ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS WWW.ITIJ.CO.UK JULY 2011 • ISSUE 126 Insurers brace for impact

The latest research from Finaccord, Travel Metrics European survey, travel insurance claims resulting in Europe, gives details of how last year’s Icelandic directly from the chaos caused by the Icelandic eruption affected the rate of travel insurance eruptions of April 2010 accounted for 5.4 per cent claims in 2010. Mandy Aitchison delves into the of all reported claims. Whilst this may, at fi rst glance, report for more information appear relatively insignifi cant, it should be borne in mind that the air-traffi c disruption caused by the As Finaccord’s report was released, the Grimsvotn volcanic ash lasted only a few weeks, whereas the volcano, also in Iceland, was spewing ash into survey as a whole was based on respondents’ most the air, again affecting the fl ight plans of thousands recent trip undertaken during 2009 and 2010.” of people. Soon afterwards, the eruption of the In overall terms, the most common reasons for Chilean volcano began to affect fl ights into and out submitting a travel insurance claim were lost, of Chile and Argentina, with knock-on effects felt stolen, or damaged baggage or belongings, medical in Australia, New Zealand and Africa. Finaccord’s expenses incurred while travelling, and accidents survey has provided detailed analysis of the travel incurred while travelling. None of these core areas habits, insurance uptake and claims behaviour of of claims activity were specifi cally associated with 6,000 consumers in France, Germany, Italy, the volcanic ash. However, within the universe of Netherlands, Spain and the UK. A unique feature claims relating to fl ight or trip delay and cancellation, of the research, according to the company, was to postponement or interruption, the volcanic ash allow claimants to indicate the primary reason why cloud was seen to have had a substantial impact, they had made a claim against their travel insurance and accounted for 31.1 per cent of all such claims. policy, and given the time period covered by the The detailed breakdown of this particular segment of survey, these included various options that were claims activity is shown in the chart on p.5. specifi c to volcanic ash. Tottman said: “The fact that last year’s volcanic The survey showed some interesting results, with eruptions had a particularly strong effect on insurance Simon Tottman, a consultant at the research fi rm, claims related to trip delay and cancellation means commenting: “Across all respondents covered by the that the current situation (the continued on p.5

Ash Cloud 3: South America hit NZ counts potential

Just as the ash from the Icelandic Grimsvotn cost of World Cup volcano was settling, the Chilean Puyehue- Cordon-Caulle range of volcanoes got in on the Many of the thousands of foreign fans heading to act, sending ash and debris thousands of metres New Zealand (NZ) for this year’s Rugby World into the air. The resulting ash cloud prompted the Cup will be from Britain and Australia, and as closure of airports across South America, including both of these countries have reciprocal health the suspension of fl ights to and from Buenos Aires agreements in place with NZ, there are concerns and disruptions to fl ights in Santiago. Winds blew among health authorities that the Kiwi taxpayer the ash further afi eld, with subsequent closure of will foot the bill for the medical needs of foreign airports in Australia, New Zealand and Tasmania, fans. Sarah Watson reports before the wind changed direction and affected fl ights in Argentina, Brazil, Chile, Colombia, The reciprocal health agreements take precedence Paraguay and Uruguay. over travel insurance policy arrangements, meaning Airlines including Virgin, Qantas, Jetstar and Tiger that hospitals – public and private – are not able Airways all experienced fl ight cancellation or delays. to recover the costs incurred from treating foreign Virgin Australia operated a reduced service with patients from their insurers. Visitors from countries planes that fl ew below the continued on p.4 that do not have agreements continued on p.4 IN THIS ISSUE ITIJ CONTRIBUTORS

REGULARS David Ing is a freelance journalist covering mainly travel and tourism issues News continued 4 in Spain. He writes on air transport for a leading international news agency, as well as Editorial blog 4 contributing special features to Newsweek Company brief 8 and writing in-fl ight magazine articles and Insurance matters 9 guidebooks. Health matters 12 David Kernek has, for the past four Travel matters 14 years, been in a full-time post editing two glossy travel magazines - Holiday Villas and IPMI news 16 Holiday Cottages. He has since converted this Cross-border care 18 into a freelance role having become self- employed and now has regular commissions in Air ambulance news 20 consumer, trade and B2B publishing. Service directory 39 Mick Shippen is a freelance writer and Grapevine 46 has been based in Thailand for over a decade. On the move 47 A fl uent Thai speaker, he currently lives in Bangkok but also spent six years in Chiang Mai. Mick is a regular contributor to regional and international publications. He is also the author of The Ceramics of Southeast Asia, FEATURES published by the University of Hawaii Press.

Feature: Chance of a lifetime 24 With New Zealand hosting the upcoming Rugby World Cup, a local international assistance fi rm considers how best to cope with the infl ux of tourists

Feature: ITIC Hong Kong Review 26 A round-up of the sessions that were held in Hong Kong in June

Assistance & Healthcare World Markets: Brazil 34 Extreme wealth and extreme poverty in close proximity has led to signifi cant gaps in care levels; ITIJ points the way for tourists in need

Front page image courtesy of Associated Press

ITIJ TEAM

Editor-in-chief: Ian Cameron ITIJ Published on behalf of: Voyageur Publishing & Events Ltd, Editor: Sarah Watson Voyageur Buildings, 43 Colston St, Bristol BS1 5AX, UK Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK Title editor: Mandy Aitchison Telephone: +44 (0)117 922 6600 The information contained in this publication has been published in good faith and Copy editor: James Paul Wallis every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur editorial dept: Ext. 3 Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, Conference manager: Denise Clements disappointment, negligence or other damage caused by reliance on the information advertising dept: Ext. 1 contained in this publication, or in the event of bankruptcy or liquidation or cessation Production: Kirsty Diclaudio of the trade of any company, individual or fi rm mentioned is hereby excluded. subscriptions dept: Ext. 209 Helen Watts

Printed by Pensord Press, South Wales, United Kingdom Subscriptions: Kate Knowles fax: +44 (0)117 929 2023 Copyright © Voyageur Publishing 2011. Materials in this publication may not be reproduced in any Advertising sales: David Fitzpatrick email: [email protected] form without permission James Miller web: www.itij.co.uk INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522 Finance: Elspeth Reid Would you like to make a comment? Louise Goddard Please get in touch with Ian Cameron, Design: V Creative Design WOULD YOU LIKE TO SUBSCRIBE? Editor-in-Chief of ITIJ on +44 (0)117 922 6600 ext205 vcreativedesign.co.uk VISIT www.itij.co.uk

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

4 NEWS

Ash Cloud 3: NZ counts potential cost South America hit of World Cup continued from p.1 continued from p.1 in place will be billed for their care, with district health it will be owed. Rosser Thornley, group accounting level of the ash cloud. The impact of ash on aircraft boards believing that most costs could be recovered manager at the board, said: “We’ve certainly got it could be significant, although some European either through insurance or debt repayments. on the radar. We expect that the volume [of bills] will So the ash cloud strikes again, and this time in airlines claimed recently that the effect was not as A briefing document released by the Hutt Valley District be higher than usual, but if we put a bit more [debt South America, affecting flights as far away as bad as the experts were csaying, complicating the Health Board has warned of the potential impact that collecting] resources in, then we’d hope to recover Australia and New Zealand ... it’s becoming a situation. Siva Govindasamy, editor of Flight Global could be felt as a result of the estimated influx of 80,000 more costs.” According to governmental figures, around bit like being stuck on an aircraft with a bunch magazine, said at the time of the disruption: “The foreign tourists, some of whom will almost inevitably 80 per cent of the debt owed by foreigners to the NZ of flatulent people. You don’t know when or problem is that there is a lot of speculation about need some kind of medical assistance during their visit. health system was paid in 2010, but this takes in the from which direction the nasty smell is going the actual impact of the ash. This is a big worry for The document states: “It is likely that many of these entire country, and some district health boards will have to come ... but come it will. So much for one- the airlines, and as a result they are cancelling flights visitors will reside in countries which have reciprocal lower payback rates than others, explained Thornley, off eruptions eh? as a precautionary measure.” health agreements with NZ. Whilst it must be hoped adding: “Those that don’t have such good processes The unrest in the MENA countries have seen The US Travel Insurance Association (UStiA) took the that others will have appropriate health insurance, it may find that there’s a cost to them.” tourist numbers drop drastically, and Egypt in is likely that many will default on payments, at least as Greg Phillips, emergency management service particular has taken a hefty hit because of this, often as occurs normally. Both these scenarios represent leader of the Capital and Coast District Health with Greece being one of the beneficiaries of Airlines including increased activity without attached revenue.” Board, said his own board did not expect a switches from those markets. It remains to be Auckland District Health Board, which is likely to handle noticeable increase in unpaid debt as a result of the seen whether the current turmoil in Greece, Virgin, Qantas, Jetstar the majority of any medical cases, has said that although rugby competition: “We talked about it, and the though, will also have the effect of turning there could be an increase in tourists requiring medical feeling was that the overseas visitors we’d expect away visitors ... and Tiger Airways all attention, the board expects to recover most of what would be well-behaved and well-insured.” In 2009-2010, the latest year ... beware cancellation clauses. experienced flight for which figures are available, district health boards in NZ Otherwise its business usual ... cancellation or delays wrote off around $8 million in debt owed by non-residents. opportunity of further flight disruption due to volcanic Although most did not break Ian Cameron ash to remind travellers about the importance of down their debt into countries, Editor-in-Chief taking out insurance against such events: “Most among those that did, figures [email protected] travel insurance policies provide reimbursement up showed that around $2.3 million to a set amount for overnight accommodation and was spent treating British and necessities if your trip is delayed or interrupted due Australian tourists. to airport closure, or flight cancellation because of For more information about weather-related events. If you have a connecting the Rugby World Cup, and flight and your checked baggage is delayed beyond preparations that assistance a specified period of time, many travel insurance companies are making for policies will reimburse for necessities purchased to the tournament, please see tide you over.” our feature on p.24.

VHI criticised for cancelling cover

It has emerged that Irish insurer VHI has come under their health cover stood at around 50,000. These fire from a consumer organisation after it refused people, said Kilcoyne, were at the very least due a to refund customers who had their travel insurance partial refund. He urged those who found themselves policy cancelled when they stopped receiving health without travel insurance to approach VHI, and if they insurance from the company. The company’s travel were unsatisfied by the company’s response, to then cover is now only on offer to people who already approach the Financial Services Ombudsman. have VHI health insurance, with people who have Ann Fitzgerald, chief executive of the National chosen another health insurance supplier having their Consumer Agency in Ireland, urged consumers: “If you policies summarily cancelled. had travel insurance as a benefit with another policy, Many consumers who have fallen foul of the rule still and you cancelled your policy, your travel insurance had several months left to go on their annual travel may have ceased. So always check with your provider insurance policies, yet they were not informed that to see if you are still covered.” The Agency has their coverage had been cancelled, nor were they recently released a guide for consumers buying travel refunded the cost of the policy, despite the fact that cover to ensure they are fully aware of the need for they were asked to pay upfront for the whole year of disclosure and common exclusions placed on policies. A cover at the time of purchase. spokeswoman for VHI said in response to the criticism: Michael Kilcoyne, chairman of the Consumers’ “In the past, if a member cancelled their VHI Healthcare Association, accused VHI of using ‘sharp practice’, hospital plan, their multi-trip policy was automatically adding: “You would expect higher service standards cancelled too, with no refund. This was something from a semi-state company.” we clearly highlighted in our terms and conditions and VHI has had a difficult start to this year, with some marketing materials.” However, she added that the 14,000 people cancelling their health insurance company had recently changed its policy and is now policies held with the insurer in the first three months allowing customers who have health insurance with alone. In 2010, the number of people who cancelled rivals Aviva or Quinn to obtain travel cover from VHI.

UStiA concerned over business cover

The US Travel Insurance Association (UStiA) has said and terrorist attacks mean that employees who travel that in today’s fast paced, global economy, it is more internationally may need special types of coverage important than ever for companies to carefully assess depending on what part of the world they are in. their travel-related insurance needs, with particular The UStiA points out that policies for corporate concern for those companies whose employees travel, as well as expatriate policies, are usually travel abroad regularly. The US Department of customised to meet the needs of each company, with Commerce states that business travellers account large multinational organisations tending to purchase for over 15 per cent of all outbound travel from the comprehensive cover that includes 24/7 emergency country, and the higher incidence of natural disasters assistance, with added security services.

International Travel Insurance Journal NEWS 5

Seniors still Protection importance searching recognised

A recent report from UK consumer organisation The results of the latest TNS consumer survey for Travel Weekly has Which? has found that older travellers are still finding revealed that four in five UK holidaymakers recognised the importance it difficult to find appropriate and affordable travel of financial protection for their trip. The study, which included 700 insurance, despite some companies taking the upper adults who have been on holiday in the past 12 months, found that 57 age limit off their policies. per cent view protection as ‘very important’, with 24 per cent viewing Gordon Morris of Age UK, a charity focused on it as ‘quite important’. Just one in 10 rated it important. Furthermore, helping older people, commented on the report: the survey found that only one in three respondents realised that “The Which? report reveals real difficulties that those the Air Travel Organisers Licence (ATOL) logo signifies that a holiday in later life can face when purchasing travel insurance. booking is protected, while 70 per cent of people over 45 wrongly Why should you say to people who are over 65 ‘you viewed the Association of British Travel Agents (ABTA) logo as a can’t go skiing’?” He added, though: “The important guarantor of protection. The survey also found that among those who thing to note is that there are still options available did rate protection as important, more than two thirds of respondents and consumers just need to take the time to shop said they would be willing to pay £5 or more for cover. and get the best policy. However, it is essential to be completely transparent when purchasing a policy, advising your provider of any medical conditions.” Michelle Mitchell, also of Age UK, added: “It is shameful that older consumers be denied travel insurance simply because of their age. It is also unbelievably short sighted. Discriminating against our ageing population in this way is not just bad for older people, it is bad for business.” She went on to say: “Older people complain about this area of age discrimination more than any other, but insurance will be exempt from age discrimination, [thanks to a] law coming into force in 2012. After years of inaction, the only way to improve the situation is government intervention. We urge ministers to change their mind and outlaw unjustified discrimination in financial services.”

Insurers brace for impact continued from p.1 eruption of Grimsvotn) could once again represent particularly bad news for distributors and underwriters of basic or ‘value’ travel insurance policies, as these policies are often configured specifically to cover trip cancellation, either alone or in conjunction with a small number of other risks.” He went on to point out that basic travel insurance is also commonly offered by airlines. Ryanair, for example, offers its customers two levels of coverage: ‘economy’, which just covers cancellation and personal belongings; and ‘standard’, which is a more comprehensive travel policy. For a distributor or an insurance company, having a large and sudden influx of claims against what are, for the consumer, very cheap policies, is clearly not ideal. It should be noted that the Travel Metrics research and the data included only relates to travel policies held by individual consumers, while the insurance consequences of volcanic ash disruption run deeper than this.

26.7% 40%

4.4%

28.9%

Trip cancellation, posponement or 40% interuption (not volcanic ash) Trip cancellation, posponement or 26.7% interuption (volcanic ash)

4.4% Flight or trip delay (volcanic ash)

28.9% Flight or trip delay (not volcanic ash)

www.itij.co.uk 6 NEWS

Domestic travellers opt out

According to research from online insurance in EU countries.” He added: “Our research comparison site Moneysupermarket, 58 per cent showed three per cent of people travelling of British holidaymakers would holiday in the UK worldwide wouldn’t take out travel insurance without taking out travel insurance. The report states because they believed an EHIC would cover them, that just 35 per cent of those polled would take despite it being useless if you’re heading for a adequate travel cover out if they were holidaying in destination outside the EU.” the UK, but more would take out adequate travel insurance if venturing off the UK mainland. Fifty-six per cent of respondents to the survey said they would take out travel insurance when visiting the Channel Islands, while the figure rises to 81 per cent for those travelling to Europe. For those heading further afield, insurance becomes even more important, with nine out of 10 travellers purchasing cover. Bob Atkinson, travel expert at the website, commented on the findings: “It may seem a waste of time having travel insurance for holidays within the UK, but you can still be caught out by events RSA acquires etfs beyond your control. For example, during the recent ash cloud disruption, several internal flights RSA Travel Insurance Inc./Assurance Voyage RSA opportunity to further deliver competitive products between UK airports were cancelled. With many Inc. has agreed to acquire, subject to the satisfaction and travel expertise to the market. We will continue annual travel insurance policies including UK travel of certain closing conditions, the business assets to build and expand our offering to provide our as standard, it can be worthwhile, especially if you and insurance expertise of etfs, along with the etfs distributors with an even stronger proposition.” travel regularly. It is also important not to get caught trademarks. As one of Canada’s largest distributors of This deal pertains to etfs and not Global Excel out when travelling to the Channel Isles, as you do travel and health insurance, etfs has deep expertise and Management Inc. (GEM), the claims and assistance not get free National Health Service care on the a successful track record within the travel insurance business. RSA will continue its long-term partnership islands and a good policy is essential if you fall ill.” market. RSA is already a top-three travel insurer in with GEM, which will remain the claims and The Moneysupermarket research also found Canada and has an ambition to strategically grow in the assistance provider for RSA’s travel business. that some travellers view their European Health travel marketplace. etfs currently provides a full range “Today’s announcement validates the strength of our Insurance Cards (EHICs) as an alternative to of travel and health insurance products on an individual offering and the solid expertise of our employees,” having travel insurance to cover their trip, even and group basis through brokers, associations, travel said etfs CEO Reg Allatt. “This deal enables GEM to when they are travelling outside the European agents, direct, affinity groups and corporate clients. focus on the claims side of the business, allowing etfs, Union (EU). Atkinson said: “While [EHICs] help “etfs and RSA have a long-standing partnership with together with RSA, to continue building its presence out towards some of the medical costs, it is not a expertise and a successful track record with travel in the travel insurance market. It presents exciting replacement for a travel insurance policy and will insurance – a strategic specialty segment for RSA,” growth opportunities for all parties involved.” leave many nursing not only their health, but a said Rowan Saunders, president and chief executive Completion of the transaction is expected to take hefty bill. I recommend taking out a suitable travel officer (CEO) of RSA. “This deal provides us with the place by mid-July. insurance policy as well as an EHIC when travelling

Tourists targeted

Police in Spain have rounded up a gang of 24 identification papers. “When the supposed tourist people who have been accused of claiming to be followed the instructions given by what appeared law officers and then robbing the tourists they to be officers, the real tourists followed suit,” said a questioned. David Ing has the details police spokesperson. This usually involved handing over a wallet, at which point the criminals took The group has been connected with more than 80 advantage to steal some but not all the money – cases of thefts and robberies carried out in the city so as not to be noticed straight away – and credit of Barcelona, according to the Mossos d’Esquadra, cards. Several victims said they were pressured the Catalonia regional police force. More arrests are into punching their PIN numbers into the alleged expected. The Mossos said the crimes were carried officers’ cell phones, ostensibly so that their data out in prominent tourist areas such as near the Camp could be verified. Nou stadium of Barcelona football club, the Guell While nobody was injured, some claimed that park and in the old centre, the Ciutat Vella. the thieves let it be seen that they were carrying All the gang members were said to be Romanians, handcuffs and pistols. The Mossos said they working in groups of three or four at a time suspected the gang of carrying out substantially and out of hotels and hostels that they switched more thefts, but the victims did not report them regularly. They also used rented cars similar to because either they thought the gang members those used by the Mossos. really were police, or because of lack of time or The typical ploy was for one to play the role of knowledge of the police system. Four of the 24 a tourist, even to the point of carrying a map in arrested were said to have been involved in a hand. He then approached and began talking to similar scam operation carried out in 2009. Most genuine tourists, just as his companions arrived on of their victims this time were North Americans the scene, claiming to be police and asking to see and Asians.

Growth in comparison site quotes

Comparethemarket, an online insurance price giving further indications that more people are trying comparison site in the UK, has reported a 44-per- to find the right product, at the right price, for their cent rise in the number of people seeking travel insurance requirements. insurance quotes in the first quarter of the year. Jeremy Mill, commercial director of Despite a challenging economic situation, the website Comparethemarket, said: “Our priority is to ensure has seen quarter-on-quarter rises in the number of our customers can find the right product for them, people sourcing a quote for a travel insurance policy it’s never been more important to ensure that you over the past 12 months. The first quarter of 2011 have the right level of cover when travelling, [so] we saw the website garner a 33-per-cent increase in the are really pleased to see a significant increase in the number of visitors to the site’s travel insurance pages, number of people benefitting and getting quotes.”

International Travel Insurance Journal NEWS 7

Teabags or Prime Travel Protection reimbursement AXA research shows travel cover? The Florida Department of Financial Services has $10,000. One customer, Sheldon Satty, is hoping to insurance lacking reached an agreement with Sarasota-based travel recover $10,332 to cover the cost of a Caribbean Research from the UK’s Foreign and Commonwealth agent Legendary Journeys to reimburse customers cruise he was forced to cancel at the last moment due Research by major insurance provider AXA Office (FCO) has shown that Britons planning a trip of the agent to the sum of $90,000, after it was to an operation he wife had to undergo just before has shown that as many as nine out of every abroad are more interested in making sure they pack found to have sold unauthorised travel cover offered they were supposed to leave on their holiday. ITIJ has 10 travellers from the UK will be either their own supply of teabags than ensuring they have by Prime Travel Protection to its clients between been following the development of the controversy uninsured or incorrectly insured for their appropriate travel cover in place. Over 12 million 2006 and 2008. Legendary Journeys was just one surrounding Prime Travel Protection Services since summer holiday this year. A poll has found that British nationals are planning to visit family and friends of around 20 travel agents that was responsible April 2009, when the firm received a cease and desist nearly one in three travellers does not take abroad this year, according to the research, yet for selling travel cover on behalf of Prime Travel order from the Colorado Division of Insurance. The out travel insurance at all, with 25 per cent nearly half of young people say they did not take out Protection Services Inc. to customers in Florida, company has also been known in the past as Vacation of those polled claiming they don’t need the travel insurance last time they stayed with family and where it was not in fact licensed to operate. Protection Services, Inc., Universal Assurance, and cover, while 21 per cent labelled it ‘a waste of friends. Thirty-nine per cent of people visiting friends The $90,000 will be divided among travellers who Traveler Protection Services Inc. Its owners, Jerry and money’. Furthermore, 35 per cent of those or relatives in Africa failed to take out insurance for unknowingly bought an unlicensed product from Christine Watson, have described what the company who do purchase travel insurance do so at the their trip, while for those visiting people in South Prime Travel Protection, which went out of business sold as ‘protection’, not insurance, therefore the last moment, thus placing themselves at risk of Asia, 48 per cent bought travel insurance. In all, 77 in 2009. The payments will range from $80 to over company was not subject to insurance laws. missing out on cancellation cover. per cent of those polled who are planning to visit friends or family abroad this year are not planning to take out travel insurance, saying that saving money is the most important factor in their decision to do so. Jeremy Browne, minister for consular affairs, said: “With over five million Britons living abroad, people are increasingly making the most of opportunities to visit their loved ones across the world. However, it is important to understand that staying in someone’s home does not make you exempt from encountering serious problems.” He advised travellers: “Take the same steps before you go as you would for any other holiday, such as taking out travel insurance and doing some pre-trip research, to ensure you are prepared if something does go wrong.” The research found that despite the apparent belief that people do not need travel insurance if they are visiting family or friends, 39 per cent of those polled have ended up relying on their host when things have gone wrong on their trips, with expatriates and families having to do everything from just taking a friend to hospital, to footing the bill when the medical costs spiral. Dean Churm, British Consul for Florida, US, asked: “What would your host appreciate more? A box of

77 per cent of those polled who are planning to visit friends or family abroad this year are not planning to take out travel insurance

teabags or dealing with a hefty medical bill because you had an accident and were not insured? Getting comprehensive travel insurance means that while an accident may disrupt your holiday, it won’t bankrupt you in extortionate medical or repatriation bills.” Phil Lord, who works on the FCO’s Know Before You Go campaign, added that it is often not just insurance that travellers are neglecting, as most do not consider the health risks of countries they are visiting: “It’s easy to think that travel preparation advice does not apply to you if you’re visiting a familiar destination, but knowing a country well does not make you exempt from encountering problems. If you’re visiting a malaria hotspot, make sure you have taken preventive measures and don’t assume you are immune. Far better to be prepared so you can avoid any nasty surprises and focus on enjoying your time with loved ones.” Following the release of the FCO’s research, Sean Tipton, spokesman for the Association of British Travel Agents, recommended that travellers take out annual insurance policies, eliminating the need to make last-minute insurance arrangements. He added: “Our general advice is that wherever you are going, especially if you are someone who is likely to make last-minute decisions on breaks, buy an annual policy. It’s the easiest thing to do and also insurance is the cheapest it’s ever been – it’s not expensive anymore.”

www.itij.co.uk 8 COMPANYBRIEF

ICICI Lombard Corporate Travel Guard chosen NEWSWIRE teams with Air India site opens ARC has announced that Travel Guard North America has become an ARC Helix preferred supplier, meaning Express UK-based travel insurance specialists Rothwell & that Travel Guard will allow Helix member agencies The management team of the Ancile Towler has launched its new company website, the ability to offer their clients comprehensive travel Insurance Group has announced an agreement to ICICI Lombard, India’s largest private sector general providing a one-stop shop for enquiries from the insurance plans covering trip cancellation, interruption, purchase the entire share capital of the business insurer, has collaborated with Air India Express travel insurance industry and potential business delay, medical expenses, baggage loss and other from its shareholders. Graham Linney, managing to provide unique travel insurance solutions to customers. The company operates several travel unexpected travel-related events. director of Ancile, leads the management buyout, overseas and domestic travellers. The agreement insurance brands, including World First Travel Tom Zavadsky, executive vice-president of sales supported by Chris Payne, broking director. between the two companies enables customers Insurance, Guest First and Hotelsure. The new and underwriting at Travel Guard North America, to take advantage of Group Travel Insurance website outlines many of the services and products said: “We’re pleased to be joining the ARC Helix Cunningham Lindsay UK has partnered (Overseas), which is valid for a period of 15 days that Rothwell & Towler can provide. programme, and look forward to being there for with The Surveillance Group to offer clients or when the traveller returns to India, whichever Martin Rothwell, managing partner, said: “Rothwell travellers and the agencies serving them.” what it claims is the most comprehensive fraud is sooner. The policy covers a host of situations & Towler has incredibly well designed systems that Christopher Flores, Helix programme director, investigations capability in the UK. The Surveillance such as medical expenses caused by hospitalisation operate across a range of brands and products. We added: “Travel Guard is an excellent addition to the Group, along with servicing insurers, works for local arising from an accident, losses from trip delays, loss can apply these to offer flexible, results-driven solutions Helix preferred supplier portfolio, which gives our authorities, government and public sector clients. or delay of checked-in baggage and loss of passport. to industry counterparts, whereby we all contribute members a profitable travel insurance option. Their The insurance can by purchased from the airline’s to making travel insurance more accessible and cost reputation, customer service, commitment to the Groupama Insurances has launched a series website while simultaneously booking flight tickets, effective. Our new website is designed to highlight agency channel, and quality product in the travel of specialist commercial insurance products for and the e-policy is issued instantaneously via email these key points and showcase our knowledge, insurance coverage arena, are the reasons why we open market trading with supporting brokers. First and SMS. expertise and the breadth of services available.” look forward to this partnership.” to launch under the new ‘Exclusively’ brand is a product for brokers targeting recruitment and Dynamiq employs employment agencies in the UK. Gnu Insurance in the UK, part of Aegon, is technology marketing a pay-per-day travel insurance policy for older travellers. It is offering a made-to-measure Australian employees required to travel overseas product for travellers who often have changing with their work will have access to unprecedented medical conditions and medical needs throughout levels of protection as a result of a new technology the duration of an annual travel insurance policy. suite launched recently by Sydney emergency management firm Dynamiq. The company’s Travel TravMark, a US-based speciality insurance Risk Management (TRM) Suite also gives employers company, is offering cancellation insurance that can the highest possible legal protection by helping them be purchased for a variety of activities, including meet and exceed their duty of care to travelling staff. summer camps, trade shows, sports programmes Anthony Moorhouse, founder and chief executive and education programmes. The A+ protection officer of Dynamiq, said the TRM Suite delivered a plan is designed to protect interests with pre- level of protection never before available to Australians paid costs. travelling abroad for work purposes: “It gives businesses the ability to track employees anywhere in the world, The National Bank of Kuwait is now offering to broadcast urgent information and safety alerts, and its customers Travel Safe, a travel insurance to ensure their staff are acting on those alerts. From the package, in co-operation with Al Ahleia Insurance dashboard of the TRM Suite, managers have access Company. Customers of the bank can buy the to a range of location information, security alerts and insurance at any of the branches around Kuwait, travel itinerary data, which will tell them in an instant which includes the required insurance certificate for whether staff may be in danger, and allow them to a Shengen visa. respond accordingly.” Moorhouse added that with the Federal Government pushing towards a new national Security awareness Chartis Malaysia Travel Insurance Singapore.com has teamed workplace health and safety regime, the protection of up with Scans Associates Pte Ltd to offer clients and staff around the world will become more important in the spotlight launches website new customers a personalised service, as well as an than ever for Australian businesses. after-hours office service, specialising in travel, car Drum Cussac, the international business risk Chartis Malaysia Insurance Berhad (Chartis and medical/health insurance products. consultancy firm, has announced the launch Malaysia) has launched its direct-to-consumer Business travellers of TravelSafe – its highly interactive and visually micro-website to cater to the growing consumer Travelex Insurance Services and Disney powerful travel security awareness training course need for better understanding of general Vacation Club have joined forces to help the covered for international travellers. The company says the insurance products. The website, says the 475,000 individual Disney Vacation Club members multimedia programme includes more than 40 different company, is the first to provide instant fulfilment travel with peace of mind from unexpected events, AXA Assistance, iJet (a 3i-Mind company), and aspects of global travel safety and features experienced for comprehensive travel insurance in Malaysia, providing comprehensive coverage for common G4S have confirmed the formation of a new global travellers and security professionals reliving past where customers can select, purchase and print travel concerns including medical emergencies, partnership to provide full travel risk management experiences, sharing key safety strategies and providing out their policy online. The site also provides trip cancellation or interruption and baggage loss and protection services for business travellers and personal security tips. Created in consultation with information on several general insurance products, or delay. expat staff working overseas. The companies have Bournemouth University, TravelSafe incorporates the including travel cover, personal accident and combined their expertise to create a comprehensive latest training and information retention, and can in health insurance. Strengthening the co-operation between and integrated global travel risk management solution addition be tailored to match the profile of any traveller, Commenting on the new site, chief executive of Assistance Finland and SOS International, the that will provide optimum protection for staff when from the novice to a seasoned globetrotter. Chartis Malaysia Matt Harris said the new micro- two companies recently signed a Letter of living in or travelling to countries worldwide. Jeremy Stampa Orwin, founder and managing director site provides ‘an educational window to the library Intent formalising closer collaboration in offering By combining their areas of expertise, customers will of Drum Cussac, said: “The civil unrest around the of product offerings in a lifestyle setting’, adding: “It roadside assistance in the Nordic countries receive medical assistance provided by AXA Assistance globe today only heightens the risks that await an allows a discerning consumer to take their time to and internationally. medical teams; global travel intelligence, tracking unwary or complacent traveller. TravelSafe provides browse and understand the products at their leisure and communications from iJet; and security support business travellers with valuable skills, enabling them to before making the decision to buy an insurance plan UK-based InsureandGo has introduced from G4S in 120 countries through its specialised risk effectively manage risks before, during and after travel.” than will best suit their needs.” Scheduled Airline Failure insurance on its policies, consulting business, Hill & Associates. Companies signed offering its customers financial protection in up to the service can offer their employees a complete the event the airline operating their scheduled package of protection via a single contract with flight fails. centralised management procedures and standardised processes, no matter where they are in the world. MAPFRE deals done Europ Assistance UK has announced Serge Morelli, chairman of AXA Assistance, said: an exclusive partnership with Premier Occupational “Associating our medical offering with the security MAPFRE Assistance is to provide underwriting and agreement, which lasts for an initial minimum period Healthcare, a provider of affordable occupational services proposed by Hill & Associates, G4S and iJet emergency assistance services to the UK’s Ancile of three years, commenced in April and covers the health and well-being services. The partnership is creates a turnkey package that meets companies’ Insurance Group in a multi-million-pound deal following underwriting and emergency assistance for three of the next stage of development of Europ Assistance’s real needs and will thus ensure the enduring a competitive tender run by UK wholesale insurance the Ancile Group’s consumer travel insurance brands: healthcare proposition. success of the partnership.” intermediary Healix Insurance Services Limited. The Insurewithease, Top Notch and OUL Direct.

International Travel Insurance Journal INSURANCEMATTERS 9

NEWSWIRE Vietnamese growth E&Y fraud survey shows industry concern confirmed Ernst & Young’s (E&Y) latest Indian insurance fraud of the respondents expressed concern that their Mark Hodges, Aviva UK’s chief executive, is survey has revealed that the rising incidence of fraud organisations do not have a dedicated anti-fraud leaving the insurer after 20 years to take the reins AM Best’s latest report – Vietnam’s Insurance Market is driving up costs for insurance companies and department. Worse still, around 43 per cent said at Towergate Insurance with a view to taking the – Awakening to Further Change – has found that premiums for policyholders. Insurance companies that manual red flags are used to detect fraud in insurer public. Hodges succeeds Andy Homer, who the country’s non-life insurance market, which saw are waking up to this grim reality, which may threaten their organisations. Given the quantity of data these is retiring as chief executive of Towergate. premiums increase at a compound annual growth their viability and profitability, said E&Y. insurance companies have to handle, this method rate of 19.5 per cent from 2007 to 2010, is expected According to 80 per cent of the survey respondents, may not be effective enough as a measure. Following a lengthy search, John McFarlane, to continue to grow. The report states that continued representing India’s largest public and private The Indian insurance industry relies heavily on third a director at Royal Bank of Scotland and former growth will be powered by the demographics of insurance companies, fraud in insurance can parties, whether as a distribution channel for selling its head of a large Australian bank, is poised to become Vietnam, where an emerging middle class is taking an increase costs for insurers by at least one per cent products or to conduct due diligence, and, as a result, the next chairman of Aviva. increasing interest in protection products. As the level and by more than five per cent in certain cases. the exposure to fraud risk increases, which makes it of wealth increases, more cars are being purchased, Furthermore, over 50 per cent of the respondents imperative for a company to conduct due-diligence Insurance companies in India added more fuelling growth for personal lines cover, including believe that fraud directly impacts premiums, in some checks before associating itself with any third party for retail investors in the 2010-2011 financial year third-party liability insurance. The largest of the non- cases increasing premiums by more than three per business. Yet, according to the survey, one-third of the than the mutual fund industry, according to an life sectors, continued the report, is motor, which cent. This adversely affects innocent consumers who respondents reported that their company does not analysis of policy as well as folio figures for the represents 31 per cent of direct written premiums end up paying higher premiums. screen all key vendors and employees. insurance and mutual fund sectors, according to the in 2010. The survey was conducted to assess the fraud Arpinder Singh added: “The survey provides a wake- Financial Express. In general, Vietnam’s economy is demonstrating scenario in the Indian insurance industry, the potential up call for insurance companies. Lack of third-party strong upward movements thanks to an increase risk exposure, the economic impact of rising incidents due diligence and focus on anti-fraud measures and a Taiwanese authorities are said to be working in foreign and domestic trade. Construction and of fraud, and industry practices to counter fraud. Of continued reliance on manual methods to detect fraud on draft amendments to certain articles of the erection risks, hull protection and indemnity, and the survey’s respondents, 50 per cent expressed the inevitably increases the risk exposure. The adoption country’s insurance law, which would lift the ban marine cargo cover collectively represent 30 per cent need for heightened and more stringent anti-fraud of a definite methodology and a comprehensive and on the use of sensitive personal information by of premiums written for the non-life insurance sector, regulations in the area of claims and surrender. This integrated approach to fraud risk can help companies insurance companies, the China Post has reported. and AM Best believes that other new construction area is most prone to fraud, with nearly 27 per cent address the rising risk of fraud in the insurance sector.” projects will further contribute to growth for the of respondents rating it among the topmost fraud The results of the survey indicate that business leaders The Sydney Morning Herald has said that insurance industry. risks in the insurance sector. are aware of the need to address fraud risk. Some of annual pricing talks between Suncorp Group and some The report states that the most significant risk facing The sector regulator, the Insurance Regulatory and the more successful organisations have already begun of the world’s largest reinsurers have hit an impasse, the industry in Vietnam lies in natural catastrophes, Development Authority (IRDA), appears to share focusing on this area and have consequently benefitted with the insurer resisting demands for steep price with northern regions facing the risk of earthquakes the concern of most of the respondents. According from improved profitability. increases in the wake of recent natural disasters. and other areas being prone to flooding. It noted to public media sources, the IRDA has reportedly Arpinder Singh concludes: “Some of the points specifically that typhoons, especially around the decided to appoint well-reputed firms to develop that companies must include in their Insurance payouts to victims of the Mekong River, have been responsible for seriously effective reporting on industry-wide fraud within fight against fraud are a well-defined 11 March earthquake in Japan will amount to ¥2.6 damaging or wiping out crops and livestock. In order healthcare insurance. whistle-blowing policy, periodic fraud trillion, with the total set to become the biggest to protect against such known risks, the Vietnamese The survey findings should cause concern among risk assessment, third-party due insurance payout resulting from a natural disaster in government is to promote a pilot insurance project insurance company directors, says Ernst & diligence, data analytics tools to the country. for farmers in up to 15 provinces that would protect Young, as complacency around fraud, bribery and identify red flags, and the them from such disasters. corruption, combined with cost-cutting initiatives automation of processes.” The Economic Times of India has said that The report continued: “The non-life insurance at many companies, creates additional exposure. life insurance premiums have become progressively industry also faces widespread challenges, particularly With new legislation such as the UK Bribery Act cheaper as insurers are marketing more online intense competition.” There are currently 29 giving regulators stronger enforcement powers, term plans. With each new online insurance non-life insurance companies in the country, with management, in particular, should demonstrate plan launched, the deal has become better for competition most keenly felt in personal lines greater commitment to ethical conduct through their consumers, who benefit from increased competition. and small commercial lines cover. “Local insurers actions, including making tough choices regarding tend to dominate personal lines,” added the departmental budgets and disciplinary measures. According to a report by IDC Financial report, “but most lack the capacity and expertise Arpinder Singh, Ernst & Young’s India fraud Insights, social media is becoming an increasingly to create a significant presence in commercial investigation and disputes services leader, said: “It distinct contributor to customer outreach lines. Underwriting losses are attributed to fierce is management’s job to set the tone and frame the programmes in the Asia Pacific and insurers are competition, high operating costs and increasing controls and programmes to mitigate the fraud risk.” exploring ways to integrate this into their sales and frequency and severity of losses.” The report found that many companies have to marketing efforts. The company based its report on Although the overwhelming majority of the report do more to establish a robust and effective fraud findings from a regional insurance executive survey notes positive development for the industry in risk management process. As much as 40 per cent conducted on 18 organisations in the region. Vietnam, it also makes clear there remain hurdles to be overcome, including a shortage of talent and The China Insurance Regulatory regulatory reforms. The impending Law on Insurance Commission looks set to lower hurdles for insurers Business is also expected to impose more rigorous Confidence in short supply seeking to raise capital through subordinated bonds, regulation on foreign-invested companies and with its recent release of a revised draft guideline brokers that offer cross-border insurance services. The Aon Aerospace Insurance Market Outlook, recently 2010/11, reflecting the reduction in turnover caused relating to the use of such instruments. released, shows that confidence is still limited for by the global economic downturn, coupled with the airports for 2010/11 as insurance prices continue overall perception of risk in the sector. The Algerian insurance market saw its to drift down. The aerospace sector weathered the Overall, four of the five regions saw lead premium premiums grow by four per cent to DZD80.7 billion global financial crisis relatively well, but confidence prices fall on average, with only the Middle East going (US$1.1 billion) in 2010. The total volume did not is still in short supply, with passenger and revenue against the trend; although, as the second smallest include premiums from two companies that did not forecasts still comparatively conservative, according region in the world from an aerospace point of view, submit figures, GAM and MAATEC. to Aon Risk Solutions, the global risk management it is subject to the influence of changes at the region’s business of Aon Corporation. major operations. Gras Savoye Reinsurance Brokers has The sector is now in its fifth consecutive year of “The insurance programmes placed for the aerospace received its licence from the Egyptian Financial falling insurance premium prices, says the report, sector so far in 2011 suggest a fifth consecutive year of Supervisory Authority to conduct reinsurance broking with preliminary data for 2011/12 renewals pointing the soft market,” observes Danny Green, head of Aon operations in Egypt, MENA and Africa. to a continuation of the trend. The ongoing soft Risk Solutions’ aerospace team in London. “While the market is being driven by a variety of factors, with long-term declines in premium levels would suggest The Syrian Insurance Company generated changing insurance strategies, falling exposure as that insurers will begin raising premiums at some point gross written premiums of SYP9.5 billion (US$200.2 a result of the global economic downturn and the in order to maintain profitability, there are several million) in 2010, a 40-per-cent increase over the industry’s evolving risk profile all playing a role. reasons why this may not happen in the short term. previous year. It now has a share of the market of Airport operators enjoyed the best results from Over capacity attracted by the sector’s relatively good around 50 per cent. the insurance markets, with lead premiums falling, loss history, as well as reductions in exposure, or the on average, by seven per cent. Service providers actual volume of risks being insured, driven by the global Regulatory shifts across Asia are leading experienced an average five-per-cent reduction economic conditions, have meant that there is lower insurers to review their bancassurance models, in prices, an impressive level of consistency after exposure to be covered. The long-term improvements according to Ramnath Balasubramanian, associate the six-per-cent average reduction reported for in safety that are being made by organisations across partner at McKinsey & Co. 2007/08, 2008/09, and 2009/10. Lead premium in the sector are also a major factor. As a result, there will the manufacturer sector was stable once again for continue to be pressure on insurance prices.”

www.itij.co.uk 10 INSURANCEMATTERS

Demand for improved risk models up Brokers support NEWSWIRE Aon Benfield, the global reinsurance intermediary, vendors’ assumptions before deciding upon capital fraud database has recently highlighted how natural disasters, reserves and reinsurance levels.” coupled with the effect of Solvency II, are Paul Miller, head of international catastrophe A survey undertaken by Groupama Insurances The China Economic Net website has fuelling demand for more in-depth evaluation of management at Aon Benfield Analytics, said: has revealed that the vast majority of brokers feel reported that slower vehicle sales in China have catastrophe models. At its recent International “Model evaluation is a crucial part of ensuring penalties for insurance fraud should be higher and affected growth of car insurance sales and Analytics conference, the firm advised insurers a company is adequately capitalised to meet its a central database of fraudsters, used at the point consequently, the non-life insurance market, given how they can drill deeper than just the loss catastrophe exposures. Through our understanding of sale, would help to deter potential fraudsters. that car insurance accounts for more than half of estimates in order to better understand how of the robustness of each catastrophe model and Over 200 brokers took part in the survey, which total non-life insurance premiums. models performs and in turn influence their assessing its uncertainty, insurers are armed with also found that brokers feel that the insurance decisions on reinsurance purchases. The company the necessary information to make appropriate industry could and should be sharing more All non-life insurers in India that have told attendees: “While it is still too early to review adjustments to the models’ output.” information to tackle fraud and that brokers have announced earnings for the financial year ending the modelling firms’ performance in the recent Ben Fox of the model evaluation team at the a key role to play in the process of fraud detection 31 March 2011 have either reported losses or earthquake in Japan, the models overestimated company added: “The proposed Solvency II and prevention. significant profit declines from a year earlier, due the actual losses in last year’s Chile earthquake. regulation has further driven the need for more Respondents to the survey were clear in their to higher provisions for the third-party motor pool, This is in contrast to the US hurricane events of transparency as insurers are required to explain views, with 93 per cent of brokers saying that reports the Economic Times. the past decade, where catastrophe models have why they have chosen a particular model. Until penalties for fraudsters should be higher as a consistently underestimated the actual incurred ‘open’ models – such as those from Impact means of deterrent, while 95 per cent felt that The Indonesian government has proposed losses, in some cases by a factor of two or greater. Forecasting – are widely available, evaluating is the insurers should share more information. Eighty- the creation of two new state insurance entities This illustrates the need for insurers to understand only way to drill down into the inner workings of to manage five basic social benefits for citizens, as much as possible about uncertainty and the these products.” including health and pension benefits, in a revamp of the social insurance sector.

AXA has announced that it is to sell its Indemnity cover-up Canadian operations in property and casualty and life and savings insurance to Intact Financial New research by Finaccord, a market research which accounted for around €1.59 billion of the Corporation for a total cash consideration of consultancy specialising in financial services, has total for 2010. CA$2.6 billion. forecast that the market for professional indemnity “Across the 10 countries, there are over six million insurance across 10 European countries – Belgium, enterprises potentially eligible for professional Gross premiums in Jordan increased by 7.3 France, Germany, the Netherlands, Poland, Spain, indemnity insurance,” said Alan Leach, director at per cent year on year to US$212.1 million by the Sweden, Switzerland and the UK – will be worth Finaccord. “For some, holding professional indemnity end of April, compared to $197.7 million recorded around €7 billion by 2014. Finaccord analysts cover is compulsory in order to exercise their in the same period last year, according to the have calculated that gross written premiums for profession, while for others, it is optional. However, Insurance Commission of Jordan. this form of insurance amounted to around €5.81 increasing take-up rates among those for which it is billion across the 10 countries in 2010, having often not obligatory will be one of the drivers of the The Qatar Financial Centre Authority has grown from approximately €5.17 billion in 2006. market in the future, notably in the IT, management said the local captive insurance market is expected Moreover, gross written premiums grew between and financial consulting sector, which is the largest to grow rapidly during the next few years, spurred Andy Pagett 2006 and 2010 in all countries other than the UK, segment with 1.45 million insurable enterprises.” on by the expectation of over US$140 billion on infrastructure spending in the country through to 2015. eight per cent were in favour of the creation of a central database of known fraudsters, which they Asia Insurance Review says that the pace believe would increase the chances of deterring of mergers and acquisitions in the Thai potential opportunistic criminals. insurance sector appears to be slow despite Andy Pagett, counter fraud manager at Groupama the approaching implementation of risk-based Insurances, commented on the findings: “This capital regulations. There are still more than 90 survey certainly indicates that brokers are just as insurance companies in the country, including concerned as insurers about fraud. Pleasingly, 72 more than 60 non-life insurers. per cent agreed with the statement that ‘brokers have a significant part to play in communicating The Beijing municipal government is making counter fraud messages’.” He added: “A central it mandatory for high-risk industries in the Chinese database of known fraudsters is well underway. capital to acquire insurance to protect against The proposed Insurance Fraud Register (IFR) is losses arising from accidents in their operations. The currently being worked on as a ‘proof of concept’ rule takes effect from July onwards. and will be presented to the General Insurance Council for sign-off and to obtain agreement to Cinda Property, Casualty Insurance and fund it. We firmly support this initiative, along with Happy Life Insurance have signed an agreement to any similar moves to enhance data sets such as the cross-sell each others’ products, in what is the first CUE Travel proposal.” such formal model of co-operation between a non- Other results from the survey showed that 54 life company and a life insurer in China. per cent of brokers felt that more could be done to deter potential fraudsters, yet 34 per cent of Certain insurers have suspended sales respondents were unsure that it was possible to of new earthquake insurance policies in the mid- do more than they are already doing. When asked Canterbury region, of which Christchurch is the how the industry could address the perception main city, following a significant tremor on 13 June, that opportunistic fraud is acceptable, a significant according to media reports from New Zealand. majority – 77 per cent – said they felt that it should be made clear that fraud, regardless of its nature, Taiwan’s Financial Supervisory Commission is a crime. Furthermore, 69 per cent felt maximum is studying how it could resolve a taxation issue exposure in the media, publicising successful fraud related to the special reserve fund of domestic prosecutions, would help tackle the issue, while 54 insurers that amounts to around NT$100 billion per cent believed that all documentation released (US$3.45 billion). to the consumer should clearly state that fraud adds costs to premiums. Dutch insurer ING has reached an Paggett said: “Sadly, opportunistic fraud is endemic, agreement to sell ING Direct USA for a and half the battle is in changing the perception consideration of US$9 billion to Capital One that it is acceptable to fabricate or exaggerate Financial Corporation, a financial holding certain elements of a claim. This issue is also self company based in the US. Under the terms of the perpetuating – the higher premiums rise due to a agreement, ING will receive $6.2 billion in cash and range of factors, including fraud, the more likely it $2.8 billion in shares in Capital One. is for people to look for ways to claw back their expenditure by inflating or falsifying a claim.”

International Travel Insurance Journal INSURANCEMATTERS 11

Consumer insurance BIBA welcomes comparison site guidance

bill progresses The British Insurance Brokers’ Association (BIBA) has welcomed the UK Financial Services Authority’s The China Economic Net website has The UK Government recently introduced (FSA) guidance consultation for insurance comparison reported that slower vehicle sales in China have the Consumer Insurance (Disclosure and websites. The FSA has stated that it has found failures affected growth of car insurance sales and Representations) Bill to the House of Lords for its to comply with its rules, which could result in the consequently, the non-life insurance market, given first reading. The Bill, if accepted, would change the consumer not being treated fairly. that car insurance accounts for more than half of law governing the information that consumers must The proposed guidance means that comparison total non-life insurance premiums. provide when they purchase insurance policies, websites may need to review their disclosure and the remedies available to both consumers and documentation, sales procedures and terms and All non-life insurers in India that have insurers should the consumer get that information conditions in order to comply with all relevant announced earnings for the financial year ending wrong. This update would be the first substantial regulatory requirements. These include customer 31 March 2011 have either reported losses or change of statutory insurance law since the Marine eligibility, status disclosure, advice suitability and significant profit declines from a year earlier, due Insurance Act of 1906. The Bill, which is part providing a proper statement of demands and needs. to higher provisions for the third-party motor pool, of a wider reform of insurance law, stems from Eric Galbraith, BIBA chief executive, said: “Our reports the Economic Times. recommendations made by the Scottish Law concerns from 2008 have focused on the gap Commission and the UK Law Commission, in developing between the pace of technological change The Indonesian government has proposed a report entitled Consumer Insurance Law: Pre- and the regulations, which were written in 2005. the creation of two new state insurance entities Contract Disclosure and Misrepresentation, which was We are pleased that the FSA recognises the price implemented by the sites without delay. We a policy through a lack of opportunity to disclose all to manage five basic social benefits for citizens, produced in December 2009. The Law Commission comparison website activities to be more than simply think it is particularly important that the FSA has material facts, and that there could be confusion about including health and pension benefits, in a revamp has indicated that it will publish a second consultation introducing and we trust that the steps that they are highlighted a concern that we share, where in which firm to complain to, and whether they have the of the social insurance sector. paper, which will consider business insurance law, taking will close this gap.” many cases questions are pre-populated with right to go to the Financial Ombudsman Service. later this year. Graeme Trudgill, BIBA’s head of corporate affairs, default answers.” Steve White, head of compliance and training at the AXA has announced that it is to sell its The main recommendation of the new Bill is the added: “For the FSA to say that comparison In its letter to comparison websites, the FSA said Association, added: “This is a really important step Canadian operations in property and casualty replacement of the consumer’s duty of disclosure websites are falling short of their regulatory consumers may be being misled about the services in consumer protection. This should lead to greater and life and savings insurance to Intact Financial to a new duty for the consumer to instead ‘take requirements is of great concern and we strongly they are receiving from these sites, adding that clarity for customers in terms of who they are dealing Corporation for a total cash consideration of reasonable care to answer the insurer’s questions believe that these recommendations must be consumers may be unable to claim benefits against with and the policy that they are purchasing.” CA$2.6 billion. fully and accurately’. Accordingly, a consumer is no longer under the obligation to provide everything that Gross premiums in Jordan increased by 7.3 a ‘prudent insurer’ would consider to be relevant, per cent year on year to US$212.1 million by the and instead must answer correctly specific questions Barnier defends Solvency II Lloyd’s says end of April, compared to $197.7 million recorded that relate to the insurance being purchased. The Bill in the same period last year, according to the states that, in the event that the consumer answers levelled at the regulation, however, and noted premiums must rise Insurance Commission of Jordan. these questions dishonestly or recklessly, then the that the commission staff have proposed what he insurer can rescind the policy and revoke cover and described as ‘a long list of suggestions’ that would Richard Ward, chief executive of Lloyd’s of The Qatar Financial Centre Authority has pay back the premium. However, if a consumer has simplify the new regime. London, has warned that insurance companies said the local captive insurance market is expected been merely ‘careless’ in answering the questions, Michael Wainwright, a partner at international that fail to raise premiums in the wake of natural to grow rapidly during the next few years, spurred the insurer must consider what it would have done law firm Eversheds, commented on the directive: disasters will be the first to collapse should on by the expectation of over US$140 billion on had it had all of the relevant information at the time “Solvency II will impose a new regulatory regime on another disaster strike. Ward believes that the infrastructure spending in the country through to 2015. of issuing the policy and, if cover would still have insurers comparable to the Basel II banking regime. London market’s ‘lucky streak’ of relatively been provided albeit for a higher premium, the It will be an improvement on the existing directives, harmless US hurricane seasons over the past Asia Insurance Review says that the pace insurer should honour the policy and indemnify but it has the same fundamental weakness as Basel few years could be coming to an end, and says of mergers and acquisitions in the Thai the consumer, taking into consideration the higher II, in that it concentrates on the strength of individual that unless rates rise, the next significant natural insurance sector appears to be slow despite premium that should have been paid. companies and does not address systemic risk in the catastrophe will adversely affect the overall the approaching implementation of risk-based Law firm Thomas Eggar responded: “The Bill has been Michel Barnier MaGali/Flickr industry as a whole.” He went on to say: “There is a capital of the insurance industry. capital regulations. There are still more than 90 well received by both consumer groups and insurers. danger that it will increase systemic risk by imposing Should another major natural disaster occur, the insurance companies in the country, including Indeed, many insurers have been acting in accordance European Union internal market commissioner heavy and inflexible capital requirements on insurers, firms that would suffer the most would be property more than 60 non-life insurers. with the proposed Bill as a matter of good practice. Michel Barnier has responded to criticism from with the result that all insurers are forced to respond insurers, as well as marine insurance companies The Bill, if it is accepted by Parliament, will ultimately insurance companies that the new Solvency II capital to market movements in the same way, thereby that offer cover for oil rigs. However, Lloyd’s noted The Beijing municipal government is making provide protection for consumers by bringing greater rules are too conservative by saying that the changes aggravating those market movements. This danger that rising commercial premiums would also affect it mandatory for high-risk industries in the Chinese transparency and certainty to the industry. Those are needed to protect policyholders and improve has been pointed out to the EU Commission, but personal line insurance consumers, with higher capital to acquire insurance to protect against insurers who do not currently adopt this practice an antiquated regime. Barnier said: “Criticisms levied they seem to have missed the point.” He urged the household cover premiums. losses arising from accidents in their operations. The should move towards adopting it now so as to ensure against Solvency II, particularly that calibrations are Commission to address systemic risk in the insurance After this year’s disasters so far, including major rule takes effect from July onwards. that they are ready, as it seems highly likely, given its too high, have not been confirmed by evidence.” industry through the application of more flexible earthquakes and floods, it is estimated that popularity, that the Bill will be enacted in due course.” He went on to acknowledge some of the complaints capital requirements. Lloyd’s insurers are facing a bill of £2.33 billion, Cinda Property, Casualty Insurance and exceeding claims from the whole of 2010. If Happy Life Insurance have signed an agreement to the impact from recent American tornadoes cross-sell each others’ products, in what is the first are included in the total, the insurance market such formal model of co-operation between a non- Branches closed in favour of web as a whole could be hit by losses of as much as life company and a life insurer in China. $50 billion. AAMI Insurance, one of the biggest insurance brands landscape for direct life insurance sales in Australia, At a recent conference in London, Ward Certain insurers have suspended sales in Australia, has announced that it is closing its which features new and more sophisticated marketing, told delegates: “Rates should rise. Prices are of new earthquake insurance policies in the mid- national network of 24 branches over the coming wider public acceptance, multi-channel distribution dangerously low at present. Clients may think Canterbury region, of which Christchurch is the two months and is shifting its entire business online, and an increasing acceptance of online sales. The they are getting a bargain, but … the insurers who main city, following a significant tremor on 13 June, affecting around 100 staff. report shows that direct life insurance constitutes write unprofitable business are inevitably the first according to media reports from New Zealand. Reuben Atchison, corporate affairs manager for the 17.8 per cent of insurance sales and 11.8 per cent of to collapse when disaster strikes.” company, whose parent is Suncorp, said that the firm in-force business. Overall, from 2009 to 2010, sales Ward added that he believes that recent Taiwan’s Financial Supervisory Commission has witnessed a sea change in consumer behaviour, were up 3.3 per cent to AU$403.1 million, while catastrophes highlight how globalisation has is studying how it could resolve a taxation issue with the majority preferring to conduct their business in-force annual premiums increased by 9.7 per cent to served to change the nature of a single disaster, related to the special reserve fund of domestic with the insurer online, and he is confident that the $1,108.5 million at the end of last year. explaining that the Japanese earthquake and insurers that amounts to around NT$100 billion trend will continue. “These days,” he told the Sydney Richard Weatherhead, director and head of life volcanic eruption in Iceland last year could (US$3.45 billion). Morning Herald, “the vast majority of business is now insurance for Rice Warner Actuaries, gives credit end up being viewed as the first systemic transacted over the phone or over the Internet. In fact, for the growing market to a shift in mindset from natural catastrophes: “What the earthquake Dutch insurer ING has reached an the branch network accounts for less than two per major insurance companies: “Major insurers have and tsunami in Japan – and, to an extent, the agreement to sell ING Direct USA for a cent of our revenue these days.” been devoting significant resources to direct eruption of the Icelandic volcano last year – consideration of US$9 billion to Capital One Atchison went on to say that AAMI Insurance would distribution and direct life business over the past shows us, is that risk travels further and faster. Financial Corporation, a financial holding now centre its energies on providing telephone and year, because they are viewing it as an integral part Insurers should be looking at how they build company based in the US. Under the terms of the online services, with hopes of employing branch staff of most business planning rather than being a ‘blue business continuity policies into the modelling agreement, ING will receive $6.2 billion in cash and in its call centres to cope with the increasing number sky’ venture.” of natural disasters. And risk managers may $2.8 billion in shares in Capital One. of calls received. The report identifies the reasons behind the growth want to bring back the concept of Plan B – for In related news, a recent insurance industry report of the industry, which include targeted marketing and example, spare stock in the warehouse or from actuary firm Rice Warner has revealed a changing a focus on cross-selling. alternative suppliers.”

www.itij.co.uk 12 HEALTHMATTERS

Measles numbers up Traveller catches encephalitis

Measles, a highly contagious viral illness that was Murray Valley encephalitis virus (MVEV) has been hospital for medial assessment. Several rounds nearing eradication in industrialised nations, is making identified in the cerebrospinal fluid of a 19-year- of testing for various diseases followed, with the a comeback. A fall in the number of people being old Canadian female who recently returned from eventual discovery that MVEV was to blame. Despite vaccinated against the disease is causing outbreaks all travelling in the Northern Territory of Australia, an medical and surgical interventions, she developed over Europe, with knock-on effects for travellers to area endemic for the virus after recent flooding. progressive cerebral oedema, progressing to the region. The woman had spent six months working at a neurological death on day eight of her hospitalisation. The Canary Islands are suffering from the worst measles farm in New Zealand followed by a 10-day holiday Alberta Health Services has said that it is the first outbreak for 10 years, with 25 confirmed cases in in Australia, camping in the Darwin and Alice laboratory-confirmed case of MVEV reported in April alone. It is thought that the most likely cause of Springs area. Upon her return home, the traveller Canada, and serves as a cautionary reminder of the the increase in measles sufferers is contact with tourists complained of feeling tired, which she attributed to other viral etiologies that should be considered in entering the country from the UK and Germany. jet lag. However, with the development of rigours, returning travellers that may be outside the diagnostic One local expert, Dr Amos Garcia-Rojas, head of chills and increasing confusion, she was taken to capability of many clinical laboratories. epidemiology and prevention at the Canarian public health service, said the re-emergence of measles is occurring in many European countries as people decide against vaccination over concerns about side-effects. Dr reported that more than three-quarters of the 6,500 Garcia-Rojas indicated that such concerns are due to European measles cases have been reported in disproven research that linked the measles vaccine with France, with 4,397 reported cases between January autism, adding: “It has been clearly proven that this is not and March. true, but the idea still remains in people’s minds that this Rebecca Martin, head of the WHO’s office in vaccine may be dangerous, so they have decided not to Copenhagen, said: “This is a lot of cases, to put it expose their children to the vaccines.” mildly. There has been a build up of children who have In the Canaries, a Plan for the Eradication of Measles not been immunised over the years [and] it’s almost began in 2000 and now the vaccine coverage of like a threshold – when you have enough people who locals on the islands exceeds 95 per cent. have not been immunised, then outbreaks can occur.” Dr Garcia-Rojas’ theory about where the cases of Meanwhile in Chile, the first outbreak of measles measles are coming from is corroborated by figures in eight years has led to a mass re-vaccination of from the German Ministry of Health, which has 1.5 million people. The alert was given after the confirmed a rise in the number of cases seen in the appearance of three cases of the disease in March in country. There are currently 45 cases in Frankfurt, 13 of one family, followed by the case of a woman from whom are young adults, 11 of which were hospitalised. Santiago that subsequently affected her treating doctor. As a result, the Municipal Health Department has And in the US, officials are concerned that the country distributed leaflets advising teachers and staff in schools seems to be on track to have more measles cases than to obtain a second dose of the vaccine if necessary. any one year in more than a decade, with virtually The number of cases in Switzerland is also on the all cases linked to other countries, including Europe. increase, rising to 486 so far this year, four-times So far, there have been 89 cases reported in the higher than the total from 2010. Health authorities US, whereas a normal year would result in around have said they believe the outbreak is due to cases 50 cases. Ebola emerges in Uganda spreading from the border of France, with nearly half Concern over the increasing number of cases the cases seen in Geneva, with a further 78 cases in has prompted advice to travellers to seek the The Ugandan Ministry of Health has reported that with an imported outbreak of Yellow Fever, as well the Vaud Canton. recommended two doses of vaccine before one person has died from Ebola in the Luwero as the last time Ebola surfaced in the country, when The World Health Organization (WHO) has flying overseas. District of the country, and there are two more a comprehensive reaction from authorities led to a suspected cases currently under investigation. swift containment of the disease. Following the announcement, measures taken by the The US Centres for Disease Control and Ministry of Health and the World Health Organization Prevention has informed travellers that the risk to Imported dengue cases concerning (WHO) were intensified to prevent any further them from Ebola is considered to be extremely outbreak of the disease beyond the immediate areas low, unless they are directly involved in caring for The UK’s Health Protection Agency (HPA) has and Commonwealth Office (FCO) about dengue in which it is known the disease is present. people who may have Ebola, and have advised released new figures that show the number of UK fever in Fiji, another popular destination, with the The tourist industry in Uganda moved quickly US citizens living and travelling in Uganda to be travellers found to be suffering from dengue fever has organisation warning that there is no vaccination against to dispel the concerns of tourists heading to the aware of the disease situation and take suitable more than doubled in the past year. In 2009, there dengue, but preventive measures against the disease country by pointing out that most tourists would precautions. It advises travellers to: “Avoid direct were 166 cases of imported dengue fever among should be taken. In addition, travellers were told that not travel to the region where the outbreak has contact with blood or other body fluids from travellers, while in 2010 the number rose to 406. Of while the Fiji Ministry of Health reported that the occurred, and they would not be able to reach people with severe illness, especially with those the total number of cases reported in the UK, the incidence of typhoid on the island is generally declining, the region now anyway, as containment measures whose cause of disease is unknown; to avoid highest proportion was associated with people who cases do still occur. In total, health officials said that 149 have been put in place to control movement from direct contact with a dead body whose cause of had travelled to India, with 21 per cent of the cases, cases of typhoid were reported in Fiji between January the affected area. Health officials were also keen death is unknown; and to avoid eating wild animals and a further 15 per cent of cases were in people and May this year, and typhoid hotspots are being to point out the recent success they had in dealing and bushmeat, including primates.” who had been travelling in Thailand. monitored by local public health officials. Other figures from the HPA also show an increase in The FCO warned: “Healthcare facilities are adequate the number of cases of chikungunya virus being seen in for routine medical treatment, but are limited in the UK – 79 cases were reported in 2010, a 34-per- range and availability. Doctors and hospitals often E.Coli outbreak in Europe cent rise on 2009. The statistics for chikungunya expect immediate cash payment for health services. showed that 50 per cent of those stricken with the In the event of a medical emergency, evacuation German health authorities have reported German health officials initially recommended that mosquito-borne virus had travelled to India. could be a likely option for treatment, and you should an outbreak of a severe illness called people in Germany, especially in the northern part Travellers were recently warned by the UK’s Foreign ensure that your insurance policy covers this.” haemolyticuraemic syndrome (HUS) in the country, of the country, avoid eating raw tomatoes, fresh starting on 2 May. In the outbreak, HUS is caused cucumbers and leafy salads until the source of the by an infection with a Shiga toxin-producing outbreak was identified. Suspicion then fell on an Escherichia coli (E.Coli) bacteria. Hundreds of organic beansprout farm in Northern Germany. CDC publishes yellow fever guide people have been hospitalised, and at the time of Although initial tests proved inconclusive, the writing 35 people had died from the infection in authorities declared the farm had been proven to be The US Centres for Disease Control and Prevention Germany, with new cases being reported each day. the source by the pattern of the outbreak. (CDC) in the US has published a lengthy guide Most of the infections have been reported in people By the start of June, the country’s health minister offering travellers information on yellow fever vaccine in northern Germany, mainly Bremen, Hamburg, announced that the worst of the outbreak requirements on a country-by-country basis. The Lower Saxony and Schleswig-Holstein, or in people was over, with numbers of infections dropping report, by Mark Gersham, Betsy Schroeder, Emily who had recently travelled to those areas. Cases in significantly. At that stage, more than 3,255 people Jentes and Nina Marano, gives the country’s own travellers to northern Germany have been reported had been infected, hundreds of whom suffered recommendations and requirements for travellers in Denmark, the Netherlands, Spain, France, kidney complications. regarding necessary vaccinations, as well as containing Switzerland, Sweden – where one case has so far The World Health Organization identified the bacterium recommendations from the CDC itself, offering proved fatal – and the UK, while two tourists who as a ‘completely new’ mutant strain that is more toxic additional information to those concerned about the risk travelled to Germany recently were also tested for and infectious than usual varieties. It is resistant to of contracting the disease while in a foreign country. the disease upon their return to the US. antibiotics and has an eight-day incubation period.

International Travel Insurance Journal

14 TRAVELMATTERS

Summer travel US inbound rebounds tourism to boom

With the official beginning of the northern According to a recent report released by the hemisphere’s summer holiday season, Travel Guard Commerce Department, tourism in the US will North America polled consumers to find out more boom over the next five years, with the number of about their summer vacation plans about the effect tourists coming from emerging markets such as China of rising travel costs. According to the Travel Beat expected to rise dramatically. The report, entitled Survey, an overwhelming majority of consumers – 2011 International Travel and Tourism Forecast, states: 96 per cent – are in the midst of planning summer “The US can expect six to eight-per-cent average getaways. With rising oil prices driving gas (petrol) annual growth in tourism over the next five years, and to $4 a gallon or more in many US cities, 63 per this year, 64 million foreign travellers are projected to cent of those travelling this summer say that just means they’ll plan to fly to their destination instead of opting for a destination within driving distance. Though taking a plane is the preferred mode of transportation, 34 per cent of respondents cited potential flight delays and cancellations being concerns while travelling. Of travel destinations, cultural and educational experiences remain popular, with 30 per cent of

Southampton, UK’s Ocean Terminal visit the US, spending $144 billion during their stays, setting a new record for travel exports.” Cruise popularity predicted The report also shows that the services trade surplus in the country, which includes travel and tourism Cruise news and review website Cruise Critic According to the Passenger Shipping Association, revenue, is up 28 per cent on a year earlier, putting predicted a surge in cruise bookings from UK ports this year more than one in three British cruise it on track to exceed the record of $32 billion set in as travellers were once again reminded of the stress holidays will sail from a home port. Talking about 2010. In particular, it noted that the number of tourists and disruption caused to holiday plans by the recent the growth in home-port cruises, Carolyn Spencer from China will increase by 232 per cent over the ash cloud debacle. A poll by the website showed Brown, editor in chief of Cruise Critic, said the next year, while South Korean arrivals will grow by that just over half of cruisers stated that avoiding air increasing popularity of the trend was down to a 200 per cent, and Brazil by 150 per cent on a year travel aggravation would be the biggest benefit of combination of factors: “First off, most people no earlier. Russian and Indian tourists are also expected to choosing to leave from a UK port. A further quarter longer find flying, with its delays and three-hour be among the top visitor origin countries to America. of respondents cited lower costs as the best reason check-in, a pleasant experience and will try and US Commerce Secretary Gary Locke commented for sailing directly out of Britain, while 15 per cent avoid it if at all possible. Airport strikes and the on the predicted rise in visitors: “Growth in travel selected the choice of destinations now available. eruption of further ash clouds will compound the and tourism, with many international visitors spending Only eight per cent of those polled said they would situation, driving more people to seek out a home a lot of money in America, will help us achieve the prefer to fly to meet their cruise ship. port option.” President’s goal of doubling exports, which will support millions of American jobs. Last year, our nation hosted those surveyed planning a trip of this nature. Not a record-breaking number of international visitors, and far behind, 24 per cent of respondents are planning the future looks even brighter.” Lion attack prompts warning cruise holidays during the season of sun. Regarding travel budgets, the poll showed that 55 per cent of With the summer holiday season already in full swing, He then provided five key tips for people going respondents said they plan to spend about the same many people will be looking forward to a safari on safari in Africa this year, which are to always on this year’s summer vacation as they did last year, MBD releases UK adventure in Africa, but a recent lion attack on an stay in the safari vehicle; to never turn your back while 27 per cent noted that they expect to exceed American tourist near Victoria Falls, between Zambia on an animal; listen to the guide at all times; keep their budget from the previous year. To cope with market report and Zimbabwe, has served as a reminder of the your voice down and ensure you are protected by ever-increasing travel expenses, travellers were dangers of viewing African wildlife in its natural habitat. travelling with a licensed safari guide and ensuring encouraged to pack a travel insurance plan with them The UK Tour Operator Market Development Report, Ian Jackson, general manager of Australian insurer adequate travel insurance is in place. to cover their increased investment. published by market research company MBD, has Travel Insurance Direct said: “Now that the dream Jackson said that animal attacks on tourists were Travel Guard vice-president Carol Mueller said: “As revealed that total expenditure on holidays abroad by of an African safari has become more commonplace, still very rare, but the growing popularity of African the economy continues to grow, we are seeing UK residents declined by an estimated five per cent we’re hearing occasional reports that travellers aren’t tourism has brought increasing contact between more people planning summer family getaways than to £20.7 billion in 2010. The drop reflects the recent always paying full attention to their safety. A safari is animals and humans in some areas. He added: “No in the past few years. However, as the cost of travel economic downturn, increased job insecurity and generally a very safe and rewarding experience, but it photograph is ever worth the risk of an animal attack. increases, more and more summer vacations are lower levels of disposable income. Expenditure had is vital that travellers take precautions and follow the Never try to get closer and remember to put the becoming an annual vacation investment. Even for increased year-on-year between 2006 and 2008, but instructions of their guides.” camera down and be aware of your surroundings.” the family summer vacation, a travel insurance plan peaked at £25.4 million in 2008, said the company. can help cover that investment in the event vacation The report also estimated that UK residents plans go awry.” would only spend around £20.5 billion on holidays abroad in 2011 due to unfavourable exchange rate conditions and continued economic uncertainties – a one-per-cent decline. However, MBD predicted Facebook marketing that the projected decline will be more moderate than that of 2010 and expenditure on holidays will, tool launched in fact, increase between 2012 and 2015, reaching a projected peak of £23.2 billion in 2015. Overall Univalence, a UK-based company offering Facebook spending is anticipated to increase by 12 per cent in applications to travel companies, has launched real terms between 2012 and 2015, which MBD TravelPromoter, a new Facebook application that is believes should help ensure that demand for foreign designed to allow travel companies to publish their holidays continues to grow. brochures in a ‘search and browse’ format within the Meanwhile, spending on inclusive tours abroad by social networking site. The app allows users to browse UK residents is expected to decline by one per details of each travel product, share comments and cent in 2011, taking expenditure to £8.6 million, reviews with their friends, view pictures and videos, but is projected to grow in the following four years and even book holidays. Many travel companies by between one and five per cent. According to have established a presence on Facebook, but so far the company, the financial protection offered by have lacked the tools with which to make the site an booking package holidays will encourage consumers efficient and viral marketing channel. With the launch to use this route, particularly if they are concerned of the app, travel agents, tour operators, tourist by disposable income. With this in mind, overall offices, airlines, resorts and hotels can now reach out spending on inclusive tours is expected to increase by to current and potential customers. 17 per cent in real terms between 2010 and 2015.

International Travel Insurance Journal TRAVELMATTERS 15

Tourism growth for UAE and Saudi Arabia MENA unrest prompts review of

Research unveiled at the recent World Travel Market In addition, the report predicted a 6.9-per-cent annual political risk cover Vision Conference in Dubai revealed that the United increase in arrivals to the UAE over the forecast Arab Emirates (UAE) and Saudi Arabia are set to review period, making it 14th in the world in terms of In a report entitled Mind the Gap, Willis Group has and concluded that full political violence insurance would experience the strongest growth in inbound tourism absolute arrivals growth with 3.6 million new arrivals. stated that companies operating in volatile parts of provide the most comprehensive coverage. over the next five years. According to theTravel and Nadejda Popova of Euromonitor International stated the world may soon be unable to provide sufficient Grahame Millwater, Willis group president, Tourism Global Overview report, Saudi Arabia could that both countries have proven themselves capable insurance coverage to protect their assets and staff commented: “Exposure to political unrest will only expect annual growth rates of 12.3 per cent in arrivals of dealing with challenging events, demonstrated by due to ongoing turmoil in the MENA region and civil grow as global business continues to expand into in the period between 2010 and 2015, which would the resilience of their respective travel and tourism unrest in other regions. The report also added that new and often hostile territories where the threat result in an additional 9.3 million visitors to the country. industries. In addition, Saudi Arabia benefits from a these companies ran the risk of discovering that their of resource nationalism, creeping expropriation and This places Saudi Arabia fifth in the world in terms healthy demand for religious tourism. Popova also existing policies may not cover the type of political supply chain vulnerability is increasing. Our message of absolute arrivals growth over the forecast period added that the UAE had remained ‘stable’ during unrest occurring in the MENA and Asia. to companies around the world is to use their with growth driven mainly by religious tourism to recent political and civil unrest, and could expect an The report compared the three main types of brokers to navigate the insurance options available Mecca and Medinah, alongside developments in air increase in outbound trips of two million between insurance against political unrest – strikes; riots and civil for these risks and to identify any potential gaps in transportation and travel accommodation. 2010 and 2015. commotion; and terrorism and political violence cover – their coverage.”

New research from WTTC positive

Travel and tourism is widely recognised as a major engine for future economic growth within the economies of the Asia Pacific Economic Cooperation (APEC) grouping – in 2010, APEC countries attracted over 40 per cent of total international arrivals worldwide and generated more than 40 per cent of world visitor exports. The latest research from the World Travel and Tourism Council (WTTC) has suggested that the APEC region’s visitor exports will increase by between four and five per cent per year over the next 10 years, rising to US$750 billion by 2021 – representing a four-per-cent share of APEC’s total exports. The WTTC report shows that travel and tourism constitues three per cent of APEC’s GDP, or a projected $90 billion in 2011, as well as supporting 45 million jobs, or three per cent of total employment. “And,” it continues, “if the direct and indirect impacts of travel and tourism are factored into the calculations, the total contribution is almost three times greater. Moreover, both the direct and total contributions of travel and tourism to GDP and employment are forecast to rise strongly over the coming decade.” Helen Marano, director of the Office of Travel & Tourism Industries at the US Department of Commerce, commented on the findings in the report: “While this is good reason for optimism, it will be critical to make every effort going forward to ensure that the potential is fully tapped. The political, economic and operating environments must all be conducive to growth, so that travel and tourism can stimulate and facilitate private sector enterprise and investment, stimulate exports and foreign exchange, generate new jobs, and create new business opportunities.” Barriers to the projected growth that were highlighted include a proliferation of taxes and other surcharges on travellers, visa restrictions, ill-thought-out environmental and other legislation, inadequate infrastructure and transport access, as well as constraints on workforce mobility, capital flows and access to capital. In order to overcome such obstacles and establish a more realistic dialogue between public and private sectors, APEC has approved ground-breaking research that is to be conducted in partnership with the Pacific Asia Travel Association (PATA) and the WTTC. The study, entitled Creating Business Growth Opportunities for Travel and Tourism in the New APEC Economy, will involve consultation with governments, experts and industry leaders in order to identify business opportunities to create an enabling environment that will drive sustainable tourism growth. John Koldowski, deputy chief executive of PATA, said: “This is a significant study since it dovetails the needs of investors in tourism throughout the APEC region with those of the policymakers who are mandated with increasing the wellbeing of their various communities – in a manner that promotes long-term, sustainable and equitable development.”

www.itij.co.uk 16 IPMI NEWS

Increased cover from ALC

As part of a review of ALC Health’s Prima range of ensure that they meet the exacting needs of our Apps said of the new policy: “Combining a range international medical insurance plans, the company policyholders. As a result, we have increased a number of comprehensive benefits with complete flexibility has increased the annual limits of its Premier, Classic of key benefits, thereby helping to ensure that our to visit any private clinic or public hospital, clinic or and Iberica plans and has also increased the cover members can be safe in the knowledge that should doctor, our Medmedia plan allows our members benefits provided for organ transplants and out-of- the unexpected happen and a major medical incident to concentrate on their careers and the things that area cover. Under the terms of the changes, the occurs, they have the right cover in place to look after they enjoy, happy in the knowledge that we are here Prima Premier Plan enjoys a new annual policy limit the costs associated with their treatment.” when they need us most.” of £2,000,000, representing a cover increase of 100 Meanwhile, ALC Health has launched a new policy Another recent change to ALC Health’s offering is per cent over the previous limit, while the Prima under its Medmedia brand, which offers medical that the insurer is offering medical history disregarded Classic and Iberica plans also see an increase to their insurance to those working in the music industry, (MHD) underwriting terms to groups of just 10 annual policy limit from £750,000 to £1,000,000. media or performing arts sector. With an annual employees, whether transferring from an existing Under all three plans, the emergency treatment limit of £2,000,000 and including as standard a competitor MHD programme or setting up cover for outside-of-area benefit limit has been increased from range of comprehensive cover benefits including the first time. EA to underwrite £30,000 to £50,000, in addition to cover for organ hospital accommodation and specialist care, family Sarah Jewell, managing director of the company, transplants increasing from £150,000 to £200,000. doctor services and nursing, dental treatment and commented on the policy alteration: “By reducing African IPMI Also on the Prima plans, there have been changes emergency medical evacuation, the policy is available the minimum number of employees under a group made to the pregnancy cover. Individuals and to both global expatriates and local nationals in scheme to just 10 employees, once again we are Europ Assistance (EA) has made a deal with Africa group plan members are now able to select routine the European Union. In addition to the benefits, demonstrating our determination to deliver an easy, Wellness Solutions to underwrite the health insurance pregnancy cover with a limit of £5,000 (£10,000 in Medmedia also provides policyholders with free seamless process for even the smaller corporate plans and provide the assistance element of the plans the event of complications) or opt for a lower limit of membership to the Blood Care Foundation, client who is looking to transfer their international of Nairobi, Kenya-based JW Seagon and Company, an £3,000 (£6,000 in the event of complications). which provides screened blood in an emergency medical insurance. By making MHD underwriting insurance broker providing expatriate and international Andrew Apps, director at ALC Health, commented worldwide, and free membership to ALC World, terms available to groups of just 10 employees, ALC health insurance to clients both in Africa and around the on the changes: “With the cost of healthcare increasing the company’s online resource service, providing Health is helping to remove the barrier that many world. globally, we are continually keeping a close eye on information and contact details of medical facilities and smaller companies have previously had to face when Emmanuel Legeron, chief executive officer of EA-IHS the scope of cover offered by our programmes to healthcare providers across more than 175 countries. moving from one insurer to another.” Services, said the partnership between the two firms would offer increased business opportunities for both companies in new African markets. He added: “This regional partnership makes perfect sense in our IMG teams with strategy to be a one-stop shop solution for international healthcare needs to private and public institutions: from Marsh onsite audits through to remote medical solutions, insured products and self-funded solutions, and International Medical Group, Inc. (IMG) has assistance and evacuation services.” announced that it has entered into a national David Seagon, managing director of the insurance marketing agreement wherein Marsh US Consumer, brokerage, said: “I am very pleased to be working a service of Seabury & Smith, Inc. (Marsh) will market with Europ Assistance … our customers will soon IMG’s international insurance products under the benefit from their extensive knowledge and strong Gateway (SM) brand name. customer service. We have already seen enhancements Jeff Nasser, senior vice-president of international to our product benefits, and look forward to further marketing for IMG, said of the deal: “We chose developing our plans in the future, with our customer’s to work with Marsh because it’s a recognised needs at the forefront of our minds.” global leader in the financial services industry and its philosophy of providing superior coverage and customer service is an excellent fit with our own InterGlobal appoints similar corporate values. There is considerable market demand for international insurance coverage, and we China manager believe this will be a mutually beneficial relationship.” John Maxwell, president of employer benefits for Marsh International private medical insurer InterGlobal is US Consumer, added: “Working with IMG will afford increasing its focus on China, with the appointment us the opportunity to expand coverage options for our of Annabel Yang as its China representative, based in current customers at more competitive rates. We are Shanghai. Annabel brings long experience of working excited about the prospect of expanding our footprint in employee benefits and expatriate health insurance in this market, as well as the opportunity to work with in China and overseas markets. She joins InterGlobal FMU option available IMG, a global leader in the international benefits field.” from WA Optimum Health Care in Shanghai, where Under the terms of the agreement, Marsh has she was channel director, responsible for business Morgan Price International Healthcare Ltd has business has been sold via the moratorium route as private-labelled IMG’s Patriot Travel Medical development and client relationships. Previously, announced that following on-going product it is an immediate sell, but increasingly this is causing Insurance and Patriot Group Travel Medical Insurance she has worked for AXA-Minmetals Assurance development meetings with its reinsurers, plus issues at the back end, where customers expect fast products under the names Gateway and Gateway Company in China as healthcare manager, and Royal feedback from its intermediary partners, a full medical claims turnarounds and payments.” He added: “If a Group, respectively. The products provide short- & SunAlliance in the expatriate business unit. Yang has underwriting (FMU) option is now available on its moratorium policy is being administered properly, term international medical coverage for individuals, also worked for ANZ Bank in Sydney, Australia, and individual GlobalHealth and ExpatHealth plans. then claims stage investigation is common, and this groups and families travelling abroad. Marsh also the Royal Bank of Canada in Toronto. John Carpenter, managing director of the company, inevitably delays processing and payments while you offers several other products from IMG’s portfolio, Steven Conway, regional general manager in Asia for commented: “This is something that we have been track back through an expatriate’s medical history. providing international benefits not usually found on InterGlobal, commented on the appointment: “China working on for a while. Our new website was designed Underwriting up front might take a little longer, but domestic health plans. is an important growth market for InterGlobal. We’re with this development in mind, and customers can take the benefits are in the claims process.” seeing a considerable increase in the number of this option immediately instead of the moratorium and In related news, Morgan Price has also altered the expatriates in China and there is also an emerging buy online. I’m not sure how many of our competitors terms of its group international private medical demand from high-net-worth residents who want can do this online, but we see it as a major step forward insurance policies to offer medical history disregarded access to international treatment and the high levels for our clients and partners.” (MHD) to groups of 10 employees or more. of protection available with international private With the FMU option, customers can complete Previously, the policy offered cover to groups of 20 medical insurance. In addition, some employers want either an online or paper-based medical declaration, employees or more. Carpenter commented on the their local staff to be able to access the same high which will result in either coverage being confirmed change: “We are continually trying to make it easier quality healthcare as their expatriate staff.” He went at normal terms, a modified benefit or exclusion. for clients and intermediaries to do business with us. on to say: “Annabel brings 10 years of experience in This will give customers much greater certainty about This move, coupled with other things we are doing working in insurance between China and overseas the limit of coverage for any pre-existing conditions at the moment, including niche products to plug markets with six years’ solid marketing and sales at the outset of the policy rather than at the claims gaps in the market, and the introduction of the full background in the high-end market of China. She stage. Carpenter added: “Moratorium underwriting medical underwriting option on individual business, has tremendous strength in relationship building, has worked well for us over the past 10 years, but demonstrates this commitment.” developing sales channels and in communicating the in these days of greater clarity and transparency in The new terms have been introduced following ongoing advantages of IPMI as a core element of an employee all insurance matters, FMU seemed like a natural product development discussions with the company’s benefits programme.” progression. Traditionally, individual international underwriting partners, Europ Assistance and Generali.

International Travel Insurance Journal IPMI NEWS 17

Cigna enhances EAP

In order to offer more help to globally mobile times, our clients’ global workforce encounters Workplace Options, said: “In today’s increasingly global individuals and families, Cigna in the US is now offering stressors that are unique to an international economy, it is critical for businesses to protect their its customers and their family members access to assignment. We are excited about our new most important asset – their employees. A global EAP a more comprehensive international Employee partnership with Workplace Options, because it provides employers with a round-the-clock safety net Assistance Programme (EAP) for counselling and allows us to offer the right help, in the right place, at to support a healthy and productive workplace.” support. The enhanced programme is made possible the right time, all around the globe.” In related news, Cigna has recently published two through a relationship with Workplace Options, Services are available 24/7 in the local language of new online mental health guides to help employers the world’s largest integrated employee support 170 countries, including face-to-face counselling and limit the impact of mental health conditions in the services and work-life provider, which also provides work-life referrals. Employees also have the option of workplace. The first booklet offers support and key work-life services to the insurer’s US customers. connecting with an employee assistance professional advice to employers who are managing mental health The improvements made to the EAP mean that help from their mobile phones or computers, or by text, issues in the workplace, with conditions ranging is available for issues including balancing work and online chat or emails. Alternatively, customers can from stress and depression to addictions and eating personal life, emotional support, anxiety, depressions choose web-based counselling services, making disorders. The second online guide, meanwhile, is and relocation counselling, among other concerns. it easy for employees to schedule and conduct a members’ guide to help people living with mental Marsha Shewanown, global director of wellness for confidential counselling sessions. health disorders to manage their symptoms and Cigna International Expatriate Benefits, said: “Many Alan King, president and managing director of return to good mental wellbeing.

Clinical support for AXA PPP

AXA PPP International is introducing personal medical case management services for existing individual and corporate subscribers to its International Health Plan, which offers international private medical insurance. The service, which is elective, is provided by Medix Medical Services Europe Ltd (Medix), an independent provider of such medical case management services. Medix draws upon its own dedicated multi-disciplinary team of qualified professionals, as well as having access to a global panel of expert advisers (senior figures in world medicine chosen by the company for their experience and expertise) to review members’ cases and prepare personalised treatment plans in accordance with best clinical practice. The health insurance company hopes that providing the Medix service will enable policyholders who may require surgery or treatment of a number of serious medical conditions to secure expert guidance, supervision and support. When a member contacts Medix, a dedicated case management team is assigned to support them, led by a medically qualified case manager who can liaise with the member’s local healthcare provider and help the member to collect all available information about their condition. The case manager then collates and reviews the information with other members of Medix’s interdisciplinary team and, as appropriate, contacts a medical expert from the provider’s global panel to review the member’s case and help prepare a personalised treatment plan. In addition, Medix can recommend a care provider with the necessary experience and expertise to implement the treatment plan and, with the member’s consent, go on to instruct and supervise the selected care provider in taking the treatment forward. To further support the policyholder, the case management team also appoints a dedicated nurse case co-ordinator who is accessible to answer any further questions and discuss any concerns that they may have regarding their treatment. Medix then stays in touch with members for up to three months after the event that prompted the call for help to provide additional information and support, as well as to supervise the implementation and review progress of their treatment to ensure effective continuity of care. Andrew Coombs, AXA PPP International’s managing director, said of the service: “Medix’s personal medical case management service will be a great comfort to members and their families by giving them the peace of mind of knowing that they will be guided and supported by the advice of independent medical experts to help ensure that their treatment plans are devised and implemented in accordance with best practice – wherever they may be in the world.”

www.itij.co.uk 18 CROSS BORDER CARE

Tax breaks could prompt growth Wealthy Chinese travel for care

Malaysian health minister Datuk Seri Liow Tiong Lai As wealth increases among a small but growing added that while currently the majority of mainland is moving towards making it easier for hospitals in the proportion of the Chinese population, so the number China’s medical tourism business is outbound, country to attract international patients in an effort to of people travelling for the purposes of medical care there is also the possibility of marketing China as an improve the nation’s healthcare tourism economy. In a has risen, according to industry soures. inbound destination, as the combination of Eastern bid to help hospitals, the minister has said that facilities Ciming Health Checkup Centre in Beijing is one and Western medicine available is a unique selling involved in the provision of medical tourism services of the companies that organises such trips, and point. “What we need to do is try to develop will receive tax breaks and help with marketing according to chairman of the centre Hu Bo, more patients inbound by letting people know that there efforts. According to Lai, hospitals would be given a and more patients are moving away from spending is high-quality, affordable accessibility for medical 100-per-cent tax exemption for the construction of their money on luxury goods to spending it on their services [in China].” In order to encourage this new hospitals and for the expansion, modernisation Cambodia, Bangladesh and Europe. She said: “Many health: “The number [of health tourists] has been idea, Hu said the government could take certain and refurbishment of existing ones. He told reporters foreigners do not know that Malaysia is a healthcare constantly rising in recent years.” His organisation measures, such as simplifying the visa application at a press conference after opening the HSC Medical tourism destination due to the lack of promotion of also helps patients to complete visa applications and process for medical tourists and strengthening Centre: “We are in the midst of getting the provision the industry abroad. However, our prices are very booking services at their chosen destination. communication and co-operation with international gazetted, and hospitals registered with the minister competitive and we offer high-quality care and value The most popular countries with Chinese tourists insurance companies, which would further aid the for the promotion of healthcare travel are eligible for for money services.” looking for medical care are Switzerland, South medical tourism industry. this initiative.” He added that the government had also Meanwhile, deputy health minister Datuk Rosnah Korea for cosmetic surgery, Hong Kong and the China’s tendency towards isolation, though, will made provisions for expenses incurred by the private Abdul Rashid Shirlin said the medical tourism sector US for childbirth and Germany for general health hamper such development, according to Yang Jian, hospital sector in obtaining internationally recognised would generate income of around RM431 million check-ups, especially with accreditation to be eligible for a double deduction (US$176.9 million) in 2011, based on figures for the regards to cancer. incentive under the Income Tax Act of 1967. first three months of the year. Between January and Xu Shuo, secretary general The medical tourism industry in Malaysia is growing March, health ministry figures show that 112,951 of the Beijing Medical Doctor despite the challenges of a worldwide economic medical tourists entered Malaysia, double the amount Association, commented on malaise and increasing pressure from countries seen in 2010, generating an income of RM105 million. the trend of wealthy Chinese nearby that wish to compete for medical tourists. Rosnah told local newspaper New Straits Times that travelling abroad for medical Lai said that in 2010, 400,000 health tourists visited the increase seen in the first quarter is indicative of an care: “Actually, such health the country, and the hope is that 2011 will bring a overall trend that the number of foreigners seeking services, especially the health further 40,000. “Last year,” he added, “the industry medical care in Malaysia is rising and would continue preservation therapies, can also generated RM280 million (US$1= approx.RM3) to increase over the course of the year. be obtained within the country of revenue and the amount is expected to increase In order to further boost the competitiveness of and probably at a much lower by at least 10 per cent to RM430 million.” He also Malaysia as a healthcare destination, a benchmark price. But the rich would still told reporters that the Malaysia Healthcare Travel has been set for medical fees charged by private like to pay heavily, seeking Council (MHTC), which works under the health hospitals, which have been decided and regulated by better services abroad, largely ministry, is currently in discussions with television the Malaysian Medical Association and the Ministry of at hot tourism destinations.” companies in Hong Kong and China in the hope Health. Rosnah further explained the system: “There Xu added: “Our technology of promoting Malaysia as a healthcare destination. is also a single paying system whereby any healthcare and clinical practice are up to Elsewhere, MHTC chief executive Dr Mary Wong traveller coming to Malaysia for treatment will be international standards, but Lai Lin said that the council is promoting Malaysia charged the same fees as any Malaysian would as matching services and capacity, to potential patients in the Middle East, Indonesia, there is no double standard in terms of pricing.” like post-operative recovery and follow-ups, lag far behind.” Hu Bo of the Health Checkup Centre has said that the outbound medical tourism chief executive of the Shanghai Medical Tourism industry is still in its infancy in China, and there Platform. Jian said that only limited regions – Hainan is much potential to be tapped. President of the and Guangdong provinces, Shanghai and Beijing – US-based Medical Tourism Association Renee currently have policies in place to develop inbound Marie Stephano agreed, expressing confidence in medical tourism, but these regions are seeing the the future of the Chinese market, saying that the benefits of their efforts. For example, continued country’s ‘surging economy has produced a sharp Jian, three clinics on Hainan island recorded an increase in the number of ultra-wealthy residents annual income of ¥100 million (US$15 million) from and they are all potential customers’. Stephano Russian patients alone last year.

Canadian numbers up

A new report from Deloitte’s National Health their health systems’ wait times, improve access to Services, entitled Evolving medical tourism in Canada care and also position Canada as a medical tourism – Exploring a new frontier, has found that more than destination. But before doing this, governments 60 per cent of Canadians would be willing to leave should determine if the cost of medical tourism the country for medical care if they were covered by services [will] be less than the delivery of services health insurance to do so. Mark Fam, senior manager locally.” It adds: “A good point … is to figure out for Deloitte’s National Health Services enterprise, what is the right balance to make sure we’re taking said that medical tourism was a growth industry in advantage of what this new emerging opportunity is, the country, where it is divided into two sectors – but not jeopardising our Canadian system.” inbound, the number of patients travelling to Canada For Canada, the issue of medical tourism hit the for treatment; and outbound, those travelling outside headlines in 2010 when premier of Newfoundland the country. and Labrador Danny Williams headed to Florida for In terms of outbound travel, only two per cent of his heart surgery. Currently, the medical tourism Canadians are travelling outside the country for industry in Canada is unregulated, but Fam says that health purposes, said Fam. However, even two per if Canadian hospitals were allowed to sell services cent of the population represents a significant number to inbound medical tourists, the situation could be of potential health insurance patients, according to win-win for all parties: “It’s an opportunity to bring in the report, who would need additional coverage that foreign travellers and receive additional funds in the includes procedures undertaken abroad, as well as system, which actually can be used to provide more offering Canadian hospitals a chance to free up some services to Canadians here.” bed space. Not everyone is in favour of the idea of developing The report also shows that the most common the medical tourism industry in Canada, with Dr procedures medical tourists choose to head overseas Jeff Turnbull, president of the Canadian Medical for are cosmetic operations, fertility treatments Association, saying: “If Canadians and providers and and cardiac care. The report states: “Provincial decision-makers do their job well, then there would governments have the opportunity to encourage be no need for a Canadian to go across any border citizens to seek out procedures abroad to alleviate to receive healthcare.”

International Travel Insurance Journal CROSS BORDER CARE 19

Work to be done in Jamaica

A recent diagnostic report prepared by CTA Economic There are more than just financial barriers in place Addressing participants at a workshop in Kingston, and Export Analyst Ltd (CTA EEA) of the UK has hindering the development of medical tourism on the where the report was presented, Budhan said: “We suggested that in order to encourage medical tourism island, though, as the report goes on to state that the believe Jamaica can accrue significant benefit from the providers and customers to Jamaica, more foreign first step that needs to be taken would be to have a development of this sector.” He believes that medical investment is needed to develop new facilities. The cohesive government policy on the issue. Such a step tourism is a possible significant revenue stream for report details facilities in both the public and private would clarify and define roles and responsibilities for the country, due to the fact that physicians and nurses healthcare sectors of Jamaica that it says are insufficient the different ministries involved in the development trained in Jamaica are in high demand elsewhere in the Thais divided to attract medical tourists. However, CTA EEA noted of the sector. It would also provide a review of world. Budhan added: “The report has indicated that for that the private Hospiten Group is currently considering incentives for investments in medical tourism facilities one sub-sector within the health and wellness industry, The growth of medical tourism in Thailand is often the potential construction of a new, purpose-built, 200- and review legislation regarding medical insurance mainstream medical tourism can generate as much as praised for bringing foreign money into the country’s bed hospital in Montego Bay that would provide care to liability. $200 million over four years from one investment in economy, but there are worries that the continuing Jamaican private clients, ordinary tourists and overseas In response, Reginald Budhan, permanent secretary in a 20-bed hospital. Medical tourists have been noted growth of the industry is adversely affecting the medical tourists, adding: “This would involve an initial the Ministry of Industry, Investment and Commerce, to spend as much as $5,000 a week for a thermal spa public healthcare system. One Thai economist, investment of US$20 million and employ an additional said he hopes the Cabinet can be convinced to making facility; this is the highest value segment of the market Ammar Siamwala, has said that despite its benefits 30 Jamaican medical staff.” the necessary policy changes to take this first step. and Jamaica intends to capitalise on the ensuing benefit.” of generating income, the government’s intention to create an international medical tourism hub in Thailand is an ‘evil plan’ that will have adverse effects on health treatment for the poor. Proponents of the government’s plan have focused on the huge financial benefits it could bring. Already, the foreign medical services sector is expected to make around 100 billion baht (US$3.3 billion) by 2015, and increased investment from the government would bring more medical expertise and greater access to new medical equipment. It is also claimed that it could help reverse the ‘brain drain’ of doctors and nurses who choose to move abroad to continue their medical career. However, Ammar believes that the investment would not result in a reversal of the brain drain, as private healthcare doctors earn significantly more than those operating in the public healthcare sphere, so private expansion would result in even greater wage inflation in the state sector: “The ministry has already increased their salaries again and again, but it’s never enough. How can they compete with the private sector?” Ammar is not alone in his views, as Dr Amphon Jindawattana, secretary general of the National Health Commission of Thailand, agrees: “The medical hub policy is the accelerator causing the brain drain of doctors, super specialists and other medical workers to private hospitals.” Perhaps unsurprisingly, the Rural Doctors Society is also worried about the effect of expansion for the sake of medical tourists, saying that Bangkok already has eight times as many doctors per capita as the worst-served rural region, and points out that concentrating resources in large cities will only serve to worsen such polarity.

Australian accusation refuted

As ITIJ reported last month, infectious disease experts in Australia have voiced concern that increasing numbers of medical tourists are returning from Asian destinations with infections that cost the Australian health system money, as well as representing a danger to other patients. However, a spokesman for Phuket International Hospital has hit back at such concerns. Pete Davison, manager of international services at the hospital, said the problem was not directly related to medical tourism, saying: “Anyone who has had any form of surgery or invasive procedure in an Indian hospital could be a carrier of the new superbug and bring it into Australia.” Peter Collignon, director of the infectious diseases unit and microbiology at Australian National University had suggested placing medical tourists in isolation once they return to Australia until it can be confirmed they are not carrying any harmful disease with them. In response, Davison said the quarantine idea could be applied to ‘every tourist from any nationality who has been to an Indian hospital because of an accident, appendicitis, etc., as well as every Indian national who has also had recent surgery’. He added: “That’s a lot of people to identify and isolate, and the majority are not medical tourists at all.”

www.itij.co.uk 20 AIRAMBULANCENEWS Plaster casts Crash prompts investigation A single-engine, fi xed-wing air ambulance aircraft The crash has resulted in the Indian government crashed on 25 May, killing all seven people onboard and creating an independent panel to probe major three people on the ground in a densely populated area aviation accidents, thus separating the role of of Faridabad, India. Police and aviation offi cials said the regulator and investigator – the DGCA performed plane was coming in to land at a nearby airport when it both roles in the past. In addition, the DGCA has crashed down on top of two houses. formed a working group to review existing safety The Pilatus PC-12, registration VT-ACF, was carrying regulations of general aviation, non-scheduled a critically ill patient, Rahul Raj, from a private hospital operators and air ambulance operations. The in Patna for treatment in an Apollo Hospital when the aircraft that crashed was owned and operated by Air accident took place. Although around 20 fi refi ghters Charter Services India Private Ltd, which claimed that and numerous members of the public were on the the plane was in a good condition. scene quickly, they were unable to save any of the Although the accident was tragic, industry experts victims. have pointed out that it is the fi rst air ambulance crash to have occurred in India. Thomas Davis, When medical professionals escort patients said a spokesperson for British Airways (BA), which a consultant at Max with a plaster cast onboard commercial aircraft, last year changed its policy to allow customers with Hospital, told the Indian there are health issues to take into account, as paid-for extra seats and full leg casts to fl y short-haul. news service IANS: “Air well as airline regulations and guidelines. What Dr Khemka commented: “There should also be the ambulances have proved to should medical escorts consider in this case? ability to remove the plaster quickly if required.” be very effective in saving Femke van Iperen investigates With the growth in air travel, an alertness among lives by reducing the time airlines of the needs of injured passengers has lost for critically ill patients Flying with a plaster cast can negatively affect a increased. At high altitude, circular or closed in long-distance journeys

patient in different ways. First, there is air expansion: casts can inhibit tissue expansion, and it is also Th e aircraft while it was under its previous registration Tony Guest/Flickr to the tertiary care centre. “Air may be trapped within and beneath the cast and widely documented that pain, numbness in The medium has had a zero expand during fl ight,” said Dr Hunter from the UK’s fi ngers and low circulation can result. Dr Buchsein According to an air traffi c control offi cial, there was mortality rate. This turns out to be the fi rst accident Civil Aviation Authority Aviation Health Unit. But he commented: “It is a common and reasonable heavy wind at the time of the accident. He added: in India that happened due to bad weather.” He also added: “Nowadays, casts are increasingly made practice to ‘split’ a cast. Therefore, most cabin “Apart from the diffi culty of operating a single-engine added: “Corporate hospitals in India do not have any from a modern composite material rather than the crew are trained to enquire whether the cast of aircraft, doing so in heavy wind conditions can cause ambulance aircraft of their own. So the procedure plaster of Paris that was previously used, and there a boarding passenger with a full cast is split or a disaster. In heavy wind conditions, the backdraft is to hire it from the service providers, who manage may be less of a problem of the cast expanding.” closed.” Dr Buchsein, who has found that many from the wind hitting the tail can make the aircraft the equipment and nurse facility and provide logistical The risk of deep vein thrombosis also increases, airlines require a medical escort to cut the cast if unstable and cause it to nosedive.” support.” ‘if only very slightly, after any sort of fracture’, necessary, said: “Airline staff sometimes also insist it The Directorate General of Civil Aviation (DGCA) Meanwhile, president of Delhi-based OSS Air, a said Dr Khemka, medical director at international is ‘re-circulated with a bandage’ so it can maintain has confi rmed from its preliminary investigations that provider of helicopter air ambulance services to expatriate health insurer Bupa International. A group stability but has space for expansion.” bad weather does seem to have been the cause of hospitals in India, said: “In my memory this should the crash. A. N. Hanfee, an aviation expert, said that be one of the fi rst as this plane was customised for the accident was a ‘one-off incident in which weather medical emergency purposes.” played an important part’, and added that several Elsewhere, Pradeep Gupta, director of Life Savers BA staff have to make sure the customer has the other aircraft landing at the time had experienced Ambulance Services, which performs regular hospital adverse weather conditions: “Many bigger aircraft transfers, said that the accident would not have an correct cast and the documentation to support this reported a similar situation, fi nding it diffi cult to land affect on air ambulance usage in the country, but felt around that time. The PC-12 was fatally affected it was important to involve the patient’s family: “It is because of its smaller size.” He said that besides important for the patient’s family to fi nalise details such the size limitations of the aircraft, another aspect of as technical details of the aircraft and see if the doctors of scientists in the UK also found in a study1 that Medical certifi cation the crash was that it had been fl ying at a very low are specialised to treat patients before they sign the compartmental pressure (injury caused by pressure “It is important that the passenger obtains a letter altitude, therefore not giving the pilots enough space agreements proposed by the service provider or the inside the compartments of limb muscles which confi rming the date and time of application of the to recover when they encountered bad weather. referral hospital.” He added: “The frequency of such negatively affects blood supply) can be a problem for cast,” said Dr Hunter. As an example, BA staff have A pilot for Air India, who did not wish to be air medical evacuations is four to fi ve patients per patients with a plaster cast at high altitude. to make sure the customer has the correct cast and named, told The Tribune that more stringent safety week. It depends on the seating confi guration of the But the most commonly reported issue is tissue documentation to support this. The hospital and requirements for smaller aircraft should be considered: plane as to how many trained staffers can accompany swelling, to which inactivity, leg position, trapped doctor are integral to the whole decision process, “At least [a fl ight data recorder] should be fi tted so that the patient, but the norm is to have two doctors, one air, low humidity and dehydration are all thought to said the company, adding: “The doctor has to issue in case of a crash one knows what happened. Cockpit nurse, one attendant and one family member.” contribute. There is also a belief that reduced cabin fi t-to-fl y documentation. This would include a experience should be of a certain minimum level and The aircraft that crashed was originally delivered to air pressure has a negative effect, but opinions of diagnosis of how soon they could fl y, the severity in my opinion, single-engine aircraft should always fl y Cumbrian Seafoods Ltd UK as G-PVPC on 27 June medical experts and airline professionals are divided. of the injury and the impact a long journey might under visual fl ight rules during the day. Even if they are 2005, and was then re-registered N386F on 11 Dr Khemka attributes peripheral oedema (swelling have.” Patients have to fi ll in a medical clearance fl ying instrument fl ight rules, they should only fl y during January 2011 and delivered to India, with the US of the soft tissues near the fracture) to a slightly form (MEDA or MEDIF) in which ‘the treating daytime so they know what is happening around registration being cancelled on 19 January 2011. The depressurised air cabin: “There is a risk that this can doctor has to specify whether it is a full or split cast’, them. Single-engine aircraft should not be allowed to plane was registered VT-ACF on21 January 2011 to precipitate the formation of the condition, which can said Dr Buchsein. He continued: “Some airlines, fl y in unpredictable weather.” M/S Air Charter Services PVT Ltd. put a dangerous amount of pressure on the nerves particularly the cheaper carriers, let patients on and blood vessels in the area.” But in the case of an without a form. But the larger airlines all have the increase in tissue oedema, Dr Buchsein, medical same policy.” director of FAI rent-a-jet AG in Germany, instead Air ambulance delays a concern points to the impossibility of keeping a broken leg References elevated throughout the journey and to the increase 1Injury magazine, volume 37, issue 2, pages 138- Concerns have been raised by healthcare professionals stand up, so that was quite disappointing to us.” in stress levels following the change from hospital 144 (February 2006) working in Australia’s Northern Territory about the Dr Louise Harwood, another member of the Health bed. He said: “In my understanding of physics, a In 2006, International Journal of the Care of length of time some patients are being forced to wait Board, said that if the situation does not improve, certain amount of gas expansion can take place, the Injured reported on the study Plaster cast for medevac fl ights to appropriate medical facilities. people’s lives could be in danger. She said: “We but I don’t think that reduced cabin pressure has immobilisation during air travel – analysis of current Responsibility for running the air ambulance service in would have people evacuated from our region any measurable effect on tissue swelling. This is a practice and aircraft-simulated experimental study, the region lies with CareFlight, which has come in for probably most days, and maybe most weeks there misconception.” studying people with no fracture, immobilised criticism as a result of some patients waiting over a day would be at least one situation where that delay was in an above-knee plaster cast. However, the for a transfer. longer than we would think is acceptable.” Airline guidelines volunteers had no fractures and further studies Sean Heffernan, spokesman for the Katherine West Another local, Luke Bowen from the Northern Airline regulations on fl ying with plaster casts are into this problem was recommended. According Health Board, said that in the most recent incident, Territory’s Cattlemen’s Association, said there not uniform, but major airlines publish their travel to Evan Davies, consultant in spinal surgery SUHT, a man was forced to wait 18 hours for a medical are not enough aircraft to offer a reliable service: policy online. “The majority of airlines restrict fl ying Spire Southampton, Bournemouth Nuffi eld, Royal evacuation fl ight, despite a recent letter from Health “We have a service currently in place that is often for 24 hours on fl ights of less than two hours or 48 College of Surgeons Surgical Tutor, no other similar Minister Kon Vatskalis that guaranteed the services struggling to keep one plane in the air, let alone hours for longer fl ights,” said Dr Hunter. Exceptions studies have been done. The group of scientists is offered by CareFlight. Heffernan said: “We got a three, which is part of the contract. We have a can be made ‘if the cast has been bi-valved to help currently considering further experiments looking letter only last Wednesday [11 May] saying that situation where planes have to go to Alice Springs avoid harmful swelling, particularly on long fl ights’, at injured patients. patients will be picked up by CareFlight. Basically, the to be serviced and they spend more time in the following night we found that the letter wasn’t able to garage than they often do fl ying.”

International Travel Insurance Journal

AIRAMBULANCENEWS 23

Air Methods acquires Omniflight Helicopters

Air Methods Corporation has announced that it Omniflight generated unaudited consolidated revenue has entered into a definitive merger agreement of $172 million for the fiscal year ended 31 March to acquire OF Air Holdings Corporation and its 2011. The company expects to fund the purchase subsidiaries, including Omniflight Helicopters, Inc. price through a new commercial bank credit facility. Omniflight provides air medical transport services Aaron Todd, CEO for Air Methods, stated: “We are throughout the US under both the community- excited and pleased to have this opportunity to unite based and hospital-based service delivery models, these two industry leaders. The operational efficiencies utilising a fleet of approximately 100 helicopters that this combination should create will allow both and fixed-wing aircraft. Omniflight is headquartered entities to maintain and enhance the quality of our in Addison, Texas, with operations in 18 states services, while providing for a more competitive cost involving over 75 base locations. structure resulting from greater economies of scale. A view from inside a Tyrol Air Ambulance aircraft, configured for up to six patients who Tyrol Air Ambulance Air Methods will acquire Omniflight for an aggregate The geographical service areas of both entities are very require full medical care purchase price of $200 million in cash on a debt-free complementary and improve the combined entity’s basis, subject to working capital and other adjustments ability to maintain important resources closer to our Tyrol Air Ambulance award a first as provided in the Agreement. Upon closing, Omniflight customers and their communities.” will become a wholly-owned subsidiary of Air Methods. Omniflight CEO Tom Leverton added: “Air Methods Austria-based Tyrol Air Ambulance received the the company has, since its inception, transported The agreement has been unanimously approved by the and Omniflight have long histories in the industry EBAA Gold Safety of Flight Award in Geneva on 16 more than 46,000 patients, including VIPs such boards of directors of both companies. The transaction and, together, the two companies will bring even May, the first time an air ambulance company has as former Czech president Vaclav Havel and the is contingent upon clearance under the Hart-Scott stronger service to local communities across the received the award. Brian Humphries, president of late British prime minister Edward Heath. Tyrol Air Rodino Anti-Trust Improvements Act and certain other country. We are confident this will bring benefits to the European Business Aviation Association (EBAA), Ambulance’s past highlights include intensive care closing conditions. The transaction is expected to close the customers and employees of Omniflight and are said during the ceremony in Geneva: “We believe patient evacuation flights from as far as Hawaii to in July 2011. thrilled at the opportunity to join Air Methods.” it is important to honour exemplary safety records. Austria, and from Bangkok to the US. The company The companies that have received these awards has been recognised for its remarkable airlifts for epitomise how a long-standing commitment to children from crisis regions, including from Chernobyl safety can add up to a model safety record.” in 1986, Romania in 1989/90, and Croatia in The Gold Safety of Flight Award was made in 1991/92. Tyrol Air Ambulance also transported recognition of 81,000 ambulance flight hours patients from the tsunami-affected areas in Thailand performed by Tyrol Air Ambulance over four decades in 2004. The lightest passenger to date was a without an accident. premature 800-gramme baby, whilst the heaviest was Operating from the Alpine town of Innsbruck, Austria, a 320-kilogramme man. Norwegian government ignoring need for HEMS As Norway looks to increase specialisation and arrangements, said Norsk Luftambulanse, with the Rega centralisation of its healthcare infrastructure, patient often requiring an additional transfer to a Upgrades for Rega’s Challengers helicopter air medical provider Norsk Luftambulanse ground ambulance before reaching the hospital. is calling for the government to consider the need for Haga commented: “The draft National Health Rega recently completed a 96-month overhaul of material and equipment carried onboard each a parallel increase in air ambulance capacity in order Care Plan is not good enough. The plan does not its fleet of Challenger CL604 fixed-wing aircraft, helicopter is now distributed among three to cater for more frequent and longer transports of take sufficient account of the need of increased including an update of the onboard medical rucksacks, comprising a basic module (including an seriously ill and injured patients. transportation and rapid medical care to patients. equipment and new exterior paintwork. After oxygen cylinder), an airway module and a recovery Auslag Haga, secretary general of the Norwegian Air It is therefore our duty, on behalf of the patient, to eight years of performing repatriation flights, the module. Depending on the type of mission, these Ambulance Foundation, stated that if the centralisation of highlight this.” three ambulance jets were required to undergo bags can be combined as required. This modular the hospital sector is not compensated by rapid medical comprehensive checks and maintenance work. system has also resulted in a reduction in weight. attention and rapid transport to hospital, there would This major overhaul was completed according to The new patient stretcher is two metres long, an be a risk of people suffering long-term damage or even plan within just four weeks per aircraft and without important adaptation to cater for an ever-taller loss of life. To ensure proper capacity, three new air operations being substantially restricted. patient population. The latest improvements made ambulance bases are needed: on the inner east area, The company has staked its claim as the first to the stretcher and the new ‘Jungfrau’ recovery in the Grenland area and in the Harstad area, which rescue organisation to use the new Propaq MD, bag model, with its integrated patient safety system, currently have an inadequate emergency medical supply which integrates a multi-parameter monitor with serve to increase patient safety during rescue compared with the rest of the country, said Haga. a defibrillator and heart pacer, and was specially missions. Other updates are the new Conoxia The service also called for all hospitals to have an developed for air medical operations. The planes also carbon oxygen cylinders, which have half the weight approved landing area for medical helicopters, benefit from new suction units from Laerdal. and twice the capacity of previous models, and within walking distance of the emergency room. Auslag Haga, secretary general of the Norsk Luftambulanse On the rotary-wing fleet, all portable first-aid Medumat Transport ventilators. Many hospitals have only unsatisfactory landing Norwegian Air Ambulance Foundation

www.itij.co.uk 24 FEATURE

Hosting the Rugby World Cuo is a massive speaking, New Zealand is a safe country. We undertaking for a modest nation of just over four have a very low crime rate and rank second only million people on a landmass smaller than Great to Iceland in a recent rating of the world’s most Britain, but one that the rugby-mad country is more peaceful nations. This does not mean that crime than ready for. In fact, New Zealand has been does not occur in New Zealand, however. Tourists waiting since 1987 to see the event return to its are often shocked when their vans are broken shores – not coincidentally the last and only time into, or their laptops, credit cards and passports the All Blacks have won the trophy. The challenge: are stolen. Every country has its villains and to safely and effectively play host to the world and opportunists, and New Zealand is no exception. ensure that visitors leave the country happy, healthy First Assistance, along with its insurance and travel and with a desire to return. partners, is pushing three strong messages ahead For companies concerned with providing insurance, of Rugby World Cup to those booking through travel and tourism, medical assistance and travel agents and taking out insurance. While emergency response services, the Cup brings with these may seem like basic travel common sense, it an increased need for communication and co- the carefree attitude often shown by visitors to operation between these industries. The concerted this country is one of the leading contributors effort to share information and expertise and to drive to insurance claims for our inbound customers. education to the public has been ongoing since early These messages are:

Overseas insurers working with World Cup tourists need to be aware that ACC only covers treatment and rehabilitation costs while the customer is in New Zealand

this year and will continue until the conclusion of Do not leave passports and personal items unattended: the Rugby World Cup at the end of October. This travel insurers in New Zealand frequently deal may be the last chance our small nation has to host with cases of lost or stolen passports, luggage or the event due to the dramatic growth it continues personal items left unattended in hostels or cars. to enjoy as an international draw card, and those This fi gure rose during the last major rugby event involved are committed to making it an unforgettable hosted in New Zealand – the British and Irish Lions experience for all the right reasons. tour in 2005 – and we expect to see a number of The information sharing happening behind the these cases reported during Rugby World Cup. The KIWIS scenes will be the key to providing the kind of quick message we are putting out is: if it is important, take and effi cient response all of our customers expect – it with you. PREPARE FOR particularly in emergency situations – to make the visitor experience in New Zealand a positive one. Insurance Do not travel alone: while rates of violent crime are and assistance companies are among those to have low in New Zealand, there have been several high- met with the likes of the Ministry of Foreign Affairs and profi le cases of travellers going missing, often while KICK-OFF Trade (MFAT), district health boards, overseas partners, hitch-hiking, in recent years. Travelling in groups, with travel agents, airlines, consulates and embassies to share tours or with a friend, lessens the chance of anything information and discuss potential issues. untoward happening during a person’s trip around New Zealand is gearing up for an invasion, as 20 of the world’s best rugby teams, hundreds Through such thorough planning, we aim to be able to the country. of trainers and support staff and around 85,000 cheering rugby fans converge on the nation provide common messages at each contact point, so for the biggest event the country has ever staged – the Rugby World Cup 2011. Mary Jo if a visitor travelling between matches has an accident, Log your travel: First Assistance and New McDonald reveals how the local assistance industry is involved with the preparations the rental company, the insurer, the paramedics, Zealand’s MFAT have been hot on the issue of right through to the travel agent, will be able to give logging travel since a 2009 earthquake and tsunami information on the visitor’s best course of action should ravaged Samoa, killing almost 200 people, many they need to. This education needs to start at the of whom went unaccounted for during the days beginning of the process as customers book their fl ights after the catastrophe. Taking the time to log your and arrange their insurance. To achieve this, we will travel plans before your trip may save your life in need to remain in close contact with our international the case of a disaster. MFAT’s www.safetravel.govt. partners over the coming months. nz website is a good example of a travel logger in New Zealand. We are encouraging visitors to ask Educating travellers their insurance provider before travelling for their The perception that New Zealand is national travel log website. one of the safest nations to visit Discussions between those industry bodies preparing is one of the biggest barriers for the Rugby World Cup have also focussed around we need to break down to road safety education for those visiting New Zealand. ensure that people take Our roads, particularly outside of the major centres, the proper precautions are notoriously dangerous. Chip and metal seals are in their travels: all too commonplace when driving off the main highways, often people arrive while thin and winding roads make up a lot of our with the belief that coastal drives. ‘it won’t happen to Road rules in New Zealand can also be confusing for me’. Comparatively visitors. The rule that sees drivers give way to those

International Travel Insurance Journal FEATURE 25

and rehabilitation costs while the customer is in travelled to New Zealand, or getting on or off that New Zealand. It is also not a replacement for travel boat or plane insurance as it does not cover illness, disrupted • been injured whilst travelling around the country in internal travel or emergency repatriation should the the craft they arrived in, such as a yacht or cruise patient require it. ship, including on the gangway ACC for visitors is taken on a case-by-case basis, and • taken an excursion during their visit 300 nautical may be available to someone who is: miles or more from New Zealand. • injured in an accident in New Zealand It is important that customers and insurers know the • injured as a result of medical treatment whilst in ins and outs of ACC, as this may make a difference New Zealand to the policies they choose to take out and will give • dealing with the mental effects of a sexual assault them an appreciation for what they are entitled to or abuse suffered in New Zealand during their stay. • in certain circumstances, suffering from a health With the Rugby World Cup just months away, problem related to working in New Zealand these are exciting times for the country, but also Coverage only applies to those sustaining an injury a time when awareness, education and safety are in New Zealand and does not cover pre-existing paramount. 2011 is the year that New Zealand hosts injuries. In addition to this, ACC will not cover those the world and we look forward to showing you all who have: our wonderful hospitality and culture – and finally • been injured on the boat or plane on which they winning the Cup again! n

turning right or approaching from the right is one District Health Board, for example, has recently peculiar to New Zealand and is often seen listed as taken on a Rugby World Cup liaison person to the cause of accident in insurance claims and police manage queries and issues in the lead up and to help incident reports. The general rule of thumb: if you the hospitals plan effectively for the coming influx have the wider arcing turn, you have right of way. of visitors. For the bigger health boards, particularly Sleep deprivation or driving tired is another real those in centres hosting a large number of games, danger with many people covering long distances this additional strategic steer may prove invaluable. on unfamiliar roads from city to city after celebrating In a sense, however, the approach that most medical or commiserating the night before. Event providers across the country will be taking is one of organisers, along with the New Zealand Police ‘business as usual’ but on a far greater scale as far and many car rental companies, will be reinforcing as communications networks and contact between the danger of this practice on a local level, while each associated industry is concerned. insurers have already been in touch with global partners in the build-up so that customers travelling to New Zealand are able to make an informed decision on their internal travel arrangements. The issue was highlighted by several instances during the 2005 British Lions tour, the worst of which involved a Welsh tourist who fell asleep at the wheel of a Auckland District rented campervan on a trip to Christchurch, killing an 18-year-old woman. Health Board, for In 2006, the Ministry of Transport identified that foreign drivers of motor vehicles contributed to example, has recently 62 crashes, leading to five foreigners being killed. Anecdotal evidence is seen every day in popular taken on a Rugby resorts where people used to driving on the right veer to the wrong side of the road, often resulting World Cup liaison in narrow misses or accidents. The message to our customers: take it slow, take it easy and, when tired, person to manage take a rest. We have a number of welcoming small towns which we will be suggesting customers stop in queries and issues to rest and enjoy a little bit of Kiwi hospitality. in the lead up and Medical facilities While there is plenty of work going into to help the hospitals disseminating information around safe travel for the event, the Rugby World Cup will almost certainly plan effectively for see an increase in the number of people admitted into the country’s medical centres, accident and emergency units and hospital wards. Health facilities the coming influx of vary in size, capacity and capability throughout the country, with large expanses particularly in the far visitors north and deep south functioning without any major hospital. These areas are serviced by terrestrial ambulances and a network of rescue helicopter trusts that connect patients with hospitals in major centres. Connectivity to healthcare is something The Accident Compensation Corporation travellers should keep in mind, especially when Visitors to New Zealand are often surprised when, Helpful liks travelling off the beaten path. after receiving medical treatment for an accident, Mary Jo McDonald It is also important that travellers know what their the bill is waived and they are free to go without www.nzta.govt.nz – the New Zealand Transport is general manager insurance covers them for in terms of cost and payment. This is due to a scheme of free accident Agency website gives the national road rules of New Zealand procedure, the details around their policy and who to compensation available to all New Zealanders and and all information on national road closures to assistance company call in the event of an emergency. Most international most visitors to New Zealand known as the Accident help visitors plan their travel. First Assistance. MJ has insurance companies will have networks or partners Compensation Corporation (ACC). worked in the assistance in New Zealand who will field policyholders’ calls and For visitors injured during a visit to New Zealand, www.safetravel.govt.nz – Ministry of Foreign industry for 10 years will be able to answer any questions they might have. ACC may be able to help with the cost of treatment Affairs and Trade travel advisory website, and was previously Visitors should ask their insurer for a travel card with and give support during the journey. The advent including travel log and information for involved in the executive the details of their New Zealand partner and carry that of ACC in New Zealand replaces the right to sue international travel. recruitment, insurance and financial sectors. card at all times, as it could help them or their rescuers for personal injury, and visitors to the country, Her roles in New Zealand and overseas in case of an emergency. particularly those taking part in extreme or adventure www.mfat.govt.nz – the Ministry of Foreign have included network development, The Rugby World Cup will also see local hospitals sports, should be aware of this. Affairs and Trade website has a full list of national procurement, sales, marketing and general and district health boards reviewing their procedures Overseas insurers working with World Cup tourists consulates and embassies in New Zealand. business management. and strategies in the coming months. Auckland need to be aware that ACC only covers treatment

www.itij.co.uk 26 ITIC REVIEW

REVIEW

ITIC CONFERENCE REVIEW 21–24 JUNE 2011 THE KOWLOON SHANGRI-LA, HONG KONG The recent ITIC 2011 in Hong Kong invited travel insurance professionals from around the world to discuss challenges facing the industry today. Moderated by ITIJ’s editor-in-chief Ian Cameron, and with the focus firmly on Asian issues, delegates enjoyed three days of insight and debate concerning health and travel insurance issues in India, Japan, mainland China and Hong Kong. It was also an outstanding opportunity to meet, greet and network with some of the industry’s leading lights. Mick Shippen reports

International Travel Insurance Journal ITIC REVIEW 27

Travel and health insurance for the Asia/Pacific region – which policies are being bought?

The proceedings of the first day kicked-off with industry associates, and finally through direct Tiger Xianbo providing an overview of mainland selling. He added that while some avenues were China’s burgeoning travel insurance market. He traditional, others are newer and do not generate asserted that although the market in China was in 2010, the total large revenues at present. However, Ping An huge, it continues to grow extremely quickly and Property & Casualty Insurance Company of China, has massive potential for insurers. He said that in amount of travellers Ltd, recognised the potential of the market and is 2010, the total amount of travellers recorded in recorded in China the only company in the country actively engaged in China was in excess of 2.53 billion, a 25-per-cent all five business models. One of the most successful increase on figures for 2009. Of this, inbound was in excess of revenue streams was the use of websites. With tourists numbered 135 million. Tiger said that the the co-operation of China’s largest online travel estimated market value of tourism during 2010 2.53 billion business, ctrip.com, last year the site generated was RMB25 million or US$4 million. Despite this, $2 million selling insurance policies on the back travel insurance only accounts for three per cent of of holiday bookings, but he pointed out that this the average Chinese traveller’s expenses. In 2010, was still less than 20 per cent of travellers, a figure revenue from travel insurance sales was RMB75 In the second part of his session, Tiger shared that once again illustrated the potential for growth Zhang ‘Tiger’ Xianbo million, or $12 million. Clearly illustrating the details of business models currently being used in over the next few years. Co-operation with two of General Manager Accident & Health incredible potential for insurers in China, he added China. He said that travel insurance companies used the country’s biggest travel agents also generated Insurance - that this figure was expected to exceed RMB200 five models to acquire customers: tourism websites, significant returns from accident and inconvenience Ping An Property & Casualty Insurance million, or $30 million, in 2011. direct sales through travel agents, sales of air tickets, travel insurance sold with air tickets. Company of China, Ltd

Shanghai-based Steven followed on from Tiger, periods tended to only be for three years or so. giving an overview of insurance products currently According to Steven, the most interesting segment being sold in China. His company’s number-one of the market at the moment is the emerging international private medical insurance product high-net-worth local customers across the region. “These customers is a traditional policy bought by multinationals for He said that as the economic might of Asian their expat team. “Typically, these are benefit-rich nations such as Indonesia, Thailand, and China have little exposure products with a high level of premium,” he said. became more assertive, local money was stepping Steven added that the products are generally forward. But he also added a note of caution. to insurance purchased globally, although increasingly for “These customers have little exposure to insurance products, so a great regulatory and money laundering purposes, many products, so a great deal of education is required are now being purchased locally. “Often, the in terms of benefits and restrictions. Often we deal of education is premium is not the main driver for sales. It is the will get cases in China were we will receive benefits that companies are looking for. In common applications and claims forms from the same required.” with many companies, cover will include in and customer on the same day!” outpatient services, dental, maternity, evacuation, He also warned that customers often come from and repatriation benefits and so on, but it is the a background whereby previous companies they frills such as wellness programmes, compassionate have dealt with may have been less than ethical, so may often want to talk with someone directly,” said emergency visits, travel benefits and a free choice there can be a lot of suspicion and demands from the Steven. “Cost of premiums can also be an issue if Steven Conway of medical providers that attract customers,” he customer. “Local servicing is also important. Customers companies are trying to compete with local providers, Regional Manager - said. However, Steven pointed out that due to are not prepared to deal offshore. They require a but there are also customers who will pay extremely Asia -InterGlobal the itinerant nature of the expat customer, policy team on the ground in the area where they live and high premiums just to say they have the best.”

Eric’s talk focused on the growth of the Chinese begin with, this will be limited to citizens of Beijing travel market, both domestic and outbound. He and Shanghai, but I have no doubt that eventually began his talk with figures from the World Tourism it will be extended nationwide,” he said. According Organisation, stating that China was now the fourth- China is due to relax to Eric, favourite countries for mainland Chinese most-visited country in the world, and its tourism tour groups to visit are currently Taiwan, Macau, industry had entered a new golden era. He added its decades-long and Hong Kong, so it is expected that once they that in 2010, almost 56 million travellers visited travel restrictions for can travel independently, Taiwan will witness a China for at least one night, an annual growth of 9.5 considerable increase in Chinese visitors. He added per cent, with an additional 154 million day trippers individuals and that there were rumours that as a result, Taiwan annually. Collectively, they contributed $45 billion to could possibly introduce similar insurance cover the Chinese economy. allow them to visit requirements as Schengen countries stipulate for Interestingly, Chinese outbound travellers now Chinese visitors. exceed 57 million, an annual increase of 24 per cent. Taiwan freely Discussing insurance claims fraud, Eric explained He pointed out that Chinese travellers visiting the 25 that claims were affecting policies: “In Hong Kong, Schengen countries were required to have insurance the most common fraudulent claims are for mobile cover of c30,000 for medical expenses, and claims phones. As a result, there are now only two policies have to be recoverable in country. “It is important and spent a massive RMB1.25 trillion.” available that cover phones and these have strict Eric Tsui not to overlook the scale of domestic travel,” he Looking forward, Eric pointed out that China is limitations,” he said. The inference was that any General Manager - added. “In 2010, Chinese travellers made 211 billion due to relax its decades-long travel restrictions for increase in specific travel and medical insurance MAPFRE Asistencia Hong Kong trips, an increase of 11 per cent [on a year earlier], individuals and allow them to visit Taiwan freely. “To claims would shape future policies.

www.itij.co.uk 28 ITIC REVIEW

Tsunami in Japan – what have we learnt from previous disasters, natural and man-made?

Makiko began the second session by illustrating the “For one member of the assistance team, the return if it had been,” said Makiko. She also added that an stark reality of emergency assistance and operational home became a journey from one disaster area to assistance company must make a commitment to have challenges with two case studies of recent disasters: another. On 11 March a 9.3 quake hit Japan killing continual accessibility to clients, whatever the situation, the earthquake in Christchurch, New Zealand, and over 15,000 people, 95 per cent of which were while also ensuring the safety of its employees. the tsunami in Japan. from drowning,” said Makiko. Makiko concluded her thought-provoking talk by Emergency Assistance Japan’s most important clients According to Makiko, the Tokyo branch of saying, “While no amount of planning will ever are Japanese insurance companies and corporate Emergency Assistance Japan asked its offices in cover all bases or guard against the unexpected, I businesses, with 95 per cent of assistance being for Bangkok and Singapore to continue handling their can say that planning for the worst and hoping for outbound travellers. On 22 February, an earthquake ongoing cases because the priority in Japan was the the best is an excellent policy.” registering 6.3 struck Christchurch, leaving 181 immediate safety of employees and their families. people dead and up to 2,000 injured. A college that As a result of this swift action, the Tokyo office only collapsed in the disaster had 30 Japanese students suffered from 45 minutes of downtime. registered. “News of the disaster reached our offices Pressing operational challenges included monitoring “planning for the worst just after 10:00 a.m., and by the afternoon we had the effects of the nuclear meltdown and its risk to Makiko Sakakibara established that a number of the students were employees, and continuing to deal with requests for and hoping for the best Executive Officer - registered with Japanese companies,” said Makiko. An assistance from abroad. Makiko said many lessons had Emergency Assistance Japan assistance team was dispatched and over the next 27 been learned from both disasters. “Fortunately, the is an excellent policy.” days, they performed four medical repatriations to office in Tokyo was not damaged, but questions were Japan and the recovery of 13 mortal remains. raised about how we would deal with the situation

Dr Kay gave a talk that described the challenges season, a time when tourists outnumber locals,” he the military,” he recalled. During the five days of the of disaster management from the perspective of a said. “Hospitals were quickly overwhelmed by the recent flood, Dr Kay ran 17 helicopter missions in medical team on the scene. He began by listing the sheer number of people seeking treatment. I recall continuous rain. Of the 21 people he assisted, four world’s major natural disasters, namely flooding, asking someone how many X-rays he had done in a were trauma patients. “The fact is that people have cyclones, and earthquakes. day and he said 800.” In the case of Phuket, the army heart attacks or strokes wherever they are. Even in He said that when a disaster strikes, the majority of was called in to help evacuate stranded tourists and a disaster you have to respond,” he said. tourists will head for a private hospital, because at transfer the injured to Bangkok hospitals. Even those The issue of the cost for private hospitals assisting in a government hospitals there are usually problems who had escaped unscathed were unable to leave disaster was raised and Dr Kay said during the tsunami, with language barriers, a lack of co-ordination with the country as they had only what they were wearing Bangkok Hospital didn’t expect to recover any expenses embassies and insurance companies, and no credit when the disaster struck, with no ID or money. incurred. “But when you do good things, good things card facilities. He went on to illustrate the problems On a more positive note, Dr Kay said that Thailand happen,” he said. “We had a few foreign governments encountered at hospitals by describing events around had learnt a great deal from the tsunami experience. come forward and make financial contributions. Dr Kay the Thai tsunami of 2004, a disaster during which he “When we recently had devastating floods, we Furthermore, when the military saw what we were Aviation Medicine Director - provided medical assistance and air support. were much better prepared to handle evacuations capable of during the tsunami, it became much easier for Bangkok Hospital “When the tsunami hit Phuket, it was the high and hospitals used helicopters working alongside us to get permission quickly to work in other disasters.”

Anna opened with a quote from an article in Newsweek Once it subsides, we begin to take stock. We assess the areas. After reviewing a case study concerning the that read: “Disasters are so hugely threatening. We danger and damage. We regroup.” challenges of dealing with assistance in the aftermath can’t help but experience intense fear and distress. We “The reason I show you this quote,” said Anna, “is of the Bali bombing, she stressed that no two panic. We focus. We flee. We go numb. The initial jolt because for people working in assistance companies disasters or repatriations are the same, and there was lasts from a few minutes to a few hours to a few days. who have to react quickly, this is exactly how it is no manual to teach staff how to react to each case. following a disaster.” The key, she said, is ‘dedicated people pooling their She shared information that revealed that in the first resources and strengths to do their best’. quarter of 2011 there were more major disasters in the first quarter of than in the whole of 2010 and the intensity of claims was greater, raising the question of how the industry 2011 there were more rises to the challenge of disasters. “We have to learn “We have to learn from from these disasters and learn how we can regroup, major disasters than in how we can refocus and do our job better than these disasters and learn Anna Hue before,” asserted Anna. Managing Director - the whole of 2010 Given the increase in natural and man-made disasters how we can regroup.” Blue Dot Assistance and terrorist attacks, Anna asked if governments should subsidise insurance claims in high-risk

As a funeral director and embalmer, Clive is the lesson and that lesson is that you don’t give people I thought ‘well, Thailand has been good to me so last in line during a disaster and provided insight an option. If you don’t want to clean up the mess, it’s time to give something back’.” He decided to go into the grim but very necessary task of the get them out of there,” he said. there for a month, but ended up being involved for identification and return of bodies to families of Having worked in three major disasters, Clive two years. the deceased. Clive followed on from Dr Kay’s said that it was imperative to control access to the Clive explained that one of the problems in the optimistic closing statements by asserting that in area where people had died, because it makes the event of a large-scale emergency is that there is no his experience, some people are reluctant to learn process of identification much easier. “If bodies system in place to deal with it. However, he said from the past. In the last decade in Australia, he are identified quickly, each body can then be one of the reasons the clean up after the tsunami said he has witnessed the same results from floods embalmed and transported out of the area and was so successful was because the authorities only and fires that were happening in the 1950s. Clive kept for several months, if required, without extra allowed a certain number of bodies to be released recalled a recent bushfire in which 100 people refrigeration,” said Clive. each day and there was no mix up of names. were killed because the local government allowed He recalled his experiences working in Thailand “Today, there are only 200 to 300 bodies still held Clive Allison residents of the town the freedom to decide following the tsunami, which claimed the lives of in Phuket that remain unidentified or unclaimed. All Managing Director - whether they wanted to leave the area or stay. over 8,000 people. “I initially got involved because credit is due to the Thai authorities for carrying out John Allison Monkhouse “However, in another state they did learn from the in the past we had made coffins in Chiang Mai, and such amazing work.” International Travel Insurance Journal ITIC REVIEW 29

China healthcare reform – what’s new?

With over 30 years’ experience in hospital seen healthcare systems elsewhere, so are now A major point of concern that reforms were trying administration, 11 of which have been spent in demanding change at home. As a result, David said to address was that China only had one nurse per China, David was able to provide valuable insight that China’s healthcare marketplace is poised for thousand people – about a seventh of the US. “Any beyond that of government policy statements. dramatic growth and structural change. He outlined dramatic change in how care is delivered is going to “Many people have accepted that China is a difficult specific changes, stating that in 2009, a major have to involve more nurses and they are just not marketplace. But why?” he asked. According to national government reform initiative was aimed there right now,” said David. David, the paradox is that China says ‘yes we want at tackling pervasive corruption, excessive use of He went on to talk about the healthcare delivery your business’ but then strangles investors with red drugs, poor distribution of care providers and other system, saying that it is currently focused on tape. “In China, if you want to get a licence to open a inefficiencies in the system. large, 1,000-bed facilities that people have to medical facility, it will take four years, so, yes, I think it “In 2011, restrictions against 100-per-cent queue overnight to get into. Service, he said, is is fair to criticise the country for this,” he said. ownership of healthcare institutions were lifted. generally poor. David Wood China is now witnessing the rise of a vibrant middle This comes at a time when many were no longer David concluded that China, the world’s biggest Managing Director, Healthcare - class, the majority of whom are buying cars and willing to accept the factory-like conditions in public healthcare marketplace, was best described as a PricewaterhouseCoopers Beijing apartments. They have also travelled abroad and hospitals,” said David. place of opportunity for risk-taking investors.

Christian drew on his experience working in China were that VIP wards in public hospitals couldn’t exceed over a three-year period. The number of private to enlighten delegates about the country’s current 10 per cent of the hospitals’ total revenue. The hospitals, specialised hospitals and foreign-owned medical reforms. He began by outlining the five key government will also encourage [the development hospitals will also increase,” he said. initiatives specified in the government’s 2009-11 of] private hospitals. In fact, some public hospitals will One of the principles of the medical reforms, healthcare plans. These are: increased medical transform into private hospitals,” said Christian. Christian said, was that the government plays a insurance coverage, a basic medicine system, the Regarding government investment in healthcare, leading role and demonstrates a determination upgrading of grassroots medical institutions, the which is set at RMB850 billion, Christian said that the to increase investment in the industry. He added equalisation of services in rural and urban areas, and majority would be spent on lower-level institutions that tens of thousands of doctors would be sent to the launch of a pilot programme for public hospital to serve citizens with low living standards. The support the development of rural services. With reform. “The main principle of the medical reform total amount will be invested over a three-year more Chinese graduates returning from overseas is to set up a healthcare system that covers all rural period, with RMB330 billion coming from central and a growing population of high earners in the and urban residents by 2020, which should be safe, government and the rest from local governments. country, there is an increasing need for private Christian D. Orejudos convenient and affordable,” said Christian. Christian went on to outline the implications of the healthcare in the country. Christian concluded that COO - He went on to say that over the next few years, policies. “Under the medical reform policy, 3,700 private hospitals, high-end healthcare services and Hangzhou Aima Maternity private hospitals and high-end medical services would urban health service centres and 1,100 community high-end commercial healthcare insurance would be & Infants Hospital develop rapidly. “Stimulus factors for private hospitals health service stations will be built or expanded hot spots ripe for investment.

www.itij.co.uk 30 ITIC REVIEW

India: a country profile – the pros and cons of travel insurers operating in the Indian marketplace

Dr Chawla delivered an informative and entertaining Immediate problems will be a ‘show-me-the-money’ guarantee, otherwise clients would be awoken each talk entitled ‘the Good, the Bad and the Ugly’ about attitude. Guarantees of payment will not be accepted. morning with a demand for money. what insurers operating in India should expect. A They want to see the cash. There will also be The sheer scale of local Indian hospitals was another quick burst of statistics quickly established the fact communication problems,” she said. Regarding the harsh reality that patients would have to face, and that India was an extremely challenging place to issue of payment, she told delegates to be aware that Dr Kimberley painted a rather grim picture. “In large have an accident. “As of last week, the population wire transfers could take three to four hours to come hospitals, staff may be treating 10,000 outpatients was about 1.2 billion, and 51 children are born through, and advised against giving a daily payment with 500 coming in and 500 going out every day. every minute. We have no official language, 27 There may be betel nut stains on the walls, two regional languages and 1,500 mother tongues. patients in a bed and one underneath, only regional The roads are chaos, with 10 per cent of the Indian vegetarian food, and no release for your world’s accidents occurring in India, and 200 million Immediate client without payment.” people being moved on the railways every day. Moving on to private hospitals, she said that it was Government hospitals have six doctors per 10,000 problems will be likely that foreigners would pay more than Indians. patients,” said Dr Chawla. Patients would also have to purchase their own She then went on to focus on conditions in a ‘show-me-the- medicines from the pharmacy, so the assistance of government hospitals, and why an insurer should get a local agent was necessary to deal with this and their client out of them and into a private hospital as money’ attitude the many other problems encountered, including Dr Kimberley Chawla – soon as possible. “Often, clients will end up being overcharging. Establishing a dedicated 24-hour phone East West Rescue taken by the police to a hospital in a rural area. number in India was strongly advised.

Analysis of the extent of travel insurance fraud in the Asian region

Vincent discussed incidents of fraud that he had areas was still a relatively new product. Typical experienced and the indicators that travel insurers types of fraud he encountered were accidents that should look out for from their claimants. He began didn’t happen. “It could be coincidence, but often with the alarming figure published by Direct Travel the amount of accidents reported can be high in “every time a new Insurance, which stated that 750,000 Britons countries where cosmetic surgery is cheap. A false made fraudulent travel insurance claims by falsifying claim for an accident can be seen as a way of getting iPad is released, baggage loss or exaggerating how much was lost. teeth fixed,” he noted. He also added that the “Accurate data is difficult to find, as many insurers majority of medical claims tend to be exaggerated. there will be a huge are reluctant to publish information on insurance Issues encountered while investigating fraud in increase in the loss fraud, but it is thought that it accounts for around 10 some Asian countries include the wide availability of per cent of all claims,” he said. However, Vincent fake documents and stamps. “It is prudent to look of old models,” said that in the specific case of travel insurance closely at official-looking documents. With today’s fraud, the figure could be as high as 20 per cent. technology, it is extremely easy to create fake “The reasons for this are that claims are often small, documents. Look closely for similarities in signatures and happen in a different country where it is often and check addresses,” he advised. “We receive the claimant was drunk or high on drugs when difficult to investigate. Other factors to take into claims for medical care in hospitals that don’t exist.” the accident happened,” he said. Other indicators Vincent Scopelliti account are that people on holiday usually spend He went on to say that from a travel insurer’s of fraud were a history of prior claims, evidence Managing Director - more than they intend to and are seeking to get perspective, early intervention, in other words of prearranged treatment, and a spike in claims. LKA Group some money back any way they can,” he said. getting to the scene as soon as possible, was “A classic example is that every time a new iPad is Within Asia, Vincent said that levels of fraud varied crucial – particularly if there had been an accident. released, there will be a huge increase in the loss of from country to country, as insurance in some “Often an investigation of the scene will reveal that old models,” said Vincent.

International Travel Insurance Journal ITIC REVIEW 31

Who decides what is best for the patient?

Lynne began by saying that traditionally, it had revealed just how unprepared most travellers were. diarrhoea or other common ailments, and only 20 always been the physician that tended to make “Our research shows that 44 per cent of travellers per cent of those travelling in an area where malaria the decision on the type of treatment received did not seek health advice prior to going abroad, is endemic carried anti-malarial drugs.” It was clear and where it happened, but that process was and only 21 per cent reported verifying that their that travellers were taking unnecessary risks, but now changing. “Economic factors are playing an immunisations were up to date. Additionally, only 36 those who did seek information prior to travelling increasingly important role. The shift in decision per cent said they carried medication for traveller’s were using websites and social networking rather making is moving over to the insurer. They often than a doctor’s knowledge. have local knowledge and a network of their own In conclusion, Lynne said that it is important to accredited providers,” she said. The bottom line, have a complete loop of communication between however, was that if there was a clear difference of it is important to have doctors, insurers and hospitals so that the patient can opinion, the professional judgment of the physician make an informed choice regarding the best place had to be respected. a complete loop for treatment. She also stressed the importance Lynne also noted that the patient was now also of shared information relating to pricing: “I believe influencing the decision and was using information of communication in transparent pricing. Often organisations are gained through social networking sites to get individually pricing, whereas insurers have a much feedback about hospitals and specific physicians. between doctors, wider knowledge of what everybody is doing. If Lynne Fung Medical self-help websites are also allowing patients we can share information, the whole process will General Manager – to educate themselves and they are now more insurers and hospitals be much more transparent,” Lynne asserted. A Matilda International Hospital Hong aware of the different treatment options available. trusting relationship, she said, would lead to a better Kong Turning to data regarding travel abroad, she said it outcome for everyone.

Dr Chan began by stressing that it was crucial for insurer to pay for the patient to go home if the patient Chan told delegates that it was important to have an assistance company to be able to judge what is is actually stable? This is just one of the many questions a network of specialists to help assess a patient’s medically correct for the patient, and went on to we have to deal with as an assistance company.” condition and make a decision about care. “I worked say that it is necessary to look at the condition of the Dr Chan said an assistance company would firstly closely with a newly formed team that is comprised local hospital and assess if moving the patient was look at the patient’s safety and condition, followed of 23 medical specialists of professorial grade, each possible, while also keeping the insurer informed of by the state of the hospital. “In rural areas, the affiliated with a private hospital. If we have a case in the situation on the ground. condition of a hospital can be very poor, but we rural China, for example, where a doctor doesn’t The comfort of the client – physically, medically and also have to look at the hospital they are going to be want to move a patient, we would seek advice from psychologically – is of great importance, said Dr Chan. transferred to in order to ensure we are not moving one of our academics to assess the situation and do He also raised the question of how the level of patient them from one bad situation to another,” he said. what is best for the patient,” he said. Dr Charles W Chan care was measured. “We have to be able to judge He added that they also had to be able to accurately In conclusion, Dr Charles said that client benefit and Medical Director, AAI/Medical Director – what is medically correct and what is helping the assess if the patient was fit to be transferred. cost consideration were the main factors influencing Health Concepts Ltd patient too much,” he said. “Is it actually fair for the To help with these assessments and decisions, Dr the decision-making process.

Sarah presented a specific case study that presented a dilemma. It concerned a client working for a major bank who had been diagnosed with cervical cancer. After a period of treatment, she was given the all clear, but after a couple of years the condition returned and she began to receive periodic treatment. By 2010, her condition had worsened and she had lost a considerable amount of weight. Having heard about a doctor who gave her hope, she was admitted to his hospital. “We were concerned about the treatment she was being offered. The doctor was pumping her full of a cocktail of drugs, but we were struggling to get in communication with him and find out what it was costing. The doctor was also not communicating with the family,” she said. Sarah said that eventually, it became clear that the client’s condition was continuing to worsen and the hospital had become her home. This raised the question as to how long, under the terms of the policy, the company could continue paying for the

Sarah Jewell Managing Director - ALC Healthcare “As an insurer, we had to look at this from a PR standpoint.”

treatment. It was discussed whether she should go home or to a hospice. “This kind of decision has to be made carefully,” said Sarah. “As an insurer, we had to look at this from a PR standpoint. If we made the decision to move her and something went wrong, not only would we feel responsible, but there would also be a reaction from the banking community.” Unfortunately, the patient died in the hospital. Sarah’s insightful talk raised many questions and demonstrated the realities faced by insurers and clients.

www.itij.co.uk 32 ITIC REVIEW

Wellness programmes for expat and local employee populations

Dr Chen gave a lively and passionate talk about create a huge economic burden for China,” he said. the benefits of wellness programmes for corporate IBM has introduced a no-smoking policy and businesses. He began by saying that although our incentives for employees to kick the habit. “The lifespan had increased over the last century, the campaign has been successful and rates of smoking “Our data shows main reason for this was not improved technology within the company have been dramatically reduced and better hospitals, but socio-economic reasons to below 20 per cent,” he said. “Unfortunately, that for an and, most importantly, mass vaccinations. it has been observed that within the general investment of $80 “Education and awareness are key factors for population that although the number of males improved health, both of which can be effectively smoking is declining, smoking among females is million in wellness taught in the workplace,” he said. increasing due to targeted advertising.” Dr Chen focused on two major problems affecting The statistics for hepatitis B were equally alarming, programmes, China: smoking and hepatitis B. He said the smoking with over eight per cent chronic infection and a 20- levels in China were the highest in the world, with to 40-per-cent chance of developing cirrhosis of the the return on over 50 per cent of the population addicted to liver. “Many companies will screen employees for tobacco. “In the next decade, the amount of people hepatitis B, so this disease is not only contributing investment is $190 getting lung cancer and associated diseases will to the country’s economic burden, it is also creating million,” social stigma,” asserted Dr Chen. IBM, on the other hand, does not discriminate. It provides Dr Tong Chen voluntary screening and hepatitis vaccinations for Consulting Occupational Physician - its employees. To illustrate the importance of the Integrated Health Services, IBM The statistics for programme, he revealed data that showed during a shows that for an investment of $80 million in lifetime in China, there was a 50-per-cent chance of wellness programmes, the return on investment is hepatitis B were contracting hepatitis B. $190 million,” stated Dr Chen. equally alarming The incentives for companies to take an active He concluded that over the next decade, the most interest in the health of their employees are important way to improve the health of the nation increased productivity and savings through a would be through reduced reliance on medicine reduction in lost time due to illness. “Our data and more self care.

Hocking opened with a question: what is the value Hocking said that a proactive health management find that motivational techniques work best, getting of a wellness programme? “If we look at the overall approach for companies was a critical component people to think about what they should do and costs of healthcare for employees, it looks very of the total health of the workforce. Using a wide taking action.” different from what you may think. The real cost is range of data, he said Aetna Inc. stratified individuals Hocking said that a lot of healthcare issues arise not the healthcare expenses, it is the saving from in four groups: healthy, low risk, at risk and chronic from a lack of understanding. He also added that presenteeism,” he said. Based on his research, disease, and then looked at how to develop services ultimately, healthcare was not the responsibility of he said findings show that 63 per cent of total healthcare costs come from absenteeism and only 24 per cent come from direct medical expenses. However, he said the effect on a company depends on its size. A big company will have sufficient backup A big company will have sufficient backup to cover absenteeism, whereas a small company may not. to cover absenteeism, whereas a small He shared more interesting data concerning health risks to employees in Asia. At 33, the average age company may not of the workforce is the youngest in the world, but many employees felt that they were not in the best of health. “Looking at the figures, it is also clear that absenteeism in Asia is a big problem, almost double to assist them. “For the healthy, we help them the government or employer, but the responsibility that in North America and Europe,” said Hocking. to stay healthy, while for low-risk individuals, we of the individual. He ended by saying that in Asia in He added that if action were not taken to reduce develop services to modify their lifestyle,” he said. particular, communication and encouraging people H. Hocking Cheng absenteeism, the productivity loss would have a “The best way to change people’s health is not to take care of their own health was extremely Managing Director - negative effect for employers. through websites or telling them what to do. We important. Greater China, Aetna Inc.

Before looking at the benefits of wellness programmes, the top-three factors affecting health may surprise Susan outlined the key drivers of employee wellness, you. The number one reason is not smoking, namely an ageing workforce, more chronic diseases, but stress. Lack of physical activity is also a major and social security systems that were unable to cope concern,” she said. employer benefits with the rising cost of healthcare. She pointed out that A global health and wellness survey conducted by in some countries, the overall cost of health insurance Aon Hewitt revealed that over the next five years, from wellness benefits is currently increasing by 15 to 25 per cent most employers plan to implement a health risk or higher each year. Such increases are encouraging management strategy. Susan went on to give a case programmes that employers to take a positive interest in the health of study of a company that Aon Hewitt had assisted would be applicable their employees. “In Asia, because of the lack of public with the rollout of a health risk assessment strategy. facilities, it is common for corporations to have on-site “Based on the results, we advised the company that to all countries were clinics. In a country like China, where people have the top-three modifiable risks were diet and nutrition, to queue for hours to see a doctor, a clinic at work is exercise, and stress,” she said. “The next stage of the improved productivity highly valued by employees,” she said. programme is to help the company find a suitable Aon Hewitt has introduced a wellness programme, vendor to manage the health risks.” and a reduction in but is not constantly telling employees to exercise. She ended by saying that employer benefits from Susan Chen The focus of the programme was on six lifestyle wellness programmes that would be applicable sick leave Senior Regional Benefits Consultant - behaviours that affect wellbeing: smoking, physical to all countries were improved productivity and a Aon Hewitt exercise, diet, alcohol, stress and sleep. “In China, reduction in sick leave.

International Travel Insurance Journal ITIC REVIEW 33

Overview of the differences between the healthcare systems in China and Hong Kong

In the final session of the conference, Purple Kong do provide good medical care,” he said, “but provided an overview of the Hong Kong healthcare they are simply too busy to produce the prompt system and outlined some of the challenges that medical reports required by insurers. You could insurers may face when looking for suitable care for apply for a report, but it will take up to six weeks.” other private a client. He pointed out that good assistance begins He added that even in a private hospital, a report by seeking an appropriate doctor or specialist. “I would not be available until the end of the day. hospitals only am often asked to recommend a good hospital, Purple also said that in the case of an emergency, if work on an but in Hong Kong, care is more doctor-based a public ambulance were called, the patient would rather than hospital-based,” he said. Purple added be taken to the closest emergency room. He also outpatient basis that most good private doctors and specialists warned that the typical waiting time in a public affiliated themselves to several private hospitals hospital could be up to six hours. and do not in order to ensure the availability of a room and Purple enlightened delegates about the 12 private their equipment needs. He also said that although general hospitals in Hong Kong. He said the care is accept critical or most private hospitals were excellent, there are no very good, but warned that only the private Union Purple Tse specialist hospitals in Hong Kong. Hospital has a 24-hour emergency unit. All the emergency cases Director of Emergency Services - Regarding public hospitals, he gave the opinion that other private hospitals only work on an outpatient TY Solutions they were best avoided. “Public hospitals in Hong basis and do not accept critical or emergency cases.

Kenneth turned the delegates’ attention to is the current drive for profitability,” said Kenneth. hospital’s income. However, the government is healthcare in mainland China. He started by saying The current Chinese system has been likened currently trying to reduce the over-use of drugs.” that it was not uncommon for patients to reject to a cash machine on the backs of the patient, Despite the difficulties, Kenneth said that although local healthcare and travel for days to reach a bigger trying to extract as much money as possible by the standard of healthcare in China was behind hospital in an urban area. Interestingly, he pointed overprescribing treatment and drugs. “The reason many countries, progress is being made. However, out that although 70 per cent of the population for this is clear,” said Kenneth. “In most cases, the citizens in rural areas still have to pay 90 per cent of live in rural areas, it was urban hospitals that had sale of drugs contributes over 60 per cent of a their own medical expenses and are either unaware benefitted from recent investment, hence the need of or unable to pay for insurance. “I do think that to travel great distances to receive better care. medical insurance will be the key to changing Kenneth enlightened delegates to the true situation healthcare in China,” said Kenneth. He went on about healthcare in China with a series of short only about one to say that the government did try to implement a and informative film clips, one of which stated that system in urban areas whereby the employer and only about one third of doctors hold a four-year third of doctors employee both contributed to insurance. “In rural degree and the remaining two thirds only have basic areas, there was also something called the co- training. “However, it is important to realise that hold a four-year operative medical scheme, but it wasn’t successful. Kenneth Ng during the 1980s, public funding for hospitals was degree This was mainly due to a lack of education. The CEO - reduced from 100 per cent to less than 30 per cent, concept of insurance is still not strong and people Body Q, Health Specialists leaving the majority of running costs having to be are reluctant to pay for anything if they can’t see an met by the hospitals themselves. This is why there immediate benefit,” he said.

The ITIC Hong Kong 2011 Farewell Function

www.itij.co.uk 34 ASSISTANCE&HEALTHCAREWORLDMARKETS

Brazil: the riches and the risks

Brazil is the largest country in South America and attracts around five million international visitors each year. David Kernek reveals the nature of assistance services in the country and how well equipped the hospitals are to deal with international patients

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 35

Brazil offers unmatched natural beauty, thousands of miles of to-die-for beaches and some of the world’s most exciting cities; and as an emerging economic superpower, it will soon be hosting two of the planet’s biggest sports events – the 2014 football World Cup and the 2016 Olympics. But a struggling public health sector and the high cost of private emergency services makes medical and repatriation insurance essential.

Safety first Holiday and business travellers preparing for their first visit to Brazil – and assessing the scope of the insurance cover they might need – would do well to avoid relying entirely on the encouraging overview offered by the Brazilian embassy in London. While conceding that ‘just like in London, Paris, New York or any other major metropolitan and tourist centre, petty crime in Brazil is an unfortunate fact of life’, the embassy’s information website attributes security fears to ‘urban myth’. It says that this vast country – the world’s fifth largest by both population and geographical area and ‘including the main cities of Rio, Salvador and Sao Paulo – ‘is no more dangerous than anywhere in Europe or North America and violent crimes against tourists or foreign visitors are extremely rare, hence the headlines if they do happen’. Extremely rare? The US government’s Bureau of Consular Affairs takes a somewhat less sanguine view. “Crime throughout Brazil,” it says, “has reached very high levels. Brazilian police and media report that the crime rate continues to rise, especially in the major urban centres, though it is also spreading in rural areas. Brazil’s murder rate is more than four times higher than that of the US.

Deep in the Amazon region … there are neither airstrips nor roads. Rescues may be possible only via water craft

Rates for other crimes are similarly high.” The UK’s Foreign and Commonwealth Office’s (FCO) travel advice strikes a similar tone: “Levels of violence and crime are high. Shanty-towns – favelas – exist in all major Brazilian cities; they are characterised by poverty and extremely high levels of violent crime. Do not venture into a favela even with well-organised tours, as favelas can be unpredictably dangerous areas. Outbreaks of violence, particularly aimed at police and officials, can occur at any time and may be widespread and unpredictable.” The ‘be very cautious’ theme is echoed in the advice given by the Canadian Foreign Affairs department. “Travellers should exercise a high degree of caution in Brazil due to high crime rates and regular incidents of gang-related and other violence.” Canadians are advised that drug and other illegal trafficking make remote and largely uninhabited border areas dangerous, and that ‘robberies involving tourists occur regularly, even during the day, and are sometimes violent’. They are urged to avoid unsupervised beaches and to ensure that their hotel is ‘totally secure’. “Foreigners,” they are warned, “have been victims of sexual assault.” Tourists are not immune from the increased risk of mugging at festivals, carnivals and big sports events, and visitors who think they would be safe on four wheels should take car-jacking into account. A 19-year-old Brazilian soccer star was murdered

www.itij.co.uk 36 ASSISTANCE&HEALTHCAREWORLDMARKETS

while resisting a car-jacking attempt this year, and in relied upon to keep tourists at a respectful distance 2010, an attack on a car taking England’s Formula 1 from jaguars and anacondas, if not poison arrow ace Jensen Button to his Sao Paulo hotel highlighted frogs, some species of which pack enough venom a crime wave that is said to be twice as high as to kill ten to 20 humans. So, what kind of medical South Africa’s. facilities are available to those in need? Car-jacking aside, the FCO also says that ‘Brazil has a high road accident rate’, while the US State Medicine matters Department’s assessment is somewhat blunter: The emergency health services that sick and injured “Brazil’s inter-city roads are widely recognised as foreigners might need mirror the severely lopsided among the most dangerous in the world.” The nature of the Brazilian economy. It’s a familiar Third UK’s road death toll of 3.8 per 100,000 people World-story of public scarcity and private abundance. compares with estimates ranging from 18.3 to 21.3 – “We are the world’s seventh-largest economy,” says approximately 35,000 each year – in Brazil. Cristovam Buarque, a professor at the University Furthermore, health and safety considerations for of Brazilia and a former minister of education, “but plucky, nature-loving holidaymakers heading for the 22 per cent of our population lives without running Amazon Basin River and the Panatal – the planet’s water and more than half without sewers. Forty- largest freshwater wetland accessed only by small three per cent of Brazilian homes – 25 million – are planes, motor-boats or a raised dirt road – include not considered adequate for habitation.” malaria, dengue fever and yellow fever, all caught Brazil’s state-run hospitals – which provide from mosquito bites. Experienced tour guides can be emergency treatment for foreigners free of charge, but only up to the point of stabilisation – have been studied in depth by Dr Christina Bloem, founder member and vice president of EMEDEX International, a New York-based organisation that promotes International SOS’s alarm centre in Philadelphia emergency medicine, disaster management and has handled more than 1,000 emergency calls public health. Brazilian governments, she says, have from travellers and expats in Brazil in the past attempted to improve emergency care to cater 12 months. Trauma injuries – usually from road for an increasing number of victims of road traffic accidents – and cardiovascular and circulatory accidents and violence, as well as the overcrowding system diseases are the most common reasons of emergency departments. “But emergency services for medical evacuations or repatriations. still lack a consistent standard of care. Since 50 per Tourists for whom we are responsible are Apart from medical emergencies requiring cent of medical school graduates in Brazil do not evacuation, the most frequent request the get residency positions, these new physicians with always directed to private hospitals and company receives from members in Brazil is minimal clinical training look for work in emergency for help scheduling an appointment with a local departments. In non-tertiary care centres – the clinics, where the standards of care, hygiene healthcare provider. majority of hospitals in the country – emergency Mondial Assistance Brazil reported 167 department physicians are largely under-trained, and technology are comparable to the best medical cases from December 2010 to March underpaid and over-stressed by their working 2011, ranging from influenza to cardiac arrests conditions. This has compromised patient care and hospitals in the USA and Europe and major traumas. created an incredible need for improvement in the emergency care system,” said Dr Bloem.

In addition, long waiting times, a lack of medical In remote areas, facilities are often primitive, or there equipment – and often air conditioning – and few, are none at all. In major cities, they can be equivalent if any, English-speaking staff are features of many of to those in developed Western regions,” he says. Brazil’s public hospitals, even though they account All of Brazil’s major cities have private hospitals for more than two-thirds of the government’s capable of handling trauma cases. The two that entire health budget. The country’s best private appear on all three of the ‘best’ lists provided by hospitals and clinics, however, are world-class, MAPFRE Asistencia, Mondial and AXA are in Sao helping to make Brazil a major medical tourism Paulo – Sirio Libanes and Hospital Israelita Albert destination: high quality cosmetic surgery – Einstein. Mondial’s Dr Sallovitz describes them as everything from nose jobs and tummy tucks to ‘the best in the country’. The Albert Einstein is the thigh lifts and sex changes – is a booming industry hospital of choice of expatriates who have sufficient in Sao Paulo and Rio, with approximately 400,000 health insurance cover. Currently being expanded procedures a year at costs 30 to 70-per-cent from 485 to 700 beds, it has pioneered minimally lower than those in the US. invasive and robotic surgery in Latin America. “Despite the existence of some very good public Private hospitals of note in the Amazon region are hospitals, most of them suffer from overcrowding Porto Dias in Belem on the Atlantic coast, and the and lack of governmental investment, which reduces 81-bed Santa Julia 1,064 miles distant at the very medical assistance and hygiene to a low quality level,” heart of the Amazon Basin in Manaus. The Santa says Dr José Sallovitz, medical co-ordinator for Julia has 12 emergency and six intensive care units, Mondial Assistance Brazil (MAB). “Tourists for whom and one team of English-speaking doctors. It also MAB are responsible are always directed to private stocks – perhaps unusually for a private hospital hospitals and clinics, where the standards of care, – anti-venom for snake bites. The ‘must-know’ hygiene and technology are comparable to the best information given to field staff on a biosphere hospitals in the US and Europe. The only exceptions project in Amazonia cautions: “Public hospitals are are in areas where there are only public hospitals. In usually the only hospitals that have anti-venom for those cases, if it is necessary after the first evaluation, MAB provides transport to a private hospital.” At the same time, while Ruy Vasconcellos of MAPFRE Asistencia says care standards in public and private sector hospitals are ‘very similar’, Dr Most of the approximately 180,000 British W Jorge Kalil, medical director of AXA Assistance nationals who visit Brazil each year have in Sao Paulo, points to the private health sector as trouble-free holidays and business trips, being ‘one of the best in the world, with hospitals says the UK’s Foreign and Commonwealth of an international standard of excellence’. State Office (FCO). In the year from April 2010 to hospitals of a similar standard can be found in some March 2011, British consular staff dealt with states, he says, ‘but tourists are usually taken to approximately 200 assistance cases, most of private hospitals, except when none are available in them occurring close to or in urban areas. the area’. “Assistance cases vary, but they often include International SOS has audited multiple healthcare lost or stolen passports or hospitalisation cases, facilities in Brazil, says its Americas region medical ranging from road crashes to pre-existing director, Dr Robert Quigley. “There is a wide range medical problems,” says the FCO. of standard of care, dependent primarily on location.

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 37

poisonous snakes and other venomous animal bites. charge whatever fee they want to a sick tourist. The Secretary of Health for each state furnishes There are no regulations in Brazil that dictate fees. anti-venom for public hospitals first. Since the As is the practice in most developing countries, supply is limited, they often cannot furnish anti- medical services in Brazil must be paid up front,” venom for private hospitals.” he says. “Corruption is limited when services are Language barriers are likely to be insurmountably procured and paid for by an organisation such steep in most public hospitals and in remote areas. as International SOS, which has established a The FCO says that tourists who are attended by relationship with the provider.” local emergency services are usually taken to public “When there are such problems,” says Dr Kalil,

Brazilian governments, she says, have attempted to improve emergency care to cater for an increasing number of victims of road traffic accidents and violence, as well as the overcrowding of emergency departments

hospitals, where they are entitled to emergency “AXA Assistance has staff members who specialise assistance. The main issue raised in these cases in resolving the issues.” Mr Vasconcellos reports is the communication problem, as most of the that hospitals used by MAPFRE Asistencia are medical staff do not speak English. Only large private ‘professional and reliable at all times’. hospitals have English-speaking staff, says Dr Kalil. Dr Sallovitz explains his network’s payment Dr Sallovitz says hospitals that also cater for foreign procedure: “When Mondial sends a patient to a patients seeking elective surgery will certainly have hospital, there is always a guarantee letter that goes multi-lingual staff from the attendant to the treating with him or her. The letter specifies the services doctors. that are covered at that time. If there is a need for admittance and additional treatment, the hospital Money matters sends a report to Mondial and the guarantee amount None of the major assistance organisations that ITIJ is raised as necessary. Sometimes, depending on the spoke to report significant problems with payment severity and the patient’s limit coverage, there may – either over-charging or asking for cash up front be problems over payment.” – for the treatment of insured patients, although So, what sort of treatment costs are uninsured Dr Quigley warns: “Individual practitioners can foreign patients in private hospitals looking at? Dr

www.itij.co.uk 38 PROFILE

How to prepare for Brazil

MAPFRE Asistencia: The most important thing is to keep vaccinations up-to-date … and bring your insurance certificate.

Mondial: Anyone who plans to visit Brazil must have insurance coverage for emergencies that could happen to anyone, from medical care to assistance with legal issues. For tourists from Europe or North America, there are vaccinations that must be had before leaving home. In remote areas, having a mobile phone is desirable.

International SOS: Corporate travellers and employees should be advised to do their homework, with a ten-topic list that includes vaccination requirements, information about the closest hospitals and their capabilities, and a written medical emergency response plan.

Kalil estimates them at ‘somewhere between those will cost around $23,000 (£14,166), and a stretcher charged in France and the US, and similar to the repatriation with a medical escort on a scheduled cost of the private sector in Germany’. Mondial’s flight to the UK, approximately $22,00 (£13,550). Dr Sallovitz says: “The cost in the best hospitals is The Serviço de Atendimento Móvel de Urgência often more expensive than for the same service in (SAMU) is the country’s state-funded medical Europe, but is normally much lower than American emergency response service, equipped with land levels. The total bill for treating a non-complicated and air ambulances carrying, if needed, intensive acute appendicitis in a good hospital would be care equipment and crewed by doctors and nurses. approximately US$10,000 (GB£6,160). It is, however, free only to Brazilian citizens, it takes patients only to public hospitals, and it is not known When in need… for neither speed nor reliability. Depending on where uninsured foreigners are in What help can foreigners in trouble on the country’s Brazil when misfortune strikes, getting to a hospital 4,600-mile coast, in the Panatal or the 2.7 million – or back to Britain on a repatriation flight – is square miles of Brazil’s share of the Amazon rain likely to be even more expensive than medical forest – in which the Amazon itself is the main road treatment: a 1,000-mile private air ambulance flight – expect? “The more remote the area, the more

“Individual practitioners can charge whatever fee they want to a sick tourist. There are no regulations in Brazil that dictate fees. As is the practice in most developing countries, medical services in Brazil must be paid up front”

challenging the evacuation is likely to be,” says Dr drives of Rio and Sao Paulo. Quigley at International SOS. “Deep in the Amazon The more remote the dive site, the further away region, near the Peruvian and Bolivia borders, there are medical centres with hyperbaric chambers. are neither airstrips nor roads. Rescues may be A report from the US-based Undersea and possible only via water craft.” Hyperbaric Medical Society identifies 65 coastal “Tourists tend to like places such as the Amazon – centres with mono- and multi-place chambers, 56 where access can be extremely difficult – and empty of which are privately-owned, with nine run by beaches,” says Dr Kalil. “This can sometimes hinder the Brazilian Navy. “There are many hyperbaric an emergency evacuation.” Mondial’s Dr Sallovitz chambers spread around the country – Sao Paulo, adds: “There are no government services to rescue Rio de Janeiro, Salvador, Recife and many other or transport injured tourists from remote areas, cities,” says Dr Jose Sallovitz of Mondial Assistance. unless there is a calamity situation such as floods, in “But they are not really close to most of the diving which case the army will provide that service. But regions. Brazil has more than 4,000 miles of coast, there are many private air ambulance companies which makes it impossible to be close to a specific who do that kind of job with great expertise.” place all the time.” n Furthermore, clear, warm water and an estimated 3,000 wrecks make Brazil’s 4,600-mile Atlantic coast a powerful magnet for serious scuba divers and snorkellers, the most favoured spot being Fernando de Noronha, a group of islands north of Recife. It is See also ITIJ’s World Focus on Latin America in a marine life sanctuary, and recommended for year- this year’s Assistance & Repatriation Review. round diving. There are also good sites within short

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24hr tel: +233 243 666 111 email: [email protected] tel: +49 211 301805-0 email: [email protected] tel: +233 302 781 258 website: www.westafrican-rescue.com fax: +49 211 301805-21 website: www.drkassistance.com ) AeroMed Asia Inc. European Air Ambulance Cindy Wong / Lorraine Paul – International Account Management Patrick Schomaker – Director Sales & Marketing SINGAPORE BANGKOK THAILAND 175A, rue de Cessange, L-1321, LUXEMBOURG

tel: +603 7965 3883 email: [email protected] 24hr tel: +49 711 7007 7007 email: [email protected] fax: +603 7629 8810 website: www.aeromed-asia.com fax: +49 711 7007 7009 website: www.air-ambulance.com AUSTRALASIA ( AirMed International LLC FAI – rent-a-jet AG Jeffrey T Tolbert – President Volker Lemke – Director Sales & Marketing Airport World Trade Center, 1 Sky Plaza Road, Flughafenstrasse 100, D-90268 Nuremberg, GERMANY Hong Kong International Airport, HONG KONG tel: +852 3756 3680 email: [email protected] tel: +49 911 36009 31 email: [email protected] fax: +852 3756 3681 website: www.airmedasia.com fax: +49 911 36009 59 website: www.rent-a-jet.de

CareFlight Group Greek Flying Doctors Medical and Tasking Centre Dimitris Kanellis – Manager PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE

24hr tel: +61 7 5553 5955 email: [email protected] tel: +30 210 674 0600 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

CareFlight International IFRA Paul Smith – National Manager Dr Christian Steindl – Director Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, AUSTRALIA Bahnhofplatz 13/5, POB 160, 3500 Krems, AUSTRIA

tel: (+61) 2 9893 7683 email: [email protected] tel: +43 2732 825 610 email: [email protected] fax: +61 2 9689 2744 website: www.careflight.org fax: +43 2732 851 01 website: www.ifra.at

Flying Doctors Asia Jet Executive International Charter Prithpal Singh – CEO , Director Irena Dimitrijevic – Marketing & Sales 313 Old Bird Cage Walk, #01-15/02-16, Seletar Airport, Mündelheimer Weg 50, D-40472, Düsseldorf, GERMANY SINGAPORE “Homebase FRA & MUC” 24hr tel: +65 9297 7757 email: [email protected] tel: +49 211 602 7775 email: [email protected] fax: +65 6483 5407 website: www.flyingdoctorsasia.com fax: +49 211 602 77766 website: www.jetexecutive.com

Hope Medflight Asia Pte Ltd Mayoral Executive Jet Dr Charles Johnson – Medical Director Juan Carlos García Caparrós – Commercial Director 2 Loyang Lane 03-01, Singapore 508913, SINGAPORE Dominguez Toledo S.A., 118 La Orotava, Malaga 29006, SPAIN

24hr tel: +65 6100 1911 email: [email protected] tel: +34 952 048 609 email: [email protected] fax: +65 6400 5254 website: www.hope-flight.com fax: +34 924 048 612 website: www.mayoralaviation.com

Medic’Air International 每递安国际 Medic’Air International Dr Huaqun Gao – Medical Director Dr Herve Raffin – General Manager 885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE

tel: +86 2163 558289 email: [email protected] tel: +33 141 72 1414 email: [email protected] fax: +86 2163 558285 website: www.medic-air.com fax: +33 148 57 1010 website: www.medic-air.com

ADAC-Ambulance Service North Flying a/s Robert Glueck – Marketing & Sales Director Jesper Kragelund – Sales Manager Am Westpark 8, 81373 Munich, GERMANY North Flying Terminal, Aalborg Airport, DK-9400, Nørresundby, DENMARK

tel: +49 89 76 76 52 85 email: [email protected] tel: +45 9632 2900 email: [email protected] (EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance fax: +45 9632 2909 website: www.northflying.com

Air Medical Ltd Redstar Aviation Glenn Salt – Flight Operations Manager Mustafa Atac – CEO Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +44 1865 842 887 email: [email protected] tel: +90 216 588 0216 email: [email protected] tel: +44 1865 370 642 website: www.airmed.co.uk fax: +90 216 588 0225 website: www.redstar-aviation.com

International Travel Insurance Journal call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 41

) Swiss Air Ambulance / Rega AIMS Peter Meierhans – Director of Sales Bernadette Breton – Managing Director PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA

tel: +41 333 333 333 email: [email protected] (AFRICA) tel: +00 27 11 783 0135 email: [email protected] EUROPE

( fax: +41 44 654 3590 website: www.rega.ch fax: +00 27 11 783 2950 website: www.aims.org.za

Tyrol Air Ambulance AMREF Flying Doctor Service Jakob Ringler – Managing Director Dr Bettina Vadera – Medical Director AIR AMBULANCE PO Box 81, A-6026, Innsbruck Airport, AUSTRIA Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +43 512 224 220 email: [email protected] tel: +254 20 6000 090 email: [email protected] fax: +43 512 288 888 website: www.taa.at fax: +254 20 344 170 website: www.amref.org ASSISTANCE COMPANIES ASSISTANCE

Aero Jet International Interhealth Technologies Stuart Hayman – President Kevin Thomas – Director - International 4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA P O Box 3058, Bedfordview 2008, SOUTH AFRICA

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

Air Ambulance Professionals, Inc. Medical Services Organisation (MSO) Brian L. Weisz – President Vernon Pillay – Operations Director - International Division Ft. Lauderdale Executive Airport, 1535 South Perimeter Rd, PO Box 1578, Gallo Manor, 2052, SOUTH AFRICA Hangar 36B Ft. Lauderdale, Florida 33309, USA tel: +1 954 491 0555 email: [email protected] tel: +27 (0)11 259 5403 24hr email: [email protected] fax: +1 954 491 6114 website: www.airambulanceprof.com fax: +27 (0)11 259 5001 website: www.mso.co.za

Air Ambulance Specialists Netcare 911 International Tom Cox – Director of Business Development Louis Mabele – International Assistance Operations Manager 345 Inverness Drive South, Suite A110, Englewood, Colorado, 80112, USA Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA

tel: +1 720 875 9182 email: [email protected] tel: +27 (0)10 209 8387 24hr email: [email protected] fax: +1 720 875 9183 website: www.airaasi.com fax: +27 (0)10 209 8405 website: www.netcare911.co.za

AirMed International LLC West African Rescue Association Jeffrey T Tolbert – President Florian Zagel – Managing Director (NORTH AMERICA) 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA Klotey Cresent 6, North Labone, Accra, GHANA

tel: +1 205 443 4840 email: [email protected] tel: +233 244 312 496/7 email: [email protected] fax: +1 205 443 4841 website: www.airmed.com fax: +233 21 781 259 website: www.westafrican-rescue.com

Global Jetcare, Inc. On Call International Bart Gray – President Michael J. Kelly – President & CEO 16479 Runway Drive, Brooksville, FL 34604, USA One Delaware Drive, Salem, NH 03079, USA

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

JET ICU GORAL ASSISTANCE CANADA INC. Mike Honeycutt – President David Ohayon – Local Manager 2561 Rescue Way, Brooksville, FL 34604, USA 2335 Stevens St, VSL, Montreal, QC H4M 1H1, CANADA NEW tel: +1 352 796 2540 email: [email protected] tel: +1 514 4481343 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com fax: +1 514 4481835 website: www.goralassist.com (AMERICAS) Latitude Air Ambulance SelectCare Worldwide Jeff McIntosh Magdi Riad – President CANADA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA USA tel: +1 289 426 1133 email: [email protected] tel: +1 416 340 7265 email: [email protected] fax: + 1 289 426 1134 website: www.latitude2009.com toll free: +1 866 261 6718 website: www.selectcareworldwide.com

LIFESUPPORT Patient Transport World Travel Protection Graham Williamson – CEO David McLean – Vice President, Sales & Marketing #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA 400 University Avenue, 15th Floor, Toronto, ON, M5G 1S7, CANADA

tel: +1 250 947 9641 email: [email protected] tel: +1 416 205 4646 email: [email protected] fax: +1 877 288 2908 website: www.LifeSupportTransport.com fax: +1 416 205 4676 website: www.wtp.ca

Skyservice Air Ambulance Assistance Online David Ewing – VP International Business Development Bertrand Guichoux – CEO Montreal/PE Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA H9P 1A2, CANADA tel: +1 514 497 7000 email: [email protected] tel: +86 21 6104 9500 email: [email protected] fax: +1 514 636 0096 website: www.skyservice.com/airambulance fax: +86 21 6104 9484 website: www.assistanceonline-china.com

Dynamiq

To have your company listed in our service directory (AUSTRALASIA) Janine Benson – Director of Emergency Assistance contact the sales department now: Level 5/33 York St, Sydney 2000, NSW, AUSTRALIA [email protected] or telephone: +44 (0)117 922 66 00 tel: +61 (0) 2 9978 6600 email: [email protected] fax: +61 (0) 2 9888 3609 website: www.dynamiq.com.au/assist

www.itij.co.uk 42 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

First Assistance Marm Assistance Mary-Jo McDonald – General Manager Jill Atac – CEO PO Box 17-310, Greenlane, Auckland, NEW ZEALAND Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +64 9 356 1650 email: [email protected] tel: +90 216 588 0588 email: [email protected]

fax: +64 9 525 1278 website: www.firstassistance.co.nz (EUROPE) fax: +90 216 588 0602 website: www.marmassistance.com

Global Assistance & Healthcare med con team GmbH

(AUSTRALASIA) Mario Babin – Chief Executive Officer Michael Weinlich – Managing Director Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Gerhard-Kindler-Str.6, 72770 Reutlingen, GERMANY Jakarta 12560, INDONESIA tel: +62 21 299 78 999 email: [email protected] tel: +49 7121 433 660 email: [email protected] fax: +62 21 299 78 9555/66 website: www.global-assistance.net fax: +49 7121 433 619 website: www.medconteam.com ASSISTANCE COMPANIES ASSISTANCE ASSISTANCE COMPANIES ASSISTANCE ADAC-Ambulance Service ONE Assist Robert Glueck – Marketing & Sales Director Linda Norman – Group Client Relationship Manager C/Cardenal Rossell No.1, Esc. A 2˚. Desp 8-9, Palma de Mallorca 07007, Baleares, Am Westpark 8, 81373 Munich, GERMANY SPAIN tel: +49 89 76 76 52 85 email: [email protected] tel: +44 (0) 1992 708 700 email: [email protected]

(EUROPE) 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance 24 tel: +44 (0) 1992 405 718 website: www.oneassist.com

Altas Assistance Save Assistance France Arvydas Bebravi˘cius – Managing Director Franck Molinier – Director of Business Development Lentvario Str. 7, Lt-02300 Vilnius, LITHUANIA 19 rue de Provence, 78310 Maurepas, FRANCE

tel: +370 5 264 4020 email: [email protected] tel: +33 13062 6752 email: [email protected] fax: +370 5 264 4021 website: www.altas-assistance.lt 24 tel: +33 13062 1122 website: www.saveassistance.com

AP Companies Savitar Natalya Butakova – Business Development Manager Lydia Semchenkova – Business Development Manager 17 Varshavskoye Shosse, Moscow 117105, RUSSIA 25/1, 7th Floor, Trubnaya Str., Moscow, 127051, RUSSIA

tel: +7 495 989 1120 email: [email protected] tel: +7 495 987 1775 email: [email protected] fax: +7 495 989 1130 website: www.ap-companies.ru fax: +7 495 987 1776 website: www.savitar-gr.com

ARC Europe SA SOS International Hans Biekmann – Network Director Helle Drager Sandahl – Communications & Marketing Manager Avenue des Olympiades 2, 1140 Brussels, BELGIUM Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: +32 2 706 6660 email: [email protected] tel: +45 7010 5055 email: [email protected] fax: +32 2 706 6601 website: www.arceuropemedical.com fax: +45 7010 5056 website: www.sos.eu

CNAS TBS Team 24 d.o.o Carole Luisy – Managing Director Edvard Hojnik – General Manger 80 rue des alliés, 38100, Grenoble, FRANCE CROATIA, SLOVENIA, SERBIA, MNE, BH, KOS, MAC

tel: +33 438 49 83 49 email: [email protected] tel: +386 2616 5819 email: [email protected] fax: +33 438 49 83 40 website: www.cnas-assistance.com fax: +386 2618 5800 website: www. tbs-team24.com

DRK Assistance CONNEX Assistance Middle East Andreas Speich – Managing Director Lara Helmi – International Network Director Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY Office 703, Block B, Belrasheed Towers, Qusais, Dubai, UAE

tel: +49 211 301805-0 email: [email protected] tel: +97 14 257 82 84 email: [email protected] fax: +49 211 301805-21 website: www.drkassistance.com fax: +97 14 257 82 85 website: www.connexassistance.com (MID. EAST)

Global Assistance a.s. GORAL ASSISTANCE LTD Petr Bold – General Manager Marcel Kadoche – International Network and Development Manager Dopraváku˚ 749/3,184 00 Prague 8, CZECH REPUBLIC Maskit 27 str. Herzeliya Industrial Park 46733, ISRAEL NEW tel: +420 266 799 770 email: [email protected] tel: +972 9 9579930 email: [email protected] fax: +420 266 799 797 website: www.1220.cz fax: +972 9 9579931 website: www.goralassist.com

Global Voyager Assistance - Russia IES Medical Costas Danilenko – CEO Eitan Kariv – CEO PO Box II, 125124 Moscow, RUSSIA 2 Yagea Kapaim Street, Tel Aviv, ISRAEL

tel: +7 495 775 0999 email: [email protected] tel: +972 3 639 9990 email: [email protected] fax: +7 495 775 0998 website: www.gvassistance.com fax: +972 3 687 2950 website: www.iesmedical.co.il

Global Voyager Assistance - Black Sea Dr Colin Plotkin & Sons Consulting INC. Olga Turubarova – General Manager Dr Colin Plotkin – Managing Director 77-79 Nezhinskaya Str., 65023, Odessa, UKRAINE 27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: +38 048 7373 441 email: [email protected] tel: +1 604 241 9677 email: [email protected] fax: +38 048 7373 442 website: www.gvassistance.com fax: +1 604 241 0733 website: www.plotkinconsulting.com

Greek Flying Doctors To have your company listed in our service directory

Dimitris Kanellis – Manager CATASTROPHIC 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE contact the sales department now:

tel: +30 210 674 0600 email: [email protected] CLAIMS SPECIALISTS [email protected] or telephone: +44 (0)117 922 66 00 fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

International Travel Insurance Journal call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 43

AIMS UnitedHealth International Bernadette Breton – Managing Director Philip Brun – Vice President of Sales & Service Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA 3100 SW 145 Avenue, Miramar, FL 33027, USA

tel: +00 27 11 783 0135 email: [email protected] tel: +1 954 378 0694 email: [email protected] (AFRICA) fax: +00 27 11 783 2950 website: www.aims.org.za fax: +1 954 378 0771 website: www.uhgi.com (AMERICA) COST CONT. Interhealth Technologies Global Assistance & Healthcare Kevin Thomas – Director - International Mario Babin – Chief Executive Officer Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, P O Box 3058, Bedfordview 2008, SOUTH AFRICA Jakarta 12560, INDONESIA COST CONTAINMENT tel: +27 11 622 8010 email: [email protected] tel: +62 21 299 78 999 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +62 21 299 78 9555/66 website: www.global-assistance.net

Medical Services Organisation (MSO) Global Excel Management Vernon Pillay – Operations Director - International Division Michael Drew – Vice President of Sales 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA PO Box 1578, Gallo Manor, 2052, SOUTH AFRICA 17548 Deer Isle Circle, Winter Gdn, FL 34787, USA tel: +27 (0)11 259 5403 24hr email: [email protected] tel: +1 866 566 1130 email: [email protected] fax: +27 (0)11 259 5001 website: www.mso.co.za fax: +1 819 566 8335 website: www.globalexcel.ca CLAIMS MANAGEMENT

ChargeCare International Interhealth Technologies Christiane Burniston – Managing Director Kevin Thomas – Director - International Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK P O Box 3058, Bedfordview 2008, SOUTH AFRICA

(EUROPE) tel: +44 1865 400 007 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +44 845 003 9923 website: www.chargecareinternational.co.uk fax: +27 11 622 8264 website: www.interhealth.net

Marm Assistance ONE Claims Jill Atac – CEO Linda Norman – Group Client Relationship Manager Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY 1-4 Limes Court, Conduit Lane, Hoddesdon, Hertfordshire EN11 8EP, UK

tel: +90 216 588 0588 email: [email protected] tel: +44 (0) 1992 708 700 email: [email protected] fax: +90 216 588 0602 website: www.marmassistance.com 24 tel: +44 (0) 1992 405 718 website: www.oneassist.com

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

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

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

Global Medical Management LIFESUPPORT Patient Transport Raija Itzchaki – COO Graham Williamson – CEO (NORTH AMERICA) 1300 Concord Terrace, Suite 300, Sunrise, Florida 33323, USA #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA

tel: +1 954 370 6404 email: [email protected] tel: +1 250 947 9641 email: [email protected] fax: +1 954 370 8613 website: www.gmmusa.com fax: +1 877 288 2908 website: www.LifeSupportTransport.com

Olympus Managed Healthcare SPECIALISTS Voyageur Aeromedical Travel Steven Jacobson – CEO Marc Lucas – General Manager 777 Brickell Avenue, Suite PH70, Miami, Florida 33131, USA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: +1 305 530 8600 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

fax: +1 305 530 0766 website: www.omhc.com COMM. REPATRIATION fax: +44 (0)117 925 5940 website: www.voyageur24.com

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

tel: +1 604 303 2113 email: [email protected] tel: +49 89 7676 2912 email: [email protected] fax: +1 604 276 4593 website: www.oneworldassist.com 24hr Alm: +49 89 7676 5005 website: www.adac.de/ambulance TRANSPORT SelectCare Worldwide Lufthansa Medical Services Magdi Riad – President Doris Ehring – Manager Sales & Marketing Lufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Frankfurt/Main, GERMANY tel: +1 416 340 7265 email: [email protected] tel: +49 (0)69690-20904 email: [email protected] toll free: +1 866 261 6718 website: www.selectcareworldwide.com fax: +49 (0)69690-58147 website: www.dlh.de CRITICAL CARE PATIENT CRITICAL CARE PATIENT

Star Healthcare Albin Repatriation Ltd Gigi Galen – President Emerson De Luca – General Manager 850 7th Avenue, Suite 803, New York, 10019, USA 83 Westbourne Grove, Bayswater, London W2 4UL, UK

tel: + 1 212 581 8228 email: [email protected] tel: +44 20 7313 6920 email: [email protected] FUNERAL fax: + 1 212 581 8272 website: www.starhealthcarenet.com DIRECTOR fax: +44 20 7313 6999 website: www.albininternational.com

www.itij.co.uk 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Funeral Home AURIGA Ltd. Vejthani Hospital Helen Pradova – Chief of International Department Lauranee Sirikasem – Assistant Marketing Director 1 Ladprao Road 111, Klong-Chan Bangkapi, Bangkok 10240, B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC (ASIA) THAILAND tel: +420 724 257 899 email: [email protected] tel: (+66)-2-734-0000 email: [email protected] fax: +420 416 735 800 website: www.funeral-assistance.cz fax: (+66)-2-370-1596 website: www.vejthani.com HOSPITALS HOSPITALS

Funeralcare International CareFlight Group Louisa Killen – Repatriation Specialist Medical and Tasking Centre Murray House, 50 Whitta Road, Manor Park, London, Essex E12 5DA, UK PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA

FUNERAL DIRECTORS tel: +44 20 8788 5303 email: [email protected] 24hr tel: +61 7 5553 5955 email: [email protected] fax: +44 20 8788 2525 website: www.co-operativefuneralcare.co.uk fax: +61 7 5553 5914 website: www.cmsairambulance.com

John Allison Monkhouse Co., Ltd (Thailand) CareFlight International

Apple Kaewprasert – General Manager (AUSTRALASIA) Sue Robshaw – Co-ordinator President Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, Klongtoey, Bangkok, THAILAND AUSTRALIA tel: +66 2382 5345-7 email: [email protected] tel: +61 1300 655 855 email: [email protected] fax: +66 81 584 5942 website: www.monkhouse.com.au fax: +61 2 9689 2744 website: www.careflight.org

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

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

Mortuary Brussels Airport | Worldwide Funeral Repatriations part of DELA AMREF Flying Doctors Greta Plas – Repatriations Manager Dr Bettina Vadera – Medical Director

Ringlaan 49, 1930 Zaventem, BELGIUM MEDICAL ESCORT ON COMMERCIAL AIRLINES Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +32 2 720 80 00 email: [email protected] (AFRICA) tel: +254 20 6000 090 email: [email protected] fax: +32 2 720 88 22 website: www.repatriations.com fax: +254 20 344 170 website: www.amref.org

Rowland Brothers International Greek Flying Doctors Melanie Walkling – Partner Dimitris Kanellis – Manager 299-305 Whitehorse Road, West Croydon, Surrey CR0 2HR, UK 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE

tel: +44 20 8684 2324 email: [email protected] tel: +30 210 674 0600 email: [email protected] fax: +44 20 8684 8000 website: www.rowlandbrothersinternational.co.uk (EUROPE) fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

Servilusa Redstar Aviation Vanda Castro – Manager International Department Mustafa Atac – CEO Agencias Funerarias SA, International Dept. Rua do Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY Entreposto Industrial, 8-2 Esq, 2610-135 Amadora, PORTUGAL tel: +35 121 470 6300 email: [email protected] tel: +90 216 588 0216 email: [email protected] fax: +35 121 470 6499 website: www.servilusa.pt fax: +90 216 588 0225 website: www.redstar-aviation.com

USP Hospitales S.L Voyageur Aeromedical Travel Francisco Rico – International Relations Manager Marc Lucas – General Manager C/Miguel Angel, 23 3˚, 28010 Madrid, SPAIN Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: + 34 951 91 30 30 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

(EUROPE) fax: + 34 951 91 30 40 website: www.usphospitales.com fax: +44 (0)117 925 5940 website: www.voyageur24.com HOSPITALS HOSPITALS Baptist Health South Florida International Services AMREF Flying Doctor Service Yohandra Fuentes – Assist V-P/Int. Insurance Dev. & Revenue Mangement Dr Bettina Vadera – Medical Director 8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +1 786 596 2373 email: [email protected] tel: +254 20 6000 090 email: [email protected] fax: +1 786 596 5979 website: www.baptisthealth.net/international fax: +254 20 344 170 website: www.amref.org (N AMERICA) Integrated Healthcare Services StandbyMD Brenda Escobar - International Program Coordinator Alex Sánchez – Managing Director 450 E. Las Olas Blvd., Ft. Lauderdale, FL 33301, USA 777 Brickell Avenue, Suite 1370, Miami, Florida 33131, USA MEDICAL PROVIDER tel: + 1 305 222 6750 email: [email protected] tel: +1 305 459 4882 email: [email protected] tel: + 1 305 222 6751 website: www.hcaeastflorida.com fax: +1 305 421 5575 website: www.standbymd.com

Jackson Memorial Hospital International Voyageur Aeromedical Travel Luis Felipe Arango – Vice President of International Business Marc Lucas – General Manager Jackson Medical Towers, East Tower, Suite 829, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK 1500 NW 12th Avenue, Miami, FL 33136 - 9998, USA TRAVEL TRAVEL

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International Travel Insurance Journal call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 45

www.itij.co.uk 46 REGULARS

• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPEVINE • GRA PEVINE VINE GRAPE - - Grapevine Parrots on the piste

While it is fairly common to take your beloved dog or sometimes cat on holiday with you, news has emerged of a British woman who chooses to take her pet cacique parrots on holiday with her – even while skiing! Jane Hartley said she rarely leaves home without her beloved parrots, Fizz and Buzz, on her arm, and they are even invited on the family’s Mutiny onboard Holiday rescuers annual skiing holiday in the Alps, sitting snugly in the pocket of her ski trousers as she swooshes passenger jet rewarded down the mountain. She said: “I know that if I kept them in a cage all the time they would have A seven-hour delay for passengers who were Travel Guard North America has recently launched a miserable existence, so I take them out and already onboard their Middle East Airlines plane its latest competition, World’s Unluckiest Traveller about with me. I do get a lot of people stopping waiting to fly from Heathrow to Beirut recently 2: The Rescue, which allows people to share how and staring, but most seem to find it quite caused a mutiny on the aircraft, prompting the one kind person saved their day while travelling. amusing. They are only small birds so they are police to intervene. The airport authorities were The company said at the launch of the competition: easy to carry around.” called after some of the passengers attempted “Travel Guard knows first-hand how one good to grab the captain as the situation on the aircraft deed can turn a travel nightmare into a dream come descended into chaos. One witness described the true. So whether someone came to the rescue in situation as ‘something out of Lord of the Flies’ – a an emergency, a flight attendant personally carried Luggage stowaway novel where a group of schoolboys left on an island a passenger’s bag, or a traveller gave up their airline become savage and anarchic. seat to a fellow passenger, Travel Guard wants to stealers The problems began when the aircraft missed hear about these random acts of kindness.” its departure slot, and as the delay went from The story that wins, as voted for by the public, A Polish contortionist and his accomplice were minutes into hours, tempers began to fray. One will be awarded a $10,000 holiday. Entries will be recently arrested in Barcelona, Spain, for witness said: “The stewards told us there would accepted until 5 September, and a few weeks later stealing from travellers’ checked in luggage after be delays … after four hours, one man had a bit the 10 best stories will be chosen by a panel of travel the Pole managed to fit himself into a suitcase too much to drink and began bouncing around experts. In October, the public will get the chance to and was stowed in the luggage hold in an and had to be removed. The atmosphere was vote for their favourite story. airport transit bus. The two men were arrested very tense and a middle-aged man told the when an employee of the bus company crew member he was an idiot, and that was became suspicious after he noticed a man was did not belong to him. It transpired afterwards when the pushing and shoving began. The struggling to lift his heavy suitcase out of the that the robber used a headlamp to see the captain came out once and I told him he had bus at the end of the journey. When officers luggage from which he was pilfering in the hold. failed in his duty, to which he replied that I opened the suitcase, they found a very sweaty A spokesperson for the Catalan police said: “I believe VCD-121-qtrstrip-p39.pdf 1 24/01/2011 16:08 should fly the plane.” 5’8” thief holding a laptop and GPS device that this is what the British call ‘an open and shut case’.”

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CY We provide concise www.vcreativedesign.co.uk CMY creative solutions for the [email protected] K travel insurance industry. If you want to discuss Tel: +44 (0)117 929 46 36 your marketing needs or design requirements do V Creative Design, get in touch with us at Voyageur Buildings, 43 Colston Street, our Bristol office. Bristol, BS1 5AX, UK

International Travel Insurance Journal ONTHEMOVE 47

CEGA expands InterGlobal chooses Mike Kelly new UStiA president global risk team Young Michael J Kelly has been named president of the forum in which the industry can engage on best US Travel Insurance Association (UStiA), a national practices, challenges and innovative solutions, while CEGA Group Service, a provider of emergency International private medical insurer (PMI) organisation representing travel insurance carriers also acting to educate the public about the need for assistance and claims management, has appointed InterGlobal has appointed John Young as country and agencies, third-party administrators, travel travel cover. a development manager of global risks in order manager for Qatar, with responsibility for building assistance providers and related businesses. Kelly Jim Grace, past president, commented on the to meet the growing demand for its medical risk distribution and sales of individual and group PMI for is also president and chief executive of On Call appointment: “We are honoured to have Mike Kelly management and emergency assistance services the company’s operations in Qatar. He will report International, a provider of medical, security and as our new president. Kelly brings more than 25 in hostile and remote locations. Juan Peña Núñez, to Mike Delamere, InterGlobal’s regional general travel assistance services. In his new role, Kelly’s years of successful experience and thought leadership taking on the role, has over a decade of experience manager in the Middle East. Young has 26 years of responsibilities include directing the growth strategy within the travel industry. We are certain he will of managing the logistics of assistance, medical experience in domestic and international PMI, both in for the association to continue providing a positive provide a significant contribution to the UStiA.” evacuation and international repatriation, particularly client facing and technical roles. He joins InterGlobal in hostile areas of the world. from Europ Assistance, where he was a senior Rob Upton, director of sales and marketing for the business development manager responsible for the company, said: “As global travel to challenging areas sales and marketing of the company’s corporate Tice joins EA USA increases, this appointment demonstrates CEGA’s expatriate health insurance range of products. commitment to maintain and develop services to Previously, he was health claims manager for AIG Europ Assistance USA (EA USA) has announced innovative solutions to the corporate market. meet clients’ future needs. It will strengthen our legacy Europe and also managed the employee benefits that Gary Tice, a 20-year travel assistance industry With our new products and services, he will lead of managing medical risks and providing emergency division for AXA Gulf/Alliance Insurance in the veteran, has joined the company as corporate sales a team that will differentiate us in this competitive assistance for niche clients such as government Middle East. manager. Credited as the creator of innovative and environment by providing alternatives that are not yet agencies, landmine clearance operatives, humanitarian Mike Delamere commented on the appointment: market-leading products and services that have available in the US markets.” aid workers, the energy industry and others.” “The country manager is one of the most important become the standard of today’s travel assistance Before joining EA USA, Tice held high-level positions roles at InterGlobal. Our country managers are the industry, Tice now drives EA USA’s corporate sales with On Call International, Medaire Inc., HTH face of the company to our corporate and individual and client retention strategy, helping to promote Worldwide, AIG International and International SOS. clients and are also responsible for increasing sales of and drive increased sales of the company’s our individual and group PMI plans.” He added: “John corporate security products, including emergency brings extensive experience of the PMI market to assistance, data breach response and ID theft InterGlobal from both a client-facing and back office resolution services. perspective and has the ideal combination of skills In his long career, Tice developed the first required to succeed as a country manager.” comprehensive travel and security assistance programme for the corporate market, leading a team that launched the first online medical and security information and alert subscription service, and was instrumental in creating an executive assistance card. Dang appointed Glenn Maykish, vice-president of sales and marketing for EA USA, commented on the appointment: “Gary at 1Cover is established in the multinational corporate space Juan Peña Núñez and well positioned to help EA USA achieve our In line with plans to expand throughout Asia, insurer objectives of aggressive top-line growth by providing Gary Tice 1Cover has announced the appointment of Zeena Rowland Bros hires Dang as the region’s business development manager. A Singaporean local and familiar face to the industry, Greenwood Dang spent the past three years of her career Cigna names Nicoletti working with a global travel insurer, and brings to her Rowland Brothers International has recently new role strong knowledge of local products, insights US-based health insurer Cigna has announced the commented on the appointment: “Ralph is an appointed Fiona Greenwood as manager for the into the industry and an understanding of local appointment of Ralph Nicoletti as executive vice- experienced global leader with the skills, strategic company’s International Department. Greenwood expectation towards travel insurance. president and chief financial officer of the company, as vision and passion to deliver strong results for our has 25-plus years’ management experience in the Eddie Feltham, managing director of 1Cover, of 20 June. Nicoletti has assumed executive leadership customers and shareholders. He is ideally suited to assistance and travel claims industry. said he was pleased with the company’s growth responsibility for all of Cigna’s financial operations and enable the execution of our growth strategy to best Melanie Walking, partner at the funeral director, in Singapore and is certain that Dang is the right functions, as well as for the company’s investment service our customers and shareholders.” said: “Fiona’s proven leadership and organisational person to drive further success for the brand in management and strategic planning units. Nicoletti succeeds Thomas McCarthy, who was skills, coupled with her knowledge of the assistance the wider Asia area. He added: “1Cover is still Nicoletti brings with him decades of experience named acting chief financial officer in September industry, will enhance the services we provide to our relatively new to the Singaporean market so it is a and success driving growth and realising efficiencies 2010; McCarthy now assumes the position of clients.” Previously, Greenwood worked at Medex, very exciting time for Zeena to take the reins. It is in industries focused on meeting and exceeding vice-president of finance. Cordani said: “We were Mercury and IAG. our plan to grow throughout Asia and Singapore customer needs. Most recently, he served as fortunate to have someone with Tom’s institutional Rowland Brothers International has also recently will be our base.” executive vice-president and chief financial officer of knowledge and experience to seamlessly lead the appointed Justyna Kaminska. Although Polish by 1Cover Insurance Singapore is a travel insurance Alberto-Culver, Inc. in Chicago, a manufacturer and financial operations during this interim period. nationality, she studied at University in Florence, Italy, specialist underwritten by Tokio Marine, with marketer of personal care and household brands I thank Tom for being a strong strategic advisor and speaks fluent Italian. Kaminska brings with her a emergency assistance cover provided by recently acquired by Unilever. among the executive leadership team and allowing wealth of experience in international consultancy. Mondial Assistance. Chief executive officer of Cigna David Cordani us to effectively execute on our growth strategy.”

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