1212 email: [email protected] tel: +1 610 791 3111 email: [email protected] tel: + 1 305 355 5544 website: www.jmhi.org fax: +1 610 791 9189 website: www.medescort.com

University of Miami Health System AMREF Flying Doctor Service Jose Quesada M.D., M.B.A. – Director Finance & Operations Dr Bettina Vadera – Medical Director 1099 N.W. 14th Street, Miami, Florida 33136, USA Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +1 305 243 9100 email: [email protected] tel: +254 20 600 090 email: [email protected] fax: +1 305 243 9101 website: www.uhealthinternational.com fax: +254 20 344 170 website: www.amref.org

CareFlight Group StandbyMD Medical and Tasking Centre Alex Sánchez – Managing Director PO Box 5078, Robina Town Centre, Queensland, 4230 AUSTRALIA 777 Brickell Avenue, Suite 1370, Miami, Florida 33131, USA NEW MEDICAL PROVIDER 24hr tel: +61 7 5553 5955 email: [email protected] tel: +1 305 459 4882 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com fax: +1 305 421 5575 website: www.standbymd.com

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

tel: +61 1300 655 855 email: [email protected] AGENTS tel: +44 (0)117 927 3554 email: [email protected] fax: +61 2 9689 2744 website: www.careflight.org fax: +44 (0)117 925 5940 website: www.voyageur.co.uk AIRLINES (AUSTRALASIA) 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] MEDICAL ESCORT ON COMMERCIAL fax: +662 535 4355 website: www.medicalwings.com fax: +44 (0)117 925 2040 website: www.vcreativedesign.co.uk ADVERTISING WEB & MEDIA 46 REGULARS VINE • GRAPEVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPE- Diary Dates 2-4 December Grapevine Product Management Skills and Techniques Seminar to offer holidays that are guaranteed to be Marriott Hotel, Scottsdale, Arizona, US ‘mafia-free’. Addiopizzo Travel, (‘addiopizzo’ means ‘goodbye protection money’), is an offshoot of an organisation that brings together 6-7 December shopkeepers, restaurant owners, hoteliers Middle East Conference on and others committed to refusing the mafia’s Catastrophe Insurance unrefusable offers. Until now, the only route Oman, UAE open to tourists concerned they might be giving their business to companies owned or extorted 9-10 December by the Cosa Nostra has been to contact Addiopizzo through the Internet, but with the 3rd Middle East Healthcare launch of the travel agents, it will become easier Insurance Conference Bahrain, UAE to avoid the mafia traps. Through the agency, tourists will be able to dine in a pizzeria owned by the brother of a man who 27-29 January 2010 was killed because of his stand against the Cosa 1st Annual Medical Tourism Nostra, for example, while the next day there Research Conference could be an organised visit to land that has been San Antonio, Texas, US confiscated from the mafia.

HBO •

GRAPEVINE • 27-29 January 2010

International Maritime Wasn’t that our Mine’s a beer Conference Mafia-free Sydney, Australia stop? A 23-year-old’s thirst got the better of him on a

guarantee recent flight from Vancouver to Fort McMurray, GRAPEVINE • GRA PE - US aviation authorities have launched an Alberta, when he stole a beer from the aircraft’s 10 February investigation after an Airbus A320 carrying 144 Thousands of tourists visit the beautiful Italian drinks trolley. After supping the stolen liquid, Enter 2010 – eTourism passengers between San Diego and Minneapolis island of Sicily each year, but some do hold the passenger then proceeded to try and flush Conference reached its destination … and carried on. By concerns about the level of mafia involvement the evidence down the 50-seat jet’s toilet. Lugano, Switzerland the time the pilots had realised their error, they in businesses on the island, and wonder The plane was forced to divert to Kelowna, were 150 miles off-course and the US military whether or not the tip they are leaving will British Columbia, where police were waiting to 9-10 February had fighter jets on stand-by thinking terrorists find its way into the organised crime business. arrest the man, who faces charges of causing a 13th Annual Insurance had hijacked the plane. The pilots allegedly told However, a new travel agency has now begun disturbance on an aircraft. Conference the Federal Aviation NYSSA, New York, US Administration that they had lost track of where they were during a ‘heated 22 February discussion’ over airline 2010 P&C Insurance policy, but some suspect Technology Conference the pilots of having a Marriott Hotel, Toronto, Canada snooze on the job. It was found by the National Transportation Safety 22-23 February Board that both pilots had 5th Asian Takaful Conference been using their laptop Singapore computers during the flight, which is against regulations and could well have 23-25 March been the cause of their 10th CEO Insurance Summit inattention. in Asia Singapore EVINE • • GRAPEVINE G RAPEVINE GRAP EVINE VINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • 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

AXA Assistance Jolly joins ABI LMA appoints van der Klugt expands The Association of The Lloyd’s Market Association, which provides overview of the British Insurers (ABI) professional and technical support to the Lloyd’s UK and overseas AXA Assistance has announced the appointment has appointed Peter underwriting community, has appointed Kees van der legal and regulatory of Bruce Robertson as its head of marketing and Jolly as its assistant Klugt as its new head of legal and compliance. Kees environments. LMA product development. His immediate focus will be director for the will help represent Lloyd’s managing and members chief executive to further develop the company’s affinity and direct Consumers and agency community by providing legal and technical David Giddings said market proposition, apart from fortifying the traditional Distribution Reform. support in the areas of regulation and compliance. of the appointment: marketing functions of the team. Robertson will report Jolly is joining the ABI Having previously worked at Amlin, Kees has nearly “There is a huge directly to Rick Ware, sales and marketing director. from his previous 20 years’ experience in the Lloyd’s marketplace, amount of activity in Commenting on the appointment, Ware said: “Bruce job at Standard Life, having worked on the legal and compliance side the regulatory arena, has a deep understanding of direct marketing. His where he was head of both syndicates and the Lloyd’s Corporation. both in the UK and experience and expertise will be of great value to us of distribution policy Peter Jolly Specific areas of attention in his latest role, though, internationally, and Kees van der Klugt growing our consumer sales effort.” for the insurer, and is include the various proposals for reforming the I am delighted that someone with Kees’ experience Meanwhile, the company has appointed Jason taking over the role from Alex Roy, who has left the ABI structure and nature of financial services regulation has joined us to ensure our members’ interests are Sparrow to the business team as head of sales. to take up a new post outside the insurance industry. and their implementation, as well as maintaining an properly represented.” Sparrow has worked in the financial services industry Maggie Craig, the ABI’s director of life and savings and for 20 years in various roles, covering personal and director of consumer strategy, said of the appointment: motor finance and more recently assistance services.” “Pete has over 20 years’ experience of the industry red24 hires Thompson Sparrow commented on his new role: “I feel that with three major companies and has worked in sales, AXA Assistance offers a truly global range of products strategy and distribution. His appointment reflects the Security expert red24 has further boosted its UK his time in the military, Thompson gained operational and services to its clients, coupled with the strength importance that the ABI, and the whole insurance team with the appointment of Steve Thompson, experience in every continent and was involved in and diversification of the AXA group companies. I am industry, places on ensuring consumers are at the a military specialist and former royal marine. the planning and execution of complex operations in confident that over the next few years we will see heart of all we do.” His new role will be to lead the Thompson joins the company as senior security hostile environments. significant growth at AXA Assistance and I am looking ABI’s work on implementing the Retail Distribution consultant, and brings with him more than 20 years Maldwyn Worsley-Tonks, chief executive officer of forward to being part of this success.” Review, making sure it succeeds in its mission to in the military, as well as nine years in the commercial red24, said of the new employee: “The appointment deliver high quality, appropriate advice to as wide a sector, with major multinational companies. During of Steve further enhances our team in the UK and range of consumers as possible. will help us deliver further success and growth for the company. He brings a wealth of knowledge gleaned Box heads to Marsh from his career working in a variety of situations across the world, and a holistic approach to providing security Marsh, the solutions in the corporate environment, especially within insurance broker Allen joins Aon complex compliance and regulatory frameworks.” and risk advisor, has appointed Peter Box Prudential’s Simon Allen has been appointed chief as a non executive operating officer of UK risk and insurance firm independent Aon Limited, subject to FSA approval. Simon was RMS appoints vice director of the formerly chief operations officer at Prudential and firm’s UK Board of has also worked as vice president of international Steve Thompson president Directors. Box, who operations for Capital One Bank. held the position Rob Brown, chief executive officer of Aon Limited, Risk Management Solutions (RMS) has announced of partner with said: “We are delighted that Simon has chosen to Mark Cravens as the new vice president in its client Peter Box Pricewaterhouse- join Aon. He has a New appointment development division. Cravens, who has over 28 Coopers (PwC) very strong record years’ experience in the insurance, reinsurance, until June this year, will now chair Marsh’s Audit of successfully for Chubb and catastrophe risk disciplines, including more than Committee. Box joins Marsh following a 39-year driving operational eight years with RMS, will partner with selected career at PwC, where he was an audit and business improvement and Chubb Insurance Company of Europe (Chubb) has RMS clients to ensure they receive the highest level advisory partner to a broad range of companies will lead our drive appointed AXA’s Jon Nottingham as UK and Ireland of service and to develop mutual opportunities for – from large global groups to specialist national to consistently personal lines development manager. Jon formerly growth and development, said the company. enterprises. deliver a distinctive spent seven years at AXA, working across various Matthew Grant, global head of client development Martin South, chief executive officer of Marsh in the and rewarding roles, including corporate partnerships manager, at RMS, said of the appointment: “I am delighted UK, noted: “Peter’s exceptional market knowledge client experience.” responsible for reviewing and improving the sales to welcome Mark back to RMS. His appointment and international perspective, combined with his Simon added: “I capabilities across the retail broking division. demonstrates our continued commitment to broad experience of regulatory and governance am very excited Simon Mobey, UK and Ireland personal lines building strong relationships founded on a deep matters, will be of enormous benefit to Marsh. He to be joining Aon. Simon Allen manager, said: “Enhancing our sales culture is one understanding of our clients’ business needs, and will play a leading role in ensuring our governance This is a wonderful of our key goals, and Jon’s expertise will be vital in providing a best-in-class service.” He continued: structures, processes and risk frameworks are opportunity to join a company that has a strong spearheading this. Working with the Chubb team “Mark possesses the extensive industry experience first class, while working closely with the UK reputation and is a leader in its field. I am looking and our brokers across the UK and Ireland, Jon will together with the technical expertise and management team to identify and capitalise on the forward to being part of a team focused on driving help develop even more profitable business through relationship-building skills needed to forge and extensive growth opportunities available to us.” the business forward in a challenging environment.” targeted development strategies.” maintain these vital partnerships.”

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