NEWS & APPOINTMENTSINSIDE page 8

ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS WWW.ITIJ.CO.UK SEPTEMBER 2010 • ISSUE 116 Ombudsmen crack the whip

The Ombudsman services of the UK and Ireland arises regarding the sales process of travel insurance have been busy this year, as complaints about travel policies or what was said or not disclosed at the insurance products continue to plague the mediator. point of their sale, he cannot deal with that matter Mandy Aitchison takes a look at the fi gures as travel agents are not fi nancial service providers. He suggested that where they sell or market travel The Financial Ombudsman Service of Ireland has insurance policies, this aspect of their work should published its annual report, which found that in 2009, be classifi ed as a fi nancial service subject to the it received 7,619 complaints, which is a signifi cant Ombudsman’s remit. Matters to come under the increase of 28 per cent from 2008. However, it Ombudsman’s remit are ultimately a matter to be also showed that in 2009, the FOS received 262 decided on by the Minister of Finance.” complaints relating directly to travel insurance, which Meanwhile in the UK, the Financial Ombudsman is a drop of nearly 100 against fi gures from 2008, Service (FOS) has also been busy, with fi gures from when it saw 360 complaints. Of particular note the beginning of this year showing that there were 553 was one claim for €200,000, which was paid to a complaints about travel insurance products or services customer of a travel insurer that had denied a claim in April, May and June, 55 per cent of which were for cancellation of a holiday. Another case highlighted resolved in favour of the consumer. For the previous by the ombudsman was one where the travel fi nancial year, April 2009 to April 2010, the FOS saw insurer had delayed paying a hospital bill, resulting in 1,956 complaints related to travel cover, 44 per cent the hospital chasing the patient with threats of legal of which were found in favour of the customer. The action. The report states: “The Ombudsman found latest edition of Ombudsman News makes for interesting it clear from the evidence submitted that there was reading for travel insurers, with a number of case some confusion during the assessment of the claim studies for insurers to consider – perhaps before making and delays were incurred as a result. He was also a judgement on that claim for medical expenses. concerned about the claims administrators’ level One study centred on the case of Mr D, who was of communication with the complainant during the taken ill whilst on holiday and spent several days assessment of the claim and found that this could in hospital with pleurisy before he returned to the have been better.” The Ombudsman told the UK. Once he had recovered, he put in a claim insurer to pay the claimant €200 for the stress and with his travel insurer, which was turned down on inconvenience caused. the grounds that his illness related to pre-existing The Irish Ombudsman also raised the issue of the respiratory conditions. The insurer said its enquiries position of travel agents and other tour operators suggested that Mr D had been diagnosed with who sell travel insurance, which the report says is ‘asthma and bronchial hyperactivity’ and that he had not in the Ombudsman’s remit: “Where an issue experienced ‘previous continued on p.5 A leap of faith

Emergency services on the Spanish Balearic islands a pool, the serious nature of the injuries that tend of Mallorca, Menorca and Ibiza have issued a blanket to be sustained from such activities mean expensive warning to holidaymakers of the dangers of jumping and long-term treatment could be on the cards. currently in an intensive care unit in Ibiza after falling thinking that the EHIC covered all medical expenses. off balconies, which this summer has so far claimed This can often require medical repatriation back to from a second-fl oor balcony: his family is trying The ambulance service on the Spanish islands said the lives of four young people and left many others the patient's home country; a service not covered to raise the £15,000 needed to fl y him home for to reporters that in the space of 12 hours recently, seriously injured. Sarah Watson reports by the European Health Insurance Card (EHIC), continued treatment. The family of a honeymooner they were tasked with taking three young people to which too many people are relying on in place of who fell from her balcony in Greece and broke her hospitals after they plummeted to the ground from Whether it is due to trying to jump from one comprehensive travel insurance. Take the example back in three places also had to raise the £16,000 their balconies. One was Ryan Elley; the others were balcony to another, or jumping from a balcony into of Ryan Elley, a 20-year-old from the UK, who is needed to fl y her back to the UK after mistakenly two 18-year-olds who continued on p.4 IN THIS ISSUE ITIJ CONTRIBUTORS

REGULARS Tatum Anderson is a freelance international health and technology business writer with a decade of experience. Her News continued 4 specialist subjects include emerging markets, business, health and Editorial comment 6 public health policy. She has written for a variety of publications, Appointments 8 including The Economist, Guardian Weekly, BBC News Online, Wall Company brief 9 Street Journal Europe and the Financial Times. Insurance matters 10 Gerry Bolger is the programme director for the Quality Health matters 13 in Caring work within the Chief Nursing Officer’s (CNO) Travel matters 14 Directorate at the Department of Health in England. As well as being a registered nurse, Gerry also holds a Masters’ degree IPMI news 16 in health management. He formerly led the Royal College Cross-border care 18 of Nursing In-flight Nurses Association as their chair for eight Air ambulance news 20 years and has been involved in clarifying issues on medicines ITIJ Awards 24 administration in that role. Profile 38 Carrie Dunn is a freelance journalist who has written for Service directory 39 publications including The Guardian, The Independent and The Grapevine 46 Times. She has a Masters degree from King's College London On the move 47 and is currently researching a PhD in social sciences.

Roger St Pierre is an avid traveller who has visited 119 FEATURES countries and rising. He writes and broadcasts extensively on the tourism industry, motoring, cycling and music. He is also News Analysis: A leap year in Spain 24 fascinated by how the global economy works. At 15, he already ITIJ examines the increasing incidence of holidaymakers jumping had five regular newspaper columns covering sport but also from their balconies into hotel pools, and the cost of such reckless happens to be a qualified associate of the Chartered Insurance behaviour Institute and writes regularly on business and financial matters for a number of prestigious publications. Feature: Of sound mind 28 The onset of a mental health illness can be sudden, and often prompted by a stressful holiday or international job relocation. Are insurers prepared?

Feature: A shot in the dark 30 Travel vaccinations are more important than ever. ITIJ looks at why; and asks whether insurers should do more to educate travellers about the need to make sure they’re getting the right inoculations for their trip

Assistance & Healthcare World Markets: Norwegian gold 32 The popular destination of Norway can be expensive for travellers caught unawares; ITIJ offers an insight into the standards of healthcare and assistance on offer in the Nordic country

ITIJ TEAM

Editor-in-chief: Ian Cameron ITIJ Published on behalf of: Voyageur Publishing & Events Ltd, Editor: Sarah Watson Voyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK Title editor: Mandy Aitchison The information contained in this publication has been published in good faith and Copy editor: James Paul Wallis Telephone: +44 (0)117 922 6600 every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, Conference manager: Denise Clements editorial dept: Ext. 3 disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation Production: Helen Watts advertising dept: Ext. 1 of the trade of any company, individual or fi rm mentioned is hereby excluded. Kirsty Diclaudio Advertising sales: David Fitzpatrick fax: +44 (0)117 929 2023 Printed by Pensord Press, South Wales, United Kingdom James Miller email: [email protected] Copyright © Voyageur Publishing 2010. Materials in this publication may not be reproduced in any form without permission Finance: Elspeth Reid web: www.itij.co.uk design: V Creative Design INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522 Louise Goddard Design: V Creative Design Would you like to make a comment? vcreativedesign.co.uk WOULD YOU LIKE TO SUBSCRIBE? Please get in touch with Ian Cameron, VISIT www.itij.co.uk Editor-in-Chief of ITIJ on +44 (0)117 922 6600

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

4 NEWS

Airline cover Greek strikes end NEWSWIRE questioned Six days after it began, the strike by truck drivers in Greece that brought the country almost to a grinding Australia’s largest online travel insurer, Consumer NZ, a New Zealand-based halt was called off on 1 August as the protestors Travel Insurance Direct, and its customers have organisation that champions consumer agreed to enter into talks with the government. As helped to drive a record level of donations to online rights, has warned travellers with Air the days passed, the protest turned ugly, with some charity programme the Footprints Network, allowing New Zealand, Pacific Blue and Jet Star truck drivers clashing with police who were brought an expansion of projects that try to relieve poverty- that stowing their camera or laptop in in to try and control the situation, protecting the stricken families. their hold luggage might render any workers who chose to continue with their jobs from claim for such equipment invalid. A the strikers. The government was forced to recruit British insurer Esure has urged study of the small print of the insurance military vehicles to supply desperately needed fuel to holidaymakers who fall ill overseas to contact their offered by these airlines showed that airports, hospitals and power stations, which were in travel insurer as soon as possible, preferably before none of them covered damage to such turn escorted by police vehicles. receiving treatment, as the company could help equipment if it was placed in the plane’s The walkout by the truck drivers has had a severe them to secure the most appropriate care. hold. The airlines state that the lack of effect on tourism, at a time when the country cover is due to the fact that items such as laptops can desperately needs the revenue the sector brings in. There is disagreement in Pakistan over the be easily damaged if they are not packed properly The entire industry, from hotel owners to car rental level of compensation that must be paid to Age charity criticised by the traveller, or if there is turbulence during the companies, has felt the effects of the industrial action, the families of victims of the recent aeroplane flight. The consumer organisation has also warned either through completely cancelled bookings, or crash. The Carriage by Air Act, derived from the The recently launched charity Age UK – which is a travellers that each of the airline’s websites will assurances from holidaymakers that they would not Montreal Convention, differs from the Civil Aviation combination of Age Concern and Help the Aged – has automatically add their own insurance to a booking be returning to Greece again any time soon. On the Authority’s rules. been criticised after the cost of a travel insurance policy unless the customer ‘opts out’ of taking it. popular island of Crete and in northern Chalkidiki, offered by the charity rose significantly following the Paul Yeo, chief executive of the Travel Agents there were estimated to be around 100,000 The Icelandic volcanic ash cloud from April merger. The cost increase could have come about Association, reminded consumers that they need to opt tourists stranded with no fuel, with some taking the cost budget airline easyJet £65 million as the airline as a result of the change in insurance provider – Age out if they do not wish to have the airline’s insurance initiative and abandoning their cars by the side of was forced to cancel 7,314 flights and disrupt the UK changed its provider from added on to the cost of their flight, which he the road having run out of fuel and walking to their travel plans of nearly one million passengers. Despite Liverpool Victoria to Fortis himself had neglected to do when booking destination. Vassilis Korkidis, president of the Greek the disruption, revenues in the past three months when Age UK was created. tickets recently with Air New Zealand. He trade association, said: “The period to 15 August is rose more than five per cent to £759.2 million. A statement from the charity added: “I think selling insurance on the Internet the heart of the tourism season and an entire week was released in response to the with airlines is a lovely cash cow. Airlines are has now been lost.” A recent survey conducted by Ipsos Mori criticisms: “Following moving towards maximising extra revenue The truck drivers took action at the decision by the revealed that only five out of the 2,072 people the merger of beyond their airfares. As the airfares are government to open up their industry by making polled said that airline insolvency was an issue when Age Concern coming down they’re looking at recovering provisions for access to cheaper operating licenses, booking a holiday, despite over 65 airlines collapsing and Help the money elsewhere.” with the truckers arguing that it is not fair as existing since the start of the recession. Aged, a full review Jessica Wilson, a researcher for operators have had to pay start-up fees of around was completed Consumer NZ, said that the most €300,000. By having such a tightly controlled industry, UK-based World First Travel Insurance has to identify how important thing customers should though, the freight sector has in actual fact worsened appointed four new members of staff after seeing best to meet do before booking travel insurance the economic situation by ensuring that travel costs more than 400-per-cent growth in business during customers’ online is to read the small print, remain very high. The poor competitive nature of the the past 12 months. needs and it was and understand it: “Policies Greek economy was one of the aspects most heavily agreed that one will always have exclusions and criticised by the International Monetary Fund and the insurer should be you need to know what these European Union, which together bailed out Greece a appointed to ensure are. For example, insurance offered few months ago with a €110-billion emergency loan. a consistent and when you book a domestic ticket As if the Greeks didn’t have enough to contend with A leap of faith effective service to the with Air New Zealand, Jet Star or this summer, an urban guerrilla group has threatened continued from p.1 merged customer base. Pacific Blue doesn’t provide cover to hit the country over the summer months, again were taken to hospital in Magaluf in Mallorca. The Fortis was selected because if you simply change your mind about increasing concerns for tourists. The group, called the number of accidents resulting from people jumping of its long-standing record travelling.” John Lucas, a spokesman for the Sect of Revolutionaries, issued a leaflet on 1 August from balconies has tripled this summer compared in providing customers New Zealand Insurance Council, added that that threatened to bring mayhem on the country to last summer, the cause of which has not been with trusted products and consumers booking flights online have a right during the coming weeks. The letter said: “Tourists identified, although Spanish authorities have pointed commitment to delivering to ask for a full copy of the insurance policy they should know that Greece is no longer a haven of to a number of videos that have appeared on the excellent service to people in later life.” are agreeing to buy. capitalism. We aim to transform it into a war zone of Internet labelled ‘balconing’. One couple affected were shocked when they were In response to the recent criticism, Jet Blue said that revolutionary processes, with arson, sabotage, fierce One hotel owner in Alcudia, a popular resort in quoted a price of £1,002 for an annual travel policy, if customers wanted a more comprehensive level of demonstrations, bomb attacks, [and] armed killings.” Mallorca, told a Spanish newspaper: “This year it has which one year earlier had cost them £168. Geoffrey cover they could alter the terms of the policy while The UK director of the Greek National Tourism become a real plague. If you catch them, they say Pulzer, who is 87, said: “We can't understand why they were in the ticket booking process. Air New Organisation Sofia Panayiotaki said she did not that they have lost their room key, but mostly they there is such a difference and want to know why Age Zealand simply pointed out that products such as believe that tourists should be concerned by either are trying to get to a girl’s room or think they can UK has picked an insurance partner that offers such cameras and laptops should be covered under home the threat of terrorism or the reality of industrial jump down into the pool.” poor value for people our age. insurance policies. action, and reminded the media that the government Fiona Macrae of Insurancewith, an online insurer has already promised to compensate any tourists based in the UK, spoke to ITIJ about the problem who suffer a financial loss as a result of the strikes: of people relying on their EHIC: “There is a serious “Anyone who has a problem caused by strikes can lack of information from the government about the £20 million bill for Goldtrail collapse contact the tourist office in London when they return EHICs; even the name European Health Insurance and we will consider their claims.” The department Card gives the public the impression they have health The recent collapse of yet another package holiday why at the beginning of the busy period rather than is currently considering two claims from tourists who insurance whilst in Europe and they naturally assume group in the UK is predicted to cost the government- at the end or the middle, when you normally expect missed their ferry due to the strikes, although there it will be the same healthcare they enjoy in the UK. backed consumer protection scheme – the Air Travel a company like this to go bust.” He added: “We will surely be many more to come. This is not the case and the government needs to Trust scheme – close to £20 million in repatriation are trying to reconcile all of the invoicing and the do some sort of publicity to clarify the and refund costs. The scheme, though, is already accounts for each supplier, to check how much they situation or we will continue to hear about £32 million in debt, and another massive payout got paid and for what invoices. And then [we will] families saddling themselves with debt to on this scale could well force the government into ask the director on what basis he decided to pay pay for loved ones’ medical and ancillary further action in taxing holidaymakers. whoever he paid.” costs abroad or to bring them home.” Since the collapse of Goldtrail on 16 July, some The owner and sole director of Goldtrail is Abdulkadir For more information on the spate of confusion has arisen as to how the holiday Aydin, a Turkish travel agent who founded the balcony accidents and holidaymakers group failed so spectacularly, so quickly – on the company in 1997, who has said he will co-operate mistakenly relying on the EHIC, please morning of the collapse, £1.3 million was paid by fully with the CAA and PricewaterhouseCooper's see our News Analysis on p 26. Some of Goldtrail to a number of airline suppliers. The Civil investigators. The company focused its business on those jumping from balconies this summer Aviation Authority (CAA), which supervises the Air affordable package holidays for younger adults in have made the mistaken assumption Travel Trust scheme, has called in advisers from Turkey, but last year was expelled from the Association that their EHIC will cover any medical PricewaterhouseCoopers to examine the company’s of Specialist Turkish Tour Operators due to concerns expenses incurred while on holiday, but as collapse. Joint administrator Jamie Taylor said, “Why about standards at some of the hotels to which it sent those in the industry know, this is simply did it go bust so quickly – in a matter of days? And its customers. not the case.

International Travel Insurance Journal NEWS 5

Ash cloud Ombudsmen crack the whip continued from p.1 compensation delayed episodes of pneumonia, bronchitis and pleurisy’. insurer refused to reconsider the claim, saying that previous illnesses and the pleurisy that landed him in Although Mr D accepted that he had suffered from it had based its decision on the opinion of its own a foreign hospital. The GP, though, said that a direct Four months after causing travel misery for hundreds breathing problems in the past, including separate chief medical officer. She had considered that Mr link could only have been established if he had been of thousands of passengers, the ash cloud is episodes of pneumonia, bronchitis and pleurisy, he D’s medical history put him at ‘an increased risk of able to examine Mr D at the time of the illness. The continuing to make lives difficult for those caught up said that these episodes did not relate to a pre-existing contracting a respiratory illness and would affect its GP also said that although asthma had been put in in it, with many still awaiting financial compensation condition that he ought to have declared. They subsequent severity and recovery’. In response to the the man’s medical records, it had been recorded from their airline. One such customer is Phil Gordon came out – just like the episode he suffered whilst on complaint about multiple phone calls, the insurer said for data purposes, and had never actually been from the UK, who has been battling British Airways holiday – due to ‘one-off infections’. Mr D added that that it had made ‘very few’ calls, and these were from formally diagnosed. “And, significantly,” continues the (BA) since the debacle began. during his admission to hospital he had been ‘greatly a nurse with the assistance firm who was concerned report, “we noted that the insurer’s own records Stranded in Buenos Aires, Argentina, when the ash troubled by a number of repeated and unnecessary’ about the wellbeing of the client. Unhappy with his acknowledged that ‘pleurisy did not arise directly or cloud descended, he needed to return to the UK for phone calls from the assistance company that was service, Mr D went to the Ombudsman, who upheld indirectly from asthma’, so the insurer’s decision to a hospital appointment, and so bought tickets for an acting on behalf of the insurer. He said that he had his complaint. The FOS said that although medical reject the claim appeared to be inconsistent with its earlier flight than was offered by BA, expecting the been suffering from extreme breathing difficulties evidence confirmed the man had suffered breathing own policy terms.” One lesson here for the insurance company to reimburse him for the difference in cost at the time and the calls had created ‘additional problems in the past, his GP told the insurer that community is to make sure they are more familiar between his original flight and the new one – BA has stress at an already difficult and worrying time’. The there could possibly be a connection between these with their policy than the Ombudsman! refused to pay. “To add insult to injury,” said Gordon, “we actually saved BA having to pay us for four days expenses [on hotel bills and meals]. I will not fly with them again.” In a statement, BA said: “We have now processed the vast majority of claims, and in many cases have compensated over and above what is required by any regulation.” BA is not the only airline that has yet to pay off its customers – Virgin Atlantic, easyJet and KLM have also been criticised for taking too long to reimburse their passengers. KLM, in particular, has caused concern, as although European Union (EU) rules state that airlines must compensate passengers for the whole time they were delayed, KLM is saying that it will only pay for the first 24 hours. The airline has been threatened with legal action unless it complies with EU requirements. James Fremantle, industry affairs manager for the Air Transport Users’ Council, said that the number of complaints had risen significantly this year, adding: “The complaints show that airlines are dragging their heels; not just any particular airline, but across the board. One airline, Jet2, is breaching the rules by offering vouchers rather than cash.” Bangkok bomb injures nine

The explosion of a bomb at a central Bangkok bus stop on 25 July wounded nine people, including eight Thais who were in the centre of the city shortly after polls closed in a parliamentary election, and one Burmese national. Anuchai Lekmamroong, the major general of the Thai police force, said he was unwilling to speculate about whether or not the bomb was detonated by protestors wishing to continue the political turbulence that has been seen in recent times. The election was between a current government candidate and a leader of the red shirt protestors, who is currently in jail on terrorism charges and had to campaign from his jail cell. The elections were seen by many as a test of strength for red shirt supporters, but the government candidate, Panich Vikitsreth, won with around 54 per cent of the vote.

Short-term cover urged

Following research from Mintel that showed 20 per cent of UK holidaymakers have booked a short break over the past year in addition to their main holiday, Post Office Travel Insurance has urged consumers to make sure they have secured comprehensive cover, even for a short break. The research revealed that the driving force behind most holidaymakers’ short trips is the desire to try something new, with 72 per cent of travellers saying they like to visit destinations they have never been to before – two facts that are likely to strike fear into the heart of even the bravest travel insurer, due to the lack of research that travellers do before visiting new destinations. Post Office Travel Insurance has suggested that frequent fliers should consider multi-trip annual travel insurance, which is often better value in the long run.

www.itij.co.uk 6 NEWS

EHIC warning Hundreds stung on

Consumers of travel insurance in the UK have been group of travellers shouldn’t be tempted to take the Costa warned by an online insurance comparison site that risk of travelling without cover. Premiums do increase there is at least one travel insurer in the UK that will with age to reflect the fact that a greater number of A flotilla of tiny jellyfish has been causing misery for not cover any claims made by a customer if they claims are made, although the level of cover remains hundreds of holidaymakers in Spain, where, on the do not carry with them a valid European Health comparable, offering peace of mind in the event that a eastern Costa Blanca, a plague of the beasts have It’s official … jumping off balconies can be a danger Insurance Card (EHIC). Moneysupermarket.com’s trip is cancelled or medical help is needed.” had a field day stinging swimming tourists. Biologists to your health … no shit Sherlock! spokesman Bob Atkinson said: “Some insurers will In related news, the say that strong So, what are the Spanish authorities worrying about? refuse you cover if you failed to travel with a valid UK’s Office of Fair currents have Surely a bit of harmless ‘balconing’ (as the ‘sport’ is card. Some other insurers will waive the excess Trading (OFT) has shut swept the jellyfish now known and promoted via the Internet) is cool. on claims where you have an EHIC and used it for down a host of websites closer to the There are only three or four casualties in a night your treatment. It is vital that you have an up-to- that were charging beaches and calm (reported in the Balearics alone). I mean, what else date EHIC and a full travel insurance policy when travellers for providing seas have allowed are you going to do at two in the morning when travelling in the European Economic Area.” ITIJ spoke an EHIC, which is the creatures to you’re off your head on alcohol (etc!) and you need a to Moneysupermarket, which confirmed that it had provided for free by the stay in the same shortcut to your mate/girl/boyfriend’s or ex-mate/girl/ only found one insurer with a clause in its policy that Department of Health. areas for around boyfriend’s room or to the pool. Stands to reason refused cover if a person didn’t have an EHIC – that One website, www. three days. The you’re going to take the short, funny route with the company is EHIC Plus, which states clearly from the ehiconline.com, has jellyfish were most bravado doesn’t it? outset that it is insurance designed to complement been suspended by its concentrated in Anyway, even if it goes wrong, we got this EHIC the EHIC, not a standalone insurance policy. domain name registrar three areas near thing, init? Steve Williams, head of travel at another price after concerns were the city of Elche – Yeah, this EHIC thing is great. It guarantees that comparison site, Confused.com, said: “Insurance raised by the OFT, while on one day alone, we get picked up and operated on by that George providers won’t necessarily stop a claim on the www.e111-online. 380 people were Clooney, and then we get flown home in this private grounds of not having an EHIC but it is useful and com has voluntarily stung, compared jet thing, which has a fridge with lots of lager, yeah. free. Where claiming on the EHIC has saved the ceased trading. Three with the usual Cool, innit? insurance provider some money, the majority may other websites have daily figure of So, firstly, perhaps we should print health warnings offer to waive the excess, which will typically save been forced to sign between four and on all hotel balconies the same way we do with Francis Mariani travellers £50 to £100. As the EHIC only covers agreements with the five. A few days cigarettes. Sadly, this makes the assumption that the users for free or reduced-cost treatment, many OFT not to engage in later, the number participants in this great sport can actually read. travellers will still need to claim for certain medical ‘deceptive selling practices’, which means in practice of people stung reached over 700, prompting Secondly, perhaps it’s about time that it’s made expenses from their insurer." that they are still allowed to charge a fee to forward Juan Carlos Castellanos of the Elche city tourism abundantly clear to people (by governments or the Williams also recently urged older travellers not to risk a person’s application to the Department of Health, department to exclaim: “In the five or six years I have industry itself) what (little) the EHIC does actually cover. jetting off on holiday without travel insurance, despite but they cannot pretend to sell people cards, as been in this job, I have never seen anything like this.” Finally, even if we manage to persuade our sporting recent concerns raised about increased premiums many were doing previously. Heather Clayton from So far, the affected beaches remain open, but officials friends to take out travel insurance, I suspect we and a lack of availability (see ITIJ 115, July edition, the OFT said: “While it is not unlawful to charge have posted warning signs and stationed lookouts in might find the ‘balconying exclusion clause’ slipped in The age-old problem). Williams said: “While most money for a reviewing and forwarding service, boats offshore. there somewhere. What do you think? standard travel insurance policies offer cover up to traders must be clear about the product or service Meanwhile, on Spain's Atlantic coast, a more dangerous the age of 75, there are a number of specialist travel they are offering, and not trick consumers into type of jellyfish has stung around 300 people in the past Ian Cameron insurance policies available for older people, so this parting with money for services they don’t want.” several weeks in waters off Cantabria. Editor-in-Chief [email protected]

Fraud fallout

Figures released by the Association of British Insurers show that travel insurance fraud rose by more than six per cent in 2009, showing that many people continue to view the sector as fair game. Recent statistics published by the Association of British Insurers (ABI) show that 4,529 instances of travel insurance fraud were uncovered in 2009, Photosi a rise from the 2008 figure of 4,264. Claims management firm CEGA has used the figures to Tourists trapped in warn holidaymakers about fraudulent claims, and the consequences that could follow. Bolivia Simon Cook, fraud manager at the company, said: “A The Bolivian mountain city of Potosí, which lies lot of people making fraudulent claims on their travel in the shadow of the mountain known as ‘rich insurance are first-time fraudsters, and don’t realise mountain’ due to its silver mines, has hit the how serious it is to make a false claim. Insurance headlines after mining protestors blocked rail, land fraud can lead to a criminal conviction, which would and air links to the town, thus trapping over 100 make it very difficult, for instance, to take out any sort foreigners in the city who were unable to leave. of insurance policy in the future – and that includes The tourists were left marooned, and many voiced car and household insurance.” What many fraudsters concerned about the lack of food and increasing don’t know, and many more know but don’t care tension among the protestors. about is that false claims put the price of insurance up Sarah Hewlett from London told The Guardian for all users, as insurers have to consider how many newspaper: “We want to leave, but we can’t. We fraudulent claims they will be subject to and build that tried to leave twice, but it didn’t work – after the first into the cost of each policy. three days we crossed one of the blockades with our Insurers, though, are employing ever more complex backpacks and walked 18 kilometres, but there were techniques for identifying possible fraudsters to try no cars, nothing to pick us up, so we turned back and contain costs, as Cook explained: “Cognitive because it was futile.” A second escape attempt was interviewing techniques, investigation by overseas made later on a bus with a group of French tourists, agents and medical assessments may all be used to but this too was unsuccessful: “When we got to the assess the honesty of a suspicious claim. Insurers blockade the miners surrounded [us] and threatened will check every detail of a dubious claim, from the the driver, saying they were going to smash the bus, authenticity of a doctor’s bill issued on the other side so we had to turn around.” of the world to the validity of a witness statement in The British Embassy in La Paz advised against anyone a foreign language.” At the top of the list of CEGA’s trying to break the blockade themselves, and the fraudulent claims are genuine losses that have local governor has promised to do his best to get the been exaggerated, followed by false claims for lost stranded foreigners out of the city. baggage, and fictitious medical treatment.

International Travel Insurance Journal

8 NEWS & APPOINTMENTS

Briton named in zip wire accident Sun4U collapses

In further confirmation that while on holiday herself. She was unable to brake when she reached British travel firm Sun4U has ceased trading, leaving tourists tend to take part in more risky activities the other side and smashed violently into the rock around 1,200 holidaymakers already abroad to rely than they would do at home, yet another British face. She died immediately.” on the Civil Aviation Authority (CAA) to fly them holidaymaker has perished this summer. Following back home to the UK. A statement on the tour on from the news about the grandfather who suffered fatal injuries when his parasail failed and he plummeted onto a beach in Turkey, a British student who died when she crashed into a cliff face while using a zip wire to cross a ravine in France has been named as Andrea Watton. The 21-year-old girl was on an adventure holiday with some friends in the Swiss Alps when the accident occurred. The group of friends were navigating the Gorge Alpine – a mountain route fitted with cables, ladders and bridges that links the resort towns of Saas-Fee to Saas-Grund. According to the police, when she reached the third zip wire in a chain, Watton decided not to use the specialist equipment that had been provided for the wire. “Despite the reservations of her friends,” said a local policeman, “she fixed only two hooks to the cable and launched

operator’s website advises customers with forward bookings to contact the Association of British Travel Tummy troubles Agents (ABTA) for information about refunds or re- According to a poll of 2,000 people undertaken by four days of their trip as a result, which is the equivalent arranging their holidays. A CAA spokesperson said: Panadol, the most common holiday ailments are of losing £322 of the average cost (£564) of a holiday. “The CAA will be putting arrangements in place to stomach upsets, which were experienced by 66 per Dr Sarah Brewer, a general practitioner, said: “We ensure ATOL-protected Sun4U holidaymakers who cent of those surveyed. Sunburn was next on the work all year to enjoy a week or two in the sun, are abroad can finish their holidays as planned and list, with 62 per cent of respondents suffering from so it’s well worth taking a few simple steps to be return to the UK.” spending too long in the sun, while 55 per cent of prepared for any health complaints that might spoil ABTA has said that people already abroad who those surveyed had been bitten by an insect. The the fun. Always take a simple first aid kit with you had booked package tours through the Air Travel survey also showed that 74 per cent of those who had on holiday, plus stock up on sunscreen and after-sun Organiser’s Licence (ATOL) scheme should be fallen ill whilst on holiday had said they missed up to products and stay hydrated by drinking lots of water.” able to continue with their holidays as planned. A spokesman added: “There are approximately 1,200 people away at the moment [with the firm] and most of them are in Spain. Anyone who has booked Voluntary workers at risk a package holiday must contact the Civil Aviation Gap year students who choose to take part in went to the local hospital, as I’d been bitten by an Authority or contact the supplier named on their voluntary work in remote areas in far-flung corners insect and it turned into an abscess. But as soon as invoice.” He warned, though, that people who of the world have been reminded to take out travel the doctor saw me he said he thought I might have had simply used Sun4U as an agent to book flights cover, after one worker in Kenya contracted malaria. malaria. My temperature was really high, so I was would not be covered under the ATOL scheme, Charlotte Ferguson from the UK was struck by admitted to hospital for three days.” As she was and tourists who made bookings with separate tour the illness while carrying out voluntary work at an insured, and she had been taking anti-malaria tablets, operators have been told they should contact them orphanage inland, supposedly outside of the malaria the cost of her treatment was paid in full, but the case to confirm whether their arrangements remain in risk zone, but at the end of her trip she spent a few highlights the importance of taking precautions that place. ATOL-protected customers should also be days by the sea and was bitten. She explained: “I include preventive medicines and travel cover. able to claim refunds for future booked Sun4U holidays from the CAA. In further bad news for the travel industry in the UK, budget travel company Kiss Flights has ceased Travelocity trickster trading. London-based firm Flight Options Limited, which traded principally as Kiss Flights, folded on 17 Internet users have been warned that Yahoo! Travel it. It is safest not to do business with companies August. All of its customers with flights, or flights and and its service provider Travelocity in the US have like Travelocity and Yahoo! Travel that have such accommodation packages, will be able to complete been using some suspicious sales practices in order to egregiously dishonest practices.” He advised any their holidays and return to the UK due to the make customers purchase travel insurance with their customers that had been caught out by the automatic protection offered by the ATOL scheme, administered holiday. According to one report, once a customer opt-in to contact the Federal Trade Commission. by the Civil Aviation Authority. Flight Options also has selected their desired flights, a button reading ITIJ went through the booking process to see how traded under several other names: Africa Options, ‘Continue with flight only’ then leads the user to a easy it was to be caught out by the opt-in trick, and America Options, Canada Options, Caribbean checkout page, where, crucially, travel insurance is found that although insurance was automatically Options, Dubai Options, Elgouna Options, Elgouna added on to the cost of the flight whether or not the added to the price of the flights, it was clear that it Villas and Apartments, Florida Options, Florida customer has chosen it. was optional, and it only took one click of the ‘No Owners Club, Gold Options, Holidayops.com, Kiss Randy Abrams, director of technical education at thanks, I am going to decline the Travel Protection Holidays, Orlando Villas Direct, Sportops.com, Travel antivirus software vendor ESET, has warned users plan’ button, which was located directly and clearly Options Direct and Travel Plus. that the practice is ongoing, and was highly critical underneath the ‘Yes’ option, to update the price. In further bad news for the travel industry in the of the company: “You would expect that when you With European law mandating that customers UK, budget travel company Kiss Flights has ceased click on ‘Continue with flight only’, then you will automatically be ‘opted out’ instead of ‘in’ to travel trading. London-based firm Flight Options Limited, only be booking a flight that costs [the originally insurance purchases on flight booking websites, it which traded principally as Kiss Flights, folded on displayed amount], but this is where Travelocity and could be that US law could change soon as well. 17 August. All of its customers with flights, or flights Yahoo! Travel deliberately deceive you. They have and accommodation packages, will be able to automatically opted you in to buy insurance.” complete their holidays and return to the UK The insurance is called Travel Guard Travel due to the protection offered by the ATOL Protection, and adds $19.95 to the cost of a person’s scheme, administered by the Civil Aviation flight. An interesting point noted by Abrams is that Authority. Flight Options also traded under on the website there is a statement reading: 'If Travel several other names: Africa Options, America Protection has been purchased it is non-refundable,' Options, Canada Options, Caribbean Options, which Abrams suggests shows that the company Dubai Options, Elgouna Options, Elgouna knows it is being deceptive and doesn’t want people Villas and Apartments, Florida Options, Florida reclaiming their money after they realise what has Owners Club, Gold Options, Holidayops.com, happened. Abrams wrote: “Travel insurance is Kiss Holidays, Orlando Villas Direct, Sportops. offered at reputable sites, but you must opt in to com, Travel Options Direct and Travel Plus.

International Travel Insurance Journal COMPANYBRIEF 9

I-SOS teams with NEWSWIRE China's CNTA France-based Save Assistance has expanded International SOS (I-SOS) and the China National its roadside assistance offering to encompass the Tourism Administration (CNTA) have signed an rest of Europe and North Africa. The move gives the agreement to jointly develop national standards for the company assistance presence in 36 countries. country’s travel assistance and emergency services. These standards have a significant influence on travel The Egyptian Arab Land Bank is to provide agencies, assistance companies, and tourism reception its clients with a comprehensive range of insurance bodies operating in China and will serve as an integral services, including travel insurance, after an part of the State Council’s recommendations to agreement was signed with the Middle East speed up the development of tourism. The signing Insurance Company. The bank is fully owned by the ceremony in Beijing was attended by Dr Pascal Egyptian Government. Rey-Herme, group medical director of I-SOS, the executive management team of the Chinese branch Barclays Bank Zambia is launching an of I-SOS China, as well as officials from the CNTA. international travel insurance card for its premier After the draft of the standards is completed, it will be and premier life customers across the country. submitted to the National Standardisation Committee Customers would no longer need to inform the bank for approval and implementation. each time they wanted to travel.

International SOS and the CNTA sign an agreement to develop national assistance and emergency services in China I-SOS Mondial Assistance has won two Golden Shield awards at the Dutch insurance industry’s annual awards ceremony in the Netherlands – one Lorica chooses for its annual travel insurance product and the other Reliable Life offers EA products for its consumer roadside assistance product. Europ Assistance (EA) USA has announced that offered to Reliable Life clients. In today’s global Mondial Canadian insurer Reliable Life Insurance Company economy, it is essential that travellers be able to rely Lorica, an employee benefits consultancy, has Heart Insurance Services, a trading name is now offering EA USA’s Travel Assistance Program on comprehensive assistance while away from home.” appointed Mondial Assistance to meet its travel of Orbis Insurance Services, has launched a new under selected travel insurance plans administered benefits requirements, in a new contract for both website aimed at people suffering from heart by Reliable Life. Services provided under the travel parties. Mondial entered the employee benefits (EB) conditions, which includes travel cover specifically assistance programme include emergency medical market in the second quarter of 2009, with Lorica designed for Heart. assistance, financial, legal and communication being the latest company to sign up to its Travel assistance, and access to other critical services and Select product. resources available via the Internet. Alongside Mondial Motor Select, for roadside Assist America Guillaume Deybach, president and chief executive of assistance services, Mondial Travel Select is one of Europ Assistance US (pictured right), commented on the first products the company is providing to the heads East the tie-up: “We are proud to be a part of the benefits EB market, and delivers adaptable travel insurance solutions that allow staff to select the level of cover Assist America has announced the formation of Assist that best meets their specific requirements. America Middle East and North Africa (AAME), which will have its headquarters in Beirut, Lebanon. AAME Rightpath extends will serve as the exclusive marketing arm for the claims platform company, with its focus centring on expanding Assist America’s global emergency services in the region Rightpath Insurance Solutions has launched a new through partnerships with insurers and group benefit claims administration system, ATICS Advanced. The providers. Assist America’s family of companies already company says it works ‘seamlessly’ with its existing serves the area, having established partnerships expert system technology and provides a platform to with local insurers in Saudi Arabia, the United Arab begin recording the thousands of data fields it collects Emirates, Kuwait, Bahrain, Qatar, Lebanon and Turkey. during the claims assessment process. Paul Staples, AAME will be led by its chairman and general client services manager, explained: “Our previous manager Munzer Wehbe, who has been involved in technologies have revolutionised how we service the region’s insurance industry for over 50 years. our claims business; however, historically, these only operated as plug-ins to existing claims management systems. With ATICS Advanced, we have not only fully and seamlessly integrated the systems, but also extended the functionality that you would expect from a typical claims system to incorporate process automation, computer telephony integration, bespoke call scripting, content management, tools for collaborative working and its own knowledge base.”

Beirut, Lebanon Abacus joins ACE Online purchase on

Abacus, an Asian provider of travel services, has offer in Sri Lanka announced a new partnership with ACE Travel Sri Lanka-based Asian Alliance Insurance (AAI) has Insurance to distribute the insurer’s products to all launched Alliance Travel Assist Insurance, a new Abacus agents in the Asia Pacific region, including those policy and website that allows consumers to buy in Malaysia, Indonesia, Vietnam, China and Thailand. travel cover online and access ‘real time’ customer Agents will be able to access the policies via Abacus’ services. The demand from customers for a more travel insurance booking system, Abacus TravelSecure, comprehensive travel insurance product, following the allowing the processing of travel insurance transactions launch of Alliance Travel Assist, prompted the insurer to be made electronically within the same passenger to develop an enhanced travel policy that ‘better fits name record. Speaking at the ACE product launch the dynamic needs of the modern traveller’. Nadi in Malaysia, vice president of marketing for Abacus Dharmasiri, assistant general manager of marketing International, Brett Henry, said: “By enhancing the for AAI, commented: “We are continuously striving quality and variety of travel insurance products in to make the lives of our customers easier, and we Abacus’ distribution system, travel agents will be able recognised the need to simplify the process of to offer more choice to their customers. Concurrently, obtaining travel insurance policies. While traditional we are also helping travel agencies increase their channels of obtaining travel insurance policies are still revenue opportunities by maximising the travel operating, this is yet another endeavour to enhance insurance sales options to their customers.” the convenience of obtaining travel insurance.”

www.itij.co.uk 10 INSURANCEMATTERS

There were 55 geophysical events in the first six months of 2010, including the eruption of the Eyjafjallajökull volcano in March, which led to NEWSWIRE thousands of flights being cancelled; and there were 385 weather-related catastrophes that caused significant loss. The costliest single event was Winter Life insurance companies in Indonesia have Storm Xynthia, which hit the Canary Islands and reported solid growth for the first quarter of the swept across the Iberian peninsula, France and parts year, with the sector showing a 30-per-cent increase of central Europe – losses amounted to $4.5 billion, on the same period last year, according to figures with insurers taking a hit of $3.4 billion. released by the Association of Indonesian Life Other notable weather-related catastrophes during Insurance Companies. the first six months of this year were the floods and landslides that followed heavy rainfall on the The website of the China Insurance Portuguese island of Madeira in February; violent Regulatory Commission (CIRC) states that the storms that prompted flooding in several US states regulator is suggesting the abolition of controls on in May; flooding in central Europe in June; and pre-set interest rates used in accruing unearned widespread flooding in China, which is ongoing. premium reserves for conventional life insurance Torsten Jeworrek, chief executive of Munich Re’s policies. Insurers would be allowed to set their own Reinsurance division, commented: “In the first rates under the proposed change. six months, we recorded an exceptionally large number of substantial major losses. However, our RSA Group has acquired 123 Money core business is to help insure and carry natural Limited, one of the fastest growing direct distributors 2010: Year of the catastrophe catastrophe losses.” He added: “This is an area of personal lines insurance products in Ireland. where we benefit substantially from the know-how Following the approval of the transaction, RSA The first half of 2010 has been marked by an highlighted as being two of the most devastating of our Geo Risks Research experts. They analyse will become the second-largest general insurer in exceptionally high number of natural catastrophes, events ever recorded, based on a number of and evaluate loss trends using the world’s largest Ireland. together with the scale of losses they caused, parameters – in Haiti, 233,000 people died, one natural catastrophe loss database, thus enabling us to according to Munich Re. From January until the end of the highest death tolls on record. Overall losses calculate prices commensurate with risks, which is Bloomberg has reported that from of June, 440 events were recorded, as were losses were huge relative to the country’s economic the cornerstone of our underwriting.” September, insurers based on the island of Taiwan of US$70 billion. This figure exceeds the total for strength, even though insured losses were minimal Elsewhere, Munich Re is spreading its wings in Asia, will be allowed to invest in mainland Chinese 2009 as a whole, and is well above the first-half ($150 million) due to low insurance penetration. The where it recently signed a deal to provide reinsurance securities, after the two countries signed an average recorded for the past 10 years. Insured earthquake in Chile, meanwhile, was the fifth-largest for a new direct online insurance facility, DirectAsia. economic agreement that allows local companies losses for the events reached $22 billion, more than ever recorded, releasing 500 times the energy of com, which offers motor, home, travel and personal greater access to each other’s markets. double the first-half average since 2000 and even the Haiti quake, but the death toll was much lower accident insurance. Alexander Lay, head of casualty higher than the figure for 2008, when the previous at 521. Professor Hoppe said: “That shows how underwriting at Munich Re Singapore, said that the An improving economy has led to South record for first-half losses were set. important and effective it is to offer people as much agreement underlines the company’s position as a Korea’s car insurance market growing by 7.5 per Professor Peter Hoppe, head of Munich Re’s Geo protection as possible using modern, earthquake- ‘high-value solution provider in Southeast Asia’, adding: cent between April and June this year, reaching Risks Research division, commented: “Following a resistant construction standards.” Nevertheless, it “Our reinsurance agreement gives DirectAsia access 2.93 trillion won (E1=1,500 won). relatively benign 2009, the first six months of this was also the second-most-expensive earthquake on to our international network, consulting expertise and year were marked by three natural catastrophes record, with insured losses of $8 billion due to high extensive motor insurance know-how.” Nikolaus von The Indian Insurance Regulatory and ranked as ‘great’.” The term ‘great’ is used by the insurance penetration in Chile’s commercial and Bomhard, chief executive of Munich Re, has said he Development Authority (IRDA) has proposed that it company to describe events that incur either billions industrial sectors. The third great natural catastrophe expects the company to generate around 15 per cent produces a set of guidelines for the management of in losses or several thousand fatalities. of the year was the earthquake that struck China in of its business from Asia in the near future. Currently, insurance agents in order to identify passive agents In particular, the earthquakes in Haiti and Chile were April, claiming 2,700 lives. Asia contributes 11 per cent of the firm’s revenue. and reduce policy lapse rates.

Fitch Ratings expects Tokio Marine & Nichido Fire Insurance Group to benefit the most Cambodia cashes in Japanese outlook stable thanks to rate rises from a series of mergers in the Japanese non-life insurance sector. The General Insurance Association of Cambodia Fitch Ratings has changed the Japanese non-life (GIAC) has released figures that show insurance insurance industry’s outlook to stable from negative, Australian insurers are picking up on the premium revenues increased by 33 per cent in the reflecting the improving fundamentals of Japan’s growing appeal of mobile phone applications as a first six months of this year, demonstrating the massive three largest non-life insurance groups – MS&AD, marketing tool, and have launched one of their own potential the market has to offer. The GIAC has said Tokio Marine and KKSJ. Fitch’s special report into the that allows users to obtain a quote for cover. that the Kingdom’s six insurance companies collected Japanese non-life insurance sector found: “Non- US$11.2 million in premiums in the first six months of life premium income has recently begun to grow Cathay Life Insurance in Taiwan saw 2010, which is significantly higher than the $8.48 million again, thanks to the Japanese economy’s gradual premium revenue of US$5.6 billion in the first half that was recorded during the same period in 2009. recovery and an ongoing rise in insurance premium of this year, representing a 74-per-cent increase Chairman of the GIAC Chhay Rattanak has predicted rates resulting from the recommendations of the over the same period a year earlier. The income has that growth will remain steady for the forthcoming Non Life Insurance Rating Organisation of Japan". placed the insurer at the top of the market. months: “I think that the premium revenues will increase Furthermore, the 1 April 2010 launch of MS&AD around 20 to 25 per cent in 2010. Up to June 2010, we Insurance Group Holdings, Inc. and NNKSJ Holdings, The government in India has reassured the saw a big increase in premium revenue in engineering, Inc. has strengthened the industry’s oligopolistic are likely to start speeding up the reduction of four financial regulators in the country that they will but for other products there was not a big change.” structure, which Fitch believes is likely to enhance their equity exposure in order to cope with the each continue to have their own autonomy, despite GIAC figures show that the sector received 22.4 per pricing power. “In addition,” added the report, “the introduction of new solvency rules. the creation of a joint committee that has been cent of its premium income from fire cover, 21.4 steady growth of the three mega non-life groups’ According to the General Insurance Association of set up to resolve disputes between regulators over per cent from motor insurance, 23.8 per cent from domestic life insurance and international insurance Japan, 27 non-life insurance companies were licensed hybrid products. miscellaneous and personal accident cover, 17.3 per businesses is strengthening their creditworthiness.” as domestic insurers in the country. The industry cent from engineering, 13.8 per cent from medical, and Fitch identified that the biggest risks for the market generated direct premiums of JPY7.8 trillion (E1 = The Xinhua News Agency has reported that 1.2 per cent from marine insurance. Claims payments remain in the volatile nature of the groups’ domestic JPY106) and net written premiums of JPY7 trillion for CIRC has issued new rules for actuarial in the first six months of this year stand at $3.2 million. equity holdings, but said that it believes insurers the financial year that ended in March. appointments at non-life insurers as it is trying to improve the country’s actuarial system and minimise operational risks. Chinese life market successful Insurance Australia Group is confident that its performance will improve this year, despite Sam Radwan, partner and co-founder of management the impressive growth will continue. Radwan noted: gross domestic product is generated by the insurance the fact that it is expected to report a fall in profit consultancy Enhance International, has predicted that “A look at the insurance industry’s experience in Taiwan industry, whereas on mainland China penetration of 50 per cent for the financial year that ended on China’s life insurance market could overtake that of the provides a good way to understand the Chinese stands at just two per cent. In the US, around four 30 June this year. US as soon as 2020. In an article for Businsessweek, insurance customers’ buying behaviour as the industry per cent of GDP is generated by insurers, but it is Radwan said that the Chinese mainland life insurance matures on the mainland.” known that Asian markets have a stronger savings New York Life is said to be planning the sale market nearly doubled in size between 2006 and His point was made based on the statistic that culture, and that with growth back on the agenda in of its units in Taiwan, Hong Kong and South Korea 2008 to over US$80 billion, which was at the time Taiwan has the world’s highest rate of insurance the Asian region, Radwan has predicted significant for around US$70 million, according to the China around one fifth the size of the market in the US – and penetration, as around 13 per cent of the country’s increases in premium income. Post newspaper.

International Travel Insurance Journal INSURANCEMATTERS 11

Accidents happen

Spain has begun work on the first major reform of goes according to plan, we should have a modernised its personal damages barometer used to calculate system to suit modern times in around two years,” insurance payouts when people are killed or said a UNESPA spokesman. injured in traffic accidents. David Ing reports the In related news, the publication of the European latest developments Commission’s new road safety programme, in which it sets a new target of cutting deaths on Europe’s The reforms are expected to balance up the roads by a half over the course of 10 years, has system by increasing payments in more serious been criticised for its omission of drug-related driving cases while reducing those for lesser injuries that issues. The European Traffic Police Network’s (Tipsol) with modern treatments leave no noticeable lasting president, Javier Sanchez Ferragut, commented: “I damage. Virtually all parties involved are in favour of am disappointed that the issue of drugs driving is not updating the current system, which was introduced specifically included as a priority in the programme, as in 1994 and that, in 94 per cent of cases, manages it is a major issue across Europe. As representatives to avoid the time and expense of long, drawn-out of the enforcement community, we stressed to the court actions, according to the Spanish insurance European Commission the importance of including association UNESPA. And with Spain being one of drugs driving in its programme because we know that the world’s leading holiday destinations, the system it is a growing cause of death and serious injury on Cashless service restored in India also applies to foreigners involved in road accidents, the roads in many European countries.” However, he although most can opt for cases to be handled in then added: “We are pleased that the Commission India’s four state-owned non-life insurance companies Harinarayan has asked the Ministry of Health to set their own country if they prefer. recognised the importance of enforcement in their – Oriental Insurance Company Ltd, New Indian out standard operating procedures for hospitals so Assurance Company Ltd, National Insurance that they are more transparent. To try and head off Company Ltd, and United India Insurance Company any disputes, the regulator also recommended that Ltd – which together control around 80 per cent of a regulatory mechanism be put in place that would the health insurance market, have agreed to restore address complaints of overcharging by hospitals. cashless mediclaim services by offering a group package The move by the insurers back to a cashless system for each major hospital. Speaking at the beginning of represents a significant u-turn in policy by the August, M Ramadoss, chairman and managing director state-owned companies. In July, they withdrew the of New India Assurance, told reporters: “We have cashless payment facility from over 100 hospitals in to work out the methodology. We will do that in less India, after the hospitals refused to adopt treatment than 30 days.” At a meeting between the insurers packages that had standardised prices – all the and representatives of the healthcare industry, the hospitals from which the offer was withdrawn were decision was taken that although the group package accused of overcharging insurers for their services. offered would be different for each hospital, each The insurance industry in India has been making a loss insurer would follow the same rules for each package. on its health insurance products for some time, paying In order to bring about some uniformity in terms out claims of Rs110 billion (E1 = Rs59) compared We welcome … the cross-border exchange of pricing healthcare treatments, chairman of the to premium income of Rs80 billion in the 2009-2010 of information in the field of road safety, to Insurance Regulatory and Development Authority J financial year. allow for the identification and sanctioning of foreign offenders

Following an initial meeting held in July between new plan. It is due to continued enforcement by representatives of the insurance sector, driving and effective education, particularly of the three main accident victim organisations and the government, killers (excessive speed, wearing a seatbelt and drugs/ the first concrete step will be the creation of a drink driving), that so much progress has been made working group, scheduled for September. in reducing deaths and serious injures on Europe’s Among the main proposals being put forward by roads.” Regarding enforcement of laws across UNESPA is a new scale of payments for perceived European borders, Ferragut said: “We welcome the losses in income either because of death or permanent Commision’s commitment to prioritise the adoption of injury. By way of an example, UNESPA suggests that legally binding measures on the cross-border exchange the payout for a 10-year-old child suffering irreparable of information in the field of road safety, to allow for brain damage should rise from the current E1 million the identification and sanctioning of foreign offenders to around E2.5 million. A joint proposal put forward for seatbelts, speed, alcohol and traffic light offences. by nine different victims’ associations said they too are We have long recognised this topic as a priority, to in favour of maintaining a system that reduces the need deter those road users who visit other countries and to go to court; but they feel payments should be better ignore traffic laws because they see themselves as equated with levels in other European countries. “If all beyond punishment.”

Reinsurance focus

According to a survey conducted on behalf of Inpoint “The decision to centralise reinsurance functions Services, an Aon company, only 44 per cent of US- depends on a host of factors, including availability based insurance companies have their reinsurance of staff, the processes used, technology and the administered by a dedicated department. Most complexity of the reinsurance programme itself. insurers distribute responsibility for reinsurance Insurers need to determine the point at which administration across several departments, and, centralising the reinsurance function makes sense.” according to the survey, size is pretty much everything. The survey found that companies that do not have The survey, which encompassed 138 insurers, dedicated reinsurance departments tend to draw on found that just 21 per cent of companies that had expertise from elsewhere in their business, primarily ceded premiums of less than $100 million have a from the underwriting department. Corley noted: “In dedicated reinsurance division. Conversely, 68 per most cases, these personnel performing reinsurance cent of companies with ceded premiums of between functions received their training on the job. This $100 million and $500 million, and 87 per cent of could lead to problems as baby boomers retire and companies with premiums of over $500 million, the knowledge base walks out the door. Succession have their own dedicated departments for dealing planning, documentation of processes, standardisation with reinsurance matters. of training, or outsourcing administration to an external Tim Corley, senior solutions specialist at Inpoint service provider can help mitigate the risks associated Services, commented on the results of the survey: with the loss of key employees.”

www.itij.co.uk 12 INSURANCEMATTERS

P&C shows profit again in the US Now it’s personal NEWSWIRE According to an AM Best special in most commercial lines, Research by Australian company Lifebroker has report, the US property and weak exposure growth, found that self-employed people, such as plumbers casualty (P&C) industry benefited excess capacity and growth and electricians, are more likely to buy personal Indonesia and the Organisation for from the continued recovery in alternate forms of risk insurance, including life and income protection cover, Economic Co-operation and Development have in the financial markets to transfer. The industry’s than the average Australian. In addition, the survey signed a deal to strengthen co-operation in the post a net profit for the combined ratio found that self-employed people are more prone areas of insurance, pensions, debt management first quarter of 2010, improved, which to passing on financial advice to their colleagues. and capital markets. rebounding from a net AM Best said was The online insurance broker’s research also found loss in the first three a reflection of that even though the self-employed only constitute The Indian Government has introduced a months of 2009. favourable reserve around 9.3 per cent of the country’s workforce, they bill to parliament that allows an insurer to sell After-tax income was development on prior represent 25 per cent of all buyers of personal lines unit-linked insurance plans without having to ask $11.5 billion for the three accident years and insurance. Lifebroker based its figures on an audit of for the approval of the capital market regulator, the months ended 31 March, significant yet reduced over 7,000 financial accounts, which represented Securities and Exchange Board of India. compared with a net loss losses in the mortgage Australians across occupations, states and territories. of $0.9 billion during the and financial guaranty Considering the reasons behind such a drastic QBE Insurance Group in Australia has same period a year earlier. segments. Improved difference, the broker said that self employment issued a profit warning, with expectations being that The improvement has been underwriting and contributes to better financial planning and literacy, as its first half profit would be 40-per-cent lower than driven largely by the industry investment results, along the group is generally more careful with their finances, the same period last year – mostly due to a fall in reporting $2.9 billion in with a significant capital knowing that an illness or injury could seriously affect net investment income. realised capital gains in the contribution in the US their income. The self employed also often have a first quarter of this year, reinsurance segment, better understanding of the importance of life, income, Gross insurance premiums in Jordan for which, when compared to a drove the P&C industry’s trauma or permanent dismemberment insurance, the first half of the year increased by nearly 12 $7.9-billion loss last year, is policyholders’ surplus according to Hugh Peck, national manager of Lifebroker. per cent to US$297.6 million, according to the especially significant. up to $545 In contrast, continued Peck, when it comes to people Insurance Commission of Jordan. Highlights of the report billion for the in full-time employment, they often have a false sense by AM Best include the 12 months of security that is normally linked to their perceived Qatar Insurance Co. has revelation that the US P&C ended on working entitlements. He added: “Many employees announced plans to set up a subsidiary company industry’s net premiums written receded for an 31 March 2010. Finally, overall profitability measures believe their employer will help out if they become that would specialise in offering life and medical unprecedented tenth consecutive quarter, falling 1.2 improved for the industry, with its after-tax return on injured or ill and are unable to work. Sadly this usually insurance before the end of the year. per cent to $105 billion in the first quarter of this equity at 2.3 per cent for the 12 months ended 31 isn’t the case.” Full-time workers are accustomed year amid sustained competitive market conditions March this year, up from -0.2 per cent last year. to statutory sick leave and annual leave pay, which contributes to the assumption that their pay would continue should they be forced into leaving work for Life insurance arm health reasons. Conversely, Insurers in deep water the self employed know of RBC for sale that if they don’t The Deepwater Horizon disaster will not be a for five years and flat for the last year. Usually, a work, they don’t The Royal Bank of Canada (RBC) is said to be major event for the property and casualty insurance major event causes the market to turn, with prices get paid. seeking to offload its US life insurance business, industry, according to a special report from global rising in the wake of the red ink. We do not expect 10 years after it acquired the unit. According to professional services company Towers Watson. Based that Deepwater is a sufficiently significant event to sources, the bank’s officials have been working on available, published information, Towers Watson turn the overall commercial insurance market.” for several months with Goldman Sachs estimates that net commercially insured losses will Stephen Lowe, another managing director at the to ready the division for sale, although be between $4 billion and $6 billion, a fraction of professional services firm, said it was possible that both parties refused to comment on the the total economic loss that is currently estimated other corporations that were involved in some way situation. The US life insurance division, to be around $35 billion. The report states: “While in the design, delivery, construction or operation which trades as RBC Insurance but is litigation arising from the Gulf oil spill may take of the Deepwater well could be drawn into the registered as Liberty Life Insurance, decades to resolve, under any apportionment of liability litigation: “While somewhat unsportsmanlike, makes up the vast majority of RBC’s the liability, it is expected that the companies directly those who are helping with the cleanup may also insurance offering – the only exception involved will be called upon to pay claims substantially be drawn in. This has been the case in other large being RBC’s small travel insurance in excess of their insurance limits, thus the full value of liability situations, such as asbestos, particularly division. the insurance policies are likely to be drawn upon.” once it is clear that the insurance coverage of The estimates from Towers Watson are based on the primary players is exhausted, and the several factors, including the news that Transocean plaintiffs are looking for additional pockets Ltd, owner of the drilling rig, has disclosed it has a total to pay the claims.” Lowe believes that of $945 million of insurance coverage on the drilling insurers are likely to be involved rig itself. The company has also disclosed that it has in paying gross claims that are a liability insurance coverage of a further $950 million. multiple of the $4 billion to $6 billion BP, Anadarko Petroleum and Mitsui were in a 65/25/10 figure, and note that policyholders with first-party joint venture as the operators of the well – Anadarko property damage and business interruption losses has insurance coverage of $163 million from which it will presumably file claims with their insurers, who must draw; Mitsui has pollution liability insurance cover will then seek subrogation recoveries from the IASB proposed changes prove popular of $150 million, but BP has no commercial liability companies involved. insurance cover for the event, despite being named as Following the explosion on the Deepwater Horizon The International Accounting Standards Board (IASB) impenetrable to all but the most expert of users. The a defendant in more than 300 lawsuits stemming from oil rig, Munich Re has said it may have to re-evaluate has published an exposure draft of improvements that publication of this exposure draft marks an important the incident. BP, though, does have a captive insurer, the risk of large projects it reinsures. Thus far, the oil it would like to see made to the accounting practices milestone in this review process [as] it better but no outside coverage. Cameron International, the spill in the Gulf has cost the German reinsurer around of insurance contracts, which is open for comment reflects the economics of insurance contracts, and manufacturer of the well’s blowout preventer, has E60 million in property damage, and in total has cost until the end of November this year. The draft would result in more relevant, understandable and liability cover of $500 million, while Halliburton, which it a sum ‘in the low three-digit million euro range’. proposes a single International Financial Reporting comparable information being available to investors.” was responsible for cementing the well, has $600 It is impossible to tell what the final costs could be Standard (IFRS) that all insurers, in all jurisdictions, James Dean, global insurance leader for Ernst & million of liability insurance. for the company, as BP could become embroiled in could apply to all contract types on a consistent basis, Young, was positive about the proposed changes: The total of the above coverage limits is $3.3 billion, legal battles for some years to come. Munich Re has according to the IASB. In 2004, the IASB introduced “Insurers will have greater certainty about how their and in addition to the specific insured losses that have said that the uncertainty surrounding the cause of the IFRS4 Insurance Contracts as an interim standard organisation is viewed and evaluated by investors, been incurred, Towers Watson has said that other accident and attempts to seal the well are illustrative that permitted many existing international accounting regulators and other key stakeholders, reducing the companies could be drawn into the litigation, adding of the constantly increasing complexity of insuring practices to be retained, while beginning a more cost of capital.” Peter Vipond, director of financial to the total. Directors and officers’ liability cover, large risks. Torsten Jeworrek, head of reinsurance, comprehensive review of insurance accounting as a regulation and taxation for the Association of British together with workers compensation losses, could said: “Painful as the consequences of Deepwater second phase of the project. The new proposals are Insurers, added: “We are pleased that the IASB also add to the final insurance bill. Horizon are, it is now essential to reassess the issue a result of that review. aims to offer a modern approach based on current James Hole, managing director of Towers Watson, of adequate insurance covers and retentions for large Sir David Tweedie, chairman of the IASB, measures that may offer investors a clearer view commented: “The insurance industry has been engineering projects and the liability risks involved in commented on the draft: “A fundamental review of of insurers’ obligations and performance, and of operating in a soft market for the last six years, such projects. This should also have positive effects insurance accounting was long overdue, with current the asset/liability matching that underlies insurers’ with commercial insurance prices generally falling on the future development of pricing.” practice resulting in financial information that is business models.”

International Travel Insurance Journal HEALTHMATTERS 13

Measles numbers up in France

According to the Institute of Health Surveillance, old. The UK’s Department of Health has warned more than 2,000 cases of measles have been that the outbreak in France is intensifying, particularly reported in France since the beginning of the year, in the areas of Lille and Bordeaux, which are very compared with 1,544 in the whole of 2009. Ten per popular with both domestic and international tourists cent of the cases have been in children under a year during summer months.

Malaria drug price dropped

Private health clinics in Africa, which are responsible state that just five per cent of anti-malaria medicine for dispensing around 60 per cent of malaria drugs bought in Africa from private clinics is ACT, and the on the continent, are soon to be subsidised with problem is that the cheaper medicines need to be supplies of artimisinin combination therapy (ACT), driven out of the market. the most effective drugs for treating the disease. The The clinics will be subsidised through an arrangement Global Fund to Fight Aids, Tuberculosis and Malaria between importers and others involved in the has announced that six pharmaceutical companies delivery of the drugs, all of whom have promised to have all signed concrete deals that will enable them pass the savings on to the end user. The negotiations to provide good quality ACT to the private sector in were managed by The Clinton Foundation, which eight countries in Africa. Many mothers who try and has a good record in the past of driving down drug obtain malaria medicines for their sick children have prices in Africa for those who need it most. Bill been forced to use cheaper, less effective medicines Clinton commented on the new arrangement: “No due to the high cost of buying effective ACT. Reports mother should have to worry whether or not she can access the malaria medicines that will save the life Florida sees Dengue resurgence of her sick child. I am pleased that my Health Access Initiative, building off our experience lowering the There are concerns among health officials in the US at some point in the past. cost of life-saving malaria and HIV/AIDS medicines, that the number of people in the state of Florida “We’re concerned that if dengue gains a foothold could negotiate the agreements that enable the suffering from dengue fever is rising, showing that in Key West, it will travel to other southern cities Affordable Medicines Facility – Malaria, which is the infection is making its way north into the US where the mosquito that transmits dengue is hosted and managed by The Global Fund, to ensure from the Caribbean. Current figures from the US present, like Miami,” said Harold Margolis, chief of effective, affordable ACTs are in the reach of the Centers for Disease Control and Prevention (CDC) the dengue branch at the CDC. In a statement at mothers and children that need them most.” show that five per cent of population of Key West the International Conference on Emerging Infectious Meanwhile, news that UK celebrity Cheryl Cole in Florida have been infected with dengue. After Diseases, he added: “These cases represent the recently spent a week in intensive care suffering 27 cases of the disease were confirmed in Florida re-emergence of dengue fever in Florida and from a virulent strain of malaria she caught while on last year, scientists from the CDC and the Florida elsewhere in the US after 75 years.” Dengue fever holiday in Tanzania has put the disease at the top Department of Health took blood samples from over was eradicated in the US in the 1940s, although a of the agenda for health professionals and travel 200 randomly selected residents from the Key West few locally acquired cases were confirmed along the insurers. Sarah Findlay, online marketing manager area; of these, five per cent showed signs of infection Texas/Mexico border in the 1980s. for Insurewithease, commented: “Although a trip to Kenya, Goa or the Dominican Republic may seem fairly commonplace these days, they all carry a risk of malaria. Yet many travellers ignore the threat and head abroad without taking any medication. Of course, anti-malarial tablets won’t prevent you being bitten by an infected mosquito … but they should minimise the symptoms.”

Heart patients safe

New guidelines from the British Cardiac Society Mayaro virus have suggested that the majority of people with heart conditions are able to fly safely. Experts writing reports in Venezuela in the journal Heart have said that air travel does not present a ‘significant threat’ to heart patients, It has been reported that in the west Venezuelan especially if it is a short or medium-haul flight. The state of Portuguesa, an outbreak of Mayaro virus is experts continued: “Following this review of evidence taking a firm hold. The 71 identified cases so far have and after due consideration, it is clear that there all been found in the same area, with 69 people are few cardiovascular conditions that warrant the in the same village suffering from the disease. The denial of fitness to fly as a passenger. Given the first imported case to Europe has recently been right aircraft, onboard equipment and experienced confirmed, where a French national returning from escort personnel, aircraft can act as flying intensive Brazil’s Amazonian region brought the disease into care units and carry extremely ill passengers.” The France, causing concern for health authorities there. guidelines offered by the journal state that passengers First identified in the Caribbean in 1954, the with heart conditions should inform the airline with Mayaro virus is an Alphavirus belonging to the which they are flying about their condition, and Togaviridae family, like the Chikungunya virus. patients who are deemed to be at risk of deep vein Passed on via mosquito bites, the virus causes thrombosis are advised to take extra precautions, severe articular pain and fever. such as wearing pressure stockings.

Dengue epidemics continue

Since the start of the year, several South American cases reported so far this year, including over and Caribbean countries have suffered from 6,000 cases of dengue haemorrhagic fever and large-scale dengue fever epidemics a problem 321 deaths. particularly affecting Brazil, Colombia, Venezuela, In the Caribbean and Central America, the rise in El Salvador, Costa Rica and Puerto Rico. In Brazil, the number of cases began during the dry season, there have been a total of 730,587 suspected ahead of the normal season for the disease.

www.itij.co.uk 14 TRAVELMATTERS

UK flight trends Southeast Asia a Outbound numbers drop by 10 million identified rising star Visits abroad by UK residents fell in 2009 at the visit family or friends also fell, but at a lower rate (15 fastest rate on record since the 1970s, according per cent and 6.5 per cent respectively), as did visits Industry analyst The Pacific Asia Travel Association to the Office of National Statistics (ONS). Figures to the UK by overseas residents to visit family or firm Skyscanner has (PATA) has released figures that published in its annual Travel Trends report show friends. At the same time, expenditure abroad by UK investigated flight trends show preliminary international visitor a total of 58.6 million visits abroad were made in residents fell £5.1 billion to £31.7 billion, but earnings in Europe for June, finding arrivals to the region for April and 2009, down 10.4 million from 2008. The ONS also from visitors in the UK grew from £16.3 billion in that the four most popular May this year show year-on-year noted that visits to the UK by overseas residents fell 2008 to £16.6 billion. destinations for Britons growth of seven per cent and 16 in 2009, but at a slower rate, down 6.3 per cent However, positive news for some sectors of the UK remain unchanged from per cent respectively. Despite the from the 31.9 million made in 2008 to 29.9 million. came from the fact that holidays (leisure) to the UK May. Malaga, Spain, is in rises, the organisation has cautioned The falls in both outbound and inbound tourist numbers by overseas residents rose in 2009, up 0.5 million the top spot, Alicante took that the May 2009 arrival figures follow a sustained period of growth, though, as figures to 11.4 million. The ONS report also states: “In second place, followed were severely affected by the global demonstrate that visits abroad have actually grown at recent years, approximately half of visits to the UK by Palma and Tenerife, recession combined with the onset of an average of four per cent per year over the past 25 by overseas residents have involved an overnight showing that Spain is the swine flu pandemic. Nonetheless, years. The decline in 2009 follows small falls of less than stay in London. This was also the case in 2009, once again the leader for it is positive news for the Asian travel one per cent in the number of visits made abroad in when London was visited for at least one night on Brits heading abroad over industry that for the first five months 2007 and 2008, the first since 1991, and a fall of 2.7 14.2 million visits. This was a 3.7-per-cent fall in the the summer months. of this year, international visitor per cent in visits abroad during 2008, the first since number of visits compared to a year earlier.” Dalaman in Turkey was arrival numbers grew by 10 per cent 2001, when travel was affected by both the 9/11 attacks There were a few countries that received an increase in next on the list, displacing compared to the same period in 2009. and the UK foot and mouth disease outbreak. visits from UK residents – Egypt, Jamaica and Lithuania Faro, Portugal. London held steady at number seven, South Asia was recognised as the best growth In 2009, the ONS figures show that business visits all continued the overall trend of a rise in visitor while the white isle of Ibiza moved up to position prospect for the year, with an increase of 15 per were hardest hit in terms of a drop in numbers, falling numbers to these countries in recent years. Despite eight, taking the place of New York. Flights to cent from the first five months of 2009, with Sri by 23 per cent among UK residents going abroad and these increases, and falls elsewhere, the number of Orlando entered the top 10, rising two places since Lanka showing the most significant increase in arrival by 19 per cent among those coming to the UK. people heading to Egypt, Jamaica and Lithuania is the last Skyscanner report, most likely in response to numbers. This could be due to the cessation of Visits abroad by UK residents for holidays and to dwarfed by those going to European destinations and the opening of Harry Potter World. civil war in the country. Arrivals to Southeast Asian the US. Spain and France combined accounted for In what will be a relief to Greek authorities, Crete countries increased by more than eight per cent 21.3 million of the 58.6 million visits abroad in 2009. At was among the places that climbed up the list of compared to April and May 2009, which was slower the same time, visits to a number of countries fell by a popular destinations, rising five places to number 33. growth than had been witnessed in the first three substantial percentage in 2009, including Mexico, which Other climbers included Sydney, which also rose months of the year. It was shown without doubt that saw a drop of 40 per cent from British visitors – most by five places, as did Johannesburg, which moved the political unrest in Thailand had adversely affected likely due to the swine flu epidemic. to position 45, with credit for this being given to tourist numbers, which dropped by 13 per cent the FIFA World Cup. New entrants to the top 50 compared to May 2009. list were Corfu, Antalya and Hong Kong, while Pisa, There was bad news, though, for Australia and Frankfurt and Fuerteventura all disappeared from the New Zealand. Arrivals to the countries dropped by Chinese Internet list. Looking at the most popular countries overall, six per cent and four per cent respectively, with a Skyscanner found that Spain tops the list, followed by noticeable drop in April, when arrivals from Europe revolution the UK, US, Italy, France, Greece, Germany, Portugal were affected by the cloud of volcanic ash that closed and Cyprus. European airspace for a week. There has been a significant increase in the number of Chinese consumers who go online to buy their holidays, according to findings from iResearch. The company has found that an ever-increasing number of the estimated 404 million Internet users on the Chinese mainland are using the medium to book their holidays, and it predicts that this growth will continue, forecasting that ‘revenue from the online travel service market will more than triple between 2009 and 2013’. iResearch has predicted that by as Web must focus soon as 2011, up to 20 per cent of Chinese travel trade transactions will be made online. on service A separate report published by PhoCus Wright, called Emerging Online Travel Marketplace in China showed A survey by eDigitalResearch has revealed that some that in 2009, 15 per cent of China’s US$58-billion online travel websites are delivering sub-standard travel bookings were made online. The company customer service on a regular basis, including airline stated two reasons for the increasing number of websites that don’t answer over 50 per cent of email online purchases: buying online has, in the past, been queries. Out of 47 websites that were surveyed, difficult for Chinese Internet users, and many people 43 ranked low scores on their customer service preferred to have face-to-face contact with a travel element, falling into either ‘unsatisfactory’, ‘poor’ or agent. Now, however, the tools that support online ‘very poor’ categories. According to Lloyd Viney, an bookings have been improved, making it much easier associated director of the company that performed for users. “Chinese consumers are quickly becoming the research, it is vital that websites offer quality empowered to find and share travel information customer service to clients, as for many businesses online. Tools like metasearch engines and online travel this is where clients are won and lost. He said: “More agencies are now widely used,” says the report. online travel sites are looking to reduce traffic through The China National Tourism Administration has their customer service departments by increasing the forecast that the number of outbound travellers from amount of information they put on their the country will reach websites. A poor customer experience 52 million in 2010, here will ultimately result in customers signifying a seven-per- retracting their business.” Viney has cent rise over 2009. urged travel companies to rectify the In the first five months problem and better engage with their of this year, outbound customers, as people often rely on a travellers from China customer service contact to give them totalled 26.8 million, a a boost of confidence that encourages 19-per-cent increase them to actually go through and book a from last year, which holiday: “Leading retailers are increasingly was attributed to the involving the customer through online stable development of polls, forums, mini-communities and the country’s economy product ratings. Travel brands need to and the appreciation mirror this approach by developing more of the Chinese yuan interactive websites.” against the US dollar.

International Travel Insurance Journal TRAVELMATTERS 15

Business recovery drives demand Airline law criticised

Carlson Wagonlit Travel (CWT), a specialist in Nonetheless, it is clear to us that companies fully The new tarmac delay law introduced by the US business travel management, handled nearly 24.9 understand the role business travel and meetings Department of Transportation, which was designed million transactions during the first six months of this and events play in helping them successfully reach to limit the amount of time passengers are kept year, a 13.2-per-cent increase compared to the same their objectives.” He added: “Today, as economic waiting after they have boarded an aircraft, have period a year earlier. Traffic for the company totalled recovery continues, CWT is more committed than been heavily criticised, as certain industry groups US$12.3 billion, which is a rise of 16.6 per cent ever to providing efficient and innovative solutions have said that the law will encourage airlines to year-on-year. Although performance varied from that complement our clients’ business strategy.” cancel 2,600 more flights than they normally one region to the next, the greatest gains in traffic In the area of meetings and events, CWT also saw would have done in order to escape the hefty were seen in Latin America, where there was an signs of economic recovery in the first half of this fine. Due to the design of aircraft networks, the increase of over 48 per cent, while in the Asia Pacific year. For example, in Europe, clients of CWT are cancellations would have a knock-on effect to a region there was growth of 43 per cent. In North organising 30 per cent of their meetings outside further 2,600 cancellations, according to a study America, meanwhile, traffic increased by just over their home country, compared to 20 per cent a year into the effects of the law, which was undertaken by Oz tourism needs 18 per cent, and in the EMEA (Europe, Middle East, ago. The most popular destinations in which to hold Marks Aviation LLC, The Airline Zone LLC and the and Africa) growth stood at 7.7 per cent, reflecting meetings are Barcelona, Madrid, Nice, Paris and George Washington University Aviation Program. support the somewhat slower economic recovery in that Rome. Research from the business travel specialist The study found that: “In short, the new rules will region. Carlson Wagonlit Travel also reported new found that the average spend per participant per day mean that 110,000 passengers will be spared an The Australian Transport and Tourism Forum (TTF) sales, excluding renewals, of $781 million, and client stands at €175, versus €150 last year. average of 3.26 hours of taxi-out delays, but the - MasterCard Tourism Industry Sentiment Survey retention remained strong at 96 per cent. Anderson noted that clients around the world are cost will be 5,200 cancelled flights, affecting 400,000 has shown that in the second quarter of this year, Commenting on the company’s performance, increasingly looking to combine passengers.” international tourism to the country fell by 20 points, Douglas Anderson, president and chief executive, savings with impact, and to that end, In order to and expectations of the current quarter are that it will said: “Business travel is back on the corporate agenda they appear to be taking a more calculate the see a drop of 10 points. Domestic tourism was rated but if we compare figures for the first six months of strategic approach to managing their effects of the as ‘average’, with expectations moving up slightly. this year to the first half of 2008, we can see traffic business travel costs, and also their new law, the As a result of the survey, Chris Brown, managing has not yet returned to pre-recessionary levels. spend at meetings and events. study used director of industry group TTF, has called for more historical data financial support from the government to prop up that examined the travel sector. “Industry is putting its money where the causes and its mouth is and backing Tourism Australia’s ‘There’s Time to get tweet-savvy patterns of tarmac nothing like Australia’ campaign, but the agency’s delays in the US. funding has declined in real terms in recent years.” He The latest research from Greenlight, an independent brands by considering the number of ‘posts’ and The report then analysed airline responses to the credited the government with reinvigorating Tourism search and social marketing consulting firm, shows that ‘tweets’ brands produced for consumers to interact new law and stated that while the Department of Australia through new leadership, but added: “Now UK consumers made 10.8 million online searches for with in May. It found that lastminute was the most Transportation had projected that public benefits it is essential that the new leadership is backed by an holidays in May this year. This represents an increase followed brand in social media, with a combined from the law outweighed public cost, initial results appropriate level of financial support. TTF is calling for of 25 per cent from April, when 8.6 million searches following of over 77,000 on Facebook and Twitter. actually show the opposite being true. “We both the government and opposition to commit to were made. Greenlight’s research also reveals the Low Cost Holidays was the most interactive brand, conclude,” said the study, “that the DoT’s tarmac increasing Tourism Australia’s funding to at least $140 most popular short- and long-haul destinations, the producing a total of 129 posts or tweets in April. By rules and punitive fine threats have driven significant million to maximise the impact of the new campaign 60 most visible holiday websites and advertisers contrast, Greenlight noted, Holiday Hypermarket cancellations and public costs far in excess of and to give industry partners the certainty they need to online, and a ranking of the 15 most proactive holiday had a combined following of over 1,000 on the two quantifiable benefits.” plan future marketing and promotional activities.” brands and aggregators in social media. Using industry social networking sites, data, the company identified and classified 356 of yet failed to produce the most popular global destinations UK a single ‘post’ or consumers booked holidays to. ‘tweet’ in May, The results of the research thereby missing show that Europe out on vital interaction accounted for with social media 35 per cent of consumers. holiday-related Greenlight also searches. Africa researched the number of followed with a flight searches for June, finding nine-per-cent share, that there were 28-per-cent more while North America searches than in May. According to enjoyed a six-per-cent share. Turkey was revealed as the company’s Flight Report June 2010, the top short-haul destination, with the terms ‘Turkey there were 38 million searches performed online in holidays’ and ‘Holidays Turkey’ accounting for 23 per June by consumers compared to 29 million in May. cent of the 3.8 million searches performed for short- However, the research observed a dramatic shift in haul holidays. On the long-haul side of business, the way in which people searched for flights online Egypt dominated, accounting for a 21-per-cent share compared to the previous quarter. While generic of the 2.3 million searches. keywords accounted for just six per cent of searches In order to gauge media interaction with brands, in March, they jumped more than fivefold to 40 per Greenlight monitored the Facebook and Twitter cent in June. Meanwhile, searches for short-haul accounts of the top 15 brands in its league table flights, which accounted for 64 per cent of overall in order to assess how many ‘fans’ and ‘followers’ flight search volumes in March, suffered a sharp each one had. It further analysed the proactivity of drop, accounting for just 38 per cent in June.

Japan eases visa restrictions for Chinese

Hotels and tour operators in Japan have been In the first five months of this year, the number welcoming an increasing number of mainland of Chinese visitors to Japan rose by 36 per cent Chinese tourists after Japanese authorities eased compared to the same period a year earlier, and the conditions for granting visas to individual Chinese total number of arrivals is forecast to be just under travellers. The growth in Chinese arrivals to Japan two million for this year. During their stay in Japan, has been impressive in recent years, and the move Chinese visitors will spend an average 200,000 to make visa appropriation easier has been hailed as yen (US$2,273), demonstrating how much such a another step forward. According to figures, around significant increase in numbers would be worth to 350,000 Chinese tourists visited Japan in 2000, the country. Travel insurers in Japan, including Sompo and in 2009 the number reached over one million. Japan Insurance, are ready for the predicted increase Japanese tourist authorities hope that by 2013, 3.9 in travellers, and the company is said to be considering million Chinese visitors will arrive, increasing to six the development of a medical insurance product that million in 2016. would be designed specifically for Chinese travellers.

www.itij.co.uk 16 IPMI NEWS

Aetna signs provider network deal Indian overseas

Aetna and Continuum Health Partners have and much give and take from both sides, but, in the end, students covered announced a new three-year agreement for we believe that we have in place a new contract that is the hospital system’s participation in the Aetna mutually satisfactory and one that preserves the working India’s ICICI Lombard General Insurance Company participating provider network. Under the terms relationship between Continuum and Aetna.” Ltd, the country’s largest private sector general of the agreement, six Continuum hospitals will Elsewhere, Aetna has reported that its second quarter insurance company, is now offering Overseas participate in all Aetna commercial products, including operating earnings reached $450.2 million, an increase Student Travel Insurance – Gold Plan, which offers student health plans. The hospitals now included of 46 per cent over the same period in 2009. The customers comprehensive health insurance against in the network are Beth Israel increase has been attributed to a higher medical expenses incurred by a travelling student Medical Center – Petrie Division; commercial underwriting margin and while they are abroad. The product has been Beth Israel Medical Center – Kings an improved underlying performance. specifi cally designed for international student use, Highway Division; Long Island Ronald Williams, chairman and chief and provides cover for personal accidents, dental College Hospital; New York Eye & executive of the insurer, said of the treatment, personal liability, bail bond, sponsors’ Ear Infi rmary; St Luke’s-Roosevelt results: “[They] refl ect the positive protection, repatriation of remains and baggage loss. Hospital Center – Roosevelt impact of disciplined, focused initiatives The plan offers students US$7,500 if their studies are Division and St Luke’s-Roosevelt to improve our performance. Going interrupted for medical reasons, or compassionate Hospital Medical Center – St forward, our focus on performance reasons; and if they are hospitalised for more than Luke’s Division. improvement will enable us to continue seven days, a member of the family can visit at the Steve Logan, president of Aetna’s to make investments that help address expense of the insurer. Making the insurance more New York market, commented: the challenges our customers face convenient for the user, clients will also benefi t from “This agreement refl ects the genuine with respect to affordability and quality a cashless claims settlement agreement, through the United results commitment both parties have in healthcare.” Joseph Zubretsky, insurer’s third party administrator, Europ Assistance. had to the process of negotiating executive vice president and chief ICICI Lombard has also tried its best to make sure UnitedHealth Group (UNH) has reported better- an agreement that is in the best Ronald Williams, Aetna fi nancial offi cer of Aetna, said: “Our that students are buying appropriate cover, through than-expected second quarter results, including interest of all parties concerned – improved performance in the fi rst half its University Tracker website, which allows a student growth in Health Benefi ts and Health Services. Key especially Continuum Health Partners’ patients who are of 2010, along with a strong capital position, gives us to match and compare university requirements to performance metrics and costs were in line with our members, and the many local businesses that pay confi dence in our ability to execute on our goals. We the company’s products. or better than company expectations, prompting for their health coverage.” John Collura, Continuum’s expect the remainder of 2010 will refl ect the impact Stephen Hemsley, president and chief executive executive vice president and chief fi nancial offi cer, added: of business investments for future profi tably growth, as offi cer, to say: “The growth performances of “Both sides worked tremendously hard to fi nalise this well as the need to prepare for healthcare reform and both our business platforms are the result of our agreement. There were many challenges to overcome regulatory changes.” continued focus on fundamental execution and practical innovation on behalf of our customers. We believe our market share in both business groups is increasing, due to the quality of our innovative Pioneering Bupa partnership offerings, distinctive service and the consistent value we bring to customers.” UNH has updated its Almost 4,000 Sanitas customers with heart disease and Spanish businesses. Health Dialog España is fi nancial outlook, and now anticipates full year 2010 and other chronic illnesses are benefi ting from delivering guidance and support to members with revenues of approximately $93 billion. a pioneering partnership between Bupa’s US diabetes, cardiovascular disease, chronic lung disease and other conditions through its Sanitas Responde health service. The joint venture between Health Dialog and Sanitas has seen the 32-strong team of qualifi ed health professionals take more than 33,000 calls from over 3,700 customers since its launch. When they call the team, members are provided with information on their illness, guided in understanding symptoms, encouraged to adopt healthy habits and offered advice on treatment. Although Health Dialog already serves around 24 million customers in the US, telephone health coaching is a new concept in Spain and Health Dialog España marks the fi rst time two separate Bupa businesses have created a joint venture to launch a product in a specifi c marketplace.

HTH honours HTH Worldwide, a global health and safety services company, has announced that its Healthy Travel Blog has won an IGLU award for being one of the best health and lifestyle websites available. IGLU is a leading online travel agency serving the UK and Canada. IPMI PROVIDER IGLU recognised the blog for excelling at helping business and leisure travellers ‘maintain good health and lifestyle practices while they are on the road’. Angelo Masciantonio, chief executive offi cer of HTH Worldwide, commented on the award: “We launched Healthy Travel Blog because we saw a signifi cant, growing need among business and leisure travellers Interglobal – they need a reliable source of information that helps them make the most of their travels. HTH is CONTACT: Peter Rousseau - Group Business Devlpmt. Director dedicated to promoting safe and healthy world travel, Woolmead Hs East, The Woolmead, Farnham, and [the blog] is one of the many ways we reach out Surrey, GU9 7TT UNITED KINGDOM to the travelling public.” Launched in March last year, tel: +44 (0)1252 745 900 the blog covers health topics ranging from the quality fax: +44 (0)1252 745 920 email: [email protected] of healthcare services abroad to environmental risks, web: www.interglobalpmi.com infectious disease outbreaks, food safety, road hazards and travel health mobile applications.

International Travel Insurance Journal IPMI NEWS 17

AXA PPP Expat tax considered partners The Kuwaiti government is said to be considering levying taxes on high- in Asia income expatriate employees, while middle and lower-income workers are AXA PPP International exempt. According to Arab News, it has has teamed up with AXA been reported that the government has Asia General Insurance in made changes to the country’s tax law in a order to begin a dedicated bid to impose higher levels of taxation on international health those who earn the most – whether they insurance operation in are expatriates in the country or not. At Asia. The plan is to target the moment, there is no tax on income or expatriates and locals wealth in Kuwait, although businesses are in Singapore, Malaysia, subject to tax legislation. The move by the Kuwait revealed that the Indonesia, Thailand, Hong government to tap a new source of wealth country is the largest source of expatriate remittances Kong and China, where comes soon after the National Bank of in the Gulf Co-operation Council. the company already provides general insurance products. Taking the helm of the new Asian business is Laurent Pochat- Cottiloux, who was formerly the commercial director of Standard Life Healthcare, and he will be reporting to both managing director of AXA PPP International Andrew Coombs, as well as Victor Kuk, chief executive of Greater China and South East Asia for AXA. Roger Kelly has taken on the role of sales director for the company, having served previously as new business director for the International business. Coombs commented that although the target for the new business will be the local population, the provision of services will be ‘inextricably linked’ to improving AXA PPP International’s offering for global corporate firms. “The true prize is bringing the two things together,” he said, “not only providing expatriate cover if they want that but also providing a local market proposition for local employees. The message we hear from global corporates is that it’s no longer good enough to buy a UK private medical insurance scheme and cover expatriates. They want to buy that but also cover, say, 15,000 employees in India. They want much more of a holistic solution.”

Growth strategy paying off

CIGNA Corporation has reported its second quarter results, which show that the company’s adjusted income from operations in the period was $384 million, compared to $313 million from the same period last year. David Cordani, president and chief executive officer of CIGNA, commented: “Our second quarter results demonstrate that we continue to effectively execute our global growth strategy. Our focus is on delivering value for our customers and shareholders.” On the international side of the business, adjusted segment earnings for the first half of the year reached $136 million. The company said: “Adjusted segment earnings for the second quarter 2010 also continued to benefit from favourable claims experience in the Expatriate Benefits business, as well as rate increases on renewals. The net favourable after-tax impact from foreign currency movements was $4 million in the quarter compared to the same period last year, which was in line with expectations.” Following the announcement of the results, CIGNA now estimates that full year 2010 consolidated income from operations will be between $1.1 billion and $1.2 David Cordani billion.

www.itij.co.uk 18 CROSS BORDER CARE

Russian-Korean Record transfer partnership begins agreement reached

Officials from the Incheon Medical Tourism US-based The Estate Vault, Inc., a provider Inducement Group, which incorporates the of electronic data management services for Incheon Center for International Co-operation & consolidating and protecting medical records, has Exchange, Gachon University Gil Hospital, Inha partnered with the International Medical Trust University Hospital, Naeun Hospital and Seoul Fund (IMTF), based in the British Virgin Islands, to Women’s Hospital, visited Russia recently to take deliver a suite of secure and interactive personal the first step in attracting overseas patients through data management tools that are focused on helping its medical tourism programme. The Group invited patients take greater control of their personal decision-makers from Russian hospitals, along information while travelling out of their home with the Vladivostok branch of the Korea Tourism country for medical treatment. Organisation (KTO), to a briefing session where Boyd Soussana, chief executive of The Estate Vault, delegates heard presentations on Incheon’s medical said the potential market is vast: “More than 800,000 tourism business, the current state of the hospitals, Americans reportedly travelled overseas from the US and the specialised advanced medical technology last year, to undergo a wide range of elective medical available. Following the briefing, Incheon, Russia and dental procedures. Similarly, an increasing number and the Far East Russia branch of the KTO signed an of Canadians are also seeking treatment overseas, and agreement with the Primorksy Club, an organisation a substantial number of Canadians travel to warmer specialising in medical tourism. climates overseas to avoid the harsh cold winter Our survey says… climate in Canada. Both the US and Canada are also major contributors to Western expatriate communities The US-based Medical Tourism Association (MTA) respondents said that this practice would essentially contain costs, according to the MTA. throughout the world [and] collectively these sectors recently surveyed over 100 US insurance companies destroy the underwriting process. Furthermore, 87 Jonathan Edelheit, chief executive of the MTA, form a multi-billion dollar market.” and US employers about the effect that healthcare per cent of those surveyed are concerned about commented on the results of the survey: “It shows Patients who sign up to the new membership service reform will have on them, and discovered that both employee cost penalties, believing that they are the future growth potential of the medical tourism will have access to a range of specially developed groups have similar concerns about the forthcoming insufficient to force employees to buy cover – in 2014, industry because in the survey 71 per cent of membership plans for overseas medical travel, changes. Seventy-three per cent of those surveyed the penalty would be US$95. If this does prove to be insurance companies and employers felt healthcare medical and surgical complications, medical holidays predicted that health insurance costs would increase true, healthcare reform will have a negative impact on reform was extremely positive for the medical and international health and travel insurance plans, significantly, while 24 per cent believe it will increase employers. Being forced to waive pre-existing clauses tourism industry and more Americans would travel along with USB data storage cards and a Prepaid to a certain level. and making premiums equal for healthy and sick people under the new law. Employers and insurance MasterCard. Boyd added: “Customers will also be One of the key parts of Obama’s healthcare reform will both serve to drive up the cost of health insurance companies know that healthcare reform will increase able to put all their sensitive personal data, medical package is that anyone can wait until they are taken significantly, which will in turn make employers and costs and medical tourism is one of the few ways to files/X-rays and legal information into their own ill before they buy health insurance – 96 per cent of insurers more interested in medical tourism options to lower those costs.” e-vault that can be accessed from anywhere they are in the world.” The prepaid credit card also means that patients do not have to worry about taking large amounts of cash anywhere with them. Professionalism IMTF president Kenneth Hunt said: “[Our] company has designed and developed a unique range of examined world-first and industry-first insurance and non- insurance alternative products for these markets. In the competitive world of medical tourism, Partnering with Estate Vault has provided IMTF agent professionalism is a vital component, and to a unique and innovative document management that end, the Medical Travel and Health Tourism system, which is ideally suited for mobile and Quality Alliance (MTQUA) is offering online courses transient expatriate populations.” for individual medical tourism agents and patient Boyd added: “IMFT and Estate Vault have in principle managers. While there are several medical and agreed to establish an international business company non-medical accreditation agencies that seek to in the British Virgin Islands, which will become the certify international hospitals and doctors, those provider of the range of converged hybrid products. people working as medical tourism agents have not This business will be established under the Estate been best served by ‘accreditors’ thus far, according Vault International brand name … and will also offer to some in the industry. As the medical tourism white-labelled products to strategic partners that are sector has developed, so have the regulations uniquely positioned in this nearly created medical that govern it; however, the legal responsibilities tourism marketplace.” of medical tourism agents are not yet tested, and much depends on which country the agent is based in, which country the medical tourist comes from, and in which country the treatment takes place. The MTQUA is one of the first organisations that is attempting to bridge this gap by offering qualifications Fortis Healthcare to focus on tourism to individuals through its Certification Programme, One of India’s largest healthcare groups, Fortis million rupees to make its final, unsuccessful bid for the which trains and certifies individuals involved in Healthcare, has posted a first-quarter loss of 143 hospital chain, it would have declared net profit for the the care, management and support of medical million rupees (100 rupees = €1.6 or $2.1), which quarter of 216 million rupees. travellers. The aim of the online programme is to the company says is a result of trying to borrow However, despite the Parkway debacle, net sales for provide a deeper understanding of the complexities enough money to offer a suitable bid for Singapore’s Fortis grew by 83 per cent to 3.34 billion rupees for the surrounding medical tourism so that the agent is hospitals chain Parkway Holdings. In late July, Fortis quarter, compared to the same period a year earlier. sure the patient is receiving the best possible care. bowed out of the race for Parkway, and agreed to sell Chief executive Bhavdeep Singh is cheerful about the It also intends to offer assurance to a hospital or its current 25-per-cent stake to Khazanah, a Malaysian future of the company, which he said hopes to double an individual’s employer that a uniform standard of wealth fund that had been a direct competitor in international operations revenue by the end of next patient care management is being practiced. the bid for Parkway. If Fortis had not borrowed 359 year, primarily by offering medical tourism services. Meeting of minds puts focus on Middle East The great and the good of the medical tourism Middle East and other Gulf states. of health and healthcare. Gulf states, such as the UAE, Egypt, Tunisia and Lebanon. Renee-Marie Stephano, industry will be at the 3rd Annual Medical Tourism Laila Al Jassmi, chief executive officer of health policy have highly advanced healthcare services and provide a president of the Medical Tourism Association, added: Congress, held at the end of September in and strategy sector for the Dubai Health Authority, great strategic location to help facilitate healthcare travel “The Middle East plays an important role in global Los Angeles, California. Regional government commented: “Medical tourism is a growing trend – these are just two of the reasons why Dubai is playing healthcare travel, as states in this part of the world authorities and private healthcare organisations across the world and this phenomenon is encouraging an increasingly important role in medical tourism.” are making major investment and upgrading their will be participating, with one of the main points of healthcare bodies to develop a highly standardised Other regional players who are attending the infrastructure to provide a first-class service for this discussion being the international importance of the regulation system to improve and maintain the quality conference include delegations from Jordan, Turkey, sector of the healthcare market.” CROSS BORDER CARE 19

Potential unfulfilled in UAE

A survey published by Dr Prem Jagyasi, a UAE- much more that can be achieved.” be providing a vital service for them, as well as giving a based health travel consultant, has revealed that The purpose of the health tourism survey was to welcome boost to the region’s health sector.” 94 per cent of medical tourism industry experts gain an insight into aspects of the medical tourism Thirty-five countries were identified by the survey believe that the medical tourism industry has yet to industry from professionals who are actually involved as significant medical tourism providers, with India reach its full potential. The report states that factors in the delivery of the service. Now that the primary taking the top spot, followed by Thailand and then such as confusion, a lack of information, and fear of concerns of medical tourists have been identified, Singapore. The US was a surprise entrant into complications following surgery are the main reasons continued Dr Jagyasi, operators can make inroads position four, while the UAE came in 11th. Dr Jagyasi why people are nervous about medical tourism. Dr into addressing these concerns. “This is important commented: “The Asian and Far Eastern countries Jagyasi commented: “The medical tourism industry is information,” he said, “as it clearly shows that are well-established medical tourism destinations, so going through an exciting phase where international education is a vital component in allowing us to the top three placings were expected. The US came and intra-regional activities are taking place within this facilitate medical tourism to reach its greatest potential. in at number four, which wasn’t anticipated. It could sector of the health market. The responses received If we can allay people’s fears about foreign treatments mean that there are as yet untapped opportunities clearly revealed that there is an overwhelming and guide potential health tourists with information for facilitators looking to incorporate this potentially perception among industry leaders that there is so and advice about visa and travel issues, then we will lucrative market in their service provision.”

Japanese promotion

The Ministry of Economy, Trade and Industry in Japan has announced plans to launch a new organisation in 2011 that has the sole aim of increasing the number of medical tourists that head to Japan. The Japanese Government recently published a growth strategy plan for the country, in which it identified medical tourism as a potential growth area. The new organisation will be jointly funded by both public and private sectors, and it is hoped that it will be fully operational by 2012. The ways and means of exactly how to increase the number of medical tourists the country receives on an annual basis have been identified, and include partnering with overseas medical facilities, and serving as a middleman between foreign hospitals and those in Japan. Certain nations will be targeted at first, with China, Russia and the Middle East all being recognised as potential partners. There are, however, concerns that the new organisation will find it difficult to obtain funding from the private sector. It has been reported that private medical institutions have yet to be approached about the project. The Ministry of Economy, Trade and Industry has said it has already put aside a certain amount of money for starting up the organisation, but the vast investment needed to pay for ongoing expenses, marketing and advertising will come, it is hoped, from private sources. The Ministry is soon to conduct a survey that will determine which hospitals would like to become a medical tourist destination – although the level of interest will most likely be heavily dependent on how much money they would be expected to contribute to the new organisation.

Commonwealth opportunity

With the Commonwealth Games just around the corner, in October this year, India is gearing up to host the event, which attracts a large number of supporters and tourists from all over the world. Officials from the National Capital Region of Delhi are using the Games as an opportunity to showcase the area’s medical tourism wares, in the hope that the event will raise awareness of the facilities on offer. The services it boasts include eye surgery by ‘some of the top ophthalmic and ocular surgeons’, cosmetic procedures, spine therapies and non- conventional treatments. 20 AIRAMBULANCENEWS

The ABC of pressure ulcers Jamaican service takes off Medserve Jamaica Ltd has launched its new air – part 1 ambulance service from the Caribbean island of Jamaica, operating under the brand name JamaicaMed, with junior industry minister Michael This first of two articles outlines the factors patient and skin care throughout the whole journey Stern commenting that the new service would allow and issues that affect occurrence and potential must be considered, as well as having a documented access to affordable air medical transportation to just reputation or claims associated with pressure skin assessment prior to flight. As well as damage about anyone. In a presentation at the launch of the ulcers. By Gerry Bolger from friction and shear, or failure (or inability) to service, Stern said: “The advent of this exciting new move a due to lack of space, localised skin damage company will usher in an era of affordable access to Introduction can occur from equipment used, such as IV drips or high-quality air ambulance services, which will serve In the aeromedical environment, the issues of even oxygen tubes and masks. As such, anything that to significantly enhance the quality of life for the pressure ulcers should be factored in even before can cause pressure should be considered. average Jamaican citizen by putting emergency ‘off the point of repatriation. Clinical teams in assistance island’ healthcare within their reach.” Bryan Cummings State minister for industry, investment and commerce Michael Stern (2nd companies should be considering the aspects of the Factors affecting pressure ulcer The air ambulance service will be offered to right) listens attentively as president of JAMPRO/Jamaica Trade and Invest potential for the development of pressure ulcers occurrence everyone on the island, but with discounted rates for Sancia Bennett Templer (second left) speaks at the launch of the new air ambulance programme launched by MedServe Jamaica Limited. Sharing in throughout the whole episode of care. This will A number of factors will affect the likelihood of locals based on the business links of the investment the moment are Duane Boise (left) and John Linns, stakeholders in the air ambulance company. include understanding the potential risk factors, occurrence, such as body frame size, weight, age partners, MedicaView International and Emergency preventative approaches and where those measures and the person’s sex – all of which have known risk Medical Services International. Jamaica a hub, and whatever treatment you can’t get don't succeed, and the implications of repatriating a factors; specific factors such as independence and Duane Boise, one of the stakeholders in Medserve in Jamaica then we will fly persons [to where they can patient back to a hospital or care setting. The latter mobility, cause of admission to care (trauma, for Jamaica, said: “We have been in all of the Caribbean receive the appropriate treatment]. We have a wide may mean the requirement of evidence that there is example), current skin integrity and incontinence islands for years, but we never looked at Jamaica network of hospitals all over that we fly people to no localised tissue infection, such as MRSA, resulting will affect the risk of development. However, other as such as large island. What we plan to do is make depending on what individual treatment should be.” in the need for isolation on arrival. factors that can be overlooked include nutritional There is also a need and hydration state; to bring this issue certain underlying risks to the attention of there are signs that litigation such as cardiac failure, King Air based in Medical flight crash all providers as the and vascular disease; public are becoming proceedings regarding and drugs, especially Malta A Cessna 206 air ambulance aircraft crashed at the very aware of this. steroids, cytotoxic and end of July into Lake Michigan, killing all onboard The reason for pressure ulcers certain inflammatory UK-based Synergy Aviation has decided to base a except one of the pilots, who was pulled from the this is that even in medications – all of King Air 200 and a medical flight crew at Luqa Airport wrecked plane by fishermen who had been nearby the publicly funded are starting to occur which can influence in Malta due to a high level of demand. The aircraft, at the time of the accident. The aircraft was regularly National Health the risk of a pressure said managing director Glen Heavens, is ‘configured used for medical transport flights to the Mayo Clinic Service (NHS) where ulcer. Therefore, with a Lifeport stretcher system and five passengers in Rochester, Minnesota. The flight originated in litigation is less likely, the complete clinical seats, is available 24/7 and will primarily serve North Alma, Michigan, and it is known that it developed it is starting to see picture is key, Africa’. Soon after being brought into service, the engine problems that were severe enough to compensation claims whether you are aircraft was in demand, with its first mission being a prompt the pilots to attempt a return to the western for the care of people seeing a patient with flight to Tripoli, in Libya to help an oil worker who Michigan shore. They fell short by around five miles, who have developed some risks or higher was suffering from appendicitis. with the aircraft plunging into the lake. The sole pressure ulcers in its risk, and whether Heavens said: “Having an air ambulance based survivor of the crash was the pilot who had radioed care. key equipment is in Malta and another based in London gives us air traffic control in Minneapolis that he had lost Sometimes referred necessary. As such, the flexibility to react quickly to our customers’ power about 10 minutes before the to as bedsores, it is not possible requirements throughout Europe and North Africa. aircraft was seen going pressure ulcers in to say we can We are [also] eyeing further opportunities in the down. the majority of (but have complete Mediterranean.” not all) cases are avoidance because preventable. Pressure of the associated ulcers are defined factors, and this as ‘localised injury to the skin and/or underlying does not give licence for unacceptable standards India calls for tissue usually over a bony prominence because of of care. In the US, funding systems do not pay pressure, or pressure in combination with shear for avoidable pressure ulcers. Avoidable means, defibrillators or friction’. Left untreated, the risks of secondary in summary, that the ulcer(s) developed because infection, including osteomyelitis (infection into the provider did not evaluate the patient's clinical The Indian Directorate General of Civil the bone), increases requirements of long stays condition and pressure ulcer factors; did not define Aviation has issued a draft proposal that, in hospital, surgery and untold distress. Pressure and implement prevention actions of accepted if accepted, would make it mandatory ulcers are now seen as a quality indicator of the standards; and did not continue ongoing monitoring for Indian airlines to carry automated care patients’ have received – regardless of who is to change the approaches. In other words, the external defibrillators onboard all providing it. burden is on the provider to prove they did international flights, along with a flight Occurrence is well established in likely sites – heels, everything possible to prevent the ulcer, or there attendant who is trained to use the sacrum, shoulders, elbows and head are common were no signs of one developing – which can device. The proposal has come about sites for pressure ulcers. However, these are not be from as little as one hour to five days. In the as a result of the increasing number of the only areas where pressure ulcers can occur; NHS in England, we have used three days as the medical emergencies that have been any part of the body is at risk, as a simple crease in standard cut off in the absence of evidence. recorded by airlines in the past five a sheet with lack of movement in someone whose The National Institute for Health and Clinical years, which has been attributed to the skin has poor blood flow can quickly lead to a Excellence (NICE) in England, with the Royal rising number of senior citizens who pressure ulcer. College of Nursing of the United Kingdom, have take long-haul international flights. Hospital data from the NHS in England shows produced a national clinical guideline (CG029) for The draft contains some clear details, that the majority of cases occur in the over 65’s, the prevention and management of pressure ulcers. such as a list of the all the medical supplies although there are occurrences in all age groups, While this is primarily focussed on hospitalised that would be carried onboard the aircraft, as well as including children and neonates. Even in England, settings, there is much in there that would support the rules applying to flight attendants when it came where there is a public tolerance of system errors, assistance companies and their clinical teams' to handling a medical emergency mid-flight. Nasim Rega reaccredited there are signs that litigation proceedings regarding prevention and monitoring of pressure ulcers. Zaidi, the director general of civil aviation, said: “The pressure ulcers are starting to occur. Furthermore NICE has produced separate guidance automated external defibrillators (AED) may be stored Rega has successfully completed the reaccredidation In the in-flight environment, where there is minimal (CG07) on selecting pressure relieving surfaces. in the passenger cabin and should be operated by process with the European AeroMedical Institute space, and for those patients who are especially However, it is worth noting that there is neither any cabin crew trained for the purpose.” In addition, the (EURAMI), the first international air ambulance prone to skin damage such as diabetics – and patients advice nor reference to the care of patients in the draft states that airlines must do a risk assessment in programme to do so. Following a thorough review with neurological impairment, pressure ulcers can aeromedical environment or in transportation. order to decide whether AEDs should also be carried of the company, including a site visit, the board of develop fairly quickly. Those with incontinence, on domestic flights, although it follows up by saying EURAMI unanimously approved Rega as a fully stroke or people with poor blood flow are equally, The next article will look at strategies to assess, that any aircraft capable of carrying more than 100 accredited ‘special care’ air ambulance provider. The if not more, at risk. As such, the placement of the prevent and document pressure ulcers. passengers should include a first-aid kit onboard, accreditation is valid for both fixed and rotary-wing equipped with life-saving drugs. operations and is valid for three years.

International Travel Insurance Journal AIRAMBULANCENEWS 21

Requests for equipment vital

rural areas in Germany are facing a decrease The importance of ensuring that the airline you and monitor, humidifier, suction apparatus and a vital signs your patient are travelling with has the required monitor, and stated that without these, the patient [in the number] of emergency physicians medical kit onboard has been highlighted by a recent could not fly. The airline couldn’t arrange all the case that involved poor preparation, resulting in the necessary equipment at such short notice, but Kumar patient not being allowed onboard the aircraft. The added: “To our staff, the demand for this equipment case surrounds Air India and a comatose patient it was indicated that [the patient] was in a much more asked to fly from Jeddah to Culcutta; but in the event serious condition than was stated in the medical the aircraft did not have all the medical supplies that forms submitted at the time of issuing the ticket. were needed, so the patient was sent back to hospital. What the paramedic was asking for essentially was According to Air India’s Eastern Province manager creating a mini-ICU in the aircraft.” Vinod Kumar, the coma patient’s doctors were However, the guardians who arranged the flight say asked to give a full description of all the medical kit that they clearly stated the patient’s condition on the they required: “This is a standard procedure in such form: “This report was submitted to the Air India cases, and the ailing passenger’s medical data is then reservations office. They then asked us to arrange passed on to our headquarters in India, which in turn for a qualified nurse to accompany him, which we

Mission numbers in

DRF Luftrettung has reported that in the first half Lutz commented on what was behind the increase of the year, the organisation flew a total of 17,975 in the number of flights: “The time factor is decisive missions, which involved helicopter missions from in air rescue. Particularly, rural areas in Germany its 31 bases in Germany, Austria and Denmark, as are facing a decrease [in the number] of emergency well as international worldwide repatriations using its physicians. As a consequence, helicopters are being fixed-wing air ambulance aircraft. In Germany alone, used more and more to bring the emergency arranges all the necessary equipment. In the medical did. We assumed Air India’s medical department the helicopter crews were alerted 16,645 times in physician rapidly to the scene.” papers that were submitted to us, [the patient’s] in Mumbai, which is where it claims the medical the first half of the year in what often proved to be In the field of international air ambulance flights, DRF, local guardians had only requested a stretcher and report was sent for clearance, would know what is life-saving rescues. The distinctive red and white together with Luxembourg Air Rescue, conducted two litres of oxygen.” The stretcher and oxygen required to transport a comatose patient.” However, helicopters were on scene 12,747 times as fast 364 repatriations under the European Air Ambulance were provided as per the request, but problems the medical escort team confirmed that they did providers of emergency care to injured or acutely brand name. Utilising all six of its air ambulance aircraft, arose when the ground ambulance crew brought the not specify the exact equipment they would need, ill patients. There were 3,903 cases of transports of the company flew to a total of 70 different countries coma patient to the airport and the accompanying instead depending on the Air India medical team to intensive care patients between hospitals, meaning worldwide, all of which were co-ordinated by the paramedic Ahmed Al-Enazy asked for a saturisation extrapolate the information from the medical report. that in total, the German crews flew 275 more Mission Control Centre rescues than in the same period last year. at Baden Baden airport in Chief executive of the air rescue organisation Steffen Germany. AMREF Medical refit for Mustang commended

At the recent Experimental Aircraft Association’s better accommodate Dr Stephen Mallinga, Uganda’s Minister of annual conference, it was revealed that Cessna had patient loading. The date Health, has publicly thanked AMREF’s team of teamed up with avionics firm Spectrum Aeromed for delivery of the first 10 medical specialists who arrived in Kampala to in order to develop a medical transport version medically equipped Mustang help treat the influx of patients that were injured of Cessna’s Citation Mustang aircraft. Spectrum has already been set: this in the twin explosions that happened in a sports Aeromed has already developed the medical October, Caribbean charter operator Jet Budget will and performance, combined with the Spectrum bar in the city in July. The team, led by AMREF’s interior and patient loading system for the Mustang, receive its aircraft. Aeromed interior, will make this a popular addition head of surgical outreach Dr John Wachira, and is at the moment said to be in the process of Scott Sarver, manager of special mission sales at to the medical transport community.” The medical worked with the doctors and nurses at Kampala’s obtaining a Supplemental Type Certificate for both Cessna, said of the deal: “Adapting the Spectrum configuration is based on Spectrum Aeromed’s 2200 Mulago National Hospital, which received an products, while Cessna has developed a pre- Aeromed system for the Mustang gives this series advanced life support system, which includes overwhelming number of patients as a result of installation modification that includes an enhanced versatile aircraft one more mission profile. The storage provision and a manual loading system that the bombing, in which 76 people died and 40 power system and new aft-facing fold seats that operating economies of the Mustang, its range has been customised for the Mustang. were critically injured.

www.itij.co.uk

24 NEWSANALYSIS

It’s leap year in Spain!

The craze for balcony diving has the Spanish Hollywood movies where the hero is thrown from strenuous efforts to bar pool access to anyone who deaths and more than 30 cases of serious injury holiday industry worried, as Roger St Pierre a 10th-floor window and is saved by landing in the shows signs of having been drinking heavily or of from balcony falls and dives in Spain this year, the investigates pool and now youngsters, urged on by their friends indulging in drugs. latest being that of a 25-year old Spaniard who died and often fuelled by drink and drugs, are emulating The injuries from balcony dives that go wrong can in July: “This year it has become a real plague,” a When 23-year old Scottish labourer Leigh John such big-screen feats by deliberately jumping from be truly horrendous and there has been a spate of receptionist at an Alcudia hotel told the Spanish Reeve took a flying dive into the crowd from a 20-ft hotel balconies into the pool beneath.” national newspaper, El Pais, adding, “When caught balcony at a Prodigy rock group gig at Dundee’s Laird Emergency doctor Maria Azos, at Palma de Mallorca’s climbing between balconies, these young men often Hall in July, he escaped any injuries but landed himself Son Dureta Hospital, said: “Too often, they miss or say they’re trying to access their own room from in court and received a whopping £750 fine for his else the entry speed proves too high or the water too outside because they have left the key in the room troubles. Imposing the financial penalty rather than a shallow.” One hapless diver mistook an only inches One hapless but truth is they are trying to impress their friends or possible custodial sentence, Sherriff Richard Davidson deep ornamental pond for a swimming pool, with the girls with a dare.” acknowledged the heady influence of youthful high disastrous results. Others have misjudged their plunge Most of the deliberate plunges seem to take place spirits but commented: “Hopefully, this stiff fine will and hit concrete instead of water. diver mistook an from third-floor balconies – high enough to create discourage other idiots from jumping off balconies.” The problem of such foolhardy stunts has become an impression of daring-do among watching friends, It’s a problem that’s been around the music scene so serious for hoteliers that some have raised the only inches deep low enough to tempt, especially when the diver is since the head banging early days of punk rockers height of balcony railings or have taken to removing being egged on and does not want to lose face with and heavy metal fans. In recent years, to the dismay temptation by allocating young holidaymakers rooms ornamental pond for his friends. The trouble is, some jumpers miss and hit of both tourism bosses and health authorities, it’s on the ground or first floors. One has even put signs the concrete instead, resulting in serious spinal, neck taken on an even more dangerous dimension. on his balconies proclaiming: ‘This balcony is NOT a swimming pool, or head injuries. on the ground floor’. Summer madness “It’s become such a problem that our members are with disastrous results Costly care This summer, Spanish holiday resorts have witnessed now tacking action to evict guests who indulge in The penalties for a balcony dive that goes wrong are a veritable epidemic of what the Spanish now call such stupidly dangerous behaviour,” says Sebastian fiscal as well as physical: “Too many of these young ‘balconing’ – jumping 40 feet and more off hotel Darder of the Balearic Hoteliers Association, adding, people are so excited about their holiday that they balconies into beckoning swimming pools – and it’s “A strict no-tolerance attitude is now being adopted forget to take out any travel insurance, but even if been encouraged by a veritable rash of YouTube and we are being backed by the tourist board, the recent fatalities: “More than a third of the patients they have done so, such foolhardy activities would video clip postings. It looks fun, exciting, crowd police and the civil authorities in our efforts to stamp currently in our hospital in a critical or serious state not be covered,” comments an underwriter at pleasing even – but it’s stupid and highly dangerous. out such behaviour.” are the self-created victims of such stupid antics,” travel insurer Aviva. Even if balcony jumping were Says veteran Costa Blanca-based independent Additionally, some hoteliers are now putting up according to Son Dureta’s Dr Azos. to be considered a bona fide extreme sport, which tour guide Gemma Ulrich: “We’ve all seen those screens to block off jump areas. Others are making According to official statistics, there have been nine it isn’t, then it would be excluded. Adds the Aviva

International Travel Insurance Journal

26 NEWSANALYSIS

spokesman: “Our policies provide the customer with ambulance to repatriate their son to the UK. by British and German tabloids. It’s all been taken so does break the rules of common sense and social a comprehensive list of the leisure activities that we It isn’t just travel insurance that will be invalidated by seriously on America’s sunshine coast that climbing – good behaviour,” comments Ashley Gibbins of the cover when they are undertaken on a recreational acts of balcony climbing or jumping. Most providers and jumping from – balconies in the state of Florida International Travel Writers Alliance. and incidental basis during the trip. Such cover meets of PHI (Permanent Health Insurance), which gives has now been made specifi cally illegal and is today Even Finnish Goth-metal band H.I.M. have come the needs of most holidaymakers. We clearly state an income to policyholders who are unable to work punishable by substantial fi nes. out against balcony diving following an incident at that they will not be covered for anything that is not due to illness or accident, will not pay out if injury One of the latest victims in Spain was 21-year old one of their gigs, at London’s Astoria, which left specifi cally included in the list – and that means any arises from participating in such highly dangerous Briton, Andrew Henderson, who was on a weekend an innocent member of the crowd off work for six claim for death or injuries caused by balcony jumping activities as balcony jumping. away with the lads at the Torremolinos Beach Club weeks with a cracked vertebrae: “Our long-time fan would most certainly not be considered.” Says Colin Young of specialist health insurer Unum: and after an all-day drinking session tried to jump Bam Margera, of ‘Jackass’ fame, took a controlled Add in the factor that many of these youngsters also “We only provide cover for so-called adventure sports between two fi fth-fl oor terraces to reach his friends’ leap into the crowd. He does this for a living and fail to carry a European Health Insurance Card (EHIC) if they are carried out in a regulated environment, room. He slipped and plunged to the ground, knows what he is doing but some idiot then tried to and a frightening scenario unfolds for the ill-fated jumper’s family. Even if an EHIC is carried, it does not cover the cost of repatriation, which can run into “We only provide cover for so-called adventure sports if they are carried thousands of pounds. The parents of 20-year old Ryan Elley, from Portsmouth, UK, who suffered a out in a regulated environment, following strict safety procedures. Balcony brain haemorrhage after jumping from a second fl oor apartment balcony in the Mallorcan resort of Playa jumping would certainly not meet such criteria.” d’en Bossa in August, face a £15,000 bill for an air

following strict safety procedures. Balcony jumping sustaining multiple injuries from which he later died in emulate him and it all went wrong. Whether it’s at a would certainly not meet such criteria.” Malaga General Hospital. gig or at a hotel pool, leave this kind of thing to the The most worrying version of the craze involves Berkshire coroner Peter Bedford returned a verdict professional stunt artists.” Insurers are at pains jumping from one balcony across to the adjacent of death by misadventure and commented: “This Balcony jumpers who end up maimed or killed do one – often in a foolhardy attempt to impress the was not an unusual scenario, lads going abroad not receive much sympathy from their peers either: to point out that even watching girls. The risk of death is far greater because together and consuming large amounts of alcohol “I don’t like to get preachy,” says American blogger such leaps often happen at far higher levels, in tower over a short period. There is evidence that Andrew Naomi Rockler-Glasden, “But for heavens sakes, at vastly inflated block hotels. Falls have been recorded from as high had been jumping back and forth between balconies students, don’t climb on balconies. If you are smart as the 10th fl oor. While most balcony jumpers seem on one or more occasions. It is reasonable to say he enough to get into college, you’re smart enough not premium rates they to be British, young German tourists and Spaniards was the worse for drink at the time he fell.” to do something so stupid.” too have fi gured in the injury list. As the alcudiaguide.com website puts it: “The annual would not grant cover Nor is balcony climbing and jumping confi ned to Conclusion ritual of people falling out of hotels has been taken the popular resorts of the Balearic Islands and the Insurers are at pains to point out that even at vastly to a new level this year, to the variant on audience- for such foolhardy and mainland Spanish Costas. Increasing incidences have infl ated premium rates they would not grant cover surfi ng and stage-diving which has become known been reported in Mexican resorts like Cancun and for such foolhardy and anti-social antics: “Besides as balcony-diving. Rather than a sea of people in anti-social antics in Florida too – especially at Spring Break time when the frightening risks for their own good health, these an audience waiting to catch the diver there is, he the American student population traditionally lets its fools ruin other people’s holidays with the massive hopes, a small sea of a pool to break the dive. The hair down. The phenomenon has even made the splashes they make when they hit the water. In some trouble comes when there isn’t and the medics and pages of USA Today, as well as being splash-headlined places it may not strictly be against the law but it hotel staff have to scrape up the mess.” n

International Travel Insurance Journal

28 FEATURE

Of sound mind

The effect of travel – whether for work or leisure, mental health, where people think that a mental cover, whether it’s for work or leisure, they usually to reassess how they approach the issue of mental and whether on a short or long-term basis – on condition is with a person forever when in reality expect to tick boxes about physical conditions they health, especially given the commonality of such the mental health of a person can often be quite they tend to be episodic and a person can often have have – asthma, diabetes, recent operations, that kind problems as depression and stress, which are often surprising. Carrie Dunn looks at how travel insurers a mental condition, such as anxiety, and then never of thing. Mental health issues? That’s another matter not covered by standard policies: the issue of public and IPMI providers can prepare for the unexpected have it again.” entirely. But it is important for insurers to ask image and perception is a key topic for insurers, But the act of travelling can, itself, spark anxieties questions on this subject and not just to determine not to mention customer retention in these strained “The premise of insurance is to cover the risks and create mental health issues or lead to the whether the traveller has a pre-existing mental health economic times. that are not yet known. It’s very rare for insurance resurgence of a previously diagnosed condition. issue and subsequently decline cover or issue a non- “As many as one in six of the UK population has to cover pre-existing conditions, whether they’re As Dr Suzanne Black, a clinical psychologist, told standard policy to take their illness into account. suffered from a mental health problem, and a physical or mental – so if you were to declare that delegates at a recent International Travel Insurance “I haven’t actually been refused, but have been quarter of these people seek professional treatment you’d previously been treated for depression, there Conference (ITIC), an expatriate moving to an unable to easily purchase online policies as I always for this,” explains Peter Hayman of specialist travel would probably be an exclusion on all mental unfamiliar country is a foreigner in a strange land, have to tick a box relating to my illness,” says Sarah, insurer PJ Hayman in the UK, “However, if an health issues,” explains Matthew Aspon, head of and may travellers experience hyper vigilance a 38-year-old public sector manager. “This either individual has a diagnosed mental health disorder, international marketing at AXA PPP International. and a heightening of the senses as they become means I have to call to speak to somebody and some travel insurers may refuse to cover them, even But others believe that it’s not necessary to take such accustomed to their new environment. “Those with answer a lot of questions, and in some cases make if the disorder is managed.” This creates additional a blanket approach to cover. Catherine O’Neill, existing psychiatric disorders will often find their declarations and give assurances about my current hassle for companies looking to relocate their service manager at Anxiety UK, states: “It shouldn’t symptoms are exacerbated or suddenly reappear and state of health, or sometimes get directed to further employees, especially now that the global workforce be difficult for a person with any mental health issue a sense of social isolation sets in,” she explained, questions that are long, generic and often difficult to is so mobile. If a candidate is set to move to a to actually get travel insurance, but often buried continuing: “Psychiatric symptoms can appear for apply to an individual’s circumstances. Again, this different country but they’ve had a mental health away in the small print, policies include clauses the first time, particularly in those aged between 17 usually involves making assertions or assurances, or issue at any stage, there may be a lot of paperwork to that state that they can refuse to pay out a claim if and 23.” agreeing that any claims related to my illness would complete and to read. they can prove a person’s pre-existing mental illness not be covered, or even paying higher premiums. It’s Hayman adds: “In my view I don’t believe insurers contributed to them getting ill in the first place. Shaking off the stigma not easy.” Maybe this is just the nature of the do make it exceptionally hard for people with This can often stem from a misunderstanding about When people look for travel insurance or IPMI insurance game, or perhaps insurers might need mental health issues to obtain insurance. Like other International Travel Insurance Journal FEATURE 29

medical conditions, consideration has to be given do not provide any form of Employee Assistance International’s 2009 survey of over 1,000 expats If a crisis does occur, Dr Khemka says that to the extent of the problem and how that could Programme for psychological support while working revealed that 42 per cent of people worry about companies should not shy away from continuing to impact on the proposed journey. Medical warranties overseas.” Dr Khemka believes that companies who finding accommodation – ‘so help in locating, offer support and putting employees in touch with on travel policies will inevitably differ but most offer proper support to employees will benefit in the securing and equipping a property is a must’, he assistance if necessary. “The best an employer can no longer have an absolute exclusion for mental long run, as supporting staff in their management of says. This was closely followed by concerns about do is ensure that their employee is covered in all illness.” Still, insurers also have to bear in mind that stress, anxiety and depression will resultantly mean a finding doctors, dentists and hospitals in a new eventualities through adequate insurance, so they applicants often don’t know they have to declare a decrease in claims, better management of insurance country – 41 per cent of people worry about finding are safe in the knowledge they can seek help from a ‘previous’ mental health problem – or may even be professional when they need it. This is best backed tempted to keep it secret so as to secure their policy. up by access to occupational health services, whether Dr Sneh Khemka, medical director at Bupa in person or by phone, which can help manage International, agrees that the more common mental someone’s wellbeing in the workplace over a long- health problems such as anxiety and depression consideration has to be given to term period.” need special consideration of their own, and points Aspon of AXA PPP explains: “Many insurers out that these illnesses can have a detrimental effect the extent of the problem and now include access to all medical support abroad on a person’s overall wellbeing. “When people that a traveller is likely to need – whether that’s think of mental health conditions, they tend to counselling, occupational health, or an optician. It’s think of the more serious psychiatric diseases such how that could impact on the not so much about the cost of the treatment; we as schizophrenia,” he says. “In fact, stress, anxiety try not to just offer direct claims reimbursement, and depression are by far the most common but access to assistance. We have offices all over conditions. It is well established that these, on proposed journey the world with a huge database of practitioners, so their own, can affect productivity and absenteeism; an individual can be put in touch with whatever when combined with a physical health condition, they need – and most insurers now have a similar they can make that condition much worse. Thus, mental health has a larger than expected impact on insurance premiums.” The amount people claim for psychiatric disorders is actually very low, he stated, but poor general mental health contributes heavily to the burden of disease, and therefore claiming patterns. PJ Hayman deals with policies that offer comprehensive coverage to applicants with mental health problems at the more serious end of the scale, so their experience is slightly different to Dr Khemka’s. “The most common we tend to see, given the fact that these are almost certainly likely to be declined elsewhere, are bipolar disorder, which was once called manic depression, and schizophrenia. Further down the scale are the anxiety-depression areas which typically will be picked up elsewhere,” says Hayman. “There is a limited availability of bespoke cover for people with more serious mental health disorders. We’ve always adopted a pragmatic approach here relying, to a large extent, on the person’s knowledge of their condition and recognising the fact that typically trips will be booked only a short time ahead when there is a window of opportunity or stability.” Furthermore, in Hayman’s experience, claims on such travel policies don’t generally happen mid-trip if the applicant is off on holiday. “Typically, claims that occur are for cancellation, for example a last- minute change in the condition rather than a relapse abroad necessitating repatriation.” His company doesn’t see many assistance cases for this type of risk as cancellation tends to be the option. Having said this, for those already travelling – or already abroad – he declares that there is a heightened repatriation risk should there be a marked deterioration in the provision.” This is a particularly important issue, condition: “These are invariably handled by the says Dr Black, who stresses the importance of assistance company and do not in fact represent such companies who offer proper selecting the right mental health practitioner for a high risk as, for example, somebody with a heart those requiring assistance while abroad. If possible, condition.” she says, it is best if both the clinician and the support to employees will benefit patient share a similar culture and background and Corporate responsibility speak the same language, as sessions where patient Companies looking to insure their employees either in the long run and clinician do not understand each other can be for travel or relocation need to be aware of their unproductive and increases the risk of misdiagnosis responsibilities should the individual need to make which, ultimately, can affect the type of medication a claim. With so much to think about when moving premiums, and ‘a more engaged, productive and healthcare for themselves, and 25 per cent worry prescribed. Speaking at ITIC, Dr Black also urged abroad, even the calmest individual needs help and motivated workforce’. about finding healthcare for their families. health insurers to check the credentials of clinicians advice. He also points out that travelling or relocating A health check is almost standard in many to ensure they meet local licensing requirements, “In the wake of the global economic downturn and can be stressful for anyone, regardless of whether companies for employees at home and globally, and and said it was insurers’ responsibility to ask for the resultant squeeze on budgets, indicators suggest or not they have a history of mental health issues, Floyd suggests that companies should be assessing letters of recommendation and qualifications, as it is that necessary levels of support have dropped down and someone who is not usually a worrier can find their employees’ psychological wellbeing just as not unusual for practitioners to be working without the corporate agenda,” says Rachael Floyd, director themselves fretting when they’re settling in another much as their physical state. This, she thinks, will the relevant visa or under a misleading title. She of international employee healthcare specialist country. Furthermore, as Dr Black explains, a new be especially helpful when someone is looking to also says insurers should be aware of local standards PMI Global. “This is certainly the case according life abroad can also place a strain on family life, relocate, highlighting any potential issues. of care and should ensure their clients are clear to recent research conducted by our company, particularly on marriages when partners are forced to “An in-depth psychological assessment can flag on what treatment they can receive abroad. They which highlighted the need for a greater duty of rely more heavily on each other and, in some cases, up any potential stress points in advance and help could also provide a list of dos and don’ts for clients care amongst many employers that assign staff gender roles are reversed. Relocation can also cause predict how they will get on with colleagues in with mental health problems before they leave overseas. [The study] revealed that a third of UK children to become affected as well. the new location,” says Floyd, “Similarly, a wider the country, including advice to take with them companies fail to make regular contact with staff “The support that employers offer to a relocating medical health check to identify and address any written documentation of their condition in their working overseas, with one in 10 leaving their expat employee can vary, but there are some essentials that potential medical problems before they go, giving native language and their new country of residence, employees completely in the dark over where to turn should be supplied when considering relocation, employees reassurance and peace of mind before prescriptions, and two months’ supply of relevant to for health advice abroad. A further 24 per cent especially abroad”, says Dr Khemka. Bupa they go can prevent crises later on.” medication. n www.itij.co.uk 30 FEATURE A shot in the dark

Travel vaccine programmes are recommended in tropical Africa and South America, where a by most national health services around the few cases, often fatal, have been reported in world, but why are these so important and unvaccinated travellers. In view of concerns about do travel insurers have to pick up the tab if rare but serious side effects from the yellow fever travellers fail to heed travel health advice? Robert vaccine, it should only be used when clearly Steffen gets to the point indicated, and should not be given, for example, to those who have had a severe reaction in the past Travel trends have changed in recent times, as travel to eggs. Based on the WHO’s International Health insurers are well aware; with vacationers favouring Regulations, only travel clinics or medical centres adventure holidays over traditional beach destinations with special authorisation are licensed to give this at an increasing rate. Such adventure holidays, or vaccine. trips off the beaten track, pose a greater risk to Additionally, the Kingdom of Saudi Arabia requires travellers’ health, which is why vaccines appropriate proof of vaccination against meningococcal disease to the country or countries being visited are more for all pilgrims to Mecca (Hajj, Umrah). important than ever. Unfortunately, however, many A doctor or nurse consultation prior to travel travellers – especially business travellers – ignore the is a good opportunity to ascertain that routine vaccination recommendations put forward by both immunisations have been performed, especially national health authorities and private travel clinics. as it is often necessary to update immunity against But once a recommendation is issued by a health diphtheria and tetanus, and some younger travellers authority, do travellers have to pay the price (in may have missed immunisations against measles. more ways than one) of ignoring such advice, or is it In fact, a lack of immunity due to non-compliance travel insurers who have to pick up the pieces when with recommendations that children and younger travellers become sick when abroad? What checks adults ought to have received two doses of the do International Private Medical Insurance (IPMI) measles vaccine resulted in a measles epidemic in providers make before issuing a policy to someone Switzerland, which saw more than 4,000 cases of relocating to an area with a known preventable- the contagious viral illness. Ten per cent of those disease risk? And why is it so important for travellers affected needed to be hospitalised, eight infections to receive the correct inoculations? resulted in encephalitis, and at least one patient has permanent sequelae (disorders that are a result This won’t hurt a bit of the original illness). Viral analysis has further Travel vaccines contribute heavily to keeping travellers determined that the epidemic was imported from healthy during and after a journey abroad. Obviously, Southeast Asia, and some anthroposophic school not every available vaccine is recommended for classes exported it to other German-speaking every traveller; recommended vaccines are based on countries. This outbreak meant Switzerland environmental factors relative to the destination, as accounted for 42 per cent of all cases of measles well as such issues as duration of stay. But the reason in Europe in the third quarter of 2007, and led to for travel and travel style must also be considered. a warning being issued to all travellers planning to For example, those visiting friends and relatives attend the country’s hosting of football’s EURO have been shown to be at greater risk of infection. 2008. Furthermore, in Canada, a Japanese group of Thus, evidence-based decisions must determine the tourists was recently quarantined before their return recommendation of a vaccination. flight home because of a measles outbreak. Some countries require visitors to be protected Travel health consultations would also flag up against certain diseases before they are allowed those younger travellers who need catch-up to enter. For example, many countries require doses of vaccines such as hepatitis A and/or B, or visitors to have had a yellow fever vaccination, human papilloma virus. Furthermore, according to particularly if they have travelled to the country most national immunisation programmes, senior from another that has infected areas. Such countries travellers – who make up 15 per cent of the Dr Michael Braida will require proof of inoculation in the form of travelling population – ought to be protected against regional medical director, International SOS, UK an International Certificate of Vaccination and influenza during the winter season at their respective Prophylaxis, which is a document approved by the destination. In fact, influenza is the most commonly ITIJ: Should insurers only cover people who have ITIJ: How often does your company deal with World Health Organization (WHO) to verify that occurring vaccine-preventable disease; with an had the correct vaccinations for their intended cases of vaccine-preventable diseases? destination? The most common risks we currently see are proper procedures were followed in administrating incidence rate of one per cent per month. In the This is a very difficult question and there is no rabies and tuberculosis; and, on occasion, yellow vaccinations for foreign travel. These documents are tropics, infection occurs all year. simple answer. International SOS has many clients fever can be a medical issue. Japanese encephalitis designed to fit into a passport and are predominantly The second most frequently observed disease operating in remote areas of the world where a is a risk in Asia, though a vaccine is available. It is issued by nationally licensed travel health clinics. correct vaccination programme is a prerequisite for difficult to state any numbers, but considering the Yellow fever is a virus that is passed to humans employees to work there. The employer’s duty of number of international travellers the rate of infection care is clearly the driving force behind this. is remarkably low. It is the unknown, the possible by bites from infected mosquitoes. It is endemic Dr Tim Hammond, The travel leisure market does not operate resurrection of past epidemics such as polio or chief medical officer, CEGA Group Services, UK under such pretenses, and it is very common for smallpox that makes the situation unpredictable. Polio travellers to visit areas with some very challenging vaccination cannot be ignored, especially after the Sophie Walker We would always recommend that people are medical risks. Risk mitigation in the form of a resurgence of polio in developing nations like Nigeria. Head of claims at InterGlobal, UK fully vaccinated before they travel and some proper vaccination programme is often not the Once we have assisted a patient, we often quickly countries will not allow entry to travellers – for case. A typical example would be a tourist visiting lose track of them because they have returned If an insured was to travel to an area where a instance those coming from yellow fever areas – a remote area in South East Asia with a known risk to their own national healthcare system. I expect vaccination requirement existed and this advice without the appropriate vaccinations. However, for rabies. If an actual animal contact incident does that there is an unknown number of returning was specified by the government in their local whilst vaccination will significantly reduce risk, it occur, proper rabies post exposure prophylaxis travellers with vaccine-preventable infections that residing country, yet they did not have the will not guarantee complete protection against (PEP) is essential. This can, in some cases, result simply have not been diagnosed or statistically vaccination, but then contracted the disease, then an illness. Some people are not able to tolerate in a medical evacuation because of the lack of PEP. captured whilst being overseas. This is often due an insurer would normally reject the claim on the vaccinations; for instance if they are allergic to A proper rabies vaccination plus PEP would have to the lack of proper credentialed laboratories in needless danger clause. It would be expected eggs (on which many vaccines are cultured), or significantly reduced the risk of infection. This has many regions of the world. Tests results that may that an insured person must follow the medical if they have a needle phobia. been shown in numerous studies. have been deemed as being negative in one lab protocols outlined in respect of vaccinations Many vaccinations need to be given well in At this point in time, we cannot stipulate to the can be proven to be incorrect once ‘back home’! before travelling to an at-risk country ... At point advance of travel; demanding a good degree of insured that a proper, up-to-date vaccination The risk of inconsistent laboratory testing is a very of claim we would check whether they were organisation – and they can also be expensive. programme is a prerequisite for coverage. realistic problem and there is no indication that it is appropriately vaccinated as recommended by Malaria tablets, for example, are not available Currently, the traveller will carry the medical risk. improving. My team of physicians and nurses are their residing country government. on the National Health Service and can be very The assistance provider/underwriter will carry the very much attuned to this issue and often challenge costly if taken for several weeks. financial risk. laboratory results.

International Travel Insurance Journal FEATURE 31

and they often fail to report the bite; but they are comparatively frequent victims of rabies. Rabies still has a 100 per cent case fatality rate, unless post- exposure prophylaxis has been initiated before symptoms develop. Meningococcal meningitis, another vaccine- preventable neurological disease, is rare even in travellers staying in countries where the infection is highly endemic, such as in the sub-Saharan African Meningitis Belt, where almost annual epidemics are reported mainly between December and June. A few dozen cases of Japanese encephalitis have been diagnosed in travellers within the last 25 years, yet the incidence rate for both this and meningococcal meningitis infections among civilians is only around one per million. Those affected, however, have a substantial risk of death or of survival with sequelae. There is a new vaccine available for Japanese encephalitis, but if all 17 million visitors to Asian endemic areas were to be immunised against the disease, it would cost around €2.9 billion. This, naturally, raises the question of who should be immunised.

Conclusions Although between 2000 and 2004, just 1.4 per cent of French people abroad had died of infection- related causes (compared to 28.1 per cent who had perished in traffic accidents), vaccinations for those people who will potentially put themselves at risk when travelling are an essential pain in the arm. Correct priorities are, however, paramount when deciding which vaccines are essential for future travellers: According to most expert groups, many travel immunisations are reserved for ‘at-risk groups’. amongst non-immune travellers to developing B. Around 14 per cent of all travellers expose only approximately 0.3 per 100,000, although Above all, one should not vaccinate against rare risks countries is hepatitis A, which is most commonly themselves – either voluntarily or involuntarily – to infections without symptoms or a clinical picture while leaving the traveller unprotected against far transmitted via contaminated food or drinking water, the virus, which is predominantly sexually contracted indistinguishable from travellers’ diarrhoea may be more frequent diseases of similar severity. and has an average incidence rate of 30 per 100,000 (five per cent of holidaymakers will have casual more frequent. To conduct the necessary risk assessment, travel per month. Luxury hotels are more likely to pass sex on holiday), but can also be picked up through Furthermore, travellers are at a low risk of several health professionals ought to know the planned on the virus, as staff handle food more frequently, poorly cleaned medical equipment (such as syringes), vaccine-preventable neurological infections that can travel itinerary of their client, such as destination, thus increasing the risk of infection. Hepatitis A is or exposure to tattoo, piercing or acupuncture be devastating. Every year, many of the two to four duration of stay, exposure to the local population, usually asymptomatic in children, who may thus instruments. For expatriates, hepatitis B is mainly a per cent of travellers who experience an animal bite and proposed standard of food and beverage intake. inadvertently cause outbreaks, particularly if they problem for those living close to the local population. are at risk of rabies. Rabies is particularly a risk for Additionally, they should take into account future attend a kindergarten or similar institution; so The monthly incidence rate of hepatitis B is 25 per those who are in close contact with locals over a travel plans to determine a cumulative exposure at routinely vaccinating children would be a sensible 100,000 for symptomatic infections and between 80 prolonged time, such as missionaries and, potentially, an early stage. The travel insurance industry should option. Furthermore, the disease of the liver is fatal and 420 per 100,000 for all infections. expatriates; those travelling overland by bike; those sit down with underwriters and medical professionals for one in 50 of all those over the age of 40 who Other vaccine-preventable diseases include typhoid working with animals; and those who explore caves. to draw new conclusions as to who should be contracts the disease. fever, which is diagnosed with an incidence rate Children often have a shorter incubation period, immunised against infections such as rabies, and Many immunisations are recommended for special- of 30 per 100,000 per month among travellers to formulate a way to encourage people to take risk groups only, though there is a growing tendency the Indian subcontinent; North (except Tunisia), appropriate health measures, such as vaccinations, in most countries to immunise at least all young Central and West Africa; and Peru. Elsewhere, before being accepted for insurance. n travellers to developing countries against hepatitis this rate is tenfold lower. The rate of cholera is Brendan Sharkey director of individual travel programes, HTH Worldwide, US Dra Virginia Villanueva de Pedro medical director, MAPFRE Asistencia, Spain Martyn Armitage ITIJ: Should travel insurers only provide for Europ Assistance, UK cover for those people who have had the This is an interesting issue. Prophylaxis is [not a recommended vaccinations for their travel consideration] on most travel assistance policies ITIJ: Should travel insurers only provide cover for inoculation, in addition to a list of recommended destination? and it is not a requirement in pre-screening. those people who have had the recommended clinics in key tourist destinations. Customers can No, travel insurers should not exclude illnesses In Spain, the patient goes to the International vaccinations for their travel destination? also access a 24-hour telephone line and speak to based on vaccination recommendations, which Vaccinations Office before their trip to receive It is not a requirement when purchasing travel a customer services agent for pre-travel advice. can vary. the proper prophylaxis (vaccination, pills insurance for a customer to prove that they have In 2009, the Europ Assistance Group launched a against malaria, and so forth) depending on the had the recommended vaccinations for their trip. global travel portal aimed at increasing awareness ITIJ: Should travel insurers do more to destination – but it is voluntary. For example, under an annual multi-trip policy of potential risks that exist in a given country or encourage travellers to take appropriate It would be a good idea for travel insurance the customer only has to specify zone of travel. area. [We are] also an active partner in the Foreign health measures, such as vaccinations, prior companies to take into account the preventive Therefore, it is not unreasonable for a customer and Commonwealth Office’s ‘Know Before You to travel? measures provided when a vaccine is available prior to embarking on any trip to find out details Go’ campaign. Absolutely. Travel insurers now offer more and against endemic diseases. on length of passport validity and visa requirements more information to help travellers take in addition to recommended or required ITIJ: If an insured contracts a vaccine-preventable precautions. For instance, [we] provide vaccinations. disease whilst abroad, but has not had the vaccination recommendations by destination recommended vaccination for the disease prior and also provide travel clinics where travellers ITIJ: Should travel insurers do more to to travel and ends up in a local hospital and/or can be inoculated. encourage travellers to take appropriate health needing repatriation, would you still cover this Dr Robert Steffen heads the Division of measures, such as vaccinations, prior to travel? person? ITIJ: If an insured contracts a vaccine- Epidemiology and Prevention of Communicable The travel insurance industry actively works to If a customer has not had the recommended preventable disease whilst abroad, but has Diseases at the University of Zurich and is educate and increase customer awareness in an inoculations and/or taken the recommended not had the recommended vaccination for the director of a World Health Organization endeavour to help customers understand both medication to protect against a vaccine-preventable the disease prior to travel and ends up in a Collaborating Centre for travellers’ health. He what their policy entitles them to as much as to disease, then any expenses incurred as a result of a local hospital and/or needing repatriation, highlight what their responsibilities are. Europ vaccine-preventable disease are not covered. We would you still cover this person? is also the co-founder and president of the Assistance offers travel advice online including pre- would, of course, offer assistance to them, albeit Yes, HTH Worldwide would cover this person International Society of Travel Medicine and is travel advice, top-five diseases preventable by on an uninsured basis. to the full extent of the policy. editor-in-chief of the Journal of Travel Medicine.

www.itij.co.uk 32 ASSISTANCE&HEALTHCAREWORLDMARKETS

Norwegian gold

With a wealth of natural beauty, and natural whole population in Norway stood at 80.6 years. are no private skiing fracture clinics of the kind that resources providing great wealth, Norway has a lot So, visitors to Norway who experience health are more common in the Alps. If surgery is needed, There are no private going for it. But what of medical provision and problems during their stay can expect a generally patients can find a good standard of treatment at access to care for the 4.4 million visitors who arrive high-quality public healthcare system, especially state hospitals. skiing fracture in this Nordic country each year? Tatum Anderson around cities and larger conurbations. Norway’s public health system is divided into finds out five regional health authorities, which each A glowing example operate several hospital trusts, groups of hospitals clinics of the kind With fjords, the world’s third largest ice-cap, Assistance companies say some of the best hospitals and specialist care facilities. The South-Eastern northern lights and the midnight sun, Norway in the country include the National Hospital in Norway Regional Health Authority, for instance, is has many natural wonders that draw visitors from Oslo, and six university hospitals in the largest cities responsible for 56 per cent of Norway’s population, that are more all over the world. But it is also one of the world’s of Norway including Oslo, Bergen, Trondheim, and encompasses Oslo. It has the most hospital richest countries as a result of being a major oil Tromsø, Stavanger and Akershus. Stavanger trusts – 11 in all plus five private non-commercial common in the Alps and gas producer. And as equality in access to University Hospital, for instance, is Norway’s hospitals. The health trusts that operate under the healthcare and social services is a political priority fourth-largest university hospital and in 2006 cared Western Norway Regional Health Authority own in Norway (public social services have been running for 45,638 inpatients and 311,725 outpatients. around 50 public hospitals. They also have in the country since the 1700s), the country The healthcare system provides tax-based universal agreements with private hospitals and a number However, he adds, many hospitals and medical spends more on health per person than almost any coverage through its Norwegian National Insurance of specialists with private practices (some private centres are often not very well-versed in handling other nation apart from the US. That’s around Scheme (Folketrygden). Foreigners who live and companies are even being contracted by the public private patients and payments processing. While US$5,003 per person, more than the average work in Norway must contribute to the scheme too. sector to build and run so-called patient hotels, or some hospitals and medical centres are used to amongst the Organisation of Economic Cooperation They are able to choose a general practitioner (GP) accommodation for patients). billing private patients, there can be problems and Development (OECD), a grouping of rich from a list of those participating in the country’s Most medical doctors and nurses speak English, in institutions that receive few foreign patients. countries, which average a spending of US$3,060. so-called Regular GP Scheme (GPs other than those German and other European languages. This is According to Kvam, some are not used to putting The density of doctors and other health professionals on the scheme can be used but they may cost more partly because this small country has historically together bills, and pricing policies may not be is one of the highest in Europe too. Norway had – see below). had less teaching capacity to train medical staff at standardised at all. That said, larger hospitals have 4.0 practising physicians per 1,000 population in Tourists are able to access services used by home. “A large percentage of doctors in Norway improved billing processes recently. Oslo University 2008, compared with an average of 3.2 in OECD Norwegian communities. Most areas have a public have done their medical training abroad, especially Hospital even has a dedicated office for foreign countries; and 14 nurses per 1,000 population, medical clinic (helsesenter) staffed by GPs who can in German-speaking countries. There are also a affairs, for instance. compared to an OECD average of 9.0 practising refer patients to hospitals. There are specialist tourist substantial number of immigrant doctors mainly nurses per 1,000 population. High investments in services too. Ski resorts provide dedicated healthcare from European countries,” says Dr Asgeir Kvam, All that glitters health services are reflected in health outcomes of its services for tourists that are state-run and staffed medical director at SOS International Global The massive investments in healthcare can have a population. In 2008, life expectancy at birth for the with specialists including orthopedic surgeons. There Medical Support, based in Norway. downside for some visitors, particularly those who International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 33

So, many services – such as inpatient treatment, medication and emergency services – are free. Interestingly, however, not everything is free at the point of delivery for Norwegian residents. The country operates a system of co-payments. Tourists will have to pay for a consultation with a GP, both public and private, at a cost of approximately NKr 300 (around €40), and a consultation with a specialist in their office or an outpatient clinic costs about NKR 500 (€65). These co-payments are usually paid up front although some outpatient clinics, especially the public ones, may send the bill directly to the insurance company. The UK Department of Health advises tourists to consult doctors with a reimbursement arrangement with the Norwegian Employment and Organization (NAV), which administers the nation’s health insurance. Costs are non-refundable in Norway but visitors may be able to seek reimbursement when they return home. Dental services also are not free.

The private option Norway’s private healthcare system is small – with over 84 per cent of all health spending coming from public sources in 2008 (compared to 72.8 per cent in the rest of OECD). The private sector tends to provide outpatient treatment and planned surgery. For example, Scanhealth Scandinavia comprises a private hospital, radiology centre and infertility centre in Haugesund, West Norway. It also specialises in occupational medicine, ear, nose, and throat disorders, orthopaedic and eye departments and boasts 2,500 surgical procedures per year. Private service providers tend to be clustered around the largest cities only, are not open 24/7 and do not offer emergency services. For that reason, the private sector plays a minor role in health provision for tourists, according to SOS International. The few private hospitals with specialist care are either non-profit organisations or deliver services predominantly to the public healthcare system. But private services are growing. An increasing number of private medical clinics or polyclinics are opening in cities, especially Oslo. They provide emergency walk-in services, and scheduled appointments for both specialists and GPs. Despite the quality of the public healthcare system, private healthcare providers do provide some benefits, say experts. Waiting times are shorter (although assistance companies say a tourist will get an appointment in a similar amount of time in a state-run hospital) and there may be better customer service. Resultantly, however, public hospitals have said the new competition from private services has led to improvements in the public healthcare sector. It has already brought about a considerable reduction in waiting lists, said one hospital. Generally, though, healthcare quality in public and private hospitals is similar. “Most private hospitals are small or medium-sized and deliver service at the same level as comparable public hospitals,” says Kvam. So, for non-emergency consultations, tourists do have a choice between governmental and private general practitioners and outpatient clinics. Indeed, some assistance companies have agreements with private clinics to take care of minor incidents.

Getting around Norway’s unique landscape also presents a unique set of circumstances for assistance companies, especially in primary and emergency care. That’s because Norway is a huge country with a population of just C.H./Innovation Norway are not covered by the various reciprocal healthcare agreements like the European Health Insurance Card. Healthcare can be very expensive and Most medical doctors and nurses speak English, German and other healthcare providers sometimes require payment at time of service, says the US State Department. European languages. This is partly because this small country has Prescription medicine costs in Norway are very low, however. Tourists from countries within the European historically had less teaching capacity to train medical staff at home Economic Area are treated on the same basis as Norwegian residents, for the length of their stay. www.itij.co.uk 34 ASSISTANCE&HEALTHCAREWORLDMARKETS

4.8 million people. There are areas with remote and according to SOS International. The emphasis on equipped with more advanced equipment – including the distances involved, planned visits to specialists can sparse populations and the most popular tourist equality of access to healthcare means there are GPs x-rays – and can provide telemedicine services take several hours). destinations are no exception – from islands in the in the smallest communities throughout the country. through links with other hospitals. For more serious And perhaps surprisingly, in the north of Norway, Arctic Ocean to a major dependency on ferries to Even acute cardiac care and trauma care is performed cases, including trauma, primary care departments from Trondheim northwards, there are quite a cross fjords in western Norway. Healthcare services at a high level of quality in Norway, despite the long within small rural hospitals are able to admit patients lot of hospitals, all of them open for emergency are generally good, however, even in rural areas, distances. In some rural areas, local health centres are before transfer to specialist trauma centres (because of care and manned by specialists, say experts.

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 35

Terje Borud/Innovation Norway

Interestingly, the health authority covering this such areas too. In cities and densely-populated areas, residents and visitors are expected to use an (Legevakt) 24 hours a day. area, Health North, has a higher proportion of its 90 per cent of the population is generally served alternative service, the local physician’s emergency These emergency local services are usually managed population in urban settlements. within 12 minutes by ground ambulance. However, reception. Norway’s 430 municipalities are in charge by the GP surgeries during office hours and by Travel to Spitsbergen, the main island of the one study has shown that ambulances rarely reach all of organising such services. Importantly for visitors, the municipality during out-of-hours. Actually, Svalbard archipelago in the Arctic, and polar areas inhabitants within half an hour in half of Norway’s each municipality has its own telephone number out-of-hours services are usually provided by on- are subject to special regulations. For instance, municipalities. In rural areas, response times can for accessing local emergency medical services call GPs who are legally obliged to work on a rota tourists venturing beyond Longyearbyen, the main be as high as 45 minutes, although ambulance settlement on Spitsberge, must apply for a permit helicopters, boats and airplanes make access to issued by the local police. But there is a small healthcare services faster. hospital and a rescue helicopter at Longyearbyen. The national emergency care system is accessed Remote areas pose several other challenges too. by calling 113. Around 20 emergency medical Researchers have noted that it’s harder to retain dispatch centres (EMCC) are responsible for doctors in these areas although this situation is answering calls and responding with out-of-hospital improving. In addition, primary care doctors are emergency resources like ambulance services and often in short supply during the holiday periods, on-call primary care doctors. The operators also so patients with non-urgent medical problems speak English. The EMCCs have access to a range are sometimes forced to wait a few days for an of ambulances from boats to helicopters (complete appointment with a doctor. with anesthesiologists and nurses) and planes. The timing of ground ambulances varies greatly in For cases that are urgent but not life-threatening,

many hospitals and medical centres are often not very well-versed in handling private patients and payments processing

Haakon Vikesaa

www.itij.co.uk 36 ASSISTANCE&HEALTHCAREWORLDMARKETS

C.H./Innovation Norway system during evenings, nights and weekends. In out-of-hours services in Norway, run by single addition, some private medical centres provide municipalities or group co-operatives. limited primary care services from Monday to Friday Healthcare can be very expensive and in Norway’s largest cities. In 2006, there were 262 Both the local emergency care system (LEMCC) healthcare providers sometimes require payment at time of service

and the EMCCs are staffed with nurses who use the ambulance team will require an insurance telephone triage to prioritise patient treatment. For document to pass onto the hospital billing office. local emergency services, the LEMCC agents work Although the ambulance service is public, the out what level of care is appropriate – whether a government does contract private suppliers to home visit by a GP or an ambulance to hospital provide air services. They are expected to compete by land, sea or air ambulance. Out-of-hours service locations and facilities vary. One study found that some districts provide out-of- hours services from hospitals, others in GP surgeries, and some were even based entirely on doctors making home visits. Despite this, some tourists may find it difficult to get a doctor to visit them, say experts. “To get a visit and examination by the doctor in the traveller’s hotel for the tenders on five to ten-year contracts. The room may be very difficult. Most medical centres prices for ambulance services are not standardised, will insist the patient comes to the doctor’s surgery. unfortunately. But ground ambulances are normally Only the critically ill patient will get an ambulance billed per kilometre. While rates are rather low in or doctor on-site,” says SOS International’s Kvam. international terms, Kvam warns that distances to a Air, road and boat ambulance services are public hospital by road may be as long as 100km. and free for Norwegian citizens and tourists with The cost of repatriation must be borne by the reciprocal healthcare agreements. This includes air patient or their insurance company. Citizens from ambulance services, which provide inter-hospital Nordic countries are exempt, however, and can be transfers within Norway and from Spitsbergen. They transported home free of charge under an agreement are integrated in the state health trusts, so the bill called the Nordic Convention. n will be included in the hospital bill. Often, though, International Travel Insurance Journal

38 PROFILE

ITIJ caught up with Donna Sweetman, ash disruption, this has featured significantly in the Data capture at the point of sale enables us to of travellers, there really is no replacement for generalSweet manager for Optimum Underwriting minds of insurers andlike customers alike; understand chocolate more about the customer and through experience and creative thinking. and winner of ITIJ‘s UK Personality of the * Medical screening – while this has always quality data captured at sale and claim we can get Year award, to find out more about her been important, today it is a paramount tool in to a point where the rating for products becomes If you could do any other job in the world background in the industry and why she underwriting what are perceived as higher-risk increasingly sophisticated. This data allows us to other than the one you do now, what would certainly doesn’t have two left feet policies. The combination of an ageing population produce detailed loss ratio information, which means it be? demographic, longer life expectancy, advances in that rating becomes more accurate and matched to There are two actually! The first is to perform at Where were you born, where did you study, medical technology and an increasing appetite for the nature of the risk posed, giving better value for all the theatre dancing in musicals … it was, after all, and where do you live now? travel amongst the ‘old’ will all ensure that this area concerned. As more data is gathered over time, this my original passion. The second choice would be a I was born in Epsom Surrey, and attended Purley will continue to grow for the foreseeable future; and will give us a good profile of the overall risk profile of criminal psychologist … although that could be from High School for Girls in Old Coulsdon, Surrey. I now * Competitive rates – in order to keep policy rates customers that can directly influence the net rate for watching too much Cracker/Wire in the Blood/CSI! live in Whyteleafe, Surrey. competitive we are often seeing higher and higher the risk they pose. excesses. As for negative aspects, any technology is only as What motivates you? What was your first job; what was your worst I think I have always enjoyed working under job; and how did you come to work in the pressure, and in this job there are many challenges. travel insurance industry? What really motivates me is working as a team to My first job was probably also my worst job – it was overcome these challenges. washing up at a local nursing home from age nine to What really motivates me is working 16 (I am sure it would be illegal now!). I would love What are you most proud of – both to say that working in the travel insurance business personally and professionally? was all part of my career plan, but in reality I ‘fell into’ as a team to overcome these challenges Personally, I am incredibly proud my two beautiful travel insurance. My first job was as a claims handler children and my great husband, who is both loving at Claims International – in my mind it was only and understanding (despite the pressures my job meant to be temporary to pay for dancing lessons! imposes). Professionally, to have been an integral part of the team of fantastic people I work with, who How did you come to your current role? have all helped get Optimum to where it is today. It was whilst I was at Claims International that I suppose I was bitten by the travel insurance bug Have you ever made a claim on your travel and have loved being in the business ever since. insurance? Immediately prior to joining Optimum, I was Yes, a cancellation claim ten years ago. working at TIA (travel subsidiary of then CGNU), which had just merged with Norwich Union and the What is your favourite holiday destination? decision was made (sadly for me) to close their travel Where would you like to visit next? operation. It was whilst I was at the ITT conference My favourite holiday destination is South Africa, even that Mike Brayne contacted me to see if I would be though I have not visited it for some time. Las Vegas interested in joining Optimum. I think I must be one is on the list of places to visit too. of the few people who has had an interview at the hotel pool bar! What do you enjoy doing in your spare time? In my spare time, I love socialising with friends and Congratulations on being named ITIJ‘s UK family – but try to balance this by trying to go to a Personality of the Year! How did it feel ‘keep fit’ session every week. I love most detective to win this award, and what traits do you TV programmes and crime fiction, without having a think made you stand out above the other particular favourite author. nominees? Thank you. I really couldn’t believe it when I heard, as I was delighted merely to be on the short list. I am sure the voting was very close and that I just pipped the others to the post. there really is no Optimum provides assistance services, amongst its other offerings. Are these replacement for outsourced, and do you plan to expand your range of service offerings further in the near experience and future? Since its inception, Optimum has outsourced all of the assistance provision. Now we are part of creative thinking the Collinson Group, we have been offered even greater opportunities to expand our services – so What are you currently reading? never say never. At the moment, I don’t have a lot of time for reading, but I have been recommended Dissolution by C. J. How do you ensure that costs are contained Samson, so that will be my next holiday book. for the insurer, whilst providing an attractive product for the traveller? What music do you enjoy? All the assistance companies Optimum works with I enjoy most music although I am not that keen on have cost containment arrangements in place. These hard rock. My real love is Soul, Motown and R&B. are agreed and monitored by us through regular The last album I bought was The Defamation of MI and audits to ensure that costs are kept to a Strickland Banks by Plan B. minimum … but we always endeavour to not lose sight of real end-user customer service. If you were having a ‘dream’ dinner party, who would be there – and what would you eat? What do you see as the top three trends Now that’s difficult; I would have to have a in travel underwriting/travel product How has technology helped to streamline good as the people using it, and while technology sumptuous champagne banquet and hog roast with development at the moment? the underwriting process, and how do you is helpful, particularly in cases where there is a guests including Sean Connery, Johnny Depp, Dawn The three top trends/issues in my view are: see technology developing in this area in the high volume of data, when one is rating a new French, Jennifer Saunders, Joanna Lumley, Sid James, * Natural disaster cover – since the recent volcanic coming years? scheme, or dealing with a highly specialised subset Elvis Presley and Henry VIII.

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 Group Mr Peter Veazey – CEO Medical and Tasking Centre P.O. Box 1044, Magnolia. Texas 77353, USA PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA

tel: +1 832 934 2390 email: [email protected] 24hr tel: +61 7 5553 5955 email: [email protected] (AFRICA) fax: +1 832 934 2395 website: www.airambulanceinternational.com fax: +61 7 5553 5914 website: www.cmsairambulance.com

Air Ambulance Network CareFlight International AUSTRALASIA

Kirk Pacheco – President ( Paul Smith – National Manager AIR AMBULANCE AIR AMBULANCE 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA

24hr tel: + 1 727 934 3999 email: [email protected] tel: (+61) 2 9893 7683 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +61 2 9689 2744 website: www.careflight.org

AMREF Flying Doctor Service European Air Ambulance Dr Bettina Vadera – Medical Director Patrick Schomaker – Director Sales & Marketing Wilson Airport, LangataRoad, PO Box 18617, Nairobi, KENYA 175A, rue de Cessange, L-1321, LUXEMBOURG

tel: +254 20 6000 090 email: [email protected] 24hr tel: +49 711 7007 7007 email: [email protected] fax: +254 20 344 170 website: www.amref.org fax: +49 711 7007 7009 website: www.air-ambulance.com

European Air Ambulance Flying Doctors Asia Patrick Schomaker – Director Sales & Marketing Prithpal Singh – CEO , Director 313 Old Bird Cage Walk, #01-15/02-16, Seletar Airport, 175A, rue de Cessange, L-1321, LUXEMBOURG SINGAPORE 24hr tel: +49 711 7007 7007 email: [email protected] 24hr tel: +65 9297 7757 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +65 6483 5407 website: www.flyingdoctorsasia.com

Netcare 911 Aeromedical Hope Medflight Asia Pte Ltd Wayne Thomson – Flight Operations Manager Dr Charles Johnson – Medical Director Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA 2 Loyang Lane 03-01, Singapore 508913, SINGAPORE

tel: +27 10 209 8387 email: [email protected] 24hr tel: +65 6100 1911 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +65 6400 5254 website: www.hope-flight.com

Skyservice Air Ambulance Medical Wings David Ewing – VP International Market Development Dr Sommart Somsiri – Medical Director YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, 222 Room 3259, Donmuang Int Airport Moo 10, Viphavadee-Rangsit Rd, Sikan, CANADA Don Muang, Bangkok 10210, THAILAND tel: +1 514 497 7000 email: [email protected] tel: +662 247 3392 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +662 535 4355 website: www.medicalwings.com

West African Rescue Association Skyservice Air Ambulance Florian Zagel – Managing Director David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, Klotey Cresent 6, North Labone, Accra, GHANA CANADA tel: +233 244 312 496/7 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: +233 21 781 259 website: www.westafrican-rescue.com fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance ) AeroMed Asia Inc. South Pacific Air Ambulance Cindy Wong / Lorraine Paul – International Account Management Scotty Watson – Managing Director SINGAPORE BANGKOK THAILAND NEW NEW ZEALAND AUSTRALIA SINGAPORE

tel: +603 7965 3883 email: [email protected] tel: +64 9256 9000 email: [email protected] fax: +603 7629 8810 website: www.aeromed-asia.com fax: +64 9256 9111 website: www.spaa.co.nz AUSTRALASIA ( Air Ambulance International ADAC-Ambulance Service Mr Peter Veazey – CEO Robert Glueck – Marketing & Sales Director P.O. Box 1044, Magnolia. Texas 77353, USA Am Westpark 8, 81373 Munich, GERMANY

tel: +1 832 934 2390 email: [email protected] tel: +49 89 76 76 52 85 email: [email protected] fax: +1 832 934 2395 website: www.airambulanceinternational.com (EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance

Air Ambulance Network Air Ambulance International Kirk Pacheco – President Mr Peter Veazey – CEO 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA P.O. Box 1044, Magnolia. Texas 77353, USA

24hr tel: + 1 727 934 3999 email: [email protected] tel: +1 832 934 2390 email: [email protected] fax: + 1 727 937 0276 website: www.airambulancenetwork.com fax: +1 832 934 2395 website: www.airambulanceinternational.com

AirMed International LLC Air Ambulance Network Jeffrey T Tolbert – President Kirk Pacheco – President Airport World Trade Center, 1 Sky Plaza Road, 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA Hong Kong International Airport, HONG KONG tel: +852 3756 3680 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected] fax: +852 3756 3681 website: www.airmedasia.com fax: + 1 727 937 0276 website: www.airambulancenetwork.com

CATEGORY KEY CLAIMS MANAGEMENT INSURERS Air Medical Ltd AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER Glenn Salt – Flight Operations Manager AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS tel: +44 1865 842 887 email: [email protected] COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES tel: +44 1865 370 642 website: www.airmed.co.uk call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 41 ) AirMed International LLC ) Medilink International Air Ambulance Jeffrey T Tolbert – President Martin Farrugia – Business Development Manager 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA 99 Mill Street, Qormi, QRM 3100, MALTA

tel: +1 205 443 4840 email: [email protected] tel: +356 2278 5400 email: [email protected] EUROPE EUROPE ( fax: +1 205 443 4841 website: www.airmed.com ( fax: +356 2278 5700 website: www.mi-aa.com

Augsburg Air Ambulance North Flying a/s Roland Schoberth – Director Jesper Kragelund – Sales Manager AIR AMBULANCE AIR AMBULANCE Roseggerstr 17, D-86368, Gersthofen, GERMANY North Flying Terminal, Aalborg Airport, DK-9400, Nørresundby, DENMARK

tel: +49 821 299 1020 email: [email protected] tel: +45 9632 2900 email: [email protected] tel: +49 821 299 2030 website: www.ambulanzflugdienst.de fax: +45 9632 2909 website: www.northflying.com

Capital Air Charter Redstar Aviation Lisa Humphries – Sales Director Mustafa Atac – CEO Exeter International Airport, EX5 2BD, UK Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +44 845 055 2828 email: [email protected] tel: +90 216 588 0216 email: [email protected] fax: +44 1392 350 039 website: www.capitalaircharter.co.uk fax: +90 216 588 0225 website: www.redstar-aviation.com

European Air Ambulance Skyservice Air Ambulance Patrick Schomaker – Director Sales & Marketing David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, 175A, rue de Cessange, L-1321, LUXEMBOURG CANADA 24hr tel: +49 711 7007 7007 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

Euro Link Air Ambulance Swiss Air Ambulance / Rega Dr. Friedrich Renner – Medical Director Peter Meierhans – Director of Sales Putzbrunner Str. 114, 81739, München, GERMANY PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND

24hr tel: +49 89 613 72103 email: [email protected] tel: +41 333 333 333 email: [email protected] fax: +49 89 613 72106 website: www.FlyEuroLink.de fax: +41 44 654 3590 website: www.rega.ch

FAI – rent-a-jet AG Tyrol Air Ambulance Volker Lemke – Director Sales & Marketing Jakob Ringler – Managing Director Flughafenstrasse 100, D-90268 Nuremberg, GERMANY PO Box 81, A-6026, Innsbruck Airport, AUSTRIA

tel: +49 911 36009 31 email: [email protected] tel: +43 512 224 220 email: [email protected] fax: +49 911 36009 59 website: www.rent-a-jet.de fax: +43 512 288 888 website: www.taa.at

German Red Cross Air Ambulance Service Aero Jet International Andreas Speich – Managing Director Stuart Hayman – President 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

IAS Medical Air Ambulance International George Ditchburn – Operations Manager Mr Peter Veazey – CEO (NORTH AMERICA) 145-157 St John Street, London, EC1V 4PY, UK P.O. Box 1044, Magnolia. Texas 77353, USA

tel: +44 870 042 1465 email: [email protected] tel: +1 832 934 2390 email: [email protected] fax: +44 870 042 1480 website: www.iasmedical.com 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. Irena Dimitrijevic – Marketing & Sales 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

Mayoral Executive Jet Air Ambulance Specialists Juan Carlos García Caparrós – Commercial Director Tom Cox – Director of Business Development Dominguez Toledo S.A., 118 La Orotava, Malaga 29006, SPAIN 345 Inverness Drive South, Suite A110, Englewood, Colorado, 80112, USA

tel: +34 952 048 609 email: [email protected] tel: +1 720 875 9182 email: [email protected] fax: +34 924 048 612 website: www.mayoralaviation.com fax: +1 720 875 9183 website: www.airaasi.com

Medic’Air International CATEGORY KEY CLAIMS MANAGEMENT INSURERS AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Dr Herve Raffin – General Manager AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE tel: +33 141 72 1414 email: [email protected] CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS fax: +33 148 57 1010 website: www.medic-air.com COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 42 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

AirMed International LLC Emergency Assistance North America Inc. Jeffrey T Tolbert – President Jaime Perez – Operations Manager 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA 580 St. Andrews Pl., West Vancouver, B.C., V7S 1V8, CANADA

tel: +1 205 443 4840 email: [email protected] tel: + 1 604 922-4443 email: [email protected] fax: +1 205 443 4841 website: www.airmed.com fax: +888 572-9956 website: www.eanorthamerica.com (AMERICAS) European Air Ambulance Global Excel Management Patrick Schomaker – Director Sales & Marketing Michael Drew – Vice-President Sales AIR AMBULANCE 73 Queen Street, Sherbrooke, QC J1M 0C9, CANADA

(NORTH AMERICA) 175A, rue de Cessange, L-1321, LUXEMBOURG 17548 Deer Isle Circle, Winter Garden, FL 34787, USA 24hr tel: +49 711 7007 7007 email: [email protected] tel: +1 866 566 1130 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +1 819 566 8335 website: www.globalexcel.ca ASSISTANCE COMPANIES ASSISTANCE Global Jetcare, Inc. On Call International Bart Gray – President Michael J. Kelly – President & CEO 16479 Runway Drive, Brooksville, FL 34604, USA One Delaware Drive, Salem, NH 03079, USA

tel: +1 352 799 7771 email: [email protected] tel: + 888 289 0567 email: [email protected] fax: +1 352 799 7776 website: www.globaljetcare.com fax: +1 603 328 1770 website: www.oncallinternational.com

JET ICU OneWorld Assist Mike Honeycutt – President Taka Katsube – Director Assistance & Cost Managment 2561 Rescue Way, Brooksville, FL 34604, USA 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA

tel: +1 352 796 2540 email: [email protected] tel: +1 604 303 2113 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com fax: +1 604 276 4593 website: www.oneworldassist.com

LIFESUPPORT Patient Transport SelectCare Worldwide Graham Williamson – CEO NEW Magdi Riad – President #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: +1 866 554 3817 email: [email protected] tel: +1 416 340 7265 email: [email protected] fax: +1 877 288 2908 website: www.LifeSupportTransport.com toll free: +1 866 261 6718 website: www.selectcareworldwide.com

Skyservice Air Ambulance Asia Assistance Partners David Ewing – VP International Market Development Siriporn Wongurai – International Operations Director YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), 184/235 Forum Tower, 36 Flr Ratchadapisek Rd Huaykwang, Bangkok 10320, H9P 1A2, CANADA THAILAND tel: +1 514 497 7000 email: [email protected] tel: +662 645 3733-5 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +662 645 3732 website: www.aapartners.net

AIMS Assistance Online Bernadette Breton – Managing Director (AUSTRALASIA) Bertrand Guichoux – CEO Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA

tel: +00 27 11 783 0135 email: [email protected] tel: +86 21 6104 9500 email: [email protected] (AFRICA) fax: +00 27 11 783 2950 website: www.aims.org.za fax: +86 21 6104 9484 website: www.assistanceonline-china.com

AMREF Flying Doctor Service Customer Care Pty Ltd Dr Bettina Vadera – Medical Director Louise Heywood – Business Development & Marketing Manager Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA Level 3, 60 Miller Street, North Sydney 2060, NSW, AUSTRALIA

tel: +254 20 6000 090 email: [email protected] tel: +612 9202 8222 email: [email protected] fax: +254 20 344 170 website: www.amref.org fax: +612 9202 8220 website: www.customercare.com.au ASSISTANCE COMPANIES ASSISTANCE

Interhealth Technologies To have your company listed in our service directory Kevin Thomas – Director - International P O Box 3058, Bedfordview 2008, SOUTH AFRICA contact the sales department now: tel: +27 11 622 8010 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +27 11 622 8264 website: www.interhealth.net

Netcare 911 International Assistance First Assistance Brenda Durow – International Assistance Manager Mary-Jo McDonald – General Manager Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA PO Box 17-310, Greenlane, Auckland, NEW ZEALAND

tel: +27 10 209 8387 email: [email protected] tel: +64 9 356 1650 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +64 9 525 1278 website: www.firstassistance.co.nz

West African Rescue Association Global Assistance & Healthcare Florian Zagel – Managing Director Mario Babin – Chief Executive Officer Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Klotey Cresent 6, North Labone, Accra, GHANA Jakarta 12560, INDONESIA tel: +233 244 312 496/7 email: [email protected] tel: +62 21 299 78 999 email: [email protected] fax: +233 21 781 259 website: www.westafrican-rescue.com fax: +62 21 299 78 9555/66 website: www.global-assistance.net

CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES South Pacific Air Ambulance AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER Scotty Watson – Managing Director AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING NEW ZEALAND AUSTRALIA SINGAPORE ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE tel: +64 9256 9000 email: [email protected] CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS (EUROPE) fax: +64 9256 9111 website: www.spaa.co.nz COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 43

ADAC-Ambulance Service Savitar Robert Glueck – Marketing & Sales Director Lydia Semchenkova – Business Development Manager Am Westpark 8, 81373 Munich, GERMANY 25/1, 7th Floor, Trubnaya Str., Moscow, 127051, RUSSIA

tel: +49 89 76 76 52 85 email: [email protected] tel: +7 495 987 1775 email: [email protected]

(EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance (EUROPE) fax: +7 495 987 1776 website: www.savitar-gr.com

Altas Assistance SOS International Arvydas Bebravi˘cius – Managing Director Helle Drager Sandahl – Communications & Marketing Manager Lentvario Str. 7, Lt-02300 Vilnius, LITHUANIA Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: +370 5 264 4020 email: [email protected] tel: +45 7010 5055 email: [email protected] fax: +370 5 264 4021 website: www.altas-assistance.lt fax: +45 7010 5056 website: www.sos.eu

ASSISTANCE COMPANIES ASSISTANCE AP Companies COMPANIES ASSISTANCE TBS Team 24 d.o.o Natalya Butakova – Business Development Manager Edvard Hojnik – General Manger str. 9, dom 5/7, ul. Nizhnyaya Syromyatnicheskaya, Moscow 105120, RUSSIA Ljubljanska Ulica 42, 2000 Maribor, SLOVENIA

tel: +7 495 989 1120 email: [email protected] tel: +386 2618 2301 email: [email protected] fax: +7 495 989 1130 website: www.ap-companies.ru fax: +386 2618 5800 website: www. tbs-team24.com

ARC Europe SA CONNEX Assistance Middle East Hans Biekmann – Network Director Lara Helmi – International Network Director Avenue des Olympiades 2, 1140 Brussels, BELGIUM Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE

tel: +32 2 706 6660 email: [email protected] tel: +97 14 257 82 84 email: [email protected] fax: +32 2 706 6601 website: www.arceurope.com fax: +97 14 257 82 85 website: www.connexassistance.com (MID. EAST) (MID. CNAS Dr Colin Plotkin & Sons Consulting INC. Carole Luisy – Managing Director Dr Colin Plotkin – Managing Director 80 rue des alliés, 38100, Grenoble, FRANCE 27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: +33 438 49 83 49 email: [email protected] tel: +1 604 241 9677 email: [email protected] fax: +33 438 49 83 40 website: www.cnas-assistance.com fax: +1 604 241 0733 website: www.plotkinconsulting.com

DRK Assistance To have your company listed in our service directory Andreas Speich – Managing Director CATASTROPHIC Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY contact the sales department now: CLAIMS SPECIALISTS tel: +49 211 2711 2020 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +49 211 3018 0527 website: www.drkassistance.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] (AFRICA) tel: +00 27 11 783 0135 email: [email protected] fax: +420 266 799 797 website: www.1220.cz fax: +00 27 11 783 2950 website: www.aims.org.za

Global Voyager Assistance - Russia 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

Global Voyager Assistance - Black Sea ChargeCare International Olga Turubarova – General Manager Christiane Burniston – Managing Director NEW 77-79 Nezhinskaya Str., 65023, Odessa, UKRAINE Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

tel: +38 048 7373 441 email: [email protected] (EUROPE) tel: +44 1865 400 007 email: [email protected] fax: +38 048 7373 442 website: www.gvassistance.com fax: +44 845 003 9923 website: www.chargecareinternational.co.uk

Marm Assistance Marm Assistance Jill Atac – CEO Jill Atac – CEO Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +90 216 588 0588 email: [email protected] tel: +90 216 588 0588 email: [email protected] fax: +90 216 588 0602 website: www.marmassistance.com fax: +90 216 588 0602 website: www.marmassistance.com

med con team GmbH Medical Claims International Spain Michael Weinlich – Managing Director Fatima Guillen Grande – Managing Director Gerhard-Kindler-Str.8, 72770 Reutlingen, GERMANY C/Ciudad de Aguilas No.2, Local 2A, Madrid 28030, SPAIN

tel: +49 7121 433 660 email: [email protected] tel: 00 34 913 016 145 email: [email protected] fax: +49 7121 433 619 website: www.medconteam.com fax: 00 34 913 016 160 website: www.mcimanager.com

Save Assistance France CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Franck Molinier – Director of Business Development AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER 19 rue de Provence, 78310 Maurepas, FRANCE AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE tel: +33 13062 6752 email: [email protected] CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS 24 tel: +33 13062 1122 website: www.saveassistance.com COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Global Excel Management Interhealth Technologies Michael Drew – Vice-President Sales Kevin Thomas – Director - International 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA P O Box 3058, Bedfordview 2008, SOUTH AFRICA 17548 Deer Isle Circle, Winter Gdn, FL 34787 USA tel: +1 866 566 1130 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca fax: +27 11 622 8264 website: www.interhealth.net

Global Medical Management SelectCare Worldwide Raija Itzchaki – COO Magdi Riad – President

(NORTH AMERICA) 7901 SW 36th Street, Suite 100, Davie, FL 33328, USA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: +1 954 370 6404 email: [email protected] tel: +1 416 340 7265 email: [email protected] COST CONTAINMENT fax: +1 954 370 8613 website: www.gmmusa.com toll free: +1 866 261 6718 website: www.selectcareworldwide.com CLAIMS MANAGEMENT

Olympus Managed Healthcare Star Healthcare Steven Jacobson – CEO Gigi Galen – President 777 Brickell Avenue, Suite PH70, Miami, Florida 33131, USA 850 7th Avenue, Suite 803, New York, 10019, USA

tel: +1 305 530 8600 email: [email protected] tel: + 1 212 581 8228 email: [email protected] fax: +1 305 530 0766 website: www.omhc.com fax: + 1 212 581 8272 website: www.starhealthcarenet.com

OneWorld Assist To have your company listed in our service directory Taka Katsube – Director Assistance & Cost Managment 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA contact the sales department now: tel: +1 604 303 2113 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +1 604 276 4593 website: www.oneworldassist.com

SelectCare Worldwide LIFESUPPORT Patient Transport NEW Magdi Riad – President Graham Williamson – CEO #1201, 438 University Avenue, Toronto M5G 2K8, CANADA #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA

tel: +1 416 340 7265 email: [email protected] tel: +1 866 554 3817 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com fax: +1 877 288 2908 website: www.LifeSupportTransport.com

Star Healthcare SPECIALISTS Voyageur Aeromedical Travel Gigi Galen – President Marc Lucas – General Manager 850 7th Avenue, Suite 803, New York, 10019, USA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: + 1 212 581 8228 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

fax: + 1 212 581 8272 website: www.starhealthcarenet.com COMM. REPATRIATION fax: +44 (0)117 925 5940 website: www.voyageur24.com

UnitedHealth International ADAC Philip Brun – Vice President of Sales & Service Christoph Ullrich – Director of Purchase / International Network 3100 SW 145 Avenue, Miramar, FL 33027, USA Am West Park 8, 81373 Munich, GERMANY

tel: +1 954 378 0694 email: [email protected] tel: +49 89 7676 2912 email: [email protected] fax: +1 954 378 0771 website: www.uhgi.com 24hr Alm: +49 89 7676 5005 website: www.adac.de/ambulance TRANSPORT Global Assistance & Healthcare Lufthansa Medical Services Mario Babin – Chief Executive Officer Doris Ehring – Manager Sales & Marketing Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Lufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, Jakarta 12560, INDONESIA Frankfurt/Main, GERMANY tel: +62 21 299 78 999 email: [email protected] tel: +49 (0)69690-20904 email: [email protected] fax: +49 (0)69690-58147 website: www.dlh.de fax: +62 21 299 78 9555/66 website: www.global-assistance.net PATIENT CARE CRITICAL

Global Excel Management Albin Repatriation Ltd Michael Drew – Vice President of Sales Emerson De Luca – General Manager 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA 83 Westbourne Grove, Bayswater, London W2 4UL, UK 17548 Deer Isle Circle, Winter Gdn, FL 34787, USA tel: +1 866 566 1130 email: [email protected] tel: +44 20 7313 6920 email: [email protected]

CLAIMS MANAGEMENT fax: +1 819 566 8335 website: www.globalexcel.ca fax: +44 20 7313 6999 website: www.albininternational.com

To have your company listed in our service directory ANUBIS International Repatriation Fabrice Kana – Development & Quality Manager contact the sales department now: Tour Pleyel, 93200 Paris, Saint Denise, FRANCE

[email protected] or telephone: +44 (0)117 922 66 00 FUNERAL DIRECTORS tel: +33 149 195 960 email: [email protected] fax: +33 149 471 901 website: www.anubisgroup.org

CATEGORY KEY CLAIMS MANAGEMENT INSURERS Funeral Home AURIGA Ltd. Helen Pradova – Chief of International Department AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMMERCIAL AIRLINE B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER tel: +420 724 257 899 email: [email protected] INTERIOR SPECIALISTS fax: +420 416 735 800 website: www.funeral-assistance.cz AIRCRAFT PERFORMANCE CRITICAL CARE SOLUTION PATIENT TRANSPORT MEDICAL SCREENING Funeralcare International ASSISTANCE FUNERAL DIRECTORS RE-INSURANCE COMPANIES Louisa Killen – Repatriation Specialist CATASTROPHIC CLAIMS Murray House, 50 Whitta Road, Manor Park, London, Essex E12 5DA, UK SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS WEB & DESIGN tel: +44 20 8788 5303 email: [email protected] COST CONTAINMENT HOSPITALS SERVICES fax: +44 20 8788 2525 website: www.co-operativefuneralcare.co.uk call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 45

John Allison Monkhouse Co., Ltd (Thailand) Medical Wings Apple Kaewprasert – General Manager Dr Sommart Somsiri – Medical Director President Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton 222 Room 3259, Bangkok Int Airport, Viphavadee-Rangsit Rd, Sikan, Don Muang,

Klongtoey, Bangkok, THAILAND (ASIA) Bangkok 10210, THAILAND tel: +66 2382 5345-7 email: [email protected] tel: +662 247 3392 email: [email protected] fax: +66 81 584 5942 website: www.monkhouse.com.au fax: +662 535 4355 website: www.medicalwings.com

Lutece International Medic’Air International 每递安国际 Zouhaier Hertelli – Repatriation Specialist Dr Huaqun Gao – Medical Director 56 rue Olivier de Serres, 75015 Paris, FRANCE 885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA

tel: +33 1 56 08 00 23 email: [email protected] tel: +86 2163 558289 email: [email protected] FUNERAL DIRECTORS fax: +33 1 56 08 00 43 website: www.pflutece.com fax: +86 2163 558285 website: www.medic-air.com

Rowland Brothers International 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] (AFRICA) tel: +254 20 6000 090 email: [email protected] fax: +44 20 8684 8000 website: www.rowlandbrothersinternational.co.uk fax: +254 20 344 170 website: www.amref.org

BUPA Cromwell Hospital To have your company listed in our service directory Shams Maladwala – Commercial Director

Cromwell Road, London SW5 0TU, UK AIRLINES COMMERCIAL ON ESCORT MEDICAL contact the sales department now: tel: +20 7460 2000 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 (EUROPE) fax: +20 7835 2444 website: www.cromwellhospital.com HOSPITALS HOSPITALS Xanit Hospital de Benalmadena Redstar Aviation Dr. Juan Bosco Rodriguez Hurtado – Director Mustafa Atac – CEO Avda. Los Argonautas, Benalmadena, 29630 Malaga, SPAIN Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +34 952 367 190 email: [email protected] tel: +90 216 588 0216 [email protected] (EUROPE) email: fax: +34 952 367 191 website: www.xanit.net fax: +90 216 588 0225 website: www.redstar-aviation.com

Baptist Health Int. Center of Miami Voyageur Aeromedical Travel Yohandra Fuentes – Finance Manager Marc Lucas – General Manager 8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: +1 786 596 2373 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

(AMERICA) fax: +1 786 596 5979 website: www.baptisthealth.net/international fax: +44 (0)117 925 5940 website: www.voyageur24.com

Integrated Healthcare Services Air Ambulance Network Brenda Escobar - International Program Coordinator Kirk Pacheco – President 450 E. Las Olas Blvd., Ft. Lauderdale, FL 33301, USA 905 Martin Luther King Jr Drive, Suite 330, Tarpon Springs, Florida 34689, USA

tel: + 1 305 222 6750 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected] tel: + 1 305 222 6751 website: www.hcaeastflorida.com fax: + 1 727 937 0276 website: www.airambulancenetwork.com (N AMERICA)

Jackson Memorial Hospital International AMREF Flying Doctor Service Luis Felipe Arango – Vice President of International Business Dr Bettina Vadera – Medical Director Jackson Medical Towers, East Tower, Suite 829, Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA 1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA 24hr tel: + 1 305 355 1212 email: [email protected] tel: +254 20 6000 090 email: [email protected] tel: + 1 305 355 5544 website: www.jmhi.org fax: +254 20 344 170 website: www.amref.org

University of Miami Health System StandbyMD Jose Quesada M.D., M.B.A. – Director Finance & Operations Alex Sánchez – Managing Director 1099 N.W. 14th Street, Miami, Florida 33136, USA 777 Brickell Avenue, Suite 1370, Miami, Florida 33131, USA MEDICAL PROVIDER tel: +1 305 243 9100 email: [email protected] tel: +1 305 459 4882 email: [email protected] fax: +1 305 243 9101 website: www.uhealthinternational.com fax: +1 305 421 5575 website: www.standbymd.com

To have your company listed in our service directory Voyageur Aeromedical Travel Marc Lucas – General Manager contact the sales department now: Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK TRAVEL TRAVEL [email protected] or telephone: +44 (0)117 922 66 00 AGENTS tel: +44 (0)117 927 3554 email: [email protected] fax: +44 (0)117 925 5940 website: www.voyageur24.com

CareFlight Group V Creative Design Medical and Tasking Centre Steve Annette – New Media Director PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

24hr tel: +61 7 5553 5955 email: [email protected] tel: +44 (0)117 929 4636 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com fax: +44 (0)117 925 2040 website: www.vcreativedesign.co.uk ADVERTISING WEB & MEDIA

CareFlight International CATEGORY KEY CLAIMS MANAGEMENT LEGAL SERVICES AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE Sue Robshaw – Co-ordinator AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING AUSTRALIA ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE

MEDICAL ESCORT ON ON ESCORT MEDICAL tel: +61 1300 655 855 email: [email protected] CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS fax: +61 2 9689 2744 website: www.careflight.org COMMERCIAL AIRLINES COMMERCIAL COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 46 REGULARS

GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • • GRAPEVINE Grapevine

camera was in a waterproof casing, such as those The investigation began when he searched for image of a diver entering the water in front of Owner reconnects used by scuba divers, and the latest image on its clues from the pictures stored on the memory a building that Shultz found using Google Earth, memory card was dated November 2009, implying card: one of two men in wetsuits in which a part of and a picture of a child watching a Continental with camera that the camera and its owner had parted company a logo was visible, and the other of some children aircraft, which he identified from its registration many months earlier. Paul Shultz, who also happens at a school. Shultz visited a scuba diving website to number and found was in Aruba on the date In a story that will warm hearts, a member of online to be a criminal investigator for the US Coast Guard, ask for help, and initially, none was forthcoming. that the picture was taken. Scultz then visited cruise forum Cruise Critic recently found a camera took on the challenge of reuniting the camera with However, one online member saw that behind Aruba.com, and met a woman who recognised that had washed up on the rocks of the local marina its owner, and, with a combination of his own the children was writing on the wall in Dutch – the the family in the pictures, and met them to in Key West, Florida and attempted to find its owner ingenuity and the power of the Internet, he was Great Cookbook of Schakel – which is in Aruba. let them know their camera had been found. – the lengths he went to are quite astonishing. The successful. Another clue then pointed towards Aruba – an They confirmed that they had lost the camera • GRAPEVINE while diving in Aruba in November, when they GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPE- VINE • GRAPEVINE • GRAPEVINE were trying to salvage an anchor from a ship that was sunk during World War I. The family was happily reunited with their camera. US airline loses guns

It seems that not even security forces are immune from security lapses – officers from Israeli security force Shin Bet were the victims of mishandled baggage recently, when a bag belonging to agents travelling with the Prime Minister was flown from New York to Los Angeles instead of to Washington. Normally, a lost bag wouldn’t cause too much upset – annoyance, but not upset – however, this was no normal bag … it contained four 9mm Glock handguns, which are now missing. A spokesman for Shin Bet told the AP news agency that it was not known whether the guns went missing before or after the luggage was put on the wrong flight. In accordance with security procedures at New York’s JFK airport, the guns were placed in hold luggage, which was then supposed to be put on a flight to Washington, but American Airlines workers instead sent it across country to LA. By the time the luggage had been located, the guns had disappeared. Look out for local laws

Tourists be warned: mayors of towns the length and breadth of Italy are producing new and controversial laws that take advantage of a 2008 ruling that frees authorities to enact ordinances for ‘all that which could affect public order and security’. La Stampa, an Italian newspaper, has said that at the last count there were 150 new local prohibitions, which include the banning of kissing in cars in Eboli, south of Naples, while in Lucca, Tuscany, it is now illegal to open a kebab shop. In the capital, meanwhile, police are quite relaxed about motorists running red lights, but if they catch someone eating in the street (gasp), then they will hit that person with a fine. The council of Eraclea has banned the removal of shells and sand from the beach, which many children and adults do as a way of remembering their holidays – and even those who build sandcastles or play with a ball on the beach are also going to fall foul of the law. Other laws that tourists could well break include the one in Lerici, where you are not allowed to hang your towel out to dry from the window. Who knew you were not allowed to feed the pigeons in Venice? Fashionistas look out – women have been banned from wearing wedges in Positano and on the island of Capri!

• GRAPEVINE • GRAPEVINE • GRAPEVINE • International Travel Insurance Journal ONTHEMOVE 47

Dynamiq captures talent Quadra team grows AXA promotions

Dynamiq, an Australia-based international emergency for Customer Care as a medical advisor, for the UK-based AXA has announced that Francois Pierson will fully management specialist, has welcomed several Careflight service and for the Royal Flying Doctors Quadra Claims dedicate himself to his role of global head of AXA’s new recruits for the launch of what will be a major service in remote Queensland and Western Australia. Services has property and casualty insurance operations, and that undertaking by the company – its global emergency He is currently a practising intensive care specialist at announced that Nicolas Moreau will become chief executive officer assistance capability. the Gold Coast Hospital in Queensland. Iain Johnston of AXA France. Paul Evans, meanwhile, has been Janine Benson has been appointed director of Christine Jones has been appointed as operations has joined the appointed as chief executive officer of AXA UK and emergency assistance. She has been heavily manager. As a registered nurse with a variety of business as a will also join the company’s executive committee. involved with the emergency assistance industry additional health qualifications and a BHSc (Mgmt) senior adjuster, Commenting on the moves, chairman and CEO of since its earliest days in Australia. In her 13 years at degree, Chris spent many years in the NSW hospital to further AXA Henri de Castries said: “Francois Pierson has Customer Care, Janine built a very profitable and system before getting involved in the emergency strengthen done a fantastic job at the helm of AXA France, and highly regarded business unit with 100 per cent assistance industry in 2001. Due to her extensive the depth of I am very pleased that our property and casualty client retention in her time as operations manager. management experience, Chris excelled in various expertise on operations across the world will now fully benefit

She also recruited, trained and managed a team roles and functions within Customer Care during her the team. A Iain Johnston from his expertise and vision.” He went on to add: of professionals that delivered 24/7 emergency nine years with the company. chartered loss “Over his 19-year experience at AXA, Nicolas assistance services to travellers around the globe Shirley Thompson has been appointed as senior adjuster with Moreau has shown great leadership and strategic whenever they needed it – including events such as registered nurse. She has a wealth of travel 13 years of experience in the UK and international insight. I am convinced he will leverage his very deep 9/11, the Bali bombings, and Bangkok riots. Janine assistance and medical repatriation experience, and arenas, Johnston joined Quadra from Concordia, and knowledge brings the key members of that team of professionals has played a vital role in managing Omega Assist has previously held roles at Carr Greenwood Smith of the group with her to Dynamiq. for 13 years. Shirley brings her extensive skill set and Chubb Insurance. In his new role with Quadra, and its values Dr Jonathan Field has been appointed as medical and experience to the day-to-day operations of Johnston will be based in London and work closely to successfully director. Jon qualified from Manchester University in Dynamiq to help solve the immediate needs of with Graham Canford Smith and Chris Rechtern. continue to 1990, has specialist qualifications in intensive care, travellers requiring assistance. Cranford Smith commented on the appointment: develop AXA emergency medicine and retrieval medicine, and Dynamiq’s growing client base includes BHP Billiton, “Our ambition in founding Quadra is to build a claims in France and has been involved in the international emergency Rio Tinto, Reuters, GE, Woodside, British Gas, The management practice which could rival any firm in to continuously assistance industry for 10 years. Jon has worked ABC, Sundance and the Australian Government. the UK on a professional level. We are therefore improve the delighted to bring Iain into the business, where his quality of the international experience dealing with major brokers services we and insurers, as well as large technical claims, makes provide to our him a hugely valuable addition.” nine million Global Life appoints regional CEOs clients.” Nic Moreau

Zurich Financial Services independent financial adviser/broker pillar for Global Group has announced Life in the US, has become the CEO of Global the appointments of four Life North America. In his newest role with the Asian appointment regional chief executive company, Dietz will be responsible for all of Zurich’s officers (CEOs) within life insurance businesses in the US and Canada. for Assist America Global Life Europe, Asia Last but not least, Jose Orlando, who was already Corporate Traveller Pacific and the Middle given the position of CEO of Global Life Latin Assist America has announced that Steven L. East, North America, America in January this year, will now report Novkov has been appointed as the company’s chief hires Richardson and Latin America. directly to Kevin Hogan. representative in Asia. Based in Thailand, Novkov David Sims, who is In another Zurich appointment, Dan Dunmoyer has will have the responsibility for Assist America David Richardson has been appointed as head currently CEO of Global been chosen as head of government and industry business in the Philippines, Indonesia, Thailand of account management at specialist travel Life Emerging Markets, affairs (GAIA) for the Americas with immediate and China, as well as for regional expansion of management company Corporate Traveller. He has been appointed effect. In his new role, Dunmoyer will lead Zurich’s strategic partnerships. The Assist America group of brings with him six years of experience in corporate to the newly created entire state and companies already has a strong presence in the Asian sales, having been part of sister company FCm position of CEO of Dan Bardin federal legislative marketplace having established relationships with Travel Solutions since 2004, when he joined as Global Life. In his new and regulatory several insurance companies. business development manager. role, Sims will have management responsibility for all affairs activities in Novkov is fresh from a long and distinguished In his new role with Corporate Traveller, Richardson the businesses in Europe, focusing on cross-border the Americas. He career at CIGNA International, where for more will be tasked with strengthening client relations to sales and executing ongoing strategic initiatives. will report to Paul than 40 years he managed life and non-life business ensure account retention, as well as investigating Meanwhile, Dan Bardin, currently CEO of Global Life Hopkins, regional throughout the Far East at a senior level. George new business within current client portfolios. He Asia Pacific, has been appointed to the newly created chairman of the Howard III, president and chief executive officer said: “We are also looking to introduce other parts position of CEO of Global Life in Asia Pacific and the Americas, as well as of Assist America in the US, commented on the of our parent company Flight Centre’s business Middle East. In addition to his current responsibilities Peter Buomberger, appointment: “Asia represents an enormous to Corporate Traveller clients in order to grow for executing the group’s strategies across all Life Zurich’s group head opportunity for our business. Steven Novkov has the additional revenue. For example, additional MICE businesses in Asia, Bardin will also oversee expansion of GAIA, and will nuanced insights and expertise that can only come business via CiEvents, Travel Club membership, in the Middle East, reporting to Kevin Hogan, CEO of be located in Los from years of working as an executive in the Asian which enables client’s employees to benefit from Global Life. Angeles, California, insurance industry. He will no doubt be invaluable in special holiday deals, and employment office, a

Elsewhere, David Dietz, currently head of the David Sims US. helping [us] to reach our potential in the region.” specialist recruitment marketing organisation.”

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