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ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS JULY 2008 • ISSUE 90 Indians inspired A recent report has shown that the travel insurance industry is fast gaining ground in India, where more people are travelling further afield than ever before. James Wallis checks out the research

Express Travelworld, an Indian magazine aimed at travel industry professionals, has reported that penetration into the market for travel insurance has an annual growth rate of around 20 per cent, from Rs1.5 billion (US$5.8 million) in 2006/07 to Rs3 billion in 2007/08. The publication cited an unnamed industry insider as saying: “The reason for the low penetration of travel insurance is excessive regulation related to who can sell it and remuneration given to the people selling it. For example, the remuneration given to insurance and corporate insurance agents is 15 per cent, while continued on page 9

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

Following the suspension, further inspections of the company headquarters were undertaken, which, according to the FAA, turned up more serious problems than those previously cited, leading to the revocation of the licence. Kathleen Bergen, a spokeswoman for the FAA’s southern region, said: “Our findings as part of that investigation indicated that revocation was in order as opposed to the suspension.” The emergency revocation letter from the FAA cited 14 different air traffic safety violations, which included flying an aircraft that had not been deemed safe to fly, failure to follow The devil is in the detail weight guidelines, deceptively recording maintenance The recent case in the UK of a man having his The debate was ignited when Insure and Go £1,000; and in most cases he was able to give details shortfalls, allowing pilots to make international flights travel insurance claim investigated because he gave received a claim from a young man who had been of the price of the item, brand name, whether it without proper training or certification, and allowing ‘too much detail’ has sparked controversy over travelling in South America when his backpack, which was bought on card or with cash and the place and pilots to fly after they had failed required tests. In what constitutes an overly accurate, and therefore contained mostly clothes, was taken from a bus month in which the item was purchased. Now, it is conclusion, the letter stated: “Air Trek’s systematic possible fraudulent, claim. Mandy Aitchison station in Peru. He sent a list of the items that had fair to say that some insurers might want to give this non compliance with regulatory requirements in reports on the case been stolen to the insurer, which totalled around claimant a hearty pat continued on page 9 unacceptable and a danger to the flying public.” 2

IN THIS ISSUE ITIJ CONTRIBUTORS

REGULARS Stewart Farr is a freelance journalist with 30 News continued 4 years’ experience in writing on insurance matters, Company brief 8 especially in the areas of life, travel and business Editorial comment 12 insurance, investment and pension planning and in Insurance matters 9 healthcare provision. For 25 years he edited a monthly Health matters 12 journal for life insurance and pension practitioners. Air ambulance news 14 Travel matters 16 David Ing is a freelance journalist covering mainly Profile 38 travel and tourism issues in Spain. He writes on air Private Healthcare News 33 transport for a leading international news agency, as Service directory 40 well as contributing special features to Newsweek and Grapevine 46 writing in-fl ight magazine articles and guidebooks. Diary dates 46 On the move 47 Milan Korcok is an award-winning freelance health policy and economics writer who covers travel insur- FEATURES ance, public health, and medical education issues in Canada and the US. He has been writing about health News analysis: Can’t take the heat 18 fi nancing and policy issues in these countries since the Milan Korcok details the latest developments and asks why hospitals in Canada are 1960s and is a frequent contributor to leading North refusing to repatriate patients from elsewhere in the world. American professional journals and consumer media. He lives in Fort Lauderdale, Florida. Feature: Sport: how dangerous can it be? 20 Stewart Farr guides insurers through the latest adventure sports on offer to holidaymakers, and asks whether cover should be continued for increasingly dangerous activities.

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

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

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

ITIJ TEAM

Editor-in-chief: Ian Cameron ITIJ Published on behalf of Voyageur Publishing Editor: Sarah Lee Voyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK & Events Ltd, Voyageur Buildings, Assistant editor: Mandy Aitchison 43 Colston Street, Bristol BS1 5AX, UK Copy editor: James Wallis editorial: +44 (0)117 929 4636 The information contained in this publication has been published in good Designers: Eli Butler advertising: +44 (0)117 925 5151 faith and every effort has been made to ensure its accuracy. Neither the Steve Annette fax editorial: +44 (0)117 925 2040 publisher nor Voyageur Ltd can accept any responsibility for any error US correspondent: Milan Korcok fax advertising: +44 (0)117 929 2023 or misinterpretation. All liability for loss, disappointment, negligence or Conference manager: Denise Clements other damage caused by reliance on the information contained in this email: [email protected] publication, or in the event of bankruptcy or liquidation or cessation of the Production: Helen Watts web: www.itij.co.uk trade of any company, individual or fi rm mentioned is hereby excluded. Kirsty Diclaudio Advertising sales: David Fitzpatrick design: V Creative Design Printed by Pensord Press, South Wales, United Kingdom James Miller Finance: Cathy Knott Louise Goddard WOULD YOU LIKE TO SUBSCRIBE? Copyright © Voyageur Publishing 2008. Materials in this publication may not be reproduced in any form without permission INTERNATIONAL Illustrations: Chris Duggan VISIT www.itij.co.uk TRAVEL INSURANCE JOURNAL ISSN 1743-1522

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

4 NEWS

Travel rise sparks insurance boom Bank of Ireland reviews market Thanks to affordable flight fares and the increasing claims process. As a final word of warning, travellers It has been reported that the Bank of Ireland is from the marketplace – all policies that have been sold number of people in India who enjoy a disposable were also told to check the small print. considering pulling out of the Irish travel insurance will be honoured until their renewal date. income, Indians are travelling in far greater numbers Further evidence, as if it were needed, of the growing market due to increasing pressure and competition In related news, a new survey conducted by TNS- than have ever been seen before. Industry sources prevalence of travel in India is the news that more and from online insurers. MRBI on behalf of Irish insurer Vhi has shown that place the number of people who travelled to foreign more low-cost carriers in the country are teaming up The Bank of Ireland offers a travel insurance service nearly half of all Irish tourists questioned admitted destinations from India last on request through its extensive branch network, to travelling overseas without any form of travel year at around six million, but change could be in the offing. A spokesperson insurance at all. Twenty-five per cent of those with most indicating that for the bank told insurance media that sales of travel surveyed who did have travel insurance also said the number will reach insurance are being evaluated and considered for their they had chosen the policy on price, rather than 10 million this year. profitability: “We review all our products on a regular benefits, highlighting the Bank of Ireland’s problem However, all of these extra basis, both in terms of pricing and product attributes, with travel insurance being a price-driven purchase. travellers mean more and and can confirm that this particular product is currently Furthermore, the survey stated that over €11 million more people are placing under review, given the increasing competition from was paid out to Irish tourists in 2007 for emergency themselves at risk through budget online propositions.” She added, though, medical treatment received abroad – an increase of a lack of travel insurance. that existing policyholders would not experience any 30 per cent on the previous year, and another timely To try and ensure Indians problems in terms of claims handling or advice, even reminder of the importance of medical treatment understand what travel if the review results in the withdrawal of the product protection as part of a travel insurance policy. insurance does and does not cover, a national paper has recently extolled the virtues of the cover, advising with insurance companies to offer travel insurance that Indians that it is a ‘must-have’ before embarking on includes flight delay, trip cancellation and baggage loss. international travel. Foreign visitors to the Schengen Starting the bandwagon was SpiceJet, which tied up AXA joins with countries are required to provide proof they have with Tata AIG; GoAir has now followed suit with the travel insurance before a visa is issued, which could same insurer and Deccan has said it is in the process Amadeus save an Indian family thousands of pounds in medical of hammering out the details of a deal with ICICI David Ing reports from Spain treatment and repatriation costs. As Khalid Sohail, head Lombard. A new entrant to the low-cost market, of travel insurance for Tata AIG General, pointed out Delhi-based Indigo Airlines, is also said to be looking AXA Assistance has agreed a deal with reservation to consumers: “When you travel to the US or any for a partner through which to offer the insurance. system Amadeus in Spain to offer a new dedicated European country, you are moving to a higher price Customer response to these offerings has been policy that it hopes will significantly boost insurance sales index zone. So the local mediclaim policy will not overwhelmingly positive, according to those in the through travel agents in what has traditionally been one cover you once you cross the Indian peripheries.” industry. Siddhanta Sharma, chairman of SpiceJet, said: of Europe’s weakest markets. The two companies say Sudhir Menon, head of travel insurance for ICICI “On the first day itself, we sold around 1,000 policies.” the tie-up will reach more than 9,100 points of sale, Lombard, agreed that in particular, insurance for Deccan CEO Ramki Sundaram agreed that it had enabling policies to be issued in less than 30 seconds travel to the US is imperative, as ‘it is the most been a good move by the airlines: “Passengers through the Amadeus Selling Platform, saving agents expensive place for medical treatment’. The are seeing significant relevance in these products. valuable time in having to switch to other web pages newspaper also gave consumers a guide to what is It’s not just the financial incentive, but an added or making phone calls. Amadeus already carries two covered, as well as information on how to start the attraction to passengers.” insurance companies in its system, but says the AXA policy will be the first geared especially to cancellations, offering agents a ‘very specific and easy product to sell’. The new link recognises the important role played by travel agencies as the main channel for reaching travellers, says AXA’s marketing director in Spain, Enrique Lamarca. With the cutting of commissions on airline tickets and other travel products, the income derived from insurance is becoming ‘increasingly more important for many agencies’. Yet while the number of consumers taking out holiday insurance policies in Spain is rising, they still represent less than 20 per cent, well below other European countries such as the UK. One of AXA’s main aims is ‘to increase Drivers warned the number of travellers who think spontaneously of taking out insurance when they book a trip’, said Lamarca: Expensive charges for excess waiver policies from “We have created a very fast and simple product, focused many leading car rental companies in Europe on what the travel agencies are asking of us.” could leave customers spending a lot more than The new agreement fits in with Amadeus’s they bargained for unless they take some basic objectives of offering agency clients a wider range of precautions, according to standalone excess complementary products and services that provide insurance specialist Insurance4carhire.com. The firm added value for the sector, said the company’s has issued a warning to the thousands of Brits that marketing director Iñigo García-Aranda: “We are hire cars in Europe every year to look closely at the aware of the growth in demand for travel insurance small print on the hire document or else be caught on the part of the consumer, and the income that the out by damage clauses that could lead to the person’s sale of such services generates for the agent.” card being debited for a sizeable amount. Last year Amadeus España handled more than 38 Larry Ursich, spokesman for the online insurer, told million bookings in Spain. AXA Assistance’s annual consumers: “It is essential that people hiring a car sales in the country reached €56 million. be aware that, although the vehicle is insured, the excess may not be covered. And those charges can range from £300 to a wallet-hammering £1,500.” He added that although some car rental companies do sell their own excess cover, it is often expensive and not always as comprehensive as one would hope: “Even if you pay to reduce the excess to zero, you may still be liable for damage to windows, tyres, roof and undercarriage.” Consumers were also advised to check whether the insurance covers all aspects of a planned trip – for example, whether or not it covers off-roading in Australia. Customers should also inspect the car thoroughly with a member of the car hire firm present to agree on any scratches or dents that are already there and even take pictures of the damage.

International Travel Insurance Journal NEWS 5

A match made in Mondial reports healthy growth heaven Mondial Assistance Group has announced positive and according to the firm, at the heart of this success results for the past year, with the ongoing success of is the delivery of e-commerce solutions such as the Research by a British newspaper has found that the its travel and healthcare divisions playing a strong role e-Magin Platform, which is used by more than 45 uptake of wedding and travel insurance is on the up, as in supporting the growth of the firm. Mike Webb, airlines worldwide. Throughout 2007, as was reported more couples opt to get hitched abroad. Those taking managing director for Mondial in the UK, explained in ITIJ’s Company Brief section, Mondial completed on a the plunge in the sun realise the benefits of having further: “We continue to increase our presence on all number of tie-ups with airlines to offer travel insurance cover for items such as the wedding dress, reception continents and in all of our activities. We also continue and assistance services through the airline’s websites. venue and gifts through their wedding insurance, to lay the foundations for our growth by responding Healthcare and lifecare activities also experienced strong while appreciating the need for a travel policy to to new market needs in areas such as e-commerce growth last year, remaining at the centre of Mondial cover them for travel to the wedding destination and and healthcare, and in developing markets like Brazil, Assistance Group’s development strategy. Thorough for their honeymoon. Figures show that one in five China, India, Russia and now Mexico.” research and development at the company also lead to British couples now opt to get married abroad, be it The company’s travel business has played an important new offerings on the table that had been adapted to the on a beach in Sri Lanka or in New York City, thanks to role in helping Mondial to improve its financial results, current state of play in the travel market. the fact that it can cost up to 50 per cent less than a normal wedding in the UK.

Parents reminded to buy for kids Seven Corners, a US-based travel health insurer, has issued a warning that reminds parents to purchase travel insurance for their children who have recently graduated high school or college and are planning to travel internationally this summer. Justin Tysdal, executive officer and co-founder of the Seven Corners, told worried parents: “Accidents, medical emergencies, disease outbreaks, terrorist activity, natural disasters and airline cancellations are just a few unplanned events that can put your child in jeopardy. No matter how careful your young graduate is, one simple fact remains – anything can happen when you travel abroad.” Karma weighs in again In the last issue of ITIJ, we reported that UK travel insurer Karma had criticised other insurance companies for discriminating against those people with controllable medical conditions such as diabetes by quoting higher premiums. Now, the company has highlighted another area where they think the industry is being discriminatory. According to research carried out by the company, some travel insurers are pressurising senior citizens into spending more than a week’s pension on over- inflated premiums. The firm’s research showed that there were large disparities between the cheapest and most expensive Internet-based premiums for a two-week holiday in Spain for a 65 and 66-year old – the difference was over £183, which is significantly more than a British couple’s weekly pension of £145. Brian Wright, managing director of Karma, said: “Insurers were recently criticised for not catering to the needs of elderly travellers and our research reveals just how widespread age discrimination is. Over a third will not cover those aged 65 plus and around 70 per cent refuse to cover over-75s. Those who do provide cover are quoting extortionate premiums – how can the difference between our premium of £25.03 and the most expensive at £208.70 be justified?” The Office of National Statistics has recently reported that life expectancy at 65 has reached its highest ever level for both men and women, and this group of people has more disposable income and more time and inclination to travel than many others. As Wright pointed out: “This age group is healthier and more adventurous than previous generations and yet many are having their pension pots raided by discriminatory insurers. My worry is that people priced out of insurance will either rely on their European Health Insurance Card, which gives very basic cover and is not accepted by private Spanish hospitals for example, or travel without any cover at all.”

www.itij.co.uk 6 NEWS

Australian legal action dropped An American man whose wife died while they to payout on the cost of the trip. Watson anguish. An initial inquiry into his wife’s death found were scuba diving on their honeymoon was seeking more than US$45,000 that equipment failure and a medical condition in Australia has dropped his intended for the trip, as well as unspecified had been ruled out as possible causes of her legal action in the US against the punitive damages for mental death, although investigations into the incident are travel agent that arranged the anguish caused by the accident. continuing, with the coroner reserving his right to trip, Getaway of Birmingham, The legal action called extradite Watson back to Australia. Alabama, and travel insurers for reimbursement for However, it has now been reported in a local paper that Old Republic Insurance Co. and accidental death, trip the action had been dismissed by Judge Ed Ramsey at Travelex Insurance Services. interruption, medical Watson’s request. In court papers, Watson referred to In March 2005, nearly two expenses, phone calls, the Australian investigation into his wife’s death, which years after Tina’s death, taxi fares, extra credit caused him to ‘reasonably apprehend that he risks self- Gabe Watson had card statements and incrimination in this case’. Watson’s lawyer in the US, intended to sue Old compensation Bob Austin, confirmed that he had dropped the case, Republic Insurance for mental while his legal team in Australia believed it ‘was not in his Co. after it refused and emotional best interest’ to pursue the damages claim. UK festival season Regulation brings opportunities starts Acumus Insurance Solutions says that travel Meanwhile, there are sounds of discontent coming Summer has officially arrived in the UK, and with firms could be missing out on a portion of from some insurers and travel firms, who are sure it comes festival season. With more music festivals general insurance market income by not being the regulation will mean that fewer companies will going on in Europe than ever before, plenty of FSA-authorised. From 30 June, applications for sell travel insurance, thus affecting the number of Brits who are fed up with three-foot deep mud at authorisation began being accepted and from people who fail to take out insurance before travelling. Glastonbury are heading off to the Continent for 1 January 2009, if unauthorised, a firm may not However, Acumus Insurance Solutions, a UK provider some sunshine and tunes. However, the problem is legally sell travel insurance. of travel insurance, says that in actual fact, through the that this group of adventurers is unlikely to take out Dan Waters, director of retail policy and themes regulation, travel firms have been given a chance to travel insurance, especially when they have already at the FSA, told firms: “Regulation is only seven capture a piece of the £42-billion general insurance spent hundreds of euros on a travel ticket. months away and firms need to make sure they are market in the UK. Acumus says that by becoming Peter Gerrard of insurance price comparison site fully prepared … firms are advised to apply early to an appointed representative, travel agents and tour moneysupermarket.com has issued a word of ensure that they are ready in good time for the start operators can significantly widen the spectrum of warning to these festival-goers, advising them to buy of the new regulation.” insurance products continued on page 9 Independent insurance to protect their mobile phones, cameras and iPods against the risk of theft or damage – both travellers warned of which occur with startling frequency at a festival. An increasing number of British tourists are leaving He also told attendees to use lockers and safes, home shores without the right travel insurance where provided, and avoid leaving expensive items policy, according to AXA. The firm’s personal in tents. “You won’t be covered if you’re just leaving insurance director, Edward Dutton, said that more them around, say, in your tent or shared room,” he tourists are organising a holiday themselves and not warned. “If you just leave them lying around then checking the terms and conditions of their insurance you’re seen to be being negligent.” policy, which would normally be done by a travel agent or tour operator. He continued: “We are aware from our own claims area that independent travellers have run into problems with their travel insurance.” He warned independent travellers to Poolside gadgets take extra care when choosing their travel insurance policy in order to ensure they are completely warning protected in the event the airline they are using folds. Chris Price, head of Direct Line Travel Insurance, Chris Rolland, head of American Express Insurance agreed that independent travellers should be extra Services, has warned that people heading abroad cautious when it comes to the small print of travel and taking gadgets with them need to make sure insurance policies: “The best way to ensure you have their travel insurance policy offers cover for the the appropriate cover is to contact your insurers items. The advices comes at a time when laptops and discuss the cover you need for the activities and and BlackBerries are fast becoming regular poolside equipment you are likely to use.” accessories – one in seven Britons surveyed said they use either one or both to keep in touch with the office while they are abroad. One in five workers Sabbaticals on the up claim they are never able to switch off; it ‘fills them UAE terror risk with dread’ that they are contactable 24/7, yet 82 Recent research by online travel organisers Hostel careers is exactly what they need to get re-energised per cent of workers are using portable technology Bookers has found that almost one third of British and re-motivated with regards to work. And 22 per changed while on holiday. respondents planned to take an extended break cent of those asked said they were feeling bored Rolland said: “The fact that workers are able to from their working lives in 2007 in order to take a and disheartened by work, meaning that more and British nationals in the UAE have been warned that carry their emails and work around with them even gap year or sabbatical – this figure is double that of more people could be taking a long break from their there is now a high risk of a terror attack occurring in when they’re not in the office means that mobile 2003. The research also showed that 27 per cent working life this year as well. the region, according to the website of the Foreign technology is not necessarily saving time, but in some of people who were asked think a break from their Chris Rolland, head of American Express Insurance and Commonwealth Office (FCO). The travel cases it is extending the workload.” He continued: Services, commented on the research: advisory states that terrorists could be planning “Before going on holiday, Brits should check their “As an increasing number of Brits take a ‘indiscriminate’ attacks in places often frequented by insurance policies to make certain their poolside break from working life to embark on expatriates, of which there are millions in the area. gadgets are covered up to their maximum price, just a sabbatical or gap year, it is important The advisory did not, however, state the reason for in case they are ruined with a splash.” they get the right type of gap year the change in the level of warning from ‘general’ to travel insurance to suit their needs. For ‘high’. instance, our new gap travel insurance The advice on the website makes it clear that attacks covers people for up to two years in could happen at any time and could target residential order to help those who gain two- compounds where there are large numbers of year visas for a country. It also allows western expatriates, as well as military, oil, transport people to return to the UK for a and aviation interests. It issues a warning to both period of 14 days in case travellers feel tourists visiting the region and people living there homesick, need to re-take exams or that: “You should maintain a high level of security attend a special family occasion.” awareness, particularly in public places.”

International Travel Insurance Journal NEWS 7

Older travellers still New tourist danger in Italy denied cover A spate of Mediterranean cruise when they stopped at Rome’s The couple awoke from their drugged sleep the next robberies and Tiburtina station. morning to find their luggage and valuables had been Intune, the financial services arm railway thefts The chief of Rome’s railway police, Felice Addonizio, taken. Phel told his wife he would go and find the of UK charity Help the Aged, in Italy being said: “The couple were planning to take a bus police when, still feeling the effects of the drugs, he has performed research that carried out from outside the station the next morning to go to walked onto the tracks, where he was killed by the shows holidaymakers over the using drugs to Hungary, but did not know Rome and were fearful of Rome-Florence train. Police believed the event was age of 80 are still marginalised by overpower leaving the station, so planned to get some sleep in suicide until they found his wife asking the bus driver insurers because most policies still victims has the waiting room.” The waiting room is recognised to delay departure to Hungary so that she could impose an upper age limit. The resulted in as a magnet for petty thieves, which is where the continue to search for her husband. researchers examined 495 travel the death of couple were when the incident began: “There Police said that elsewhere in the country, gangs using insurance policies and found that an elderly was a rough crowd arguing in the waiting room at narcotic spray to carry out train robberies are also 97 per cent of them imposed American around midnight, and the couple were given some on the rise – the gangs board sleeper trains and drug upper age limits, while 75 per cent stopped cover at tourist. The man, Hungarian-born Frank Phel, was reassurance by a middle-aged man who then offered passengers in couchettes before hopping off at the the age of 65. Intune’s figures also showed that over travelling with his wife on their way back from a them both a cappuccino.” next station. the last year, over-80s had taken more than 121,000 trips, usually lasting between three and six months. Stuart Castledine, Intune’s managing director, said of the research: “We have found that older people holiday more widely than younger age groups, and for a longer time. Many people are electing to work until 70, leaving it even later in life to make the most of their retirement and leisure time though travel.” Despite these figures, he continued, insurance is becoming ‘increasingly harder to find’. He agreed with research showing that customers over the age of 85 are eight times more likely to make a claim than those under 35, but said that this should not mean that older people are discouraged from travelling: “The over-80s traveller has particular requirements which may need accommodating, but they do not want a system that writes them off at a time when they should be enjoying life to the full.” The company’s research found only five insurers that had no upper age limit imposed on their policies.

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

www.itij.co.uk 8 COMPANYBRIEF

More options at International Medex Global TruTravel ties with Travel Insured partners sign deal acquires ASI Group aggregator

US-based Travel Insurance International has unveiled Club Méditerranée, the Europ Assistance Group TruTravel Insurance, powered by Meridian a trio of new travel insurance plans, under the (EA) and international insurer Marsh have together Management Group LLC, has recently announced company’s Worldwide Trip Protector brand. The signed a ground-breaking deal in the tourism market, a strategic marketing partnership with InsureMyTrip, new plans have stronger benefits and several new allowing the first international travel insurance the online aggregator of travel insurance offerings. options and have been dubbed Worldwide Trip scheme to be launched. It allows Club Med to offer TruTravel’s products are underwritten by Protector, Trip Protector Gold, and Trip Protector its clients, present in 21 countries, a range of policies Nationwide Mutual Insurance Company, providing Lite and Lite Expanded, giving options to customers that have been adapted to the local market and comprehensive cover to consumers. who prefer to choose the level of cost, not cover. attitudes to risk. The move will now make it possible President and CEO of the website Jim Grace Each of the three plans offers customers a ‘menu’ of to manage Club Med’s travel risks with a high degree commented: “TruTravel Insurance is a natural partner optional features that can help them to tailor their of accuracy while at the same time offering unique for InsureMyTrip, our premier travel insurance cover – options include free cover for children, cover solutions. Club Med and EA are already comparison service. We are excited that Meridian has cancel for any reason insurance and cancel for work partners in France, Belgium, Italy and the UK, but are brought two very innovative products to the market.” reasons. Other options are increased emergency now offering an international product range. Kevin Leys, president of Meridian Management medical expense benefits that include medical In France, the new packaged offer, known as Ecran Group, gave more information about the nature evacuation in an air ambulance and flight accident Total, combines the advantages of a comprehensive Medex Global Group has now formally completed of the new policies: “The combination of per-trip protection, while travellers are also given the option travel policy with a range of cover features vital its acquisition of ASI Group (formerly Air Security coverage plus year-round services with per-trip of upgrading cover to include skiing and associated to any travellers planning on participating in an International). ASI Group was founded in 1989 and cancellation, interruption and other post-departure sports equipment. adventure sport, such as a cancelled skiing holiday is based in Houston, Texas, from where it provides coverages brings a valuable package of benefits and due to lack of snow. global risk management services, including business services to the traveller’s lifestyle.” Club Med said that the intelligence and investigations, emergency evacuations agreement will enable the and crisis management. ASI currently counts eight of firm to ‘gain a valuable head the top 10 Fortune 500 companies among its clients, start in the management of sharing some of those with Medex already, with which travel-related risks’, while it has partnered for more than 10 years. Liberty Mutual EA said it demonstrated Medex CEO Bruce Kirby said of the deal: “By adding boosts value the group’s ‘capacity for the international security resources and expertise of ASI innovation and dynamism Group to Medex, we can provide our customers with US-based Liberty Mutual has, for the first time, when it comes to an enhanced, fully-integrated travel protection solution.” introduced a comprehensive suite of travel assistance supporting all of its clients Although the exact terms of the agreement were not services that have been made available to employees internationally’. The entire disclosed, it is known that ASI Group will retain its covered under the firm’s group life insurance network of Marsh was party name and locations, under the continued direction of policies, whether they are travelling for business to the development of the president Charlie LeBlanc and the management team. or pleasure. Liberty Mutual has a global network scheme to enable Club It will operate as a wholly owned subsidiary and the that helps stranded travellers with everything from Med to use its resources combined company will employ close to 200 people. replacing lost prescriptions and passports to handling and expertise in the risk Speaking after the announcement had been made, complex medical emergency evacuations. management field. LeBlanc said: “This is an outstanding fit for ASI Kevin Krzeminski, senior vice-president of Liberty both strategically and operationally. Becoming part Mutual’s department of group life services, said: of Medex Global Group will only strengthen our “Beyond financial protection, a Liberty Mutual group position in the marketplace and provide our clients life policy now helps an employee weather some of with a truly robust set of services.” travel’s toughest moments. Adding travel assistance through the group life policy is an easy way for THERE IS LIGHT ON THE HORIZON employers to strengthen their benefit programmes.” Marcus Hearn The travel assistance services include medical evacuation, medical assistance, security and political launches new cover evacuation, lost documentation and destination information so employees can find the latest on their A new travel policy has been launched by UK-based destination’s weather, immunisation requirements, Marcus Hearn, which aims to provide a competitive culture and currency. The scheme is run in contract for both holidaymakers and business travellers partnership with Medex. that is flexible enough to enable the cover to be extended, if needed, to cover adventurous activities. The policy can also be adjusted to specific business needs, for example to cover a business trip where possibly dangerous manual work is being undertaken, and Marcus Hearn has said it will even cover travel to Iraq and Afghanistan. Dean Atkin, spokesman for the company, said: “We believe there is a definite need in the marketplace for a policy that not only > worldwide AIR AMBULANCE OPERATOR provides a competitive contract for standard > worldwide REPATRIATION & MEDEVAC travellers, but can also cover both hazardous activities and destinations.” > worldwide AIRLINE STRETCHER SERVICE > worldwide MEDICAL AIRLINE ESCORTS > worldwide BED-2-BED TRANSPORTS LV= introduces policies > PERSONAL MEDICAL CONSULTANCY British insurer Liverpool Victoria (LV=) has revealed able to tailor cover to what they need – be it cover that it will soon launch two new travel insurance for an illness, golf clubs, winter sports or weddings. 24 / 7 available for those in need! products, one providing annual cover and the John O’Roarke, managing director of LV= general other offering single-trip cover. Both policies are insurance, said: “Many travellers with medical comprehensive and include as part of their benefits conditions struggle to get travel insurance as many Tel: + 43 1 600 1212 £10 million in medical cover, £2,500 personal insurers don’t offer cover. Our policies will enable based in: VIENNA (LOWW/VIE), AUSTRIA possessions cover, £500 for loss of money, £5,000 customers in this situation to go away safe in the for cancellation and £250 for delays. The policies knowledge that they are covered if they fall ill while www. medicaljetservice.com will also both offer customers insurance for delays or overseas.” He continued by saying the policy could injuries caused by a terrorist attack. The insurer has be purchased online, ‘so there is no need for a designed the plans top be flexible and customers are lengthy telephone interview’. MJSlightonhoriz76.indd 1 24/4/07 16:01:04 International Travel Insurance Journal INSURANCEMATTERS 9

Sichuan quake The devil is in the detail continued from page 1 could cost €1 billion on the back and thank him for all the detail – after According to Insure and Go, though, a great deal of prepare themselves to be scrutinised by insurers, the all, they are quick enough to deny a claim for not detail about low-value items can indicate possible companies must have evidence that fraud has been Munich Re has estimated that the 7.9-magnitude containing enough information. However, Insure and fraud, and said it had several concerns about this attempted before they are allowed to refuse a claim. earthquake that struck China in May could cost Go took a slightly dimmer view, and wrote to him particular claim, one of which was the unusually He continued with reference to the current claim: “If the insurance industry between €300 million and explaining that it would not cover any item for which complete detail for the items. Perry Wilson, the that comes as a dispute to us, we’d be saying to the €1 billion in insured damages. The firm said it he could not provide reasonable proof that he had company’s founder and owner, said all insurers must insurance company: ‘Why would there be fraud in this expected its own costs related to quake damage owned or bought. The firm wanted to see receipts, be vigilant to possible fraudulent claims: “Sometimes case, where’s the proof of it?’” Industry sources agreed to be in the ‘low to mid two-digit euro range’, copies of receipts or bank and credit card statements people give too much information, which obviously that there was such as a thing as ‘the too perfect according to Torsten Jeworrek, a management for each item on the list. sparks [the question] – why would you remember all claim’, but in the vast majority of cases the opposite board member. He continued: “It’s not a big event The claimant’s mother contacted the BBC about 39 items?” He added somewhat cryptically: “Give us problem is true. And Malcolm Tarling, spokesman for for the industry with estimates of €300 million to the matter and said she had been surprised by the some meat on the bone to look at this claim, to make the Association of British Insurers, agrees that more €1 billion for the insured market loss. Economic company’s reaction to the claim: “I think it would sure we have some kind of substantiating evidence for information is better than too little: “When you lose damage of course is much worse, in the high be fairer to say they need receipts for items over it.” He did concede that in most cases, the company items on your holidays, the golden rule is to give tens of billions of euros.” Despite the fact that the a certain amount, like cameras.” She went on to would only need to see evidence for a ‘reasonable’ your insurer full and detailed information.” He added, earthquake killed at least 69,000 people and left explain why the claim had all the detail on it: “We cross section of lost items. though, that ‘companies have a responsibility to their more than five million homeless, insurance figures just felt it would be clearer for them to see what the David Cresswell, spokesperson for the Financial customers to make sure they weed out the small are relatively small due to a lack of penetration. claim was (for), not make us look suspicious!” Ombudsman Service, said that while claimants should number of claims that may be fraudulent’. The Chinese Insurance Regulatory Commission (CIRC) has called on insurers in the country to offer all due compensation to the victims of the quake. Wu Dingfu, Regulation brings opportunities CIRC chairman, said: “On disputed continued from page 6 claims, insurers should decide in favour of customers and beneficiaries. If they can offer, as well as securing and growing current with you and provide the right support in areas such relevant documents have been lost or travel insurance revenues. as training, audit, distribution systems and access damaged, insurers should still pay up if John Bibby, managing director of Acumus Insurance to complementary insurance products.” The best they offer some information. In cases of Solutions, said: “Only a minority of the more than option for most firms will be to become appointed whole families perishing, insurers should six thousand UK travel agencies have grasped the representatives, said Bibby, because ‘the travel make every effort to find any remaining implications that authorisation allows a company to sell insurance industry is full of providers who are more members.” So far, insurers say they have a range of general insurance products. The winners than happy to take their share of the spoils without received around 200,000 claims for will capitalise on significant trading opportunities; just as ever really committing to a full partnership’. quake-related damages and paid out ¥216 large supermarket chains are white-labelling financial Options offered by Bibby include the possibility million, ¥132 million of which went to life and insurance products as a source of extra income, of offering wedding insurance to people travelling claims and the remainder to property. it is the logical next step for travel organisations to abroad to get married, two weeks of medical cover tap into a broader range of insurance products.” It for a holiday could be extended to an annual private is vital, though, that the travel agents pick ‘the right medical insurance policy, or pet insurance could be regulated principal’ to be appointed to, Bibby warned offered if the pet is going into the kennel/cattery while Indians firms: “You need someone who is going to work the owner is on holiday. inspired continued from page 1 that of a broker is 17.5 per cent.” Not only is there a disparity between the commissions paid, the source continued, but the initial investment for both outlets is high, giving agents less incentive. Travel agents also have to endure the same problem, and as most do not have sufficient profit margins for large investments, most steer clear of providing travel insurance at all. The view of the industry was made clear by the same insider: “Travel insurance is a commoditised product and it is time for the travel fraternity to have talks with the regulators and treat it differently.” Solvency II more However, the report goes on to say that those insurance companies surveyed would appear to hassle than crunch prefer selling insurance online, partly because of lower overhead costs meaning the policies can be cheaper to Standard and Poor’s has said that the disruption to the end user. Other companies, meanwhile, argue that the European insurance market caused by the credit travel agents shouldn’t sell insurance as they may not be crunch is limited compared to the amount of hassle certified, do not have the expertise, or simply may not and disruption that has happened and will continue have the most appropriate products in their portfolio. to happen as a result of Solvency II. Credit analyst There are signs that the travel insurance market with the company Simon Marshall said: “To date, in India will continue its current rise, despite the the insurance operations of groups headquartered problems associated with the sale of the product. in Europe have disclosed $7-billion mark-to-market In particular, several Indian airlines, both domestic losses associated with subprime losses, but we and international, are partnering with insurers to continue to believe that the broader disruption in offer travel insurance in conjunction with booking capital markets has had a relatively minor impact on a flight. As the portion of those wealthy enough to individual industry participants.” Although a major travel in India increases, so too will the number of catastrophe could change this, he continued, as the people choosing air travel, thus increasing the size market is not in any condition to cope with massive of the market the insurers can penetrate. Insurers recapitalisation. Marshall said that Solvency II will are also interested in train travel in the country and be much more significant for the industry than the are reported to be in talks with the Indian Railway subprime crisis has been, as it will inevitable accelerate Catering Tourism Corporation to integrate a travel consolidation of companies in the region. “The results insurance offer to its online reservation systems. from QIS3 indicate to use that Solvency II would force The growing affluence of the Indian people also more than 25 per cent of Europe’s insurers to face means a rise in travellers going to Europe and the major strategic decisions,” he continued. “They may 15 Schengen countries, all of which require a travel need to reduce scale, reduce risk, raise capital, employ health insurance policy that is valid for the entire more risk mitigation, merge with other insurers, be duration of the trip before entry is granted. acquired or close to new business.”

www.itij.co.uk 10 INSURANCEMATTERS

Active hurricane Swiss Re increases Willis moves season predicted write-down Willis Group Holdings Ltd, the world’s third- largest insurance brokerage by market share, is to Although the same was predicted last year, when Swiss Re has rocked the financial world with a bigger buy smaller rival Hilb Rogal & Hobbs Co. (HRH) the hurricane season was surprisingly light, Aon than expected write-down on a troubled credit for $1.7 billion as it seeks to boost business as Corp. has warned risk managers and insurance deal that had already caused a SFr1.2-billion loss last insurance rates are softening. Willis has also said companies that they should employ robust enterprise November. The world’s largest reinsurer announced it is prepared to take on $400 million of HRH’s risk management strategies and business continuity that it is to make a further write-down of SFr819 debt in a cash and stock deal that has been valued programmes to cope with what forecasters are million on the two credit default swaps that took the at $46 per share. According to industry analysts, predicting to be an active summer of hurricanes initial hit. The latest figure was more than three times the purchase is the largest transaction for the and tropical storms. The National Oceanic and the amount the group predicted when it reported industry since Marsh & McLennan acquired the Atmospheric Administration’s updated forecast 2007 results in February this year. The increased Sedgwick Group in 1998. least 20 per cent on the back of increases of 23 per has predicted between 12 and 16 named storms write-down has pushed first-quarter net profits Willis said that the deal with HRH will help it ‘expand cent in 2006 and 24 per cent in 2007. The plan is to between 1 June and 30 November this year, and down to SFr642 million, which is well below analysts’ its footprint’ in the North American market, as increase its stake in Shanghai-based Willis Insurance other weather forecasters are in agreement. estimates and 53 per cent lower than in the same although it has headquarters in New York, the firm Brokers Co. from 50 per cent to between 80 and “While predictions of hurricane activity are important, period last year. is domiciled in Bermuda. It expects the purchase to 100 per cent in the next 12 to 18 months, according insurance and reinsurance buyers must remember Despite the bad news of the increased write-down, effectively double its revenue in the region. Once the to Sarah Turvill, chairwoman of Willis International. that any storm can cause massive destruction, chief financial officer George Quinn expressed deal is completed, the group will be known as Willis At the moment, Willis operates 20 offices across whether that storm occurs in a season of above- confidence about the business and its outlook. He HRH in North America. China, although plans are also in the pipeline to normal activity or below-normal activity,” said Steven told the Financial Times that good performance in In 2007, HRH’s revenue was $800 million, with increase the number of employees from around 200 Drews, meteorologist and associate vice-president its asset management, property and casualty and life all except $57 million of that sum derived from the to 500 by 2011. There are also signs that the insurer of Impact Forecasting LLC, a unit of Aon Re Global. and health operations had mitigated some of the North American market. It has more than 140 offices wants to set up a back-up and client services centre in Aon believes that the low severity and number of impact of the credit crunch turmoil. Jacques Aigrain, across the US as well as two in the UK. In all, the Shanghai later this year that would offer documenting, property catastrophe losses since 2006 has resulted chief executive, noted: “Despite the continuing companies will have a combined revenue of around billing and accounting support to its fast-expanding in favourable pricing for traditional reinsurance turmoil in the financial markets, we remain confident $3.4 billion, based on figures from 2007. businesses. Ms Turvill also said that the company might schemes for mid-year renewals for insurers. in our earnings power and our ability to maximise In related news, Willis has said that it is planning to expand and relocate the back-up centre to a second- shareholder returns.” have 100-per-cent ownership of its venture in China, tier city in northern or western China in 2010 in order However, figures show that where it expects annual growth revenue to be at to better serve its Greater China business. operating income in property and casualty fell by six per cent year on year, while the all-important combined ratio US chiefs predict of the firm was 96.9 per cent, up over three percentage tough times points. In addition, operating profits in the life and health A panel of American insurance executives, speaking division fell by 45 per cent to at a Standard & Poor’s (S&P) conference recently, SFr 449 million. said they see tough times ahead for the industry over the next few years, as lower prices affect profitability and a more uncertain risk landscape requires improved risk modelling. Worries from the executives include the possibility that pricing for the sector as a whole could go so low it could be undercut by claims. William Berkley, chairman of WR Berkley Corporation, said that he had seen far more severe price competition recently, adding that his company had seen an average pricing fall of around seven per Aviva to cut cent this year over figures from last year. Berkley said that the industry as a whole should break even insurance jobs this year, although it could sink into debt in 2009 as there are signs that the cost of claims could spiral out Norwich Union’s parent company Aviva has of control. For the past three years, he continued, announced that it will cut up to 1,800 jobs in the insurance rates have been softening as claims were next two years as it restructures its insurance reduced for property and casualty lines, along with operations. Although Aviva called the move few major natural disasters and several tort reforms. ‘rationalisation’, workers union Unite said the job cuts Henry Keeling, COO at XL Capital, agreed that the were ‘brutal’, adding: “This news for staff that their market will be challenging in the future, and admitted jobs are now in jeopardy is truly devastating.” that his company had also seen a decline of around Norwich Union is to shift its operations away seven per cent on business from clients renewing from cities including Glasgow, Leeds, Sheffield, policies. In his opinion, pricing is more of an issue Birmingham, Bristol and Southampton, while offices for property/casualty lines than casualty lines, or in Dundee, Ipswich, Exeter and Worthing will also be coverage for legal liability for losses stemming from affected in some way, though the company has yet to injury or damage to property of others. He went on release the details. The bulk of operations will now to say: “We have not seen wholesale deterioration in be focused in locations the firm has called its ‘seven terms and conditions for casualty.” centres of excellence’: Norwich, Perth, Bishopbriggs, Frederick Eppinger, chief executive of the Hannover Stretford, Manchester, Leicester and Southend. Insurance group, concurred: “I think with commercial [insurance], we are in for another three years of pain.” John Iten, a director of S&P, said the firm currently rates the US commercial lines as ‘stable’, but added that he sees pricing for US commercial lines falling at least throughout this year and into next, which could lead to the rating being changed to ‘negative’ as soon as the end of 2008. Laline Carvalho, S&P’s director for reinsurance, said similar concerns prevail in that industry as well. Speaking at the conference, Carvalho reported that although the reinsurance sector has a stable outlook now, and will do for the next six months; beyond that time, the rating could change if reinsurance rates continue to decline.

International Travel Insurance Journal INSURANCEMATTERS 11

Retakaful giant AIG posts Caixa Catalunya seeks partners set up record loss The recent trend among Spanish banks to it also believes the alliance with a specialist will help seek specialist partners to take a share in their give an added boost to sales of its own products Singapore reinsurer ACR Capital Holdings (ACR) has AIG has posted its biggest ever quarterly loss, due, insurance portfolios shows no sign of abating. which are currently offered under the Ascat brand announced that it is to tie-up with Malaysian national says the firm, to its continuing exposure to bad US David Ing has the details name. The proposed partnership could also open the investment company Khazanah Nasional and Dubai mortgage debts. Reporting its results for the first door to developing further types of general insurance Banking Group, which is the global Shariah-compliant three months of this year, AIG said that it made a The latest Spanish bank seeking a partner to take a policies to sell exclusively through its network of investment company of Dubai Group, to set up one net loss of $7.81 billion, disastrous in comparison share of its insurance portfolio is the country’s third 1,200 branches, it says. large retakaful company. The new company will be to the same period a year ago, when the company largest savings bank, the Caixa Catalunya, taking the Caixa Catalunya, whose president is former national called ACR Re reported a profit of place of Banco Sabadell, which is reported to have deputy prime-minister Narcis Serra, says that in Takaful Holdings, $4.13 billion. The loss attracted as many as 15 potential associates since it recent months it has already received several offers and will be based in was caused by a $9.11- began looking for a similar tie-up. from specialists and that there is ‘a lot of interest’ the hotspot of the billion charge for the As with Banco Sabadell, Barcelona-based Caixa in such a deal. The optimism seems borne out by Dubai International decline in value of US Catalunya wants a recognised insurance group the case of Banco Sabadell, which has attracted Finance Centre; mortgage products that to take an equal 50-per-cent stake in its existing widespread attention from leading domestic and with a starting AIG had insured. The business. The search is being carried out by Morgan foreign companies since it began looking for a capital of around announcement marks Stanley, with offers due to be scrutinised at the end of potential suitor, according to financial analysts. US$300 million, the second consecutive the summer. The savings bank has said it aims to use Bankinter is among the larger banks that have already it will signify the period of loss for the the deal primarily to free up capital that is currently gone down the same path. The Caixa Sabadell was creation of the company. tied up because of the regulatory restrictions on the last to close a deal when Zurich took a 50 per world’s largest As a result of the insurance companies owned by financial entities. But cent stake for €323 million in April. retakaful entity. record loss, AIG has However, the firm been downgraded by will not simply be Standard & Poor’s (S&P) one large company, – its counterparty credit as John Tan, chief ratings on AIG and M&A still hot in Asia executive of ACR, several of its subsidiaries explained: “We plan have dropped to ‘AA- Merger and acquisition (M&A) activity involving countries, combined with an emergence of a wealthy to set up retakaful /A-1+’ from ‘AA/A-1+’. financial institutions in Asia has reached unprecedented consumer class, have both created a fertile ground for businesses in S&P noted that the levels, according to the latest report by M&A activity. “The Asian consumer is already powerful Malaysia and in the company’s loss included PricewaterhouseCoopers (PwC), which Middle East as soon post-tax write downs shows that the effects of the credit crunch as possible. We of $5.9 billion related have yet to be felt in certain corners of the are in discussions to AIG Finance Corp’s world. PwC’s report, entitled Going for with regulators in super superior credit Growth in Asia: Navigating the way, states both locations and default swap portfolio that the busiest sector in terms of M&A is hope to commence and said in a statement: life insurance, with 83 per cent of those operations in the near future.” He noted that the “When combined with charges taken in 2007, this surveyed having completed a deal in the creation of ACR Re Takaful Holdings was significant brings the cumulative after-tax charges to more than past three years. In total, M&A in Asian progress for the region, as previously much of the $13 billion on the CDS portfolio and to $6.7 billion financial services was up from US$68.5 retakaful business had been given to international for impairment of investments.” S&P also warned billion in 2006 to $105.9 million in 2007. markets outside of Asia: “Establishing ACR Re Takaful that if AIG’s proposed $12.5-billion capital raising As part of the report, 281 senior Holdings will allow us to retain the business – within ends up not raising enough, then its rating could be executives were surveyed, 75 per cent of local markets and in accordance with Islamic principles.” further lowered, by as much as ‘two notches’. whom said their firm had been involved in an M&A deal in the past three years, a figure up from 73 per cent two years ago. When the question was only focused on Chinese organisations, the figure rose Premium increase in Thailand to 86 per cent, while in India activity also picked up, but not on the same scale, Insurance consumers in Thailand could well be and services charge have become more expensive. with just 66 per cent of those asked saying facing higher premiums and bigger insurance bills as Anansiriprapha was also quoted as saying that the loss they had been involved in a merger. companies there try to pass on their costs in a bid to ratio for the entire non-life insurance industry has hit Dominic Nixon, PwC Asia financial services cope with the country’s rampant inflation problems. 71 per cent, which he described as ‘code red’ – it was leader, commented: “Asian economies The Nation, an English language newspaper in Thailand, reported that some insurers had already defaulted on are in robust shape, registering only a cited Kheedhej Anansiriprapha, chief executive of payment to some garages. If prices of goods continue single-digit percentage fall in total M&A transactions in and is changing the way financial institutions operate AXA Thailand, as saying that insurers are feeling the the current rise upwards, said Anansiripraph, then an 2007, as compared to the double-digit percentages in the region. Banks and insurers are enhancing pinch as costs spiral out of control. In just a few short increase in insurance premiums of at least five per cent in Europe and North America.” He added that their investment management divisions and wealth months, the average cost of a medical bill, car part would be inevitable. steady growth in the gross domestic products of the management options.”

www.itij.co.uk 12 HEALTHMATTERS

TB patients on the loose Editoral Health authorities in South Africa have said they are to send out a team wearing protective clothing in order to hunt down some escaped hospital patients, comment all of whom are suffering from a drug-resistant I’m particularly excited strain of the tuberculosis, three of whom have the this month about our extremely infectious XDR-TB. The patient breakout features in ITIJ and PHN. was from the Jose Pearson hospital in Port Elizabeth, Following on from our where a security guard let one of the patients leave lead ITIJ story last month to go shopping. When the other patients heard about Canadian hospitals about this, they too wanted to leave, but the same hindering the repatriation security guard attempted to stop them before being process, we have an overpowered. interesting News Analysis The area’s provincial health authority says that three of feature that looks into the problem of bed the 19 patients that escaped had gone straight home shortages in the country, and asks whether to their families, who were in the process of returning hospitals in Canada could be doing more to their family member to hospital, while 12 others had service their travel insurance and assistance simply returned to the hospital itself. In December clients. Furthermore in ITIJ, we have features last year, a similar incident occurred when 49 patients on cover for dangerous sports – what is Summer warnings to tourists with drug-resistant TB escaped from the same hospital covered, what should be covered, and how by cutting through fencing; court orders had to be we convey this to travel insurance purchasers With the arrival of summer in the Northern the host nations. The Swiss health authorities have obtained in order to force the dangerous patients back – and the spread of Takaful insurance, not just Hemisphere, and the US Centres for Disease Control recommended that all visitors receive the MMR into the safety of a hospital ward. within Muslim countries but also its infiltration and Prevention (CDC) has issued a warning to (measles, mumps and rubella) vaccine. into Western banking and insurance systems. travellers of several events that will increase the rate of Meanwhile, the Olympic and Paralympic Games Takaful policies may be something you’ve travel this summer, thus increasing the risk that a bug in Beijing are expected to attract around 600,000 never considered, but you’ve probably heard could travel further. It points out that apart from the foreign visitors and athletes, in addition to the 2.5 of them, and you’re going to be hearing a lot usual travel-related health risks in the summertime, million expected domestic visitors. The CDC has a more about them if this boom continues. So, there are also two international sporting events that special webpage dedicated to giving travellers tips on what is the relevance of Takaful for the travel are expected specifically to increase travel from the US how to avoid disease risks. One risk in particular that insurance industry and what would a Takaful to certain European countries and Asia. has again been highlighted is a risk of measles – this travel insurance policy look like? We reveal all. The European football finals in Austria and year, several US residents have acquired measles as a Our PHN feature, meanwhile, looks at how Switzerland have already kicked off, and travellers result of travelling to China or because they had been the travel and health insurance industries are have been advised to ensure they are up to date in contact with someone who had. There is also a changing, growing, and converging to cater for with their vaccinations, especially for measles. So far, risk present from the hand, foot and mouth disease the growing number of global expatriates. All 2,800 people have been reported as suffering from that has made tens of thousands of people ill in China interesting stuff – I hope you enjoy this issue! measles in several European countries, including in and killed several children.

Sarah Lee Editor [email protected]

Mongolia advice update The British Foreign and Commonwealth Office addition, says the website, ‘during the summer hunting (FCO) has reviewed and reissued its advice season, there may be isolated cases of bubonic plague, for Mongolia, with amendments to its air travel although these are usually confined to the hunters’. and health sections. Although the country is not Travellers are advised to seek medical advice before considered a hotbed for tourism, figures show travelling to ensure that all appropriate vaccinations are that there were nearly 6,000 British visitors alone in place. in 2006. Despite the fact that most visits went off The FCO also warned that there are ‘some doubts’ without a problem, the most common type of about the maintenance of some Mongolian- incident that required consular assistance was for registered aircraft used by domestic airlines. lost, stolen or expired passports. With regards to health, the FCO website states: “Mongolia has occasional outbreaks of foot and mouth and other infectious diseases. During these outbreaks affected areas may be quarantined and you may not be able to travel to them. If you are in an affected area, you may not be allowed to leave.” It says that so far this year, there have been over 1,000 cases reported of people infected with foot and mouth. In

International Travel Insurance Journal

14 AIRAMBULANCENEWS

FAA criticised over Air Trek grounding Spotlight on MBB BO 105 The suspension of Air Trek’s operating licence by the inspectors are granted authority by the Administrator FAA in May has drawn criticism from the National Air to inspect, oversee and ensure compliance with the Transportation Association (NATA), who said the Federal regulations. Operators document their procedures Aviation Administration’s (FAA) recent use of emergency for compliance in various manuals that are approved suspensions ‘calls into question fairness in regulatory by the FAA via the local offi ce. Operators seek oversight of the Part 135 community when compared guidance when compliance questions arise from to their Part 121 counterparts and raises concerns about their local inspectors. Yet clearly, operators cannot the true authority given to local FAA inspectors’. rely upon what they are told by their local FAA In a letter to FAA acting administrator Robert A offi ce. Time and again, inspection teams from FAA Sturgell, NATA president James K Coyne stated: headquarters or regional offi ces descend upon an “Despite repeated assertions from the FAA that the operator and determine that even though processes agency would ensure fairness in the evaluation of were approved locally they are now deemed operational control, it has become clear that the FAA defi cient and noncompliant. Often, these inspection favours certain classes of air carriers over others. and enforcement actions occur without the agency Over the last 24 months, the FAA has issued, or even bringing the local inspectors into the process.” threatened to issue, numerous emergency suspension He continued to say that NATA agrees the FAA must or emergency revocation orders to Part 135 carriers ensure compliance with the regulations, but the that have ultimately resulted in the loss of certifi cates FAA ‘must also provide a reliable mechanism for an for the operators involved. However, while Part 135 operator to have assurance that his or her business air carriers have received the ultimate penalty for is indeed compliant’, stating that it is ‘inexcusable and operational infractions, their Part 121 counterparts are discriminatory’ for the FAA to take enforcement against simply fi ned and permitted to operate.” an operator when the action in question was known Coyne described NATA’s operator members as being to and approved by the operator’s local FAA inspector. in a Catch-22 situation: “Their FAA-assigned local Air Trek’s licence has since been revoked - see page 1. he MBB BO 105 is a light, Capacity: Flight crew 1 twin-engined, multi-purpose Stretchers 2 Thelicopter that was developed Length: 11.86 m in 1972 by Bölkow of Stuttgart, Rotor diameter: 9.84 m Royal Med adds New plane for Jet Germany. Production began under Height: 3 m Messerschmitt-Bölkow-Blohm (MBB), Empty weight: 1,301 kg Learjet 60 Executive which was bought by Eurocopter in Max take-off weight: 2,500 kg 1991. The BO 105 was produced Royal Med, based in the Middle East, has introduced Germany-based Jet Executive has announced the full air until 2001, when it was replaced in the Max speed: 242 km/h a Lear 60 to its fl eet, enhancing its capabilities as a ambulance charter availability of its completely refurbished product line by the EC 135. Range: 564 km medevac service. Royal Med is a division of Royal and painted Challenger 600. The aircraft is equipped with Jet, which is an international luxury fl ight service state-of-the-art Swiss-made Bucher stretchers, an Oxylog Specifi cations headquartered in Abu Dhabi and chaired by Sheikh 3000 and Servo 300 ventilation systems. In addition, Hamdan Bin Mubarak Al Nahyan. a Propaq monitoring system, Braun syringe pumps, President and CEO of Royal Jet Shane O’Hare, LP10 defi brillators, complete immobilisation sets and a speaking at the announcement of the new aircraft, complete set-up of medications make it possible to meet explained: “We have made signifi cant investments the needs of any patient. The fi rm can also cater for neo- in Royal Med’s infrastructure, personnel and natal transfers, offering two Draeger 5400 incubators and aircraft in order to provide the highest quality of ventilations systems. aeromedical transport. Now with the addition of According to Jet Executive, what makes the Challenger the Learjet 60 this will add more fl exibility to our special is that it offers single stretcher plus eight medevac services and offers a greater fl ying range confi gurations as well as double stretcher plus fi ve than the Learjet 35s.” accompanying passengers, ‘so it is the perfect aircraft to The purchase of the Lear 60 brings the total number carry those patients who want to move relatives and/or of Royal Med’s fl eet to nine, with four different their personal doctors on board the same aircraft, or to aircraft types now available to users. Each one is combine fl ights picking up various patients and relatives fi tted out with the latest medical equipment and in one fl ight operation’ said Jet Executive’s marketing and intensive care facilities. sales director Gunther Krahé.

DRF improves patient care German air rescue organisation DRF has ordered communicate with each other via radio, thus making 30 new defi brillation and patient monitoring units it possible to adapt the system to the particular needs for its air rescue centres. Following extensive tests, of a mission. DRF chose the Corpulus3 system, made by German Dr Braun expanded: “In an emergency rescue, company GS Elektromedizinische Geräte G Stemple a crew quite often has to work in diffi cult GmbH (GS). The system circumstances. An example: an combines several functions, injured person is freed from his thus helping to cut both the destroyed car by fi refi ghters. cost of the device and its There is little space, heavy weight in an aircraft. Günter equipment is being used. In this Stemple, CEO of GS, handed situation, the Corpulus3 offers the fi rst unit over to Dr Jörg us the possibility to leave a little Braun, director of medical measuring device with the patient services for DRF, on 6 May in and to clip off the rest of the Stuttgart. system. Data is transferred via The Corpulus3 system radio. The emergency physician replaces two other units that can monitor the patient continually have served DRF so far – a without any cable being in the way defi brillator with a monitor of the rescue team.” In addition, and a separate patient he continued, patient data can be monitoring device. GS states sent directly from the Corpulus3 that one of the advantages of to the treating hospital via fax, using the new system is that allowing the receiving medical it can be split up into three team plenty of time to prepare for modules, all of which can the patient before they arrive.

International Travel Insurance Journal AIRAMBULANCENEWS 15

Middle East seeks AA operators Obesity problem addressed The growing girth of some air ambulance passengers transport if we can’t has been noted as an issue of concern by several take them physically in Air medical transfer is not only a life saving demographics of the region, where 100 million aeromedical providers, and was highlighted recently by the aircraft.” solution for patients, it is also a part of the macro people are under the age of 24 and millions more a case reported in Waypoint, AirMed & Rescue Magazine Statistics from the US and micro healthcare investment plans of medical are expatriates, it becomes clear that air travel will when a Hercules plane was used to airlift a patient to Centers for Disease facilities large and small, state and private, all of increasingly be seen as a necessity rather than a hospital after it was found he couldn’t fit into the jet Control and Prevention whom need to factor in how to deal with such luxury in the region. Indeed, between now and supplied by the Royal Flying Doctors Service. Now, show that one third cases. Dr Fatih Mehmet Gul tells of how despite a 2020, the Middle East is forecast to lead world however, an American company, Airlift Northwest, has of all American adults boom in healthcare provision in the Middle East, passenger traffic growth, with current travel announced new measures to help such companies – roughly 72 million people aeromedical services seem to be out of sight and demand up 18 per cent. What does this mean for deal with overweight patients. Mardie Rhodes, a – are considered to be obese. out of mind aeromedical services in the spokeswoman for the non-profit air ambulance Given that obesity rates have region? Well, the more people operator, said: “There’s been a real issue with the size been increasing steadily over the past two Investment initiative entering the region, the more and girth of some of the patients we’ve been asked decades, those numbers are only going one way, so the The Middle East region is people that are likely to need to transport.” In order to cope with the problem, the air ambulance industry must be properly prepared to currently experiencing rapid hospital treatment and the firm has started to ask hospitals and emergency site deal with such patients when the need arises. Indeed, economic growth, powered use of aeromedical services to dispatchers to fill out a special form when requesting other companies in the industry have also introduced by record oil prices, especially and from the region. transport for anyone weighing more than 250 pounds. measures designed specifically to deal with obese in the six Gulf Co-operation Since it is so difficult to find The form asks for detailed information, including patients. American Medical Response has placed a Council (GCC) countries. a local partner providing measurements of the patient’s stomach. larger ambulance in the Portland area, complete with As a result, cash-rich air medical services, most Jeff Richey, a regional manager for Airlift Northwest, heavy-duty lifting equipment to move obese patients, governments are splashing insurance policies in the said this type of information is critical to the successful said spokesperson Lucie Drum. The big ambulance has out on new infrastructure region do not yet include the completion of a transfer. For the safety of the flight crew, a larger patient compartment, carries a gurney that is projects, and the healthcare provision of such services. they need to know whether or not they will physically capable of supporting 1,000 pounds, and a sports ramp sector is benefiting nicely, International air ambulance be able to lift the patient without injuring themselves. In for patient loading. Elsewhere, the Fire Department of with expenditure in this companies are also thin on the addition, it is vital that the crew knows for sure whether Seattle now carries a device known as a Mage Mover area predicted to rise to new ground, which doesn’t help the the patient will fit into the helicopter or jet, or whether – a tough fabric sheet with 12 handles on that can carry heights in the next three situation. More investment when they are inside, they will take up too much room, up to 1,500 pounds, as well as wider backboards. years. The private medical sector is growing fast – both from local investors with the backing of local making it impossible for the crew to manoeuvre in flight. The Association of Air Medical Services has agreed and health insurance sales are rising steadily, with hospitals, and from international air ambulance The new policy on reporting details of a patient’s size that the problem needs addressing urgently by air the result that there is a new focus on raising the operators – is needed in the Middle East. aims to eliminate such problems from the equation, ambulances, as there is nowhere that weight has quality of medical care provided in the region. making for safer and faster transfers. more importance than in an aircraft. There have Even though several of the new major healthcare Work in progress According to Richey, at least once a year the Airlift even been incidents reported where a helicopter projects are not yet complete, talk of planning for Regardless of the existence of a few private air Northwest crew are called out, only to find out the has arrived to find an obese patient, and had to fly patient transfers and international repatriations is ambulance companies with their own fleets, almost patient is too big to fly, so they ended up loading around for a while burning off fuel so that the patient still pending, and incorporating such procedures all air medical services in the region are currently them onto ground ambulances and accompanying could be safely transported – hardly a favourable into the hospitals’ planning stage is just not being conducted by governmental agencies such as the patients to hospital that way – this is hardly ideal option given today’s record fuel prices. happening. The main problem, however, is the the army, and the police; most of these flights are though. “In our business, we’re called on to move If you’ve had an experience like any mentioned in this lack of companies offering aeromedical services only offered for intra-hospital transfers. Further a patient quickly,” said Richey, “We’re delaying the article, please contact ITIJ with details at [email protected]. – both for short-haul or internal hospital transfers, problems with this system lie in the fact that it or indeed for international repatriation work. Even often takes a comparatively long time to gain the ground ambulance procurement is a problem for necessary governmental approval to use an aircraft these new advanced healthcare facilities, who may for such a purpose, especially problematic given the have the latest technological medical equipment fact that fleet capacity is low anyway. The quality of and pristine facilities, but who lack available medical care on such flights is also low, and overall facilities to transfer patients either internationally quality is not assured by internationally recognised or locally. Where they do have sufficient ground agencies such as CAMTS and EURAMI. ambulances, inner-city traffic is becoming a So, the Middle East has a real and growing need for big problem for primary and secondary patient aeromedical services. Air ambulance operators that transfers in cities such as Dubai and Abu Dhabi, establish themselves in the region have a market ripe but this is a separate planning issue that needs to for promoting their services too. In the next few be addressed. years, the region will become even more affluent and people will continue their search for better services Booming business in every sector, meaning the patient transfer offering The Middle East’s aviation industry recorded will have to catch up with that of its medical facility above average growth of 5.5-per-cent between sister. The best way it’s going to do this is to bring 2002 and 2005, where the global average growth in newcomers to the region, as has been the case in rate was 4.8 per cent. By further considering the other areas of the healthcare sector.

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

Air ambulance takes Raisbeck celebrates to the skies Raisbeck Engineering has announced that the 75th ZR Lite Performance System is currently being installed The new Great Western air ambulance service has by Duncan Aviation, an authorised dealer of Raisbeck now started in the UK, based in the home town of the for the past 20 years. The Lear 35 that is being kitted ITIJ team – Bristol. The helicopter is crewed by critical out is operated by MaCair Jet SA of Buenos Aires, care paramedics and doctors and carries advanced life- Argentina on behalf of Albanesi SA and Swiss Medical saving equipment. Initially, the plan is to operate the Group SA. MaCair’s director of maintenance Daniel aircraft five days a week, but only as long as it raises Kucharzcuk said of the new system: “Raisbeck systems the necessary £1.3 million annually to keep flying. enhance the performance of the 30 series Learjet at Tim Lynch, chief executive of Great Western a relatively low cost. The fact that ZR Lite pays for Ambulance Service, said: “The new air itself in a short time is an ambulance has been set up in response to added bonus! In short, ZR an identified gap in air ambulance cover Lite brings my crew better for the people of Avon. It will save lives performance and adds safety – and complement the existing paramedic for my passengers, all while teams on the ground.” reducing fuel burn.”

www.itij.co.uk 16 TRAVELMATTERS

Thailand targets Honeymooners Fuel fears hit United the girls shun beaches The increasing cost of aviation fuel has forced United Airlines to scrap more than one-fifth of its aircraft The Tourism The traditional two-week honeymoon by the sea fleet as the industry tries to come to terms with Authority now seems to be shunned by modern couples as soaring costs and new forecasts that have predicted of Thailand being old-fashioned, according to a survey of UK the sector faces a $60-billion funding gap. United, the has recently honeymooners who used Teletext.co.uk to book second-biggest US airline, has announced that it is to launched an their holiday. Instead of the normal beach holiday, retire 100 of its 455 planes – 94 short-haul Boeing online marketing today’s British honeymooners are choosing to take 737s and six jumbo jets. The carrier has also said that campaign city breaks, adventure holidays, a cruise or simply the number of job losses will rise from a previously that has been stay in the UK. predicted 500 to between 1,400 and 1,600 people, designed to Of the more than 2,000 people who participated in along with the scrapping of Ted, the airline’s budget target women the survey, four in five said they would not choose brand. Most of the reductions in flights will be on travellers to go on a traditional beach holiday – 58 per cent domestic services in the US, with the 11 daily flights worldwide. of respondents said the idea was ‘passé’, while 56 to London so far unaffected. Her Own per cent said The decision by United follows swiftly in the Way: Thailand the idea of being footsteps of an announcement by American No holiday? No way – the Woman’s surrounded by Airlines that it was going to scrap 75 planes and cut Paradise has other couples services by 11 to 12 per cent. Michael Boyd, an New research from American Express Travellers now gone live on the Internet. The micro-site ‘filled them with aviation consultant at US-based Boyd group, said Cheques has revealed that more than 38 per cent of specialises in specific grouped female products with dread’. However, that the planes were being removed by United those surveyed would refuse to forego their summer the aim of influencing more women travellers to this new, youthful because they are older aircraft that could be axed holiday this year, despite money worries being higher choose Thailand as their holiday destination. Activities outlook on without any liability to leasing agencies: “They’re up the agenda than ever. Instead, showed the survey, such as golf, shopping, spa days, beauty therapies and what makes a being parked because they’re paid for, not because people preferred to ration their daily expenditure accommodation with special female facilities are all honeymoon they’re fuel guzzlers.” In his opinion, United is in the run up to the summer to mitigate the cost of highlighted on the website. comes with a more likely to trim the frequency on routes as travelling. According to the Tourism Authority, the targets higher price tag opposed to abandoning them altogether, although American Express interviewed 2,000 Britons about are women from Japan, Hong Kong, Singapore – the average he added a disclaimer to that opinion: “Their their holiday budgeting plans this year in order to and the Middle East. On the website, women are honeymoon this management track record has been so clumsy, I find out if the travel industry is going to feel the credit given insights into selecting single-woman friendly year will cost don’t know how successfully they are going to do crunch. Those interviewed said they are expecting accommodation, personal safety and other issues £2,580, with this. They’ve not been running an airline – they’ve to spend an average of £773 while they are on that, says the Authority, ‘are pertinent to helping most of that going been running a merger partner.” holiday, in addition to the flights and accommodation female travellers to enjoy safe and cost-effective stays towards the flights Analysis performed by USA Today found that certain already paid for. In order to fund this spending in Thailand’. Thai Airways has offered support in the (£1,029) and American destinations are already losing out to money, however, 22 per cent of respondents said form of exclusive deals through the airlines’ Royal accommodation cancelled flights – Orlando, Las Vegas and Hawaii they would not buy a new outfit, 21 per cent said Orchid Plus female members’ database. (£1,008). have all experienced lower visitor numbers this year. they would not dine out and 15 per cent said they would cut nights spent in the pub before they leave for their holiday. Thirteen per cent of respondents said they are delaying a major home purchase in order to travel, such as buying a new sofa, while one Cyclone damage will affect tourism in ten people said they would not purchase any new garden furniture this summer. Physical damage caused by Burma’s cyclone, coupled groups and airlines cancelled services out of fear Across the spectrum of the UK as a whole, those with the government’s reluctance to co-operate that the city was both damaged and dangerous and in the north of Scotland seem to be the least likely with international aid agencies and governments, will market stalls and tourist attractions were closed. to feel the pinch this summer as despite having the deepen the wounds of the already fractured tourism Over the next three to four months, Chitakasem highest estimated holiday spend of anywhere in the industry, according to Parita Chitakasem, research predicts that new arrival numbers will fall by around UK (£1,231), they also have the highest proportion manager at Euromonitor International. 70 per cent, while shortages of food, water and of people who say they will not need to make any Although Burma was receiving negative press long petrol will also result in many embassies in the West sacrifices in order to fund their holiday. Those in before the cyclone hit, there was an existing tourism discouraging their citizens from visiting. the southwest of England are the most frugal when infrastructure that was improving annually. Latest The government in Burma has many worries right now, they are abroad, with an average spend of just full-year records showed that the country received not least of which is how to bring back the tourists. £644. People aged 35 to 44, possibly with children just under 350,000 visitors in 2006 – numbers from Industry analysts have predicted that efforts will be to entertain, are the biggest spenders while abroad, 2007 took a hit at the end of the year after protests concentrated in Muse, where the country shares a expected to spend 50 per cent more than those by Buddhist monks were aired across the world and border with China, along with other regions in the north aged between 18 and 24. tourism fell drastically. Arrivals at that time plunged that were unaffected by the cyclone and as such will be Kristie Bayley, vice-president of American Express to 50 per cent of normal numbers, while hotel easier to develop as tourist hubs. Although the number Travellers Cheques, commented: “Whilst people are occupancy rates dropped off by 70 per cent. of Western tourists will probably stay reasonably small, thinking about their spending now, it’s the last thing The biggest losses in tourism will be felt in the capital Chitakasem forecast that tourists incoming from China they want to worry about when they are actually Rangoon, according to Chitakasem, where tour and Thailand will help to boost revenue. enjoying their break.”

International Travel Insurance Journal

18 NEWSANALYSIS Can’t take the heat? With news in ITIJ’s last issue that Canadian repatriations are being hindered by bed the problem of shortages in the country, Milan Korcok rationing hospital asks: is travel insurance a convenient safety valve for Canada’s overheated beds is exacerbated health system? by overcrowded emergency rooms, A Canadian vacationer in Hawaii suffers a stroke limited ward space and after successful clinical stabilisation is booked for an air ambulance transfer home to Alberta and budgetary for rehabilitation. A lot of time-consuming and complicated professional assistance work is restraints expended in the process: to say nothing of intense stress on the patient and his family. Then comes the response from as they are already getting proper medical a government bureaucrat: if the patient care’. She says: “They sometimes even is privately insured and being treated comment that insurance companies only in Hawaii, the only way to get him into worry about costs.” This is regardless of the hospital at home is to bring him back to actual need for that patient to be transferred. “The Emergency and let him line up with the receiving hospitals sometimes just refuse up front to others. No priority. No pre-arranged take the patient,” says Pejovic. “They say ‘we are full’, transfer. No assurance of a bed. The or just inform us that they cannot take patients from alternative is to wait, and wait. out of the country as they have other patients already And waiting is what Canadian patients, waiting in the hallways to be admitted.” travel insurers and their emergency Some family physicians are more empathetic than assistance representatives worldwide are others and do get involved in trying to secure beds doing as hospital admissions staffs and health for their patients who are seeking to be transferred ministry bureaucrats who run the provincially- home, she admits. “But a lot of them, regrettably, administered health systems portion out are not.” General practitioners without admitting hospital beds to those already waiting in privileges, for example, ‘often do not see urgency (in emergency rooms, bumping patients with facilitating transfer) as the patient is well taken care of private insurance to the end of the queue. in another country’. “They perceive this as assisting insurance companies not patients,” she says. In general, Pejovic concludes, ‘we are faced with huge obstacles in each and every step of the process’. And the biggest obstacles, from her perspective, are in deferral ‘is Ontario and British Columbia. To patients and their families, encountering simply another these delays in getting back to hospitals in their tool for rationing communities, to the health system they thought they could count on and for which they have paid healthcare’ all their lives, is incomprehensible. “We end up,” says Dr Ladak, “with angry patients, families and doctors, as well as stressed out case workers. Deferring priorities The clients cannot believe that we have as much Kieran Bridge, travel health insurance lawyer and past trouble as we do in securing beds, and they and president of the Travel Health Insurance Association the doctors get more and more agitated as the of Canada (THIA), says that such deferral ‘is simply days go by. Finally, the procedures get done in another tool for rationing healthcare … with the the US because everyone is unhappy.” overall goal of reducing the cost to the provincial The result is not only personal agitation, but government of providing healthcare’. very substantial cost. Provincial health insurance Bridge notes that one THIA member reported to him agencies pay only minimal amounts for emergency that during the last snowbird season (October 2007 to medical services encountered abroad by Canadian April 2008), at least eight repatriations required a wait travellers. British Columbia, for example, pays only of at least five days, and one of them took 16 days as little as $75 a day for hospital care out of Canada; from the time of medical authorization to transfer. Alberta $100. Ontario pays up to $400 per day, but The problem, say other emergency assistance often doles out less, depending upon acuity of care. professionals, is not limited to Alberta, or even This leaves the remainder to be paid by travel health British Columbia where it is said to be worst, but medical care. That coverage, however, is limited to insurance policies or by travellers themselves if they to Canada’s most populous province Ontario, and As for intensive care beds, ‘we certainly get emergency services, not to continuing or follow- are not insured or are inadequately covered because other areas as well. Dr Ferial Ladak, medical director bumped’, she says. “I have been told outright that if up care, and is predicated and priced on getting of pre-existing conditions or other limitations. of Global Excel Management Inc., a Quebec- there are patients in other hospitals in the province the stabilised patient back to his home province based assistance company that manages cases and waiting to be transferred to that particular hospital as quickly as prudence permits. It is designed as a Waiting game repatriations for residents of all provinces, says that they will get priority, (especially) for such services as supplement to provincial coverage, and is in fact not “Last year’s numbers suggest we had to wait an delays in bed procurement occur almost ‘every time catheterisations and bypasses.” allowed to duplicate it – despite the fact it is often average of five days for a bed,” says Global Excel’s [they] have a patient who is not acute and needs Without doubt, the problem of rationing hospital required to do just that when beds are deferred. Dr Ladak. “And if you consider that a day in a US rehab, especially in Ontario and Alberta’. She says beds is exacerbated by overcrowded emergency hospital can cost from $4,000 to $10,000 that can that one patient – a truck driver who had an accident rooms, limited ward space and budgetary restraints Therein lies the problem be significant.” in the United States – had to wait one month for on healthcare imposed by provincial governments. Mila Pejovic, associate director of travel assistance and WTP’s Pejovic says that though most hospitals agree a hospital bed in his home province. “We nearly Canada’s government-controlled universal healthcare medical case management for World Travel Protection to put patients awaiting repatriation on their waiting had the patient’s family go to the press. The family system prohibits private health insurance for services Assist, tells ITIJ that many ‘hospital bed coordinators lists ‘it is not unusual during [the] busy season to wanted him home, so that was not a case of trying to covered by provincial plans, although it encourages and receiving doctors do not consider patients coming wait a week or two for a bed, even longer’. “And all repat for our benefit.” private coverage for out-of-country emergency from Florida (or other foreign locations) their priority of this has a huge impact on our operation, as bed

International Travel Insurance Journal NEWSANALYSIS 19

search is extremely labour sensitive, and arranging denied beds in their own communities close to for a repatriation sometimes requires a whole day of family and friends, they are sometimes declined focused effort for just one bed,” she explains, adding: beds elsewhere in their province by regional health “In the meantime, patients can deteriorate and authorities keeping an iron grip on their own become untransportable.” parochial resources. Dr Robert MacMillan, medical What is especially galling to many leisure, business director for Medipac International, one of the largest or student travellers and their advocacy groups, is providers of snowbird insurance for Canada’s that Canada’s universal, publicly-funded healthcare seniors, recently told a travel insurance industry system ‘guarantees’ portability of health benefits conference that ‘unfortunately, (if) you even try to between provinces, although that guarantee is more get a hospital bed outside your own community, vaguely interpreted when it comes to out-of-country people say “they’re not in our catchment area”’. benefits. The Canadian Snowbird Association, which WTP’s Pejovic concurs that though dealing with represents travelling seniors, has for years lobbied hospitals in the patient’s normal catchment area governments to at least pay for out-of-country is difficult enough, trying to secure an admission services up to what it costs for those same services to beyond that area ‘becomes virtually impossible’. be provided domestically. The federal government, Some have argued, convincingly, that this rigidity because it cost shares provincial health insurance, in apportioning hospital beds is contrary to the has the power to impose fines on provinces that spirit and intent of the portability provisions of contravene portability rules, but has rarely used that the Canada Health Act that governs the criteria power, and clearly, $75 a day doesn’t cut it. provinces must meet in order to get their share The argument goes that if those needing repatriation of federal funding to run their health insurance can at least get back to Canada on their own travel programmes. Bridge notes that in British Columbia, insurance ticket – which does pay for medically his home province, hospitals in one health region necessary repatriation – they should not be routinely refuse to accept repatriated patients discriminated against and bumped out of the queue whose homes are in another. (B.C. is divided into though dealing with hospitals in the because they had the good sense to buy private six health regions or authorities, one of which patient’s normal catchment area is insurance. Health ministry officials have, on the bisects Greater Vancouver). Thus, in practical other hand, argued that people who are already in a terms, he says, if someone living in North difficult enough, trying to secure an hospital – albeit a foreign one – and receiving good Vancouver needs to be repatriated, B.C. Bedline care, should not displace patients at home who can’t will not even call St Paul’s Hospital in downtown admission beyond that area ‘becomes get beyond their crowded emergency rooms. Vancouver (a different region) for a bed for that virtually impossible’ The problem with that reasoning, says Bridge, is patient. that many of these officials are unaware of the huge “There is no legal basis for this discrimination,” says Services B.C. (an agency funded by the B.C. Health If so, how might they deal with Dr Ladak’s recent amounts charged by foreign hospitals, especially Bridge. “All British Columbians pay provincial taxes Ministry) challenged THIA, in March 2008, to dilemma in trying to repatriate a young Ottawa area those in the US, and are equally unaware of the to cover the cost of medical care. They do not pay substantiate the allegations of illegality. Does this motor cycle accident patient who was confined for pittances the provinces pay toward these charges: taxes to regional health authorities, which are simply mean the question of repatriating Canadian patients weeks in a US hospital bed but not considered a “When I explained to the medical director of B.C. administrative bureaucracies set up by the Ministry from foreign hospital beds can only be settled in the priority by Ottawa hospital authorities: “The patient Bedline (the provincial agency charged with allotting of Health.” courts? Is it inevitable that transferring sick people kept crying that he wanted to come home, which hospital beds in that province) that the B.C. Medical Bridge has argued, on behalf of THIA, that there from one clinical environment to another will had his family very upset. His head injury had made Services Plan typically pays only about five per cent is no legal requirement for hospitals to use B.C. ultimately be decided by clerks and not by treating him very emotional and he did not understand things of the cost of US hospital care, he told me I was Bedline, which he says has no legal standing and was and receiving doctors and assistance professionals? as well. He just wanted to come home.” being ‘ludicrous’.” He had obviously never seen a US set up simply as an administrative tool by the Ministry medical bill, added Bridge. of Health: thus there is no legal basis for hospitals telling assistance companies they cannot accept Compounding the problem repatriated patients unless they are directed to do so What compounds the repatriation problem, say by B.C. Bedline. some experts, is that not only are many patients In response, the chief operating officer of Healthlines

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

www.itij.co.uk 20 FEATURE Sport: how dangerous can it be?

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

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

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

International Travel Insurance Journal FEATURE 21

this confusion over – or indifference to – what the policy provides in the way of cover is not helped by the divergence of underwriting opinion among insurance companies as to what constitutes a dangerous sport or pastime

following lines, but it is by no means uniform and to many self-styled sporting experts the risk ranking would seem to be unfair if not deliberately obtuse. The most risky category includes bungee jumping, mountaineering (over 4,500 metres), powerboat racing and any professional sport. Next down the ladder comes hang gliding, parachuting and paragliding, pot holing and rock climbing, off-piste skiing, ski racing/jumping, heli-skiing and ice hockey. Middle range risk takes in scuba diving, wintersports and mortality statistics, also draw upon past claims more likely to get injured playing their sport than Categorising risk including snowboarding, and piloting aircraft, all experience and reassurance capabilities when fixing someone taking part in martial arts. A potential customer who surfs the Internet to considered more dangerous than hot air ballooning, premium levels and determining exclusions. The However, a doctor writing to The Times two years get a fix on whether his or her intended sporting microlighting, skateboarding and whitewater rafting/ consumer doesn’t know this and feels aggrieved to ago noted that, if measured by the number of activity could be prone to insurance exclusion is canoeing. find that horse-riding, for example, is not covered in fatalities occuring during play, then bowls is the most not guaranteed an edifying experience. Lists of Sports categorised with the least risk include his standard travel insurance package. dangerous sport of all, as participants are generally unacceptable activities vary and have resulted in a lot amateur contact sport, for example fencing, boxing, Can there be agreement on what is and what isn’t elderly and subsequently prone to heart attacks and of controversy over insurance company policy on polo, soccer, mountain biking, high diving and jet a dangerous sport; what should be covered as strokes. He also maintained that the sport which sport. There is a tendency to categorise along the skiing. Finally, there’s a relatively ‘safe as houses’ ‘standard’, and what falls into the ‘hazardous’ category, leads to most insurance claims is surfing, mainly due thus meriting non-inclusion? Is it really possible to to injuries incurred while removing boards from the isolate those sports (the ‘extreme’ variety such as roof of the car! base jumping being automatically excluded) with a In the US, it could be argued that cheerleading is the dangerous element and then rank them according to most dangerous sport. Statistics from the National risk acceptability? What criteria do you use? Collegiate Athletic Association (NCAA) suggest it may If death is the yardstick, then angling apparently be even riskier than American football, the sport it leads the field in the UK (drownings, fishing lines was created to support. The NCAA’s Catastrophic getting caught in overhead power cables), closely Injury Insurance Program found that 25 per cent of followed by horseriding (including eventing and show its claims for college student athletes since 1998 have jumping), climbing and car racing. But is angling a resulted from cheerleading, placing it a close second sport or a pastime? If injury is the determining factor, to football in the danger stakes. This claims statistic rugby gets the vote as the most dangerous sport; it is remarkable given that the ratio of cheerleaders to has been reported that rugby players are three times football players in US colleges is around 12 to 100.

It is the customer or client’s reasonable expectations of the level of cover and the fairness or otherwise of exclusions that should dictate whether a risk is assessed as standard.

www.itij.co.uk 22 FEATURE

the sport which leads to most insurance claims is surfing, mainly due to injuries incurred while removing boards from the roof of the car!

category that covers non-contact sports such as and winter sports from standard travel insurance, As with other travel insurance providers, the mantra underwriting expertise required, is cognisant of abseiling, motorcycle touring, yachting (inside instead offering a specialised package of cover. Direct from Direct Line is that customers wishing to ensure the varying levels of reassurance used by different territorial water!), tour operators’ safaris (not using Line is typical of several companies that offer a ‘policy they have the cover they need should contact their insurance companies, and can locate impaired life guns) and trekking, so long as it is not in remote or for people taking part in winter sports, which does insurer prior to the trip to discuss what sporting insurance for individuals involved in dangerous mountainous areas. have a higher premium but offers extensive coverage activities they plan to undertake. Winter sports are activities and pastimes. Lloyd’s of London is well This form of ranking is at odds with many people’s for customers who want to enjoy the ski slopes noted for their high accident quotient, expensive known for such specialist underwriting but here it view of what is or isn’t a hazardous sport. The fact with the peace of mind offered by travel insurance’. medical treatment and/or repatriation; there is also is argued that although the market is increasing it is that insurance companies themselves don’t trek a The company’s head of travel insurance, Chris the spectre of legal costs involved in determining still too diverse to collate meaningful figures on the uniform path to risk just adds further confusion. In Price, added: “We recognise that sporting activities who was at fault. “If a customer is on holiday and number of policies or claims. In essence, there is not North America, for instance, skiing is not considered are a major part of many people’s holidays and we is injured as the result of an accident caused by enough of the risk to enable an accurate estimate of a dangerous sport and parachuting and paragliding want to provide them with the best cover we can. someone else, we provide legal assistance cover to all possible costs and thus arrive at a ‘standard’ policy only perceived by some insurers as very high For activities with a history of high frequency and help the customer obtain costs from the responsible with a competitive price. risk. The levying of additional premiums for, say, high value claims, we will often pay the customer’s party,” said Price. Time is needed, perhaps another decade, before scuba diving might not apply if the customer can medical and personal accident costs but will not sufficient claims experience has built up to determine demonstrate proficiency or a certificate of expertise. cover personal liability for damage to third parties or Meeting expectations? what sports are dangerous to the extent of always Most European insurers, in contrast, exclude skiing their property.” Although, sensibly, most insurance companies won’t meriting non-standard cover and what activities add dangerous sports cover to the policy once the deserve to have the rules relaxed. In the meantime, customer is in situ (and on a whim has decided, no doubt, ombudsmen, such as the UK’s Financial for instance, to execute a high dive from the top of Ombudsman’s Service (FOS), will continue to see a Iguassu Falls), there is a much greater awareness high level of travel insurance complaints, partly due of intention to participate in hazardous pastimes. to the fact that such insurance has not kept abreast Back packing and adventure holidays have grown in of changing holiday fashions. The FOS gets a lot of popularity and some insurance policies now make an disputes over terminology: many of its complainants effort to provide standard cover for hitherto exotic don’t view scooter riding, surfing, jet skiing or bungee activities that are now more commonplace. jumping as dangerous, while their insurers do. “Travellers want much more out of their trip than just It can be maintained that the customer is at fault a typical beach holiday nowadays,” said Paul Dittmer, here, should pay more attention to the conditions marketing manager with UK company Columbus and exclusions of a travel insurance policy and should Travel Insurance. “Armed with guidebooks, they understand the difference between standard and non- are clued up with what’s on offer for the adrenaline standard. However, an off-the-record view expressed junkie in them – and travel insurance companies are to me by a leading North American insurer is that the responding and including the more popular sports for situation is really market driven and down to what free with the policy.” His company covers activities customers expect from their travel insurance. such as scuba diving, elephant rides and walking up It is the customer or client’s reasonable expectations Sydney Harbour Bridge, ‘for free because we found of the level of cover and the fairness or otherwise so many people were asking for them.’ of exclusions that should dictate whether a risk is A genuine attempt to provide customer service or assessed as standard. Customers need to understand just glib marketing speak? Probably neither; just that that some sports attract a higher risk rating, but it is Columbus has found from its claims experience that reasonable and eminently possible to achieve this such pursuits can be categorised as low risk. The understanding upfront in the marketing literature; company, after all, does load its premiums for certain there’s no excuse in pointing out that the small print sports it views as higher risk, such as kayaking (5 per should have been read. cent extra) or heli-skiing (50 per cent). While statistics show that most accidents and injuries whilst travelling actually occur in hotels rather than on the ski slope or in a remote, isolated This form of ranking location (in fact many of the accidents occur in the hotel room), the trend for adventure holidays can is at odds with many pose problems for risk assessment. When does an people’s view of what adventure holiday become an extreme one and how can underwriters calculate the risk incurred is or isn’t a hazardous by dangerous sporting in such circumstances? As reported earlier in ITIJ, the British Insurance Brokers sport. The fact that Association has worked hard to ensure that pursuits insurance companies one sees as extreme, for example paragliding, hot air ballooning, even horse riding, are now covered themselves don’t trek as standard in insurance policies. Nonetheless, the ultimate extreme trips with a uniform path to their high hazardous sports component are likely risk just adds further to remain non-standard. They are the remit of the specialist broker who can access the financial confusion

International Travel Insurance Journal

• conference sponsors International Travel Insurance Conference • International Private Healthcare Conference • International Air Ambulance Forum • International Pet Insurance Conference • Assistance Medicine • : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 : : ITIJ AWARDS 2008 ONE READER – ONE VOTE!

International Travel Insurance Awards Evening

After yet another successful year of the 2007 Venice ITIJ Awards, we are proud to announce that this year’s ceremony will even better last year’s event to once again provide the industry with an outstanding occasion that celebrates excellence and achievement in the global Travel Insurance and Private Healthcare industries. conference sponsors ITIJ is read by the top players in Travel Insurance today and it is this readership that allows us to compile the most comprehensive vote available. Each individual that subscribes to ITIJ will have the opportunity to vote for their top-rated company in each of the nominations categories. Once all the votes are in, a shortlist of the top three to fi ve companies in each category will be drawn up (based on the number of votes received). Each of these fi nalists will then be asked to create a presentation that will be considered by an independent judging panel, which will decide the ultimate winners on the night. The fi nalists’ presentations will be screened at the ITIC Gala Dinner awards evening in Budapest on Friday 14th November. The categories: • Air Ambulance provider of the year • Assistance/Claims Handler of the year • Cost Containment company and provider of the year (to include PPOs and general services) • Insurer/Underwriter of the year • Intermediary of the year (to include all retailers of travel insurance) • ITIJ marketing campaign of the year (judged independently) • Best International Healthcare Insurer

The rules: • One vote per category per subscriber to ITIJ • Votes/nominations must be received by 28th August 2008 Go to: www.itij.co.uk/awards • Only registered company domain names will be accepted. Hotmail, Yahoo and other Web-based emails will not be accepted • The fi nalists within each catergory will be contacted on Monday 1st September and provided with the criteria and deadline for submitting their presentation

visit www.itij.co.uk/awards for more information 26 FEATURE

Takaful:the global growth of Islamic insurance

ecent projections have Since the establishment of the first takaful operator hubs have developed in the GCC, such as the in the Sudan in 1979, there are now over 250 takaful Dubai International Financial Centre, Bahrain Shariah scholars shown that the global operators worldwide. In its World Takaful Report 2008, and Qatar, each of which is striving to differentiate Islamic insurance or Ernst & Young comments that the takaful market is itself in order to attract both conventional and have determined that ‘takaful’R industry could be growing at an annual rate of 20 per cent and will, in all takaful business. However, whilst there is a boom likelihood, reach US$4.3 billion by 2010. in competition in the takaful market in the Middle worth up to US$15 billion Whilst Malaysia is seen as the most mature East, arguably, the most interesting developments conventional insurance takaful market, with a long established regulatory are occurring in the West, with the 2007 Oliver within the next decade. Susan framework and a developed product range, the Wyman report suggesting that, in a market that Dingwall and Ffion Flockhart Gulf Cooperative Countries (GCC) now account could potentially amount to more than $20 billion products are contrary to explain what this could mean for over 33 per cent of the global takaful market, annually, over 20 per cent of the demand could be and the region is seen by many as the driver to from non-Muslim customers. the principles of Shariah for travel insurers the development of the industry. Many regional What is takaful? law as they contain In simple terms, takaful is Shariah-compliant insurance akin to mutual insurance, whereby the participants unacceptable elements of (or, in conventional terms, policyholders) pool their funds together to ‘guarantee each other’ in the event of risk and uncertainty a loss. Losses are paid from the pool of funds created by the donations (in conventional terms, premiums) of the participants. The takaful operator manages the takaful operations on behalf of the participants, deals with any claims and invests the contributions in ethical Takaful & conventional travel insurers Shariah-compliant investments. To the extent there is Currently, the main products offered by takaful a surplus in the fund at the end of a policy period, the operators tend to be personal lines products such as takaful operator will ordinarily make a distribution to motor and home contents cover as well as life cover the participants in proportion to their participation. in the Middle East. However, the basic principles of This is a unique selling point for takaful compared takaful will apply in the same way to travel products. with conventional insurance which, when coupled Some Western insurers have entered the takaful with the ethical investment strategy, is also likely to be market through alliances with Islamic operators. attractive to non-Muslims. This has certainly proven For example, SABB Takaful, an associated member to be the case in Malaysia where a relatively significant of the HSBC Group operating through a network percentage of non-Muslims opt for takaful cover. of 75 branches in Saudi Arabia, offers a fully Shariah scholars have determined that conventional comprehensive Shariah compliant takaful travel insurance products are contrary to the principles of product. SABB Takaful offers a wide range of cover Shariah law as they contain unacceptable elements from medical and hospitalisation expenses incurred of risk and uncertainty. In a conventional contract due to accidental injuries, loss of money and of insurance, the risk of loss passes to the insurer documents and loss of personal belongings to flight upon payment of a premium by the insured. Since delays. Other conventional insurers have obtained it is uncertain as to whether a loss will in fact occur, licenses to operate takaful companies in various the contract is seen as a form of gambling. In 1985, jurisdictions, for example, Hannover Re and AIG the Islamic Fiqh Academy ruled that a takaful have been granted retakaful and takaful licences contract, which is based on the principles of charity respectively to operate in Bahrain, and Munich Re is and co-operation, was acceptable on the grounds licensed to sell retakaful products in Malaysia. that participants co-operate with each other for the For conventional travel insurers who wish to expand common good and no advantage is derived at the their current portfolio to include takaful products, cost of others. it will be necessary to completely separate the On the investment side, Shariah law prohibits conventional business from the takaful business. investment in certain industries and requires the use This will normally necessitate the incorporation of financial instruments that are free of usury. This of a new company, subsidiary or takaful window means that no investments can be made in interest- to ensure the complete segregation of funds and bearing instruments such as government bonds or a Shariah compliant investment strategy. The equity investments in companies that deal with, latter is generally seen as the most problematic for for example, the manufacture or sale of alcohol, conventional insurers given the relatively small size armaments, gambling or pork products. of the Islamic finance market compared with the International Travel Insurance Journal FEATURE 27

One of the most important aspects in determining the continuing success of takaful in Europe is the regulatory landscape, which has the potential both to encourage and inhibit growth Susan Dingwall is a partner, and Ffion Flockhart is an associate, with the international law firm, Norton Rose. Susan leads the firm’s takaful practice and she and Ffion have acted for a number of takaful operators in establishing conventional investment market. However, this their businesses (including providing regulatory advice, is gradually changing with the UK government drafting takaful and retakful wordings and advising upon retakaful arrangements). In 2006, the Financial Times recently making a number of announcements that recognised the work carried out by Norton Rose in are intended to promote London as the leading developing its expertise in takaful by giving it an award for centre for Islamic finance. innovation in the category Legal Expertise/Strategy in its innovative lawyers awards.

regulatory landscape, which has the potential both recent report by Oliver Wyman stated: “Western Potential growth of the takaful market to encourage and inhibit growth. Strong regulation Europe, home to less than one per cent of the Since the launch of the first Islamic Bank in can be advantageous, particularly in securing a world’s 1.6 billion Muslims, makes up 40 per cent September 2004, London has become the centre good rating, an essential element in terms of aiding of the potential Muslim demand…adding the US of Islamic finance in the West, offering Shariah- international investment and growth. On the other brings the total up to 60 per cent”. Although there compliant products in a range of asset classes. Now, hand, strong regulation on a Member State level remain challenges, these statistics provide a strong the Financial Services Authority has authorised in areas of business that have not been harmonised indication that the takaful market in the West is Principle Insurance Company Limited (‘Principle’) at Community level can constrict cross-selling only just beginning to show its true potential. as the first takaful operator in the UK. Bradley opportunities across European states. Brandon-Cross, the Chief Executive of Principle, recently stated: “London is leading the way as the government has introduced reforms to help Islamic The future? finance. [Principle Insurance] will give Muslims in As the market grows, so too will the range of this country the opportunity to choose Shariah- products offered. It is expected that takaful travel compliant insurance products.” Principle forecasts products will be in great demand not only amongst up to 200,000 participants within five years, with the Muslim population but also amongst non- strong growth expected over the coming months. Muslims that are attracted by the unique selling This development is significant for the Western points of takaful, such as the redistribution of profits market as a whole, as authorisation in one European and the ethical investment policy. In the medium to Economic Area (EEA) state provides a platform for long term, the maturity of the European insurance ‘passporting’ into the rest of Europe, leading to the markets is likely to provide a strong platform for potential for considerable expansion of the global the growth and development of takaful products takaful market. across the EEA. In highlighting the growing interest In Europe, takaful products and operators will in the takaful and retakaful markets in the West, a inevitably be subject to layers of regulation. In addition to operating according to the principles of Shariah law, they will also be subject to the EU regulatory regime for insurers on both federal and state levels. On a federal level, the rights of insurers to carry on business throughout the EEA derive from the European Commission (EC) Treaty, which For conventional travel sets out both the freedom of establishment (Article 43) and the freedom to provide cross-border services insurers who wish to (Article 49). A single set of rules has been put into place governing the authorisation and supervision of insurance companies and takaful operators by the expand their current Member State in which their head office is located. The freedoms of establishment and the provision portfolio to include of cross-border services enshrined in the EC Treaty enable takaful operators to carry on business across the EU on the basis of a single authorisation. This takaful products, it will be enables a takaful operator that has been authorised in one Member State (the home Member State) necessary to completely to carry on its business in any host Member State within the EEA without the need for further authorisation. The passporting process, however, separate the conventional differs depending upon whether the takaful operator wishes to establish a branch in the host Member business from the takaful State or simply provide cross-border services. One of the most important aspects in determining the continuing success of takaful in Europe is the business. www.itij.co.uk 28 ASSISTANCE&HEALTHCAREWORLDMARKETS Argentinian accolades

aving begun off ering assistance services in the 1970s, HArgentina leads the way in Latin America when it comes to helping travellers in need. Alberto Camel Chapur puts the country’s healthcare and assistance market into context

In the eyes of those who are not familiar with the country in South America, after Brazil; the fourth region, Latin America is often thought of as an largest in America and eighth largest in the world. entity; perhaps because most of its population is Th e index of human development, level of economic predominantly Spanish-speaking, or because of growth and quality of life are all very high. shared features associated with its Latin lineage. A nation of keen travellers, and one that receives However, Latin America is composed of 42 more than four million visitors each year, it has a countries, 21 of which are located in the Caribbean, well developed assistance industry, and healthcare eight in Central America and 13 in South America. facilities off ering an international standard of care. Th e total population of the region is 560 million, But what is the uptake of these services, and how 8.5 per cent of world’s total population. Regarding well does the system work in practice? the socio-political situation in Latin America, the region is democratic, although social inequality and Close to home poverty still remain the main challenges in the area. Th e majority of travellers entering Latin American In this issue, we will focus on Argentina, situated countries do so from within the region. In fact, 59 per in the far south of America. It has 40 million cent of arrivals to Latin American countries are from inhabitants, most of who are descended from other Latin American countries. Sixteen per cent of Spaniards and Italians. It is the second largest arrivals are from Europe – mainly Spain and Italy – International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 29

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

ten per cent come from the United Sates and Canada, multinational assistance companies such as AXA and the remaining 15 per cent come from Asia. Assistance, Europ Assistance, AIG Assist or Mondial In 2006, tourism numbers to Argentina reached Assistance; there are a number of companies that 4,100,000 – a fi gure that increased by 11 per cent originate in Argentina, such as Cardinal Assistance, the following year. Th e country is the most popular Assist-card and Grupo IMAS, which also provide destination for tourists travelling from Chile, Brazil, assistance services on a worldwide basis. Uruguay, Spain and Italy, amongst others. As for Latin Americans travelling to other countries, Th us, most people entering Argentina – whether the vast majority of are now aware of the benefi ts from another Latin American country or from of carrying travel assistance coverage, which has led anywhere else in the world – carry with them some to substantial growth in the industry over the past form of travel assistance or travel insurance policy. few years. Today, over 60 per cent of the travelling And although these visitors, when coming from population of Latin America is aware of the security outside of Latin America, are generally covered by provided by medical assistance services, and many

It stands to reason then that travel assistance companies do not also have to be insurance companies www.itij.co.uk 30 ASSISTANCE&HEALTHCAREWORLDMARKETS

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

Americans often expect to have access to when abroad. Companies such as Cardinal Assistance visiting Europe or the United States. and Assist Card have a wide range of products with Assistance products in Argentina are very similar similar coverage levels as those products found in although coverage limits may vary. The limits on a most advanced European countries. typical worldwide travel assistance product include: Along with travel agencies, the Internet is the most popular research tool when planning a trip. Medical assistance in case of illness or accident: Over the last two years, it has also become an between US$25,000 and US$100,000 increasingly popular channel through which to Medical expenses for pre-existing conditions: purchase assistance products – either directly from between US$500 and US$1,500 an assistance company or via a broker. Assistance Medical expenses for sports-related companies accidents: between US$500 and US$1,500 Medication: now purchase such a policy each time they travel. an event occurs, without the traveller having to between US$1,000 and US$3,000 There is no chamber or association that regulates pay money; whereas insurance can compel the Dental care: travel assistance companies in Argentina, so specific policyholder to pay costs on the spot, to be later up to US$1,500 data on the country is not available, but companies reimbursed. The problem in the latter scenario is operating in the country have experienced growth that the traveller may not have the money to pay for Most travel assistance companies do in product sales and have recognised an expanding treatment on the spot. This makes ‘travel assistance’ provide a rounded product, in consumer interest in travel assistance in recent years, a more attractive product, and one that is relatively that they offer coverage for reflecting the trend in the wider geographic region. easy to market. baggage and legal assistance, It stands to reason then that travel assistance companies as well as medical coverage. What’s in a name? do not also have to be insurance companies. Thus, they Trip cancellation or early A fundamental difference in the way that trip are not regulated by government agencies such as the return coverage, however, cover for travellers is offered and provided in Latin Healthcare Ministry or the Insurance Bureau. is only available America, compared to most other parts of the For cultural reasons, many Latin American travellers through insurance world, lies in the way such services are rendered. expect a service similar to the one provided by their companies. Typical Essentially, Latin American travellers are sold ‘travel pre-paid medicine plan at home when travelling out travel assistance assistance’ services, as opposed to ‘travel insurance’ of country, and they are quite reluctant to accept policies also include policies: the objective of travel assistance being to the differences in medical coverage when travelling the provision of provide the service in a direct manner at the moment abroad. Thus, ‘house calls’ are something Latin medication, dental services, sanitary transfer, and the repatriation of mortal remains. Companies of the calibre of Cardinal Assistance or AIG Travel additionally offer exclusive benefits such as coverage for pre-existing illnesses and sporting accidents, guarantee of return trip, and even a 24- hour helpline.

Leading the way The first travel assistance companies in Argentina opened their doors in the 1970s, and now this industry is well developed. Today, there are around seven local and foreign- owned multinational assistance companies operating in the country. These include: AXA Assistance, Europ Assistance, AIG Assist and Mondial Assistance, together with Cardinal Assistance, Assist-card and Grupo IMAS. These businesses all offer assistance services although only two or three are multi-product and multi- channel companies that also provide roadside assistance and home assistance, amongst others. Thus, in the Latin American region, Argentina, together with Uruguay and Brazil, is a leader in the also offer their products through development of travel assistance services, and as the corporate market, particularly via mentioned there is a growing awareness within the credit cards, which also generally tie up with country of the need for such cover when venturing insurance companies, HMOs and loyalty clubs. International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 31

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

Alberto Camel Chapur is the president of Cardinal Assistance, an Argentinean company established over ten years ago that is dedicated to providing travel, road and home assistance 24 hours a day, every day of the Caring for health ago, when the choice of careers offered through décor and catering, are quite deficient. year. Cardinal Assistance also Although the state’s responsibility for individual university study was small. Today, most doctors work The private sector, made up of community hospitals provides cost containment services, and specialises in sanitary services varies substantially between the in both the public and private healthcare sectors. (such us the German medical centre, the British and the provision of co-ordination services, administration countries of Latin America, in general all have Argentina has around 160,000 permanent hospital the Italian medical centres), clinics owned by private and cost management. It is the sole assistance adopted measures that ensure universal access to beds, distributed between 1,280 public hospitals health companies, and private clinics, in general offer company in South America that provides state-of- basic medical services. Medical expenses in the and 2,040 private clinics. Fourteen per cent of the highest quality of medical services – as in most the-art Contact Center services. Cardinal Assistance region are ‘accessible’ (lower than in the United beds are located in the country’s capital Buenos other countries – as they have greater financial and operates all over the world, with commercial offices located in the US, Brazil, Chile, Uruguay, Colombia, States, Europe and Asia). Nevertheless, many Aires, a city that accounts for eight per cent of the technical resources. Peru, Ecuador, Venezuela and Bolivia. travellers visiting Latin America, and indeed population. The wider Buenos Aires Province has Overall, the quality of hospital care varies widely Argentina, do so bearing a travel insurance policy. 48 per cent of beds to take care of 50 per cent of Below is a scheme of health models in Latin the total population of the country. Cordoba has American countries: approximately 12 per cent and Santa Fe has seven The type of medical assistance provided to foreign per cent of total beds. In the different cities around visitors in Latin America is shown below. These the country, there are excellent public hospital figures are also reflective of the provision of such services, although facilities such as room comfort, services specifically within Argentina:

Outpatient/house calls 54% ITIJ AHWM rating Outpatient/house calls & lab tests 20% Healthcare Cost HHHH Hospitalisations 4% Access to emergency care HHHH Ground and air evacuations & repatriations of mortal remains 1% Overall quality of care HHH Odontology 8% EMS (air ambulances) HHHH Baggage loss/legal assistance, etc 13% Please note: There is an overpopulation of medical doctors These ratings are an overview of what ITIJ believes to be a in Argentina – three per 1,000 inhabitants – the fair reflection of the general standards in the country, and highest average of any Latin American country, do not represent any one hospital or service. ITIJ recognises following Cuba. The reason for this is that medicine that some individual facilities and services would receive was one of the few highly regarded university course different ratings than others, and to those shown in our chart, should ratings of each be done separately. options provided in the country until a few years

www.itij.co.uk 32 PROFILE A moment with Michael ITIJ sat down for a cup of coffee with Michael Weinlich to catch up and find out what he has been up to recently

ITIJ: Do you have a favourite holiday Roberts and Princess Diana – it would be very recognised. At the destination? intense but very stimulating. All of them are special moment about ten air MW: No – Actually I prefer to take in different personalities sticking to their inner beliefs and ambulance providers destination to find variety and find new impressions, weaknesses. They are somewhat authentic, which on several continents meeting new types of people. Every country has its makes them interesting to listen to. are in the pipeline for own speciality and charm, so no favourite. I do a accreditation. In addition lot of travel in general, some for work, but I have ITIJ: we supported the idea lived in Tokyo and the US for school. I really like to Who would play you in a movie of your life? of the Flymi empty move around and experience life and get different MW: Dustin Hoffman – I think he looks a bit like me, leg option tool, as it is impressions. and he’s a fantastic actor. He does have the ability to slip providing information into a certain personality and played very convincingly. about quality and not ITIJ: How often do you travel for work? Just think about Tootsie, Papillon or Rain Man. just the price to the MW: Once or twice a month I am abroad, usually Especially the last one shows how interested he is in a client. in Europe. As business travellers see so many nice special behaviour of someone else and how he manages On the business side places, chill out destinations for holiday are more to reproduce a very realistic behaviour. we started our new and more preferred. Our last destination was enterprise med con team Tuscany in Italy, enjoying the perfect landscape, ITIJ: How do you like to relax after work? as an excellence centre good food, red wine and some sports next to MW: Sometimes it is important just doing nothing. in the field of worldwide extensive relaxation. It took me several years to find out that the promoter emergency medicine, personality cannot just drive on forever. On the assistance medicine and ITIJ: What’s the worst job you’ve ever done? other hand sports are very important to feel satisfied. telemedicine. As the MW: I think I’ve been very lucky and all the jobs I enjoy skiing, tennis and classic dancing. Steinbeis scientific centre we were involved in the transporting back home after an accident, and until I have had have been challenging, but about 20 EU telemedical project WISECOM, which looked the medical care infrastructure in remote regions is for optimal technical and medical solutions to build on a par with Western medicine infrastructure, the up the communication infrastructure at the first air ambulance industry is safe. It will be a long time 24 hours after a major catastrophe. And finally we until the same medical service and infrastructure is are planning a large medical centre in Stuttgart, available in every country around the world, and Germany, to provide state of the art medical care in until that time, air ambulances are not merely safe, combination with excellence service. they are integral. Nobody cares about the medical care in a country until something actually goes ITIJ: Where do you see the future of the air wrong – travellers’ education needs to be improved ambulance industry going? so that people are more aware of dangers inherent to MW: I think in general, the future of the industry a country. Also, as there a more pre-existing medical is secure, as put simply there is no other possible condition travellers going abroad now, there is a high way of transporting patients in need quickly and likelihood that air ambulances will become even safely. As the normal aircraft industry is improving, more highly utilised. so is business aviation and the sector as a whole is The problem with travellers these days is that they developing and moving at a relatively rapid pace. don’t understand the value of travel insurance – they Take, for example, the launch of the A380. are more than happy to pay for a new gadget or piece of clothing for the holiday, but then they Will the A380’s ability to take patients say ‘I can’t afford travel insurance!’ – this is not have an effect on the number of patients acceptable. People just don’t care and think about transported by air ambulance? that – no-one wants to think about bad things that MW: No, it won’t directly, but indirectly there can go wrong when travelling, but at the end of the are some issues raised. More people use aircraft day, all risks must be considered by the traveller. It years ago probably my least favourite job was doing ITIJ: Do you find it hard to switch off after a great deal now as it is now so affordable and is very affordable now as well, especially when it is presentations – I used to get very nervous before you have dealt with a particularly harrowing regular, and people are travelling further and further considered that it is only three per cent of the cost of speaking at a conference or even just a business case? away. Inevitably, some of these patients will need the holiday package. presentation – I even had an increased heart rate MW: As an emergency physician you see a lot of three days before the meeting! Once I was doing a cases that others never see in their life or just on presentation on lab results at university in Vienna, horrible movies. Cases, like a mother driving with a and I had no idea about what it was I was saying and car over the head of her baby or a drowned child in it was awful, but I went on a course to try and calm the garden pool, do touch your emotions. The most myself down and I think it worked. important part to coping with harrowing cases such as these is to do an honest debrief with the involved ITIJ: If you were to have a fantasy dinner team after completion of the case. The question is: party with guests alive or dead, who would ‘Have we done everything according to the state you invite? of the art to help the patient’? Usually the answer MW: I think I would invite Bill Clinton, Nelson is ‘yes’, even though there is always some room for Mandela, Mahatma Ghandi, Meryl Streep, Julia improvement. Once you are convinced that you have done a good job, then the rest has to be put into God’s faith.

ITIJ: What are you proudest of in your life? Apologies MW: My two daughters – 18 and 14 years old, they make me very happy. We all had our fun when we were In the last issue of ITIJ, we incorrectly younger, and I think it’s important that they do too. stated that the subjects of our profile, Susanne Holst and Thorkild Lykke, ITIJ: What have you been up to recently in were from International SOS, when in your work life? fact they are both international network MW: As a physician I want to provide good managers for SOS International. medicine to my patients. I’m very happy that EURAMI accreditation became internationally International Travel Insurance Journal 33 privatehealthcareGLOBAL HEALTHCAREnews • IPMI • CORPORATE BENEFITS GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS

Private hospitals oppose increase

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

Operators in the private hospital fraternity say that increasing foreign patients’ bills could mean that Thailand would lose its battle with neighbouring countries to become a regional medical care hub. Private Hospital Association of Thailand president Aurchat Kanjanapitak asked: “Who would come here if our medical treatment costs were higher than their original country or our rival nations?” He added that as a result of the increased fees, it would be almost inevitable that providers would lose out to their competitors in Malaysia and Singapore, both of which are also attempting to market themselves as key healthcare destinations. The suggestion was given by Siamwalla in order to solve the problem of a severe lack of doctors and nurses, saying that the revenue generated by increased billing could increase government revenue by as much as Bt6 million and these extra funds could be used to fund the national health scheme, which is in a poor state due to the skills shortage. A recent study by the Thai Ministry of Health predicted that by 2015, the number of outpatients will increase to eight million and inpatients to 400,000, due to medical tourism. In order to cope continued on page 36 DHA unveils universal plan

After more than a year of intensive research high quality, accessible and affordable healthcare international experience and expertise. We will will be separated from all health service delivery. and development, the Dubai Health Authority system in place to look after us when we need it.” also deliver effective regulation across the whole of Within the new structure, it is not responsible for (DHA) has unveiled the future direction of the The government has recognised, he continued, that Dubai’s health sector, increasing transparency and the provision of health services; instead the services government’s health strategy at a meeting in Dubai. as Dubai continues to grow at an incredible rate, it accountability within the system.” He also plans to will be delivered by a government-owned public Mandy Aitchison has the details of the plan must develop a healthcare service that is driven by drive up efficiency in the sector in order to improve corporation. Murooshid said that the separation international best practices. accessibility and sustainability. would allow the DHA to be completely independent At a presentation in Dubai attended by over 500 The DHA was created a year ago with a remit to The difficulties inherent in introducing a new in managing the wider health sector, as well as people from a range of stakeholder groups including drive up standards of care and improve the health healthcare vision have not been underestimated removing a potential conflict of interest that exists government departments, healthcare experts, of everyone living and working in the emirate by the government, who said that the transition when a government both regulates and delivers insurers and representatives from private and public and under the new plans just announced, several programme would be introduced slowly over the healthcare. The aim is to give government-owned hospitals, director general of the DHA Qadhi Saeed strategies to do so were revealed by Murooshid: next four years, completing in 2012, with the DHA hospitals and primary healthcare facilities more Al Murooshid said: “A dynamic and well regulated “We will promote international accreditation of health funding process implemented by 2015. freedom, more flexibility and accountability as they healthcare sector is important to our future growth all healthcare services and promote partnership Several details were given about the role of the DHA will be responsible for their own service planning and prosperity. What we hope is that there is a between the public and private sectors, attracting under the new plan, including the fact that the DHA continued on page 37

www.itij.co.uk 34 privatehealthcarenews

Chinese Back to basics for US planners

market to Plans for truly universal healthcare in the US seem to the cover the state’s nearly six million uninsured. increasingly unlikely to be realised. Milan Korcok Enter Governor Charlie Crist, Republican governor triple by 2015 reports of Florida, with a modest, but well supported, measure to provide stripped-down, low-cost cover China’s health insurance market is With economic hard times persisting, and budget for that state’s almost four million uninsured, predicted to triple in size by 2015 deficits choking state legislators, US dreams of arguing that a little insurance is better than none. to ¥120 billion (US$17.3 billion), ‘universal healthcare’ are being replaced by more Under the Crist initiative, which he signed into according to German private pedestrian efforts at reform such as stripped law in May 2008, with full bipartisan support, health insurer DKV Deutsche down insurance plans, health cost restraints insurers would be allowed to offer scaled-back, basic Krankenversicherung (DKV). The and regulatory mandates: in effect, the creeping care coverage for as little as $150 a month. That is company attributes the phenomenal incrementalism that has failed so far to bring any about 60 per cent less than the average policy for growth rate to the country’s ageing real relief to the nation’s uninsured. a single person. Insurers would also be prohibited population and expanding economy. Forget the high-flown rhetoric of Democratic from rejecting applicants based on age or health Other industry forecasts have been presidential aspirant Barack Obama touting the status. By comparison, members of Massachusetts’ slightly more modest, saying that by Holy Grail of universal healthcare. The reality is that Commonwealth Care, the state agency set up to 2010 health insurance premiums in the expansion of health coverage is being scraped out offer residents choices of low-cost health plans, the China could reach as much as ¥60 inch by inch in State Houses by governors forced to lowest premiums range from $39 to $116 per month billion. Swiss Re, which has now think small. Though Massachusetts’ government- pegged to co-payment and income levels. People entered into the market, reported in mandated universal health insurance scheme with incomes between $21,000 and $26,000 pay one study recently that China spent continues to enrol more members than expected, $77 per month. Those earning less than $15,000 more than ¥1 trillion in 2007, with commercial premiums and co-payments for the private insurance pay no premiums. Currently, one out of five people Draft bill not medical insurance covering less than six per cent of options have risen beyond their targets and state in Florida are without health insurance, the highest that figure, which goes to show the potential of the subsidies for those who can’t afford full premiums ratio of uninsured in the nation. popular marketplace. are pushing the programme’s costs beyond the $869 The Crist programme, known as Cover Florida, will million projected by Governor Deval Patrick for be open to uninsured people aged 19 to 64 and will Despite all the problems dogging South Africa’s the 2009 budget year. The programme has simply allow insurance companies to join a state program private healthcare providers, Netcare Ltd has proven too popular – and expensive – for its own in which they will be required to provide basic care announced that first-half profit rose by 14 per cent good. such as drugs, emergency care and hospitalisation – this year after the number of patients treated rose In the meantime, California’s version of the including preventive services, office visits, screenings, through the company’s acquisitions. Net income Massachusetts plan, pumped so hard by Governor surgery, durable medical equipment and diabetes climbed to R13 million (US$43 million) in the Arnold Schwarzenegger, was sunk in the state supplies, but be exempt from including many of six months ended 31 March, from R279 million legislature earlier this year by the weight of a the 52 services that standard policies must cover a year earlier, while sales rose by 16 per cent to projected $14.9-billion cost. Not during these times, by state regulation, such as acupuncture, podiatry, R10.3 billion. The firm told the Johannesburg stock said his Republican legislative confrères. Governor certain screenings and certain transplants. In Florida, exchange that acquisitions in London and South Schwarzenegger is now looking for less ambitious ways continued on page 36 Africa had helped to add R334 million to sales figures during the period in question. Netcare also released figures that showed more South Africans are buying private medical cover – a five-per-cent rise Google releases Basque numbers up to 7.4 million in the last year, while more people are also paying cash to use private hospitals. Google Health There was a 6.8-per-cent rise in the number of Meanwhile, on 2 June, Manto Tshabalala-Msimang, people covered by private medical insurance in health minister, introduced a draft bill in Parliament Google Inc. has now unveiled Google Health, a Spain’s Basque Country in 2006 according to that proposed medical fees, tariffs and hospital long-awaited US health information service that EUSTAT data, with the greatest increase in the costs in the private healthcare industry be regulated combines the web company’s classic search services number of collective policies. The population according to set fee structures. with a user’s personal health records. covered by insurance in the region came to Understandably, the industry did not react positively The password-protected service stores a user’s basic 341,616, meaning a rise of nearly seven per cent to the news, with Dr Kgosi Letlape, chair of medical history and gathers relevant information on the previous year and the highest number the South African Medical Association (SAMA) connected to their specific health conditions. One recorded in the last 11 years. Forty-seven per cent calling the proposed fixing of tariffs ‘unethical and particular feature of the website is that it includes a of those were covered by individual or family-type diabolical’. He went on to say that these measures link to help users find doctors by location or speciality, policies, followed by collective insurance (aimed would not ‘improve access and quality in healthcare’. GE takes Asia’s while the ‘virtual pillbox’ reminds patients when they at companies), with 35.9 per cent, and public Mark Bishop, head of funder relations at Netcare, need to take their medications and also warns of mutual societies with 16.6 per cent. The EUSTAT told reporters that the firm had ‘a continued healthcare pulse potential drug mixes that could be hazardous. report noted that special mention should be given sense of discomfort at the appointment of a non- Partners with Google in the venture include to the increasing importance of collective policies, independent facilitator, and the fact that neither the US-based General Electric Co.’s $17-billion Walgreen Co., Longs Drug Stores Corp., CVS as the number of insured has grown by 71.4 per facilitator nor the Department of Health accepts healthcare unit head has said he expects revenue Caremark Group, AllScripts and the Cleveland cent between 1999 and 2006 with an accumulated any liability should the results of regulations cause from its Asia Pacific division to grow at an average of Clinic; the company had previously said it was annual growth rate of eight per cent. The total value damages to any organisation or individual’. 22 per cent annually over the next three to five years. working with insurers such as Aetna. of premiums collected by the health insurers came to Discovery Health said in a press release that it The estimate is three times the 5.7 per cent revenue €184.8 million, ‘shares the minister’s concern about the rising cost growth predicted worldwide by GE Healthcare, and representing of healthcare and how this affects affordability for double the estimated 11 per cent growth in Asia’s around 4.4 consumers’. It continued, though, by saying: “We healthcare technology market. per cent of the believe that this form of regulation is not the most Clarence Wu, general manager of Integrated IT State total and appropriate way to lower healthcare costs, and may Solutions at GE Healthcare Asia, told Reuters 0.3 per cent well lead to distortions in the market and other that governments and private firms throughout of the Basque negative unintended consequences.” Asia are expected to invest heavily in enhancing Country’s Medi-Clinic CEO Kurt Pretorius went one step healthcare provision in the future: “There is very gross domestic further and in a briefing in Cape Town, said the strong growth from both public and private sectors product. Details plan to regulate prices could tip the private hospital across Asia. When a government decides to invest in shown in the industry into an ‘Eskom scenario’. “Eskom’s tariffs healthcare IT infrastructure, it is typically a multi- report included were too low and it caught up with them,” he said, year programme, so we are seeing a sustained high information referring to the company’s battle to meet electricity growth essentially across the region.” about the demand. Last year, GE Healthcare Asia contributed $1.8 billion number of However, providers of the government’s medical to GE’s coffers, meaning the company is now vying for claims made, schemes are of a different opinion; Janine Louw, market share with Philips, Siemens and Toshiba. which was principal officer of the Naspers Medical Scheme, The top three countries investing in healthcare IT 1,257,073, said: “Already, as a result of these proposed measures, are Japan, China and Australia, with Japan alone making an certain costs, such as those of anaesthetic gases, have making up around half of that spending, according average of been cut. This can only benefit medical scheme to Vlad Dimitriu, vice-president of Asia Pacific 3.7 visits per members. It’s a small start, but a start nevertheless.” Health industry insights at consultancy firm IDC. policyholder. International Travel Insurance Journal GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 35

Private losses overestimated in Oz US insurers pitch changes

Stuart Rodger, a healthcare actuary with Deloitte, has numbers lost in Oz). Now however, Rodger said the Some of the most important US health insurance treatments to guide clinical decision making said that some predictions made over the future of the fallout from the surcharge would be dependent on companies have added their voices to the growing – such research is somewhat rare these days, as Australian private health insurance industry could be how people over 30 responded to the news. debate over the reformation of the nation’s most manufacturers have little financial incentive considered ‘alarmist’. A report commissioned by the In Rodger’s opinion, people over the age of 30 healthcare system by pitching several clinical and to do so. The plan would also include aligning Australian Medical Association states that the plan should consider the costs of leaving the private payment policy changes. patient outcomes and safety with reimbursement, by the Federal Government to increase the Medicare medical system with the intention of rejoining America’s Health Insurance Plans, a trade group an idea that has been put forward in other reform surcharge threshold will fuel a cycle of unaffordable it later on: “I think the real issue for consumers for major players such as Aetna and UnitedHealth proposals as well. It also supports a focus on disease private health insurance (PHN 89, June 2008, Private to think about is if you’re over 30 and you leave Group, said the proposals could shave around $145 management, aimed at preventing and controlling the system and then you want to get back into it, billion off the nation’s $2-trillion healthcare bill, a chronic conditions, as management is usually a lot you’re going to be hit with a penalty that’s going to figure confirmed by PricewaterhouseCoopers. The less expensive than emergency treatment. last for a long time. You really should think twice US Centres for Medicare and Medicaid Services said Len Nicholas, healthcare economist at the New about leaving the system.” However, he added recently that US healthcare spending is now around American Foundation, said the proposals seemed that provided people make sensible decisions, 16 per cent of gross domestic product (GDP) and is reasonable: “I think the important lesson is – they the predictions made about thousands of people likely to top 20 per cent of GDP by 2017. get a range of savings that is reasonable. It suggests withdrawing from private health insurance are The proposed changes would include giving doctors, there is a growing consensus that these elements are ‘probably a bit too alarmist’. patients and payers access to research that compares what are needed for change to happen.”

Patients to rate hospitals

In a new online survey, private hospital patients in Ireland are now able to give their own verdicts on the care they receive. Launched in 2006, the ‘Rate My Hospital’ online forum has so far only been available to users of public hospitals, but in a groundbreaking move, the website, run by IrishHealth, is now asking for the opinions and experiences of patients who have attended the 17 private hospitals in Ireland. The news was released at a time when the Department of Health is continuing its stance that private hospitals do not need to be inspected. The first comments to appear on the website served to highlight the divisive nature of private healthcare, with one individual saying: “In my opinion, all they care about is making money. It is your wallet they look after, not your health, although the surgeons are fantastic.” Another blogger gave their positive opinion on the Beacon Hospital in Sandyford: “They made me feel very at ease even though I was anxious about surgery. Dr Ahmed was also very good and followed up very quickly for after-care procedures.” And while one former patient gave an excellent review of another facility, another gave a somewhat damning report: “Some wards are dirty, and in general I felt nurses ignored the hygiene needs of those who needed help the most.” The IrishHealth website has served to highlight several patient worries over public hospitals in the past, helping to improve certain practices, but it also rewards those hospitals that have consistently received positive reviews through badges of merit. Website administrators have also noted that due to the reluctance of Mary Harney, Ireland’s current Minister for Health and Children, to legislate for the inspection of private hospitals, the survey is now the only form of independent analysis of standards in the Irish private healthcare sector. Meanwhile, TreatmentAbroad, the online medical tourism portal, has launched a ratings and review system for medical tourists to share their experiences. Keith Pollard, managing director of the company, said of the addition to the website: “The ratings and reviews service is intended to inform patient choice. Patients need to be clued up on overseas medical treatment, and some may be apprehensive about the risks of travelling for treatment. Patients who have become ‘medical tourists’ generally tend to be extremely positive about their experience, so the addition of ratings and reviews on the site will further build patient confidence.” www.itij.co.uk 36 privatehealthcarenews

costcontainment privatehospitals On the move Spain

William Russell chooses new managers Jeffrey Baker – President 1400 Old Country Road, Suite 109 International expatriate in 2006 to manage Asia Pacific Westbury , NY11590 USA insurance specialist William health insurance claims, and was E-m a i l : [email protected] Russell has promoted Nichola instrumental in establishing the We b : www.medsaveusa.com Duncan to UK claims company’s Kuala Lumpur office Medical Center Te l : +1 516 622 1784 Virginia Villanueva de Pedro manager and Katy Butler to last year. Katy will be managing Fac s i m i l e : +1 516 294 6761 claims manager for the Asia a team of eight claims specialists Medical Director Pacific region, based in Kuala who administer over 3,600 We b : www.caribeasistencia.com/cmcb Lumpur. Nichola joined the claims a year from China, Hong www.centromedicocaribecancun.com firm in 2004 to administer Kong, Indonesia, Vietnam, E-m a i l : [email protected] expatriate private medical Japan and elsewhere in the Te l : +00 34 91 581 6707 Sp e c i a l i t y : Primary Care Attention insurance outpatient claims. region. Gigi Galen – President Following her promotion, Nichola Duncan & Katy Butler Tim Coyne, international 850 7th Avenue, Suite 803 she is now responsible for technical manager of William New York, 10019 USA the management of William Russell’s UK claims Russell, said: “Both Katy and Nichola have E-m a i l : [email protected] Thailand department, heading a team of six claims specialists demonstrated their flair for claims management and We b : www.starhealthcarenet.com and managing over 2,000 private medical insurance a real commitment in delivering the best possible Te l : +1 212 581 8228 outpatient claims a year. service to our members. It is these qualities which Fac s i m i l e : +1 212 581 8272 Kay Butler, meanwhile, joined the firm in the UK have been recognised in their promotions to head in 2005. She transferred to the Hong Kong office the claims teams in Malaysia and the UK.” Bangkok International Hospital. 2, Soi Soonvijai 7, New Petchburi Rd, Alegro appoints InterGlobal hires Bangkok 10320 Private Bag X5, Benmore Gardens THAILAND 2010, Johannesburg, South Africa Godard operations director We b : www.bangkokhospital.com Te l : +27 11 245 5777 E-m a i l : [email protected] Toronto-based Alegro Health Corporation, InterGlobal, the Fac s i m i l e : +27 11 783 9277 Te l : +66 2 310 3000 a provider of medical, surgical and disability international private We b : www.aims.org.za Fac s i m i l e : +66 2 310 3105 management services, has announced that it has medical insurer, has E-m a i l : [email protected] Sp e c i a l i t y : general medical appointed Paul Godard to the position of chief appointed Derek Stroud financial officer. as its group operations Brenda Rasmussen, president and CEO of the director. Derek brings Dr. Colin Plotkin Consulting firm, commented: “Paul brings extensive financial with him over 28 years United States and management experience to our team. With of experience in global his exceptional knowledge of the public/private operations and customer healthcare industry in Ontario, Paul adds an insight Derek Stroud services within the that will play a key role in our growth strategy.” insurance, retail and 27-3088 Francis Road, Richmond, Paul joins Alegro with over 20 years of management utilities industries. Before joining InterGlobal, Derek British Columbia, CANADA V7C 5V9 experience, most recently in the position of held the position of head of service, employee benefit Te l : +1 604 241 9677 managing director of Shouldice Hospital, where he at Aegon Scottish Equitable and also ran his own Fac s i m i l e : +1 604 241 0733 was responsible for the financial leadership of the independent management consultancy that specialised We b : www.plotkinconsulting.com 8940 North Kendall Drive, Em a i l : [email protected] organisation. in customer services, general management and change Suite 601-E, Miami, FL 33176 management. We b : www.baptisthealth.net/international In his new role at InterGlobal, Derek will take charge of Em a i l : [email protected] the firm’s claims and customer services functions across healthcareinsurance Te l : +1 786 596 2373 Back to basics its 10 globally positioned offices. Stephen Hartigan, Fac s i m i l e : +1 786 596 5979 chief executive of the firm, noted: “Derek will make a Sp e c i a l i t y : General Health for US planners great contribution to InterGlobal. His priorities are to continued from page 33 consolidate our global operations, rationalise processes children are eligible for a government subsidised and strengthen our customer service.” programme and the elderly are eligible for federally- funded Medicare. 1st Flr Suite, West Hs, 46 High St, The bonus in this plan, says Crist, is that it will not Orpington, Kent, BR6 0JQ, UK add ‘a dime’ to existing state health budgets. And that Jackson Memorial Hospital International We b : www.travelandmedical.co.uk Jackson Medical Towers, East Tower, is a big selling factor for other state governors who Private hospitals E-m a i l : [email protected] Suite 829, 1500 NW 12th Avenue, are treading the same path. Minnesota’s Republican Te l : +44 845 058 8000 Miami, FL 33136 - 9998 USA governor Tim Pawlenty, long an advocate of universal oppose fee increase Fac s i m i l e : +44 845 053 3000 We b : www.jmhi.org health insurance, recently vetoed a bill that would continued from page 33 E-m a i l : [email protected] have expanded health insurance access to workers 24h r Te l : +1 305 355 1212 saying the costs were excessive and irresponsible. He with these numbers of patients, Thailand needs more privatehospitals Te l : +1 305 355 5544 is now drawing up plans for less ambitious, but more doctors – hundreds more, according to the study. Fac s i m i l e : +1 305 355 5545 doable coverage – perhaps along the lines of Florida’s The problem as far as the Health Ministry is Governor Crist. concerned was made clear by the author of the Pawlenty recently told the New York Times: “The study, Thinakorn Noree, who said: “The private Portugal system is busted, and you can’t take a system that sector will consume a large number of [these] is growing at several times the rate of inflation and physicians and cause shortages for public hospitals.” subsidise your way to a solution.” Aurchate admitted that private hospitals have been At least a dozen other states are now experimenting attracting doctors who might otherwise have gone to with stripped-down policies and are shifting their focus work in the public sector, but said that in the past few Jose Quesada M.D., M.B.A. away from grand schemes like universal coverage, back years, the brain drain had accounted for only 50 out Rua 25 de Abril, 12 Vila da Luz, – Director Finance & Operations 8600-174, LGS, Portugal 1099 N.W. 14th Street to the gritty business of cutting and restraining health of 1,800 specialists. He suggested that instead, the Miami, Florida, USA costs, pressuring or persuading insurance companies, shortage of doctors was a result of mismanagement in We b : www.luzdoc.com hospitals, doctors and businesses to find ways to do medical worker distribution throughout the country, E-m a i l : [email protected] We b : www.uhealthinternational.com more for less – and resorting to mandation and heavier and that the government should sort it out rather Te l : +351 282 780 700 E-m a i l : [email protected] Fac s i m i l e : +351 282 780 709 regulation if necessary. than simply placing the blame on private facilities. Te l : +1 305 243 9100 Sp e c i a l i t y : General Medical Fac s i m i l e : +1 305 243 9101

International Travel Insurance Journal GLOBAL HEALTHCARE • IPMI • CORPORATE BENEFITS 37

Company Brief Aetna teams with On Call International IMG launches UAE Patriot signs with emergency evacuations from any point on the plan Arizona Foundation globe through its partnership with the International Assistance Group and says that no matter where a International Medical Group (IMG) and Abu Dhabi- New York-based Patriot Health, an administrator student may be travelling, a multilingual team is on based Al Wathba National Insurance Company PSC and service provider of medical plans for the hand 24/7 to respond to calls for help. US-trained (AWNIC) have together announced the launch underinsured in the US, has announced that it has physicians are made immediately available to react of MediGlobal Health Insurance, an international contracted with the Arizona Foundation for Medical to a student’s medical needs, including the need for healthcare plan that meets all the local requirements Care (AFMC) to include its PPO network for all medical evacuation, critical care monitoring and of the Emirate of Abu Dhabi as well as Arizona-based evaluation, as well as physician and hospital referrals offering options that cater to differing Patriot members. or prescription drug assistance. In addition, On Call laws across the UAE. Bob Smith, director is to provide security and legal services to Aetna’s Carl Carter, managing director of IMG of marketing student members, including political evacuation in Europe Ltd, said: “We have worked very and network the event of social or governmental unrest and access closely with AWNIC to deliver effective management for to a legal hotline and bail bond. local and international cover with one the AFMC, said of On Call International, a provider of customised Michael Kelly, president of On Call International, seamless plan specially designed for the deal: “We are medical, security and travel assistance for said: “Aetna Student Health is a world-class the UAE market.” President of IMG pleased that our international travellers as well as expatriates organisation, which understands the unique and Joe Brougher added that the firm was PPO, with its large and students, has announced a new partnership often critical circumstances that can arise with ‘particularly pleased to be partnering physician, hospital, with student health insurance administrator student travel. As an emergency healthcare and travel with an insurance company like speciality and lab Aetna Student Health. Under the terms of the assistance business, we manage these urgent situations AWNIC’. networks will now collaboration, On Call will provide its emergency every day, which makes our partnership a perfect fit The need for such a specific product had be included in all medical and travel assistance services to Aetna’s for the health and well-being of Aetna’s students.” been identified by Bassam Chilmeran, Limited Medical 450,000 student members. general manager of AWNIC: “Our plans offered to On Call International specialises in high-touch review of the UAE health Patriot Health insurance sector showed members residing that the market was in Arizona.” lacking a product that Jason Krouse, could effectively combine CMO of the Cost CNA offers new local underwriting and Containment service with international Group, which is range of cover coverage and emergency services. After Patriot’s parent company, added: “Patriot Health has a an extensive review of the companies corporate philosophy of developing plans that offer its CNA Insurance, owned by US-based CNA operating in the international market, members the broadest selection of providers with the Financial Corporations, is to launch a tailored we found that IMG stood above the deepest discount available. Patriot Health members will comprehensive plan of healthcare products as market with its superior international now benefit from the deep discounts included in the part of the firm’s flagship HealthPro range. CNA service and global reputation.” AFMC PPO network.” HealthPro is offering product liability, clinical trials liability and professional indemnity cover to medical device manufacturers, small pharmaceutical firms and biotech companies. In addition, where there is Boots unveils GCC-specific plans launched exposure to medical professional liability, additional cover may be added to the policies. insurance foray Dubai Insurance Company and international term disability insurance protection. Rhonda Buege, CNA director of underwriting, said Health insurance in the UK has now hit the high expat insurer William Russell have partnered in Abdellatif Abuqurah, general manager of the Dubai a considerable need for improved protection in the street, with the news that chemist chain Boots has order to launch a range of international health, Insurance Company, said: “The expatriate workforce fast-moving medical technology centre had been teamed up with PruHealth to offer medical cover income protection and life insurance plans that in Dubai and throughout the GCC is vital to the identified by the firm and added: “We understand the to the masses. The new policy offers access to more have been designed specifically for expatriates continued success and development of the region. importance of continuing to innovate our product than 13,000 consultants across the UK, as well as and small to medium-sized expat employers. The We see a real need for a range of specialist protection range to meet the ever-changing needs of this dynamic giving policyholders the opportunity to use any plans, which are underwritten by Dubai Insurance policies designed to meet the needs of small to sector. This, combined with 40 years of experience of National Health Service private patient unit and Company and administered by William Russell, medium-sized businesses and individual expatriates.” servicing the healthcare sector in the US, has enabled private hospitals. have been called GlobalHealth, GlobalLife and Peter Hogg of Neuron agreed that the last thing a us to develop a range of new solutions for a wide array Commenting on the tie-up, Kevin Johnson, head of GlobalIncomeProtection. Corporate GlobalHealth busy expatriate needs when in a foreign country is of healthcare providers and organisations.” Boots insurance services, said: “It is a great opportunity plan members will gain access to an ever-growing to worry about which hospital to go to if they fall CNA is currently providing this coverage for UK for us to use our position on the high street to offer the network of clinics, hospitals and pharmacies ill and added: “We offer corporate GlobalHealth organisations with plans to expand in Europe. public greater access to private healthcare.” across the Gulf region through specialist claims members peace of mind with cashless access to European domiciled healthcare organisations with Shaun Matisonn, chief executive of PruHealth, administrator Neuron. In addition, there is also an medical care within our expanding GCC network, exposure in the US can also be protected, said the agreed that the deal with Boots should ‘make private option available where members can add employee and the freedom to have their treatment outside the company, regardless of the amount of exposure. health insurance more accessible and affordable’. benefits such as group life, travel, accident and long- network if they prefer.”

DHA unveils universal plan continued from page 34 and delivery. It is hoped that this will allow the health service providers.” The plan is for the DHA’s standards of healthcare services that are in developed health card and, subject to availability, will be able to facilities to run both more efficiently and effectively regulation team to work with the Federal Ministry of countries, adding ‘it will be compulsory for everyone register with a public or private outpatient clinic of by increasing capacity and creating more equal Health to streamline the current processes, helping and will be largely employer or sponsor-funded’. their choice. opportunities between public and private hospitals. to build confidence in the system and make it more Under the new system, UAE nationals will continue The new health funding system is projected to be Murooshid added: “For patients, this will result in efficient for both users and operators. Murooshid to receive existing levels of cover and care; there will implemented in January 2009, when patients can start greater choice, more accountability, better service went on to state: “The DHA’s health regulation team be no distinction between public or private health registering at clinics. In his concluding comments to the and in the longer term, higher quality healthcare.” will create a single government body responsible service providers and, for the first time, access to presentation, Murooshid said: “Further announcements Regarding the difficult topic of healthcare regulation, for health service professionals and services. It will affordable healthcare will be extended to everyone on the progress of the DHA programme will be made Murooshid said: “Regulation will be one of the main bring together current regulatory activities into living in Dubai to meet their basic medical needs. as we continue the implementation and engagement tools available to the DHA to allow it to manage one co-ordinated system, responsive to the needs Where there is no employer to sponsor cover, the process. However, as we build and develop a new health the healthcare sector. At the moment, the regulation of the public and health providers.” The team will individual resident of Dubai will be responsible system, healthcare provision must always be balanced of the sector in Dubai is fragmented into different also be responsible for managing complaints and for the payment for dependents and those they with a need to help the public to lead healthier and facilities subject to different legislation and different malpractice investigations. sponsor – this payment is called a Health Benefits safer lifestyles, consequently, the DHA will have a far processes. This has led to inconsistent standards and Concerning the new funding system, the director Contribution, with the exact figure still to be agreed more proactive approach to working across government duplication as well as a high regulatory burden on general noted that the objective is to reach the same upon. Everyone in Dubai will be issued with a to ensure that Dubai is a healthier place.” www.itij.co.uk 38 phn feature

The crumbling safety net

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

ith national or socialist health systems IPMI market has grown at least between 25 and 30 Basic plan. stretched to breaking point and looking per cent in the last five years, and will likely exceed Glenn Maykish, CIGNA International Expatriate Wto the private sector for a bailout, the $7 billion in annual premiums by the end of the Benefits’ vice-president of international sales wrote international travel and travel health insurance market decade. The data also show that the greatest growth in a trade publication that appears poised for a robust breakout into what was for international expatriate assignments over the complying with home formerly alien territory. Up until now, coverage of immediate short term is being experienced in China, and host country travellers, expatriates, foreign postings, students, Central and Eastern Europe, the Indian subcontinent benefits legislation missionaries and cross-border consultants has and Southeast Asia. is increasingly generally been considered a small but comfortable An example of this market penetration is IMG’s complex, and niche. But with the global economy transferring and recent launch of its regionally-tailored GlobalSelect infractions shifting not only individuals but whole departments, product line into China in partnership with Ping – even divisions, even companies across borders into An Property and Casualty of China Ltd, which will innocently health systems already burdened by waiting lists and provide exclusive distribution through Chinese achieved – can unmanageable costs, the need for new products insurance brokers. Ping An P&C is the third largest invoke some serious and seamless cover is challenging the travel and property and casualty insurance company in China. penalties – criminal as international health insurance industry to reinvent itself. InterGlobal too recently expanded its already well as civil. He noted that well-established presence in Asia by joining forces expatriate employees working in Meeting demand with BaoViet, Vietnam’s leading finance-insurance many countries are typically subject Carl Carter, managing director of IMG Europe Ltd, group, which will sell its health insurance plans in that to numerous rules and regulations that and chairman of the Association of International country. This coupling with BaoViet, says Tony Valin, mitigate their ability to have comprehensive, Medical Insurance Providers (AIMIP), says: “There general manager of BaoViet-InterGlobal, ‘means seamless cover. “Countries such as Saudi Arabia, are numerous opportunities in the IPMI (international we can offer our strong products to expats and Iceland, Switzerland, the Netherlands and others private medical insurance) market and these should corporations in this rapidly expanding market’. This is have enacted legislation that restricts coverage,” be of particular interest to brokers that aren’t InterGlobal’s fifth joint venture in Asia. said Maykish, just as ‘covering international currently promoting IPMI.” Whereas the existing assignees on an insurance plan that is designed domestic PMI markets around the world are typically Bridging the gap for US domestic employees is likely to be an mature and stagnant or growing at low inflationary The products and services sought by beneficiaries inadequate strategy from a benefits delivery rates, it is commonly quoted that the IPMI market is of international portfolios are not that different from and legal compliance perspective’. growing at 25 per cent year upon year. “Whereas 10 those covered by domestic insurance – government- At the same time, says Maykish, tailoring or years ago IPMI could have been regarded as a niche sponsored or private. All want comprehensive care; business, it is now very much a specialised class of all need preventive as well as curative services; all insurance in its own right,” says Carter. want coverage for chronic conditions. But the trick Peter Rousseau, business development director at is to integrate the offerings of international providers private funding UK-based InterGlobal Ltd, stresses that the need (which are sometimes more beneficent than are of facilities and and rationale for developing more comprehensive domestic national plans) into systems not meant to insurance products for the international market is accommodate them, or that are close to flat broke. private insurance a top priority not only among employers but their When the Netherlands introduced the Dutch beneficiaries as well. Citing independent research, Healthcare Act in January 2006, making enrolment in is no longer just a he notes that among employees posted abroad, the the Basic Healthcare Plan mandatory for all residents, possible option: importance of medical insurance benefits ranks just both inbound and outbound expats and other foreign behind relocation payments, home leave, schooling residents found their coverage benefits changed, in it’s mandatory in and housing, and above hardship benefits, goods some cases rendered incomplete or insufficient for and services, car allowance, incentive allowance and them and their families. Cigna International, one of most developed even spouse allowance. the largest players in the IPMI market was able to and even Citing data from Price Waterhouse Coopers and tailor alternative cover for those outbound expats Goldman Sachs, Rousseau notes also that there are who were no longer eligible for basic mandatory developing currently approximately 30 million expatriates of insurance, and provide a ‘safety net’ for inbound all nationalities working worldwide. In addition, the expats whose cases were not totally covered by the nations

International Travel Insurance Journal phn feature 39

the majority of countries Service, enacted in 1948, Britons were not bouncing in the OECD ranging from around the world taking annual holidays in Jamaica, with globalisation about nine to 16 per cent of Majorca or Phuket. They were not retiring en masse GDP (US at the top, the OECD to the Algarve or the Costa del Sol. They were not not only a fad but a average at 8.9), private funding colonising American businesses in New York or Los of facilities and private insurance Angeles as they are today. reality of everyday is no longer just a possible option: it’s Germans in the 1880s hardly ever left their life, medicine mandatory in most developed and even own districts when Otto von Bismarck launched developing nations. that nation’s vaunted statutory health insurance without boundaries Despite the ideological contradictions programme that still provides coverage for more about multi-tiered healthcare, or than 90 per cent its citizens. Expatriation was virtually seems an inevitable arguments about the evils of privatisation, unknown. Travel insurance was an irrelevancy. goal data from virtually all nations and international Foreign postings were rare. bodies document that governments alone cannot Now, with globalisation not only a fad but a reality of afford to foot the bill for the healthcare needs and everyday life, medicine without boundaries seems as Canadians leave the country, their safety net is expectations of their citizens without attaching an inevitable goal. And expectations keep rising, not withdrawn and they need private insurance to backfill private funding, and that boils down to more options only for domestic insurance, but international cover as what their provincial plans will not – which is virtually and more demand for private insurance. Among well. People want cancer cover, chronic care services, everything. That’s fine: Canadians have bitten that all member nations of the OECD, 26 per cent of critical illness and maltreatment insurance, wellness pill and now routinely pay for private out-of-country healthcare spending now derives from the private and preventive care. They want to avoid waiting lists. insurance. But what many find is that even with sector (out of pocket and private insurance). That is They want access to a cardiac bypass in India that can private insurance, if they fall ill outside of the country a steadily growing percentage. At the top of that list be done next week. They want the add-ons they see and want to return for the care their taxes have paid expatriate is the US with 55 per cent derived from the private promoted on the Internet. And who better to provide for, they can’t get a bed because of overcrowded sector, but not too far behind is Switzerland at 42 per them than international insurers who can transition hospitals, and they have to rely on the expertise, employees cent, the Netherlands at 38 per cent, Australia at 33 between a dozen different markets and health systems and sometimes cunning, of their private international per cent, and of course Canada (which has a single at the same time? travel insurers to find one for them. Or if they need working in many payer system that actually forbids private insurance “A drug or medical procedure may not be available in immediate diagnostic or therapeutic cancer care, or countries are from paying for medically necessary services), where certain countries but available in others,” says IMG’s hip replacement, or a number of other wait-listed 30 per cent of healthcare spending comes out of the Carter. Clients need access to these. The ‘new services, they join a months-long queue, or head to typically subject private sector (most of it private insurance). style’ products being developed for the international the US with cheque book in hand. And among the 30 OECD countries as a whole, 14 market may allow someone restricted by their Fortunately, the growing phenomenon of medical to numerous rules of them – the Czech Republic, Luxembourg, Poland, own medical system ‘to break free and seek their tourism is adding a lot of menu options for people and regulations Sweden, Germany, Hungary, Iceland, New Zealand, treatment anywhere in their area of cover’. constrained by their national health systems and Finland, Italy, Spain, Canada, the Netherlands, and Yet being able to cover clients abroad is often easier international insurers are providing the bridge. Cigna that mitigate their Greece – have all decreased their reliance on public and less encumbered by regulations than extending that International, for example, recently announced a spending for health since 1990, in effect shifting to same cover closer to home. InterGlobal’s Rousseau formal agreement with Fortis Healthcare Limited ability to have more private spending. Ironically, over that same notes that the old standard of international insurance as of India to make direct payments for its members comprehensive, period, the US has increased its reliance on public ‘medical’ insurance – kicking in only when people get so they might have direct access to Fortis hospitals spending by 5.7 per cent (through expansion sick, doesn’t do it any more. Expat insurance, like any in northern India. Fortis includes the internationally seamless cover in Medicare, Medicaid, children’s insurance other, must be comprehensive, it must be cost effective. recognised Escorts Heart Institute and Research programmes, federally funded research and public Data has shown that for every $1 spent on prevention, Centre in New Delhi. Bupa International, Aetna, health). But it still relies on the private sector for 55 $64 is saved in claims costs, he says. International SOS are among other major retrofitting a benefit plan for expats or others in a per cent of its healthcare spending. Whereas many companies cover the client as an international players who currently have alliances foreign country, and trying to bridge the gap between The OECD warns that this shift to out-of-pocket and expat, it is also necessary to ‘bridge the gap between with Fortis. domestic and international coverage and services private insurance is inevitable. In a policy statement domestic and international healthcare’, says Carter. If government-run health systems delivered what demands very specialised skills and availabilities, such it concludes: “Health spending continues to rise in Though IMG has been able to bridge this gap they were designed for, treatment shopping would as: offering 24/7 multilingual access to medically OECD countries and, if current trends continue through many of its products, there are still many not be necessary. But clearly they can’t. They need a proficient professionals, providing payment governments will need to raise taxes, cut spending companies that have not, he says. “In the UK, for lot of help from the private sector, and as one of the guarantees to international providers, fulfilling in other areas, or make people pay more out of example, as further strain is put on the NHS, some fastest growing segments of that sector, international various species of claims forms, providing access to their own pockets in order to maintain their existing NHS Primary Care Trusts, who manage localised medical insurance providers of all stripes must muscle skilled medical and clinical consultation teams, and healthcare systems.” It reports further: “Health care under strict budgets, have been known to turn up and show if they can lift the load. activating the services of top line case managers spending has grown faster than GDP in every OECD away expats who come home for treatment.” with knowledge of local fee levels and payment country except Finland between 1990 and 2004. It With millions crossing borders daily for business, leisure, procedures. Sound familiar? Certainly not alien turf accounted for seven per cent of GDP on average commerce, or just to do some shopping, the systems The AIMIP, formed in 2007, represents the for international travel insurers. across OECD countries in 1990 but reached 8.9 per devised by Lord Beveridge or Otto von Bismarck interests of companies offering products and cent in 2004.” simply don’t cut it: not without a private insurance safety services to the international medical insurance No longer just an option net. And even then, there are impediments. industry. AIMIP currently includes A La Carte Bridging the gap between domestic resources and Old systems, new times Healthcare, Allianz Worldwide Care, Cigna the expectations and requirements of increasingly Most national health systems relying on government Time to muscle up International, BUPA International, Exeter affluent and mobile populations has outstripped the monopoly, social insurance, or socialist methods of When Canadians adopted their universal single payer Friendly Society, Medicare International, Morgan-Price, GoodHealth, IMG Europe, abilities of many socialist systems and government delivery and funding were devised to cover relatively health system called medicare – in the late sixties InterGlobal Ltd, Healthcare International and monopoly health plans to pay the bills without raising static domestic populations. When Lord Beveridge – it was designed to provide first dollar coverage for William Russell Ltd. taxes to intolerable levels. With healthcare costs for drafted the foundation for Britain’s National Health all medically necessary services. But now, as soon

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AIR AMBULANCE AIR AMBULANCE (CoNT.) AFRICA European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange [email protected] – President Air Ambulance Network Kirk Pacheco L-1321 www.air-ambulance.com 905 Martin Luther King Jr Drive [email protected] LUXEMBoURG Tel (24 hr): +49 711 7007 7007 Suite 330 www.airambulancenetwork.com Fax: +49 711 7007 7009 Tarpon Springs Tel(24hr): +1 727 934 3999 Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276 Goodmans Rescue 24 Hrs Ground & Air Ambulances Dr Satish K Bhardwaj – Director Air Ambulance Worldwide Inc. Mark Jones – President M-2 Greater Kailash-Part 1 [email protected] New Delhi 110048 www.goodmansrescue.com NEW 35246 US Hwy 19 North [email protected] INDIA Tel: +91 11 2923 1665 #210 www.airambulanceworldwide.com Mob: +91 98 1001 2126 Palm Harbor Tel: +1 727 781 1198 Fax: +91 11 2923 4665 Florida 34684 Fax: +1 727 786 0897 USA Hope Ambulance Service Dr Charles Johnson – Medical Director AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director 56 Upavon Road [email protected] Singapore 507745 www.hopeambulance.com Wilson Airport [email protected] SINGAPoRE 24hr Tel: +65 6100 1911 LangataRoad www.amref.org Fax: +65 6400 5254 PO Box 18617 Tel: +254 20 600 090

Nairobi Fax: +254 20 344 170 KENYA JET ICU Bart Gray – President European Air Ambulance Patrick Schomaker – Director Sales & Mkt 17076 Helicopter Drive [email protected] 175A, rue de Cessange [email protected] Brooksville www.jeticu.com L-1321 www.air-ambulance.com FL 34604 Tel: +1 877 453 8428 LUXEMBoURG Tel (24 hr): +49 711 7007 7007 USA Tel: +1 727 524 9825 Fax: +49 711 7007 7009 Fax: +1 727 524 982 Medical Wings Dr Sommart Somsiri – Medical Director JET ICU Bart Gray – President 222 Room 3259 [email protected] 17076 Helicopter Drive [email protected] Donmuang Int Airport Moo 10 www.medicalwings.com Brooksville www.jeticu.com Viphavadee-Rangsit Rd, Sikan Tel: +662 247 3392 FL 34604 Tel: +1 877 453 8428 Don Muang, Bangkok 10210 Fax:+662 535 4355 USA Tel: +1 727 524 9825 THAILAND Fax: +1 727 524 982 Mediflight Chris Craft – Operations Manager Netcare 911 Aeromedical Wayne Thomson - Flight Operations Mgr Royal Adelaide Hospital [email protected] Netcare 911 House [email protected] North Terrace www.mediflight.com.au 49 New Road www.netcare911.co.za Adelaide Tel: +61 8 8378 6938 Halfway House Tel: +27 11 254 1392 SA 5000 Fax:+61 8 8423 3077 Midrand 1685 Fax: +27 11 254 1405 AUSTRALIA SoUTH AFRICA ozevac Anne Mordey – Operations Manager Skyservice Air Ambulance David Ewing – VP Int. Market Development PO Box 299 [email protected] YUL/Trudeau Int Airport [email protected] Hampton www.ozevac.com NEW 9785 Avenue Ryan www.skyservice.com/airambulance Victoria 3188 Tel: +61 409 537 333 Montreal (Quebec) N AmericaToll Free: +800 463 3482 AUSTRALIA H9P 1A2 Tel: +1 514 497 7000 CANADA Fax: +1 514 636 0096 Pacific Flight Services Pte Ltd Katherine Yeo – Assistant Marketing Mgr ST Aerospace Engineering Bldg [email protected] AUSTRALASIA Seletar West Camp www.fly-pfs.com Air Ambulance Network Kirk Pacheco – President Seletar Airport Tel: +65 6481 3756 905 Martin Luther King Jr Drive [email protected] 797796 Fax: +65 6482 1727 Suite 330 www.airambulancenetwork.com SINGAPoRE Tarpon Springs Tel(24hr): +1 727 934 3999 Skyservice Air Ambulance David Ewing – VP Int. Market Development Florida 34689 Tel(toll free): +1 800 327 1966 USA Fax: +1 727 937 0276 YUL/Trudeau Int Airport [email protected] 9785 Avenue Ryan www.skyservice.com/airambulance Air Ambulance Worldwide Inc. Mark Jones – President Montreal (Quebec) N AmericaToll Free: +800 463 3482 35246 US Hwy 19 North [email protected] H9P 1A2 Tel: +1 514 497 7000 #210 www.airambulanceworldwide.com CANADA Fax: +1 514 636 0096 Palm Harbor Tel: +1 727 781 1198 – Managing Director Florida 34684 Fax: +1 727 786 0897 South Pacific Air Ambulance Scotty Watson USA [email protected] NEW ZEALAND www.spaa.co.nz Asia Assistance Partners Siriporn Wongurai – Int. Ops. Director AUSTRALIA Tel: +64 9256 9000 184/235 Forum Tower [email protected] SINGAPoRE Fax: +64 9256 9111 36 Flr Ratchadapisek Rd www.aapartners.net Huaykwang Tel: +662 645 3733-5 Bangkok 10320 Fax: +662 645 3732 THAILAND EURoPE Asia Medical Assistance Abhijeet Sachdev – Vice President ADAC-Ambulance Service Robert Glueck – Marketing & Sales Director DLF City-ll [email protected] Am Westpark 8 [email protected] M.G Road www.privathealthcaregroup.com 81373 Munich www.adac.de/ambulance New Delhi Tel: +91 9899 198 198 GERMANY Tel: +49 89 76 76 52 85 Gurgaon 122002 Fax: +91 1242 235 2527 24-h alarm centre: INDIA +49 89 76 76 50 05 CareFlight International Colin Robshaw – Co-ordinator AeroMed 365 Brian Brooker – Clinical Director Westmead Hospital Campus [email protected] Worth Corner Business Cntr [email protected] PO Box 159 www.careflight.org Turners Hill Road www.aeromed365.com Westmead Tel: +61 1300 655 855 Pound Hill Tel: +44 8707 596 999 NSW 2145 Fax: +61 2 4751 2995 Crawley RH10 7SL Fax: +44 8707 559599 AUSTRALIA UK

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AIR AMBULANCE (CoNT.) AIR AMBULANCE (CoNT.) Air Ambulance Network Kirk Pacheco – President Medical Jet Services & Partner W Dichtl 905 Martin Luther King Jr Drive [email protected] Radetzkystr 19 [email protected] Suite 330 www.airambulancenetwork.com Vienna www.medicaljetservice.com Tarpon Springs Tel(24hr): +1 727 934 3999 1030 Tel: +43 1 600 1212 Florida 34689 Tel(toll free): +1 800 327 1966 AUSTRIA Fax: +43 1 713 2799-19 USA Fax: +1 727 937 0276 Air Ambulance Worldwide Inc. Mark Jones – President Red Star Aviation Mustafa Atac – CEO 35246 US Hwy 19 North [email protected] Sabiha Gokcen Int Airport [email protected] #210 www.airambulanceworldwide.com J Blok Kurtkoy www.redstar-aviation.com Palm Harbor Tel: +1 727 781 1198 34912 Tel: +90 216 588 0216 Florida 34684 Fax: +1 727 786 0897 Istanbul Fax: +90 216 588 0225 USA TURKEY AirMed International LLC Jeffrey T Tolbert – President Skyservice Air Ambulance David Ewing – VP Int. Market Development 1000 Urban Center Drive [email protected] YUL/Trudeau Int Airport [email protected] Suite 470 www.airmed.com 9785 Avenue Ryan www.skyservice.com/airambulance Montreal (Quebec) N AmericaToll Free: +800 463 3482 Birmingham Tel: +1 205 443 4840 H9P 1A2 Tel: +1 514 497 7000 AL 35242 Fax: +1 205 443 4841 CANADA Fax: +1 514 636 0096 USA Toll Free: +1 877 633 5387 Swiss Air Ambulance/REGA Walter Stunzi – PR/Marketing Mgr – Flight Operations Manager Air Medical Ltd Glenn Salt PO Box 1414 [email protected] Oxford Airport [email protected] Zurich Airport www.rega.ch Kidlington www.airmed.co.uk CH-8058 Tel: +41 333 333 333 Oxfordshire Tel: +44 1865 842 887 SWITZERLAND Fax: +41 44 654 3590 OX5 1QX Tel: +44 1865 370 642 UK Tyrol Air Ambulance Jakob Ringler – Managing Director Augsburg Air Ambulance Roland Schoberth – Director PO Box 81 [email protected] Roseggerstr 17 [email protected] A-6026 www.taa.at D-86368 www.ambulanzflugdienst.de Innsbruck Airport Tel: +43 512 224 220 Gersthofen Tel: +49 821 299 1020 AUSTRIA Fax: +43 512 288 888 GERMANY Tel: +49 821 299 2030

NoRTH AMERICA EMC Meditrans Servé de Klerk – President Hoevestein 23 [email protected] Aerojet Stuart Hayman – President Postbus 4190 www.emc.nl 4631 NW 31st Ave [email protected] 4900 CD Tel: +31 162 496 000 #220 www.aero-jet.com Oosterhout Fax: +31 8 42 24 64 86 Ft Lauderdale Tel: +1 954 730 9300 THE NETHERLANDS FL 33309 Fax: +1 954 485 6564 USA Euro-flite Air Ambulance Juhani Missonen – Coordinator Helsinki International Airport [email protected] Aeromedevac Air Ambulance Jesus Mendez – Provider Relations PO Box 187 Tel: +358 20510 1900 681 Kenney Street [email protected] FIN-01531 Fax: +358 20510 1901 Gillespie Field Airport www.aeromedevac.com Vantaa El Cajon Tel: US: +1 619 284 7910 FINLAND CA 92020 Tel: Mexico: 00 1-800-832-5087 USA Fax: +1 619 284-7918 European Air Ambulance Patrick Schomaker – Director Sales & Mkt 175A, rue de Cessange [email protected] L-1321 www.air-ambulance.com LUXEMBoURG Tel (24 hr): +49 711 7007 7007 Fax: +49 711 7007 7009

FAI – rent-a-jet AG Volker Lemke – Director Sales & Marketing Flughafenstrasse 100 [email protected] D-90268 Nuremberg www.rent-a-jet.de GERMANY Tel: +49 911 36009 31 Fax: +49 911 36009 59

Global Medical Support otto Karud – Marketing Director Ullevaal University Hospital [email protected] 0407 Oslo www.globalmedicalsupport.com NoRWAY Tel: +47 22 96 50 50 Tel/Fax: +47 22 96 50 51

IFRA Dr Christian Steindl – Director Bahnhofplatz 13/5 [email protected] POB 160 www.ifra.at 3500 Krems Tel: +43 2732 825 610 AUSTRIA Fax: +43 2732 851 01

Jet Executive International Charter Günter Krahé – Marketing & Sales Mündelheimer Weg 50 [email protected] D-40472 www.jetexecutive.com Düsseldorf Tel: +49 211 602 7775 GERMANY Fax: +49 211 602 77766 “Homebase FRA & MUC” JET ICU Bart Gray – President 17076 Helicopter Drive [email protected] Brooksville www.jeticu.com FL 34604 Tel: +1 877 453 8428 USA Tel: +1 727 524 9825 Fax: +1 727 524 982 Med Call GmbH Michael Diefenbach – CEO Black and Decker Str. 1-3 [email protected] 65510 www.medcallgmbh.com Idstein Tel: +49 61 2695 3708-0 GERMANY Fax: +49 61 2695 3708-11

Medic’Air International Dr Herve Raffin – General Manager 35 rue Jules Ferry [email protected] 93170 Bagnolet www.medicair.com Paris Tel: +33 141 72 1414 FRANCE Fax: +33 148 57 1010

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AIR AMBULANCE (CoNT.) ASSISTANCE CoMPANIES Air Ambulance Network Kirk Pacheco – President 905 Martin Luther King Jr Drive [email protected] AFRICA Suite 330 www.airambulancenetwork.com AIMS Bernadette Breton – Managing Director Tarpon Springs Tel(24hr): +1 727 934 3999 Private Bag X5 [email protected] Florida 34689 Tel(toll free): +1 800 327 1966 Benmore Gardens 2010 www.aims.org.za USA Fax: +1 727 937 0276 Johannesburg Tel: +27 11 245 5777 Air Ambulance Professionals, Inc. Brian L. Weisz – President SoUTH AFRICA Fax: +27 11 783 9277 Ft. Lauderdale Executive Airport [email protected] 1535 South Perimeter Rd www.airambulanceprof.com AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Hangar 36B Ft. Lauderdale Tel: +1 954 491 0555 Wilson Airport [email protected] Florida 33309 Fax: +1 954 491 6114 Langata Road www.amref.org USA PO Box 18617 Tel: +254 20 600 090 Air Ambulance Specialists, Inc. Donald Jones – President Nairobi Fax: +254 20 344 170 8001 S.Interport Blvd. [email protected] KENYA Suite 250 www.airaasi.com Netcare 911 International Assistance Brenda Durow - International Assistance Mgr Englewood Toll Free: +1 800 424 7060 Netcare 911 House [email protected] CO 80111 Tel: +1 720 875 9182 49 New Road www.netcare911.co.za USA Fax: +1 720 875 9183 Halfway House Tel: +27 11 254 1387 Air Ambulance Worldwide Inc. Mark Jones – President Midrand 1685 Fax: +27 11 254 1405 35246 US Hwy 19 North [email protected] SoUTH AFRICA #210 www.airambulanceworldwide.com West African Rescue Association Florian Zagel - Managing Director Palm Harbor Tel: +1 727 781 1198 Klotey Cresent 6 [email protected] Florida 34684 Fax: +1 727 786 0897 North Labone www.westafrican-rescue.com USA Accra Tel: +233 21 781 258 AirMed International LLC Jeffrey T Tolbert – President GHANA Tel: +233 244 312 496/7 1000 Urban Center Drive [email protected] Fax: +233 21 781 259 Suite 470 www.airmed.com Birmingham Tel: +1 205 443 4840 AUSTRALASIA AL 35242 Fax: +1 205 443 4841 Asia Assistance Partners Siriporn Wongurai – Int. Ops. Director USA Toll Free: +1 877 633 5387 184/235 Forum Tower [email protected] American Care Air Ambulance Joel Reynolds – General Manager 36 Flr Ratchadapisek Rd www.aapartners.net 8775 Aero Drive [email protected] Huaykwang Tel: +662 645 3733-5 Suite 120 www.americancareairambulance.com Bangkok 10320 Fax: +662 645 3732 San Diego Tel: +1 858 627 0515 THAILAND CA 92123 Fax: +1 858 627 0534 Asia Medical Assistance India Abhijeet Sachdev – Vice President USA DLF City-ll [email protected] Canadian Global Air Ambulance Jeff McIntosh – President M.G Road www.privathealthcaregroup.com Toronto [email protected] New Delhi Tel: +91 9899 198 198 Winnipeg www.canadianglobalair.ca Gurgaon 122002 Fax:+91 2440 147 28 Vancouver Toll Free: +1 800 563 3822 INDIA CANADA Tel: +1 204 888 5555 Asia Medical Assistance Thailand Abhijeet Sachdev – Vice President Fax: +1 204 888 9111 1011 10th Fl, BB Building [email protected] European Air Ambulance Patrick Schomaker – Director Sales & Mkt 54 Sukhumvit Soi 21 (Asoke) www.privathealthcaregroup.com 175A, rue de Cessange [email protected] N Klong Toey, Wattana Tel: +66 225 833 55 L-1321 www.air-ambulance.com Bangkok Tel: +91 9899 198 198 LUXEMBoURG Tel (24 hr): +49 711 7007 7007 THAILAND Fax:+66 225 822 77 Fax: +49 711 7007 7009 Assistance online Bertrand Guichoux – CEO

Zendai Cube Edifice 6/F [email protected] JET ICU Bart Gray – President 58, Changliu Road, www.assistanceonline-china.com NEW 17076 Helicopter Drive [email protected] Pudong Tel: +86 21 6104 9500 Brooksville www.jeticu.com 200135 Shanghai Fax: +86 21 6104 9484 FL 34604 Tel: +1 877 453 8428 CHINA USA Tel: +1 727 524 9825 Customer Care Pty Ltd Janine Benson – Operations Manager Fax: +1 727 524 982 Level 3 [email protected] Life Flight International Inc. Chris Connor – Operations 60 Miller Street www.customercare.com.au Victoria International Airport [email protected] North Sydney 2060 Tel: +612 9202 8222 Viscount Business Center www.lifeflight.ca NSW Fax: +612 9202 8220 103-9800 McDonald Pk Rd Tel: +1 250 655 1630 AUSTRALIA Sidney, British Columbia Fax: +1 250 656 9394 First Assistance Mary-Jo McDonald – General Manager CANADA PO Box 17-310 [email protected] National Air Ambulance George Martinez – Mgr Flight Co-ordination Greenlane www.firstassistance.co.nz 3495 SW 9th Ave [email protected] Auckland Tel: +64 9 356 1650 Fort Lauderdale www.nationalairambulance.com NEW ZEALAND Fax: +64 9 525 1278 FL 33315 Tel: +1 954 359 9900 USA Fax: +1 954 359 9500 Global Assistance & Healthcare Mario Babin – Chief Executive Officer

Jalan Pattimura [email protected] Skyservice Air Ambulance David Ewing – VP Int. Market Development 15 Kebayoran Baru www.global-assistance.net YUL/Trudeau Int Airport [email protected] Jakaita Tel: +62 21 725 8115 9785 Avenue Ryan www.skyservice.com/airambulance 12110 Fax: +62 21 725 7961 Montreal (Quebec) N AmericaToll Free: +800 463 3482 INDoNESIA H9P 1A2 Tel: +1 514 497 7000 – Managing Director CANADA Fax: +1 514 636 0096 South Pacific Air Ambulance Scotty Watson [email protected] NEW ZEALAND www.spaa.co.nz AUSTRALIA Tel: +64 9256 9000 AIR AMBULANCE INTERIoR SINGAPoRE Fax: +64 9256 9111

Air Ambulance Technology Egon Kuntner – President A-5282 [email protected] EURoPE & THE MEDITERRANEAN Ranshofen www.airambulancetechnology.com AUSTRIA Tel: +43 7722 85051 ADAC-Ambulance Service Robert Glueck – Marketing & Sales Director Fax: +43 7722 85051-22 Am Westpark 8 [email protected] 81373 Munich www.adac.de/ambulance GERMANY Tel: +49 89 76 76 52 85 24-h alarm centre: AIRCRAFT PERFoRMANCE SoLUTIoNS +49 89 76 76 50 05 RAISBECK Engineering Nick Nicholson – Sales Manager AGI Assistance Dr Jacques Guedj – Medical Director 4411 South Ryan Way [email protected] 99 Bis, Avenue du [email protected] Seattle WA98178 www.raisbeck.com Général Leclerc USA Tel: +1 206 723 2000 75014 Paris Tel: +33 1 43 95 00 55 Fax: +1 206 723 2884 FRANCE Fax: +33 1 43 95 00 66

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ASSISTANCE CoMPANIES (CoNT.) ASSISTANCE CoMPANIES (CoNT.) ARC Transistance Hans Biekmann – Network Director Medex Assistance Corporation Linda McGee – SVP of Sales Avenue des Olympiades 2 [email protected] 8501 LaSalle Road [email protected] 1140 Brussels www.arctransistance.com Suite 200 www.medexassist.com BELGIUM Tel: +32 2 706 6660 Baltimore Tel: +1 410 453 6300 Fax: +32 2 706 6601 MD 21286 Fax: +1 410 453 6301 USA Assistance Plus Maria Berkova – General Manager oneWorld Assist Taka Katsube – Dir Assist & Cost Mngment 10 Building 3, Office 17 [email protected] 10th Floor [email protected] Petrovsko-Razumovskaya alleya www.assistplus.ru 6081 No.3 Road www.oneworldassist.com Moscow 127083 Tel: +7 495 785 5525 Richmond, BC Tel: +1 604 303 2113 RUSSIA Fax: +7 495 786 9683 V6Y 2B2 Fax: +1 604 276 4593 CANADA Atlantic Assist Adriano Gouveia – Operations Manager TMCA Margaret Whartom – Ops Manager Rua da Alfandega 10-2.D [email protected] 217 Broadway [email protected] PO Box 750 www.atlanticassist.com Suite 600 www.tmcatravel.com 9000-056 Funchal Tel: +351 291 214 200 NYC Tel: +1 212 964 8580 Madeira Fax: +351 291 214 202 NY 10007 Fax: +1 212 406 1520 PoRTUGAL USA Express Assist Vardan Azatian – General Director World Travel Protection Canada Inc. Dr Ron Mayer – President & Chf Med Officer 11-th Radialnaya, 2 [email protected] 400 University Avenue [email protected] 115404 www.expressassist.ru 15th Floor www.wtp.ca Moscow Tel: +7 495 775 2090 Toronto Tel: +1 416 977 3565 RUSSIA Fax: +7 495 775 2091 Ontario M5G IS7 Fax: +1 416 205 4676 CANADA Global Voyager Assistance Costas Danilenko – CEO SoUTH AMERICA PO Box II [email protected] 125124 www.gvassistance.com Cardinal Assistance Alberto C. Chapur – President Moscow Tel: +7 495 775 0999 Av. Cordoba 890 7° piso [email protected] RUSSIA Fax: +7 495 775 0998 (C 1054AAU) www. cardinalassistance.com Capital Federal Tel: +54 11 4129 7514 Buenos Aires Mapfre Asistencia Natalia Jorquera – Int Com & Mkt Mgr ARGENTINA Sor Ángela de la Cruz, 6 [email protected] 28020 Madrid www.mapfreasistencia.com SPAIN Tel: +34 91 581 4998 CATASTRoPHIC CLAIMS SPECIALIST Fax: +34 91 581 1850 Dr Colin Plotkin Consulting Dr Colin Plotkin – Managing Director 27-3088 Francis Road [email protected] Marm Assistance Jill Atac – CEO Richmond Tel: +1 604 241 9677 Sabiha Gokcen Int Airport [email protected] British Columbia Fax: +1 604 241 0733 J Blok Kurtkoy www.marmassistance.com V7C 5V9 34912 Tel: +90 216 588 0588 CANADA Istanbul Fax: +90 216 588 0602 TURKEY med con team GmbH Michael Weinlich – Managing Director CoST CoNTAINMENT Gerhard-Kindler-Str.8 [email protected] 72770 Reutlingen www.medconteam.com AFRICA Tel: +49 7121 433 660 GERMANY Fax: +49 7121 433 619 AIMS Bernadette Breton – Managing Director Private Bag X5 [email protected] Benmore Gardens www.aims.org.za MK International Emergency Serv Minas Kaloumenos – General Manager 2010 Tel: +27 11 245 5777 95, Ioanninon Street [email protected] Johannesburg Fax: +27 11 783 9277 10444 Tel: +30 210 5154600 SoUTH AFRICA Athens Fax: +30 210 5131660 GREECE EURoPE

ChargeCare International Christiane Burniston – Managing Director Save Assistance France Franck Molinier – Director of Business Dev. Monument Business Park [email protected] 19 rue de Provence [email protected] 1D, Park Offices www.chargecare.co.uk 78310 www.saveassistance.com Warpsgrove Lane Tel: +44 1865 400 007 Maurepas Tel: +33 13062 6752 Chalgrove, Oxford Fax: +44 1865 400 707 24hr Alarm Cntr: +33 13062 1122 UK Mobile: +44 777 44 35 649 FRANCE Marm Assistance Jill Atac – CEO SoS International Helle Drager – Comms & Marketing Manager Sabiha Gokcen Int Airport [email protected] Nitivej 6 [email protected] J Blok Kurtkoy www.marmassistance.com DK-2000 www.sos.eu 34912 Tel: +90 216 588 0588 Frederiksberg Tel: +45 7010 5055 Istanbul Fax: +90 216 588 0602 Copenhagen Fax: +45 7010 5056 TURKEY DENMARK Medical Claims International Spain Fatima Guillen Grande – Managing Director TBS Team 24 d.o.o Edvard Hojnik – General Manager C/Ciudad de Aguilas No.2 [email protected] Ljubljanska Ulica 42 [email protected] Local 2A www.mcimanager.com 2000 Maribor www.tbs-team24.com Madrid 28030 Tel: 00 34 913 016 145 SLoVENIJA Tel: +386 2618 2301 SPAIN Fax: 00 34 913 016 160 (Croatia, Slovenia, Fax: +386 2618 5800 Bosnia-Herzegovina, Macedonia, Serbia-Montenegro, Kosovo) oneWorld Assist Taka Katsube – Dir Assist & Cost Mngment 10th Floor [email protected] NoRTH & CENTRAL AMERICA 6081 No.3 Road www.oneworldassist.com ASISTUR Emilio Guevara – Managing Director Richmond, BC Tel: +1 604 303 2113 Prado 208 [email protected] V6Y 2B2 Fax: +1 604 276 4593 e/ Colon y Trocadero www.asistur.cu CANADA Habana Vieja Tel: +537 8664499 Ciudad Habana 10100 Fax: +537 8668087 NoRTH AMERICA CUBA Global Excel Management Brian Allatt – CEO Assured Assistance Inc. Martha Turnbull – Director of Operations 73 Queen Street, Lennoxville [email protected] 6880 Financial Drive [email protected] Quebec, JIM 1J3, CANADA www.globalexcel.ca Mississauga Tel: +1 905 816 2495 4242 Cranmore Court Tel: +1 866 566 1130 Ontario Fax: +1 905 813 4719 Belle Isle, FL 32812, USA Fax: +1 819 566 8335 L5N 7Y5 CANADA Global Medical Management Raija Itzchaki – COO Global Excel Management Brian Allatt – CEO 7901 SW 36th Street [email protected] 73 Queen Street [email protected] Suite 100 www.gmmusa.com Lennoxville, Quebec www.globalexcel.ca Davie Tel: +1 954 370 6404 JIM IJ3, CANADA Tel: +1 866 566 1130 FL 33328 Fax: +1 954 370 8613 4242 Cranmore Court Fax: +1 819 566 8335 USA Belle Isle, Fl 32812, USA www.itij.co.uk 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

CoST CoNTAINMENT (CoNT.) FUNERAL DIRECToRS

Health Systems International Peggy Novotny – VP / Gen Mngr Intl Bus. Antea International Funeral Assistance Marica Hunyadi – Managing Director 5975 Castle Creek Parkway [email protected] Suite 100 www.us-hsi.com Mihálkovics utca 12 [email protected] Indianapolis Tel: +1 317 806 2000 H-1091 www.antea.hu IN 46250 Fax: +1 317 806 2033 Budapest Tel: +36 30944 0944 USA HUNGARY Fax: +36 1216 6107

Medsave USA Jeffrey Baker – President 1400 Old Country Road [email protected] Funeral Home AURIGA Ltd. Helen Pradova – Chief of Intnl Dept Suite 109 www.medsaveusa.com B. Nmcové Street 1052/1 [email protected] Westbury Tel: +1 516 622 1784 NY 11590 Fax: +1 516 294 6761 412 01 [email protected] USA Litomerice www.funeral-assistance.cz Star Healthcare Gigi Galen – President CZECH REPUBLIC Tel: +420 724 257 899 850 7th Avenue [email protected] Fax: +420 416 735 800 Suit 803 www.starhealthcarenet.com New York 10019 Tel: +1 212 581 8228 Funeralcare International Roger Waddington USA Fax: +1 212 581 8272 221 Upper Richmond Road [email protected]

Putney www.co-operativefuneralcare.co.uk TMCA Margaret Whartom – Ops Manager London Tel: +44 20 8788 5303 217 Broadway [email protected] SW15 6SQ Fax: +44 20 8788 2525 Suite 600 www.tmcatravel.com NYC Tel: +1 212 964 8580 UK NY 10007 Fax: +1 212 406 1520 USA Global Networks Funeral Assistance Cristina Almudi – Managing Director 23 Blindmans Lane [email protected] United Health International Philip Brun – Director of Business Development 15500 New Barn Road [email protected] Cheshunt www.gnfa.info Suite 200 www.hygeia.net Hertfordshire Tel: +44 1992 640 066 Miami Lakes Tel: +1 305 594 9291 Ext.3312 EN8 9DR Fax: +44 1992 785 030 FL 33014 Fax: +1 305 594 9201 USA UK John Allison Monkhouse Co., Ltd (Thailand) Apple Kaewprasert – General Manager CLAIMS MANAGEMENT President Park View Tower [email protected] 99/243 (30B) Pine Tower www. monkhouse.com.au NEW Global Assistance & Healthcare Nathan Hannah – TPA Mgr Asia/Pac Sukhumvit soi 24 Tel: +66 2382 5345-7 Jalan Pattimura [email protected] Klongton Klongtoey, Bangkok Fax: +66 81 584 5942 15 Kebayoran Baru www.global-assistance.net THAILAND Jakaita Tel: +62 21 725 8115 12110 Fax: +62 21 725 8951 KCH Repatriation Specialists Robert Rowntree – Managing Director INDoNESIA 83 Westbourne Grove [email protected] – CEO Global Excel Management Brian Allatt Bayswater www. kchrepatriation.com 73 Queen Street, Lennoxville [email protected] Quebec, JIM 1J3, CANADA www.globalexcel.ca London W2 4UL Tel: +44 20 7313 6920 4242 Cranmore Court Tel: +1 866 566 1130 UK Fax: +44 20 7313 6999 Belle Isle, FL 32812 USA Fax: +1 819 566 8335

Star Healthcare Gigi Galen – President MK Funeral & Transportation Services Minas Kaloumenos – General Manager 850 7th Avenue [email protected] 95, Ioanninon Street [email protected] Suit 803 www.starhealthcarenet.com 10444 Tel: +30 210 5154600 New York Tel: +1 212 581 8228 Athens Fax: +30 210 5131660 10019 Fax: +1 212 581 8272 USA GREECE

CLAIMS SUBRoGATIoN Rowland Brothers International Melanie Walkling – Partner Medsave USA Jeffrey Baker – President 299-305 Whitehorse Road [email protected] 1400 Old Country Road [email protected] West Croydon www.rowlandbrothersinternational.co.uk Suite 109 www.medsaveusa.com Surrey Tel: +44 20 8684 2324 Westbury Tel: +1 516 622 1784 CR0 2HR Fax: +44 20 8684 8000 NY 11590 Fax: +1 516 294 6761 USA UK Servilusa Vanda Castro – Manager Int Dept

CoMMERCIAL REPATRIATIoN SPECIALISTS Agencias Funerarias SA [email protected] Voyageur Aeromedical Travel Marc Lucas – General Manager International Dept. www.servilusa.pt Voyageur Buildings [email protected] Rua do Entreposto Industrial Tel: +35 121 470 6300 43 Colston Street www.voyageur.co.uk 8-2 Esq, 2610-135 Amadora Fax: +35 121 470 6499 Bristol Tel: +44 (0)117 927 3554 PoRTUGAL BS1 5AX Fax: +44 (0)117 925 5940 UK ZEGA Roberto Funeral Home Cristina Zega – General Manager MedEscort International Craig Poliner – President Via Clelia, 26/28 [email protected] 1730 Vultee Street [email protected] 00181 Rome www.zega.it Allentown www.medescort.com PA 18103 Toll Free: +1 800 255 7182 ITALY Tel: +39 06 78 40 300 Tel (US): 610 791 3111 Fax: +39 06 78 02 488 USA Fax: +1 610 791 9189

CATEGORY KEY Claims Management Legal Services Air Ambulance Claims Subrogation Medical Escort on Commercial Airlines Air Ambulance Interior Commercial Repatriation 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

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HEALTHCARE CLINICS MEDICAL ESCoRT oN CoMMERCIAL AIRLINES American Medical Center Natalia oleinik – Insurance & Assistance Companies AFRICA 26 build 6 Prospekt Mira [email protected] 129090 www.amcenter.ru NEW AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Moscow Tel: +7 495 933 7700 Wilson Airport [email protected] RUSSIA Fax: +7 495 933 7701 Langata Road www.amref.org PO Box 18617 Tel: +254 20 600 090 Luzdoc Dr Maria Alica Silva – Medical Director Nairobi Fax: +254 20 344 170 Rua 25 de Abril [email protected] KENYA 12 Vila da Luz www.luzdoc.com 8600-174 LGS Tel: +351 282 780 700 AUSTRALASIA PoRTUGAL Fax: +351 282 780 709 CareFlight International Sue Robshaw – Co-ordinator

Westmead Hospital Campus [email protected] Number one Health Group Dr Charlie Easmon – Director PO Box 159 www.careflight.org 1 Harley Street [email protected] Westmead Tel: +61 1300 655 855 London www.numberonehealth.co.uk NSW 2145 Fax:+61 2 4751 2995 W1G 9QD Tel: +44 207 307 8756 AUSTRALIA UK Fax: +44 207 504 3758 Medic’Air International 每递安国际 Dr Huaqun Gao – Medical Director 885 Renmin Road [email protected] Huaihai China Building www.medic-air.com HoSPITALS Room 808 Tel: +86 2163 558289 200010 Shanghai Fax: +86 2163 558285 ASIA CHINA Bangkok Hospital Medical Center Judy Mitchell – Third Party Payor Services Medical Wings Dr Sommart Somsiri – Medical Director Bangkok International Hospital [email protected] 222 Room 3259 [email protected] 2 Soi Soonvijai 7 www.bangkokhospital.com Bangkok Int Airport www.medicalwings.com New Petchburi Road Tel: +66 2310 3000 Viphavadee-Rangsit Rd, Sikan Tel: +662 247 3392 Bangkok 10320 Fax: +66 2310 3105 Don Muang, Bangkok 10210 Fax:+662 535 4355 THAILAND THAILAND Piyavate Hospital Intl. Health Care Dr. Tanatip Suppradit – CEO – Operations Manager Piyavate International Hospital [email protected] Mediflight Debra o’Brien 998 Rimklongsamsaen Rd. www.piyavate.com Royal Adelaide Hospital [email protected] (Rama IX Rd.), Bangkapi, Tel: +66 2625 6500 North Terrace www.mediflight.com.au Huay Kwang, Bangkok 10310 Fax: +66 2625 6890 Adelaide Tel: +61 8 8223 6618 THAILAND SA 5000 Fax: +61 8 8223 6340 AUSTRALIA Privat Hospital Abhijeet Sachdev – Vice President DLF City-ll [email protected] EURoPE M.G Road www.privathealthcaregroup.com New Delhi Tel: +91 9899 198 198 AeroMed 365 Brian Brooker – Clinical Director Gurgaon 122002 Fax: +91 124 235 3794 Worth Corner Business Cntr [email protected] INDIA Turners Hill Road www.aeromed365.com Wockhardt Hospitals Pradeep Thukral – Head International Mrktg Pound Hill Tel: +44 8707 596 999 Mulund Goregaon [email protected], [email protected] Crawley RH10 7SL Fax: +44 8707 559599 Link Road www.wockhardthospitals.net UK Mumbai Tel: +91 9819015749 EMC Meditrans Servé de Klerk – President 400 078 Tel: +91 22 26596502 Hoevestein 23 [email protected] INDIA Fax: +91-22-55994242 Postbus 4190 www.emc.nl EURoPE 4900 CD Tel: +31 162 496 000 Oosterhout Fax: +31 8 42 24 64 86 American Medical Center Natalia oleinik – Insurance & Assistance Companies THE NETHERLANDS 26 build 6 Prospekt Mira [email protected] 129090 www.amcenter.ru NEW Voyageur Aeromedical Travel Marc Lucas – General Manager Moscow Tel: +7 495 933 7700 Voyageur Buildings [email protected] RUSSIA Fax: +7 495 933 7701 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 BS1 5AX Fax: +44 (0)117 925 5940 Xanit Hospital de Benalmadena Dr. Juan Bosco Rodriguez Hurtado – Director UK Camino de Gilabert s/n [email protected] Benalmadena www.xanit.net NoRTH AMERICA 29630 Tel: +34 952 367 190 Malaga Fax: +34 952 367 191 Aeromedevac Air Ambulance Jesus Mendez – Provider Relations SPAIN 681 Kenney Street [email protected] Gillespie Field Airport www.aeromedevac.com NoRTH AMERICA El Cajon Tel: US: +1 619 284 7910 Baptist Health Int. Center of Miami Yohandra Fuentes – Finance Manager CA 92020 Tel: Mexico: 00 1-800-832-5087 8940 North Kendall Drive [email protected] USA Fax: +1 619 284-7918 Suite 601-E www.baptisthealth.net/international Air Ambulance Network Kirk Pacheco – President Miami Tel: +1 786 596 2373 Fl 33176 Fax: +1 786 596 5979 905 Martin Luther King Jr Drive [email protected] USA Suite 330 www.airambulancenetwork.com Tarpon Springs Tel(24hr): +1 727 934 3999 Jackson Memorial Hospital Int. Shai Gold – Vice President Florida 34689 Tel(toll free): +1 800 327 1966 Jackson Medical Towers [email protected] USA Fax: +1 727 937 0276 East Tower, Suite 829 www.jmhi.org 1500 NW 12th Avenue 24 hr: +1 305 355 12 12 Air Ambulance Worldwide Inc. Mark Jones – President Miami, FL 33136-9998 Tel: +1 305 355 5544 35246 US Hwy 19 North [email protected] USA Fax: +1 305 355 5545 #210 www.airambulanceworldwide.com Palm Harbor Tel: +1 727 781 1198 M.D., M.B.A. – Dir Finance & Operations University of Miami Health System Jose Quesada Florida 34684 Fax: +1 727 786 0897 1099 N.W. 14th Street [email protected] USA Miami www.uhealthinternational.com NEW Florida Toll Free: +1 877 442 8676 American Care Air Ambulance Joel Reynolds – General Manager USA Tel: +1 305 243 9100 8775 Aero Drive [email protected] Fax: +1 305 243 9101 Suite 120 www.americancareairambulance.com San Diego Tel: +1 858 627 0515 CA 92123 Fax:+1 858 627 0534 LEGAL SERVICES USA

Pannone LLP Andrew Morton – Head of Travel Litigation Life Flight International Inc. Chris Connor – Operations 123 Deansgate [email protected] Victoria International Airport [email protected] Manchester www.pannone.com NEW Viscount Business Center www.lifeflight.ca M3 2BU Tel: +44 (0)161 909 3000 103-9800 McDonald Pk Rd Tel: +1 250 655 1630 UK Fax: +44 (0)161 909 4444 Sidney, British Columbia Fax: +1 250 656 9394 CANADA

www.itij.co.uk 46 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

MEDICAL ESCoRT oN CoMMERCIAL AIRLINES (CoNT) TRAVEL AGENTS

National Air Ambulance George Martinez – Mgr Flight Co-ordination Voyageur Aeromedical Travel Marc Lucas – General Manager 3495 SW 9th Ave [email protected] Voyageur Buildings [email protected] Fort Lauderdale www.nationalairambulance.com 43 Colston Street www.voyageur.co.uk Bristol Tel: +44 (0)117 927 3554 FL 33315 Tel: +1 954 359 9900 BS1 5AX Fax: +44 (0)117 925 5940 USA Fax: +1 954 359 9500 UK

MedEscort International Craig Poliner – President 1730 Vultee Street [email protected] MEDICAL SCREENING Allentown www.medescort.com – Call Centre Manager PA 18103 Toll Free: +1 800 255 7182 Travel & Medical Insurance Services Lara Suttie 1st Flr Suite, West House [email protected] Tel (US): 610 791 3111 46 High Street www.travelandmedical.co.uk USA Fax: +1 610 791 9189 Orpington Tel: +44 845 058 8000 Kent BR6 0JQ Fax: +44 845 053 3000 UK MEDICAL PRoVIDER Travel Screen Sandra Howell – General Manager The Seedbed Centre [email protected] AMREF Flying Doctor Service Dr Bettina Vadera – Medical Director Vanguard Way www.travelscreen.co.uk Wilson Airport [email protected] Shoeburyness Tel: +44 1702 587 007 Langata Road www.amref.org Essex SS3 9QY Fax: +44 1702 584 731 UK PO Box 18617 Tel: +254 20 600 090 Nairobi Fax: +254 20 344 170 KENYA WEB & MEDIA ADVERTISING Atlantic Assist Adriano Gouveia – Operations Manager Rua da Alfandega 10-2.D [email protected] V Creative Design Steve Annette – New Media Director PO Box 750 www.atlanticassist.com Voyageur Buildings [email protected] 43 Colston Street www.vcreativedesign.co.uk NEW 9000-056 Funchal Tel: +351 291 214 200 Bristol Tel: +44 (0)117 922 6600 Madeira Fax: +351 291 214 202 BS1 5AX Fax: +44 (0)117 925 2040 PoRTUGAL UK

GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE •G •

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P DIARY DATES V E E V P I

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improves recovery N Sydney, Australia G

• 3,000 women’s bottoms as they toured the sights E

E Doctors in the UK may soon be prescribing of Venice has been arrested. The man was stopped G 14-16 August N R I A V chewing gum after research found it helps patients by police who became suspicious of a large bag 9th International Mental Health E P P recover faster from operations on their bowels. he was carrying as he followed several different E Conference V A

I Holiday Inn, Gold Coast, Australia R women around the ever-popular St Mark’s Square. N G

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E G N through a small hole he had apparently made in the R 6-9 September I A V Casualty and Property Insurance

E lining. P P E Underwriters Annual Meeting & Seminar V A A video released by police shows a man in jeans I R

N Philadelphia, PA, US and a hooded top walking closely behind certain G E

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women – all of whom happened to be wearing E G N R I miniskirts. The Italian man would try to position the 11-12 September A V E bag close to their legs and that when the women P Measuring and Managing Mortality & P E V A stopped or bent down to pick something up, the Longevity Risk I R N London, UK G E

footage shows him lining the bag up under their •

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E skirts. After he had been arrested, the police found G N R I A

V several DVDs and more than 3,000 images of 21-23 September E P P women’s bottoms in his house. Although he has E 9th China Rendezvous V A China I

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E www.asiainsurancereview.com/pages/conferences

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R 24-25 September I Trouser snake fright A V 4th Insurance Executives’ Summit on E P P A tourist in Australia received a nasty reminder E Technology V A I R about the dangers of the local wildlife recently, N Shanghai, China G E

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when he was travelling by car to Cairns. It was a •

E G N R I long trip, and he had to stop to relieve himself by 2 October A V E the side of the road at one point, whereupon a P Life and Pensions Italia P E V A highly venomous brown snake darted between his Milan, Italy I R N www.life-pensions.com

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E ‘sensitive area’. Emergency workers rushed to the People who endured bowel surgery and were G 12-15 October N R I scene, where they swiftly wrapped the appendage then given chewing gum regularly were able to go A V Global Business Development Institute E in plastic in case it had become infected with home nearly two whole days earlier. The patients P

P 10th Annual conference E V A poison. were asked to chew the gum for 30 minutes in the Las Vegas, NV, US I R N

G www.gbdi-conference.org/8.html V The tourist, suffering from a painful wound, morning, afternoon and night in order to trigger •

I N E vomiting and stomach pain, was given the all clear their gastric hormones, thus stimulating their bowel E

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R 15th International Association of E A P venom had not entered his bloodstream. One normal eating habits. Insurance Supervisors P A E

R of the ambulance personnel told local reporters Consultant nurse Harriet Wright led the six- Budapest, Hungary V G

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that the tourist was ‘lucky’ – something the tourist month study of 67 patients, and said: “We now E E

wouldn’t perhaps agree with. “It certainly had a recommend it after surgery to help bowels to N • I 30 October G V

swipe at him,” said the paramedic, “but it didn’t recover quicker. Hopefully this will become R

E Solvency II and Risk Management for A P envenomate him. As it came through it must have practice now.” P

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International Travel Insurance Journal ONTHEMOVE 47

New CEO for Aon E&Y chooses team Griffin appointed at Grant chosen as Rück leader Amlin group executive On 1 July, Jan-Olivier Ernst & Young’s newly created insurance run-off Amlin, the Lloyd’s insurer, has appointed Andrew Matthew Grant has been Thofern took over as team now has a lead partner – Kevin Gill has joined Griffin to the post of class underwriter on the appointed to the position CEO and chairman the firm in that capacity. Kevin will be based in the accident and health account, reporting to leading of group executive of global of Germany’s largest firm’s financial services’ transaction advisory services class underwriter Mark Clements. Andrew will join client development at Risk reinsurance broker, Aon practice, where he is responsible for building up Amlin in the autumn from Ace Global Markets, Management Consulting Rück, which is part of Aon existing capabilities and growing the team. where he held the position of product line head, (RMS). Matthew joined the Re Global. He replaces Prior to joining Ernst & Young, Kevin ran his own responsible for overseeing the accident and health company in 1996 and since Holger Gaserow, who is consultancy business, where he developed and account there. Duncan Deal, interim joint divisional then has held various roles retiring at the end of this advised underwriters and brokers on how to deal underwriter at Amlin, said of the move: “With in the client development

year. Michael O’Halleran, Holger Gaserow with their legacy business. Before this, he worked for Andrew’s appointment, we will be fielding two group, including senior executive chairman of PriceWaterhouseCoopers for 18 years, finally serving senior underwriters on an account where we vice-president of the Matthew Grant Aon Re Global, said: “Our clients in Germany have as a director of the company. believe there to be good development opportunities RMS international region. come to expect the industry’s best in integrated Will Bridger, lead partner for Ernst & Young’s and where Amlin intends to cement its leadership Speaking at the announcement of his promotion, capital solutions and services from Aon Re Global, insurance transaction advisory services, noted: “I position over the coming years.” Matthew said: “The insurance industry is going and I am confident that Aon Rück, under Jan-Olivier’s am delighted that Kevin is joining us to lead the through a period of change. Over 3,000 people are leadership, will continue to give our clients our best. dedicated insurance run-off team. He brings a wealth using RMS data, models and technology on a regular We are grateful for Holger’s leadership and vision and of experience, not just in dealing with underwriter basis, many of whom have advanced qualifications in wish him well in his retirement.” legacy, but also in restructuring other financial Mondial rewards mathematics, science or engineering. I look forward In the 40 years he has spent with Aon, Holger has services entities such as intermediaries.” On his to continuing to build a team that knows our partners risen steadily through the ranks – initially employed appointment, Kevin said: “Changes in European success and their businesses extremely well, and that has the in the reinsurance division of Hamburg brokers Union regulations provide opportunities for skills and experience to ensure they gain long-lasting Jauch & Hübener, he was appointed to the board European insurers to restructure their businesses to Mondial Assistance has value from their relationships with RMS.” Matthew in 1989 and became a partner in 1997. Following make better use of their capital. I am looking forward announced the promotion is taking over from Bill Keogh, who, after 12 years, Aon’s purchase of the company, Holger held the to further advising Ernst & Young clients on ways to of Aimee Charlwood to the has decided to leave the company to pursue other position of chairman of the reinsurance broker Aon restructure their businesses to ensure they get the position of senior account interests. Hemany Shah, CEO of RMS said: “Bill Rück Hamburg. Jan-Olivier, meanwhile, has been best value from their capital.” manager for its corporate played a central role at RMS for over a decade. On

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R with Aon since 1993, has been a member of the and travel sales department. behalf of my many colleagues at RMS we thank him E A N I

P management board since 2005 and a member of the In her previous position for his dedicated services and wish him the best of V E E V executive committee since 2006. as business development luck in his endeavours.” P I N A manager, Aimee was E Aimee Charlwood R

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E successful expansion of the easyJet travel insurance A

N Hiscox I P account. Commenting on the promotion was Ben New manager at V E

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R insurer, has announced that Michael Gould is to “Mondial Assistance has played a key part in easyJet’s I

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• join the company in the position of chief operating record profits for 2007, which soared by 48 per cent Chubb Insurance has announced that Sarah Lidell E

E G ING announced recently that officer. He will report directly to Bronek Masojada, to £191 million. Aimee took the lead for this account, has been appointed to the position of manager of N R I A V Ludo Wijngaarden, chairman CEO, and will be responsible for operations, IT and driving forward expansion of the travel insurance the London casualty team. In this role, Sarah will E P P E of the Dutch intermediary property services across the Hiscox group. offering on a pan-European scale.” be responsible for all aspects of management of V A I R N division, will step down on 1 Michael joins Hiscox from Aon, where most recently Aimee joined Mondial in 2003 and within two years the London team and for the continued growth G E

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• August this year after 19 years he held the position of chief operating officer for and profitability of the portfolio. Her remit, said the

E G N R of service to the company. At the business’s corporate division. Before this, he for the automotive team. In 2007, she made her company, would also include broker management I A V

E the same time, Ludo will also worked at American Express for 14 years in a variety move to business development manager for the and product development. Sarah’s appointment P P E V A step down as board member of roles. Speaking at the announcement, Bronek corporate and travel division, and in her new role was in response to the recent promotion of I R N of other ING companies. Masojada said: “Michael’s understanding of customer she will oversee the account management team, as Mark Roberts, who is now risk management and G

E Ludo Wijngaarden

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Ludo began his tenure as experience as it relates to premium and corporate well as continuing to focus on the easyJet and CSMA multinational underwriting manager for Europe. Tim E G N R I chairman of the intermediary division at the beginning services combined with his leadership skills and accounts. Speaking after the announcement had been Darley, UK & Ireland casualty practice leader and A V E P of 2004 and since then has successfully guided the knowledge of the insurance industry is the right mix made, Aimee said: “My new position offers me more risk management manager at Chubb Insurance, said: P E V A division through a number of milestones, including for this role. His experience links in well with our exciting opportunities and reflects Mondial Assistance’s “We are delighted to promote Sarah into this role. I R N G E

the improvement of customer experiences and ambition to provide flexible underwriting with superb commitment to recognising and rewarding its staff. I Her underwriting skills and knowledge of the London •

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E G increased operating efficiency. ING said it has already customer service and will complement our existing will be able to drive the team forward and create new market make her the perfect candidate to move the N R I A

V started the search for his successor. management team.” opportunities for the business across Europe.” portfolio to the next level.” E P P E V A I R N G E

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