ESSENTIAL READING FOR TRAVEL INSURANCE INDUSTRY PROFESSIONALS WWW.ITIJ.CO.UK NOVEMBER 2010 • ISSUE 118 Canadians warned

The Travel Health Association of Canada (THIA) has told Canadian snowbirds they should have proof of private health insurance in place prior to leaving the country this winter. Sarah Watson has the details

THIA states that private insurance is ‘essential’ for all winter destinations, but in particular for the US, where soaring health costs and uncertainty about the future of healthcare reform is forcing many economically stressed hospitals to demand up-front deposits or direct payment arrangements for patients who cannot prove they have insurance coverage. David Hartman, current president of THIA, commented on the situation: “The relentless increase in healthcare costs worldwide makes international travel insurance absolutely essential, even for one-day trips, as provincial health insurance reimbursements for out-of-country medical services don’t come close to covering foreign hospital bills Strength in numbers Mondial Assistance UK is calling for fellow travel the fi rms to prevent multiple fi ctitious claims – made of concern is personal possessions and baggage’. insurers to get behind a number of industry to a number of insurers – even if the policyholder has “In some cases,” he continued, “the whole claim initiatives to tackle fraud. Mandy Aitchison reports used different names in their attempt to defraud. is false and the growth of websites that sell fake Other moves by Mondial that could easily be receipts is further adding to the problem. We “There’s no question that the travel insurance adopted by other travel insurers is expert training estimate that up to 50 per cent of all claims for that can total thousands of dollars per day.” sector is facing tough times,” says Mike Webb, chief of call handlers, according to Webb: “Training has baggage and personal possessions may be infl ated, THIA has offered a number of helpful suggestions executive offi cer of Mondial Assistance in the UK. been given to the Mondial travel claims teams or completely false.” to travellers, including one that will resonate with “There is no need to list the catalogue of events that to help them identify the behavioural ‘shows’ Webb went on to ask: “As this is such a costly problem travel insurers around the globe: don’t buy on have made 2010 a year not to be remembered! that could suggest fraud. There is also a system for all travel insurers, why is there such a lack of focus price alone – all policies need to fi t the health However, the industry has the ability to deal with its of ‘red-fl agging’ customer responses to key on this? It is enormously disappointing that even after profi le of the person travelling. Hartman added: two largest problems – low premium income and questions asked as part of the claims process.” If many years of discussion, the travel insurance industry “There are a lot of travel insurance products in the fraud, but still fails to tackle these issues.” Mondial a claimant makes three ‘red fl ag’ comments, the still haven’t joined forces to create a generic system to marketplace and very few Canadians who don’t Assistance has been working with four other insurers case is passed on to a fraud manager for further prevent fraud. It is a relatively simple problem to resolve qualify for some level of coverage. For those with in order to create a shared database for all claims, investigation. According to Webb, although the and it’s worked in other sectors of the insurance industry medical conditions, the best way to purchase travel which creates a risk score, allowing the companies to company does see some attempts at fraudulent such as the Claims Underwriting Exchange.” insurance is to deal with a qualifi ed adviser who improve their fraud detection rates. It has also helped medical and cancellation claims, ‘the major area ITIJ asked Julie Remmington continued on p5 deals extensively in travel insurance.”

4 NEWS

IN THIS ISSUE ITIJ CONTRIBUTORS

REGULARS Tatum Anderson is a freelance international health and technology business writer with a decade of experience. Her News continued 5 specialist subjects include emerging markets, business, health and public health policy. She has written for a variety of publications, Editorial comment 6 including The Economist, Guardian Weekly, BBC News Online, Wall Company brief 9 Street Journal Europe and the Financial Times. Insurance matters 10 Gerry Bolger MHM, RN, is a freelance in-flight nurse Health matters 15 and policy advisory on pressure ulcers at the Department of Travel matters 16 Health, England. He is also the programme director for the Quality in Caring work within the Chief Nursing Officer’s (CNO) IPMI news 18 Directorate at the Department of Health. As well as being a Cross-border care 20 registered nurse, Gerry also holds a Masters’ degree in health management. He formerly led the Royal College of Nursing Air ambulance news: 22 In-flight Nurses Association as their chair for eight years and has ITIJ Awards 26 been involved in clarifying issues on medicines administration in that role. Service directory 43 Grapevine 50 Milan Korcok is an award-winning freelance health policy On the move 51 and economics writer who covers travel insurance, public health, and medical education issues in Canada and the US. He has been writing about health financing and policy issues in these countries since the 1960s, is a frequent contributor to leading North American professional journals and consumer media, and is publisher of the consumer website www.travelinsurancefile.com. FEATURES He lives in Fort Lauderdale, Florida.

Feature: Doctors! Please do no harm! 28 ITIJ asks if general practitioners know enough about travel insurance rules

Feature: In the line of fi re 30 Evacuating clients from war zones takes a particular set of skills

Assistance & Healthcare World Markets: Belgium 36 A small European country with plenty to offer a tourist in need of help

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: Helen Watts of the trade of any company, individual or fi rm mentioned is hereby excluded.

Kirsty Diclaudio fax: +44 (0)117 929 2023 Printed by Pensord Press, South Wales, United Kingdom Advertising sales: David Fitzpatrick email: [email protected] James Miller Copyright © Voyageur Publishing 2010. Materials in this publication may not be reproduced in any web: www.itij.co.uk form without permission Finance: Elspeth Reid INTERNATIONAL TRAVEL INSURANCE JOURNAL ISSN 1743-1522 Louise Goddard Would you like to make a comment? Design: V Creative Design WOULD YOU LIKE TO SUBSCRIBE? Please get in touch with Ian Cameron, vcreativedesign.co.uk VISIT www.itij.co.uk Editor-in-Chief of ITIJ on +44 (0)117 922 6600 ext205

InternationalInternational TravelTravel InsuranceInsurance JournalJournal ■ www.itij.co.uk NEWS 5

Executives told to Strength in check policies numbers continued from p1

Business travellers have been urged to check the from The Travel Insurance Claims Committee small print of their travel insurance to make sure it is (TICC) her view of how insurers deal with fraud up to date and contains all the necessary coverage, in the UK. She said: “The TICC has been trying as the Association of Corporate Travel Executives to assist in launching a database along the lines of (ACTE) reports that the sale of such policies will rise the household and motor Claims Underwriting in tandem with the increasing number of corporate Exchange for a number of years now, but with very travellers. Ron DiLeo, executive director of ACTE, little support until recently. The major resistance to said the improving economy and better outlook for the database has been cost, as the margins in travel the travel industry has contributed to more business insurance are very low and there has also been a excursions being booked: “Everyone is expecting debate as to whether the cost should be borne by their travel activities to be up.” the insurer or the claims handler. While everyone at TICC agrees the idea in principle, trying to move the project up the agenda of senior decision makers in certain insurers has been painfully slow.” Julie added: “A number of claims handlers and some insurers have been working together to try and prove Brits abroad uncovered the benefit of the idea and last year we were able to get some historical data analysed by one of the The Association of British Travel Agents (ABTA) repatriation.” ABTA’s survey also found that in the database hosts. There is still a lot of work to do on has presented new research, which shows that past five years, 12 per cent of respondents had made the project, but the team now has the backing of the around one in five holidaymakers is taking a risk by a claim on their travel insurance policy, with three per Insurance Fraud Bureau (IFB) and a tender has just going abroad without any travel insurance. ABTA cent claiming over £500. been agreed upon to find a host for the database. The polled over 2,000 people, and found that 17 per Meanwhile, research from insurer Sheila’s Wheels project team presently consists of representatives from cent of respondents do not think it is important has found that one fifth of the 3,000 people it polled AXA, Chartis (AIG), Groupama, Cunningham Lindsey, to take out travel cover before they travel. Other do not take out any travel insurance, while those that Insure & Go, IFB, and the Chairman of the TICC. worrying statistics were also revealed by the travel do manage to buy a policy vastly underestimate the Hopefully, once the tender process is complete, all the organisation, including the fact that 16 per cent of value of what is in their suitcase and hand luggage. underwriters of travel insurance will subscribe and the respondents believe the UK government would Jacky Brown at Shelia’s Wheels said: “The majority of claims teams in all companies will have an additional cover the cost of medical expenses incurred abroad. folk don’t give a second thought to the value of goods resource in the combat of fraud.” Mike Monk, head of finance at ABTA, said: “It is very they are packing into their suitcase and hand luggage, worrying that almost 20 per cent of holidaymakers but in reality the contents are worth thousands.” are going abroad without insurance and running According to the poll, the contents held within an the risk of substantial medical bills. In the current average Brit’s holiday bag are worth around £3,175. economic climate, saving the cost of travel insurance The sum takes into account sunglasses to the value of MAPFRE acquires could prove a very false economy.” £94, jewellery worth £237, and electrical equipment Columbus rewarded Lynda St Cooke, part of the UK Foreign Office’s such as cameras, camcorders, shavers, mp3 players, InsureandGo Know Before You Go campaign, which is aimed laptops and phones. The electrical equipment Columbus Direct has been awarded a Best For an undisclosed sum, Spanish insurance at educating travellers, added: “Like ABTA, we are category includes some of the most expensive goods Business Award for Best Customer Focus. Rob company MAPFRE has bought UK-based worried that so many British travellers are going in a traveller’s suitcase, and reaches an average sum Thomas, marketing manager for the company, said: InsureandGo – the biggest online provider abroad without travel insurance. We see many cases of £1,208. Further expenses were clothes, shoes, “Customer satisfaction is one of the key driving forces of travel insurance to the UK market, which where holidaymakers are faced with bills of tens personal grooming and hygiene products, and the behind Columbus Direct, and being able to provide generates c50 million in premiums a year. As a of thousands of pounds for medical treatment and value of the suitcase itself. a quick, efficient and hassle-free service to our result of the buyout, InsureandGo will switch its customers is extremely important to our success. We underwriter from Europ Assistance to MAPFRE. are so pleased that we’ve picked up this award; it is The Spanish insurer said the acquisition, which is its great to be recognised for one of the things we care biggest to date, would bring ‘experience and know about most in our customer service.” how’ in the distribution of products and services to the end consumer and direct marketing channels, particularly for Internet sales. Rafael Senén, chairman and chief executive of MAPFRE, said: “It is our aim, Insurance for India once the integration process is completed, to export this business model to other markets at a timetable vital to be established. Therefore, MAPFRE Assistance According to statistics, around 25,000 Australians were will have a major new distribution channel for retail in need of the help of a travel insurer in India last year business, placing us, once again, at the forefront of alone, and with 900 deaths abroad overall throughout innovation in the international assistance market.” the year, 1,200 hospitalisations and 50 medical Senén went on to say that in addition to supporting evacuations, industry experts have said that travel MAPFRE’s new distribution channels, the purchase insurance is ‘becoming increasingly inevitable’. However, of InsureandGo would held the Spanish company to in many of the above cases, the victims did not have achieve its strategic objectives of ‘growth, profitability travel cover and their already bad situations were made increase and diversification’. much worse by the long-term financial implications of Following the buyout, all 250 staff members currently Small print defended their decision to travel without insurance. employed by InsureandGo will join the MAPFRE team. Amy Bach, executive director of US consumer have done a better job disclosing the terms and group United Policyholders, has said that travel conditions of their policies. I think I have the same Ash cloud casts a shadow insurance companies should be more up front booklet you [Bach] are looking at, and I’ve noticed when it comes to what they will and won’t cover, so on page one that it says, ‘Please make sure you Peter Hayman, director of specialist travel to be paid by the airline or tour operator. that consumers of the product are not misled into read these documents carefully’. On page three, insurance provider PJ Hayman, has criticised the Hayman said: “It is now six months since the volcanic thinking that it covers any emergency that may crop it says, ‘It is important that you read the certificate slow response of the industry to the fallout of eruption, and insurers’ reactions to plug this gap in up during the trip. She was prompted to become carefully’. Page five says, ‘Please see section the volcanic ash cloud that caused so many travel cover has been slow and sporadic. A number of involved after two consumers informed her of their three, ‘What this certificate excludes’, for more problems in April and May this year. He made companies have provided an operation extension, problems with Access America, which had denied information.” He continued: “I think that a prudent reference to a consumer television programme with prices ranging from £10 to £20 per person. their claims for cancellation and curtailment due to consumer would then read section three to learn shown in October in the UK, which focused on However, the majority still provide no cover.” He pre-existing medical conditions. about the exclusions. After reading the exclusions, if the continuing problems that consumers are having added: “As travel insurance specialists, we feel that Bach approached Access America, whose parent they then decided the insurance wasn’t appropriate with airlines in resolving refunds and compensation insurers should reconsider their position and look company is Mondial Assistance, to ask whether for their needs, they could take advantage of our claims. At that time, the vast majority of travel to extend the policy wording to include events the exclusions in their travel insurance booklet 10-day money-back guarantee and get a full refund insurance policies in the UK did not offer cover for such as this where they are clearly totally outside could be made more prominent. Daniel Durazo, with no questions asked.” Durazo added that he will the event, and those that did include cover only the consumer’s control and for costs that are not communications manager for the company, replied: bring the suggestion of making the exclusions more paid out where the incurred costs were not meant recoverable elsewhere.” “I’m sorry these customers felt that we could obvious to the product team.

www.itij.co.uk 6 NEWS

Travel Insured offers tips

US-based Travel Insured International has urged families on tight budgets to consider ways to keep Well it’s been so exiting in the wild and wacky of holiday travel affordable before skipping plans to travel insurance this month that we nearly re-read visit friends and relatives, as well as protecting their our old copy … nearly … holiday investment through obtaining travel cover So... First Assist (Services) has been by acquired by that includes insurance against cancellation or delay. Capita, MAPFRE has acquired InsureandGo, Liverpool Consumers were encouraged to use the Internet FC has been acquired by the owners of the Boston to compare prices of flights for different days, as on Red Socks and Wayne Rooney (who?) only threatened Thanksgiving, Christmas Day, New Year’s Eve and to leave Man U … sorry, the last two have nothing to New Year’s Day flight surcharges are either waived do with travel insurance, but hey… or are much cheaper. When it comes to travel insurance, the company said: Oh yes, then of course there are this month’s front “When saving money by planning ahead on family page stories ... Mondial Assistance’s Mike Webb is holiday travel, a prudent parent will seek to protect leading the charge in the UK to get insurers to share the family’s travel budget against trip cancellation data to create a database to assist in fraud prevention. or trip delay caused by unforeseen disruptions. For Good luck there Mike, its difficult enough to get most families, a sudden childhood illness, or one them to share a taxi, let alone data... unwelcome winter storm can be enough to either force a holiday trip to be cancelled or cause lengthy Then there are the rising number of snowbirds who delays and unforeseen expenses for food and lodging.” are choosing to ignore advice and travel without Stay surf aware cover. THIA has been making efforts to bring home to the snowbirds the dangers of travelling without The British Foreign and Commonwealth Office With foreign nationals representing around a third of all insurance, particularly if they’re travelling to the US (FCO) has warned tourists heading for some coastal drowning deaths in Australia last year, Surf Life – advice that we, the insurance community, would winter sun down under that they must be aware Saving Australia (SLSA) has launched a campaign aimed heartily agree with. Sadly, phrases like, ‘you can bring of the dangers of taking to the surf unprepared at raising awareness of surf safety among international a horse to water …’ spring to mind. Mind you, trying and uneducated. Every year, a number of British visitors. Speaking in support of the campaign, British to hand over a horse instead of an insurance policy nationals drown off Australian beaches and consul-general Richard Morris said: “In some ways, tends not to work in US hospitals. hundreds have to be rescued, and tourists have SLSA epitomises what’s best about Australia and been told that following some fairly basic surf safety we’re incredibly grateful to them for their continued Oh well. rules could help them to stay out of trouble when in great work in helping British nationals who get in the water. The advice is: always swim between the trouble in the surf. It’s moving and chastening to hear Ian Cameron Editor-in-Chief red and yellow flags; read the safety signs; ask a surf from individual lifesavers who have been involved in [email protected] lifesaver or lifeguard for advice; swim with a friend; rescuing Britons. We’re going to continue to work and if they do get into trouble, to stay calm and with SLSA to find new and innovative ways of raising attract attention. awareness of the dangers of the surf.”

Research takes time

UK-based travel insurer World First has discovered according to the insurer’s research, that people with that travellers seeking specific insurance coverage can complicated needs tend to opt initially for carrying out spend as long as six hours researching and buying Internet research, and then using the data they have it – longer than the time it takes to fly to Greece found to contact the relevant company. Managing from the UK. Those with more complex insurance partner of the firm, Martin Rothwell, advocates needs average 12 calls to insurance companies, with contacting a travel insurance specialist early on, rather calls taking up to 25 minutes, plus 15 minutes spent than lengthy Internet searches, as it is a more effective searching on the Internet. It is commonly the case, method of obtaining specialist insurance coverage.

Five tips for a worry-free gap year

24/7 Travel Insurance, a trading name of travel white water rafting are not covered by all policies. insurance specialists P J Hayman & Company, has A tip bound to be ignored by some is not to ‘overdo given travellers its top five tips for enjoying a worry- the partying or take unnecessary risks’. The firm said: free gap year, saying that a few simple measures can “While no-one is expected to live like a monk on their go a long way towards ensuring a problem-free trip. gap year, it is important to bear in mind the implications First and foremost, backpackers travelling to exotic of overindulgence. Policies will exclude claims resulting climates and coming into contact with unfamiliar from alcohol and drug-related incidents.” illnesses are advised to ‘get vaccinated’. The firm Rounding off the advice is the suggestion that notes that illness and medical costs were responsible backpackers get a travel policy specific to the needs for 52 per cent of the cost of claims on its specialist of each trip, as tailored gap year cover includes cover ‘Backpacker’ gap year policy last year. Having for activities such as extreme sports and manual the correct vaccinations and taking appropriate work, and covers a longer period than standard travel medication, such as anti-malaria pills, is vital to insurance. minimising this risk. Peter Hayman, director of P J Hayman, said: “With The second tip is to protect belongings, as 53 per record numbers of people missing out on university cent of the total number of claims received on the places this year, and graduates heading into an Backpacker policy are for personal effects and money. extremely competitive job market, the number of Of these claims, just over half were for theft and over people taking a gap year is likely to rise considerably. It a third were for lost luggage. is a fantastic opportunity, but even if it is a last-minute Travellers are also urged to research their trips, arrangement, people should not neglect these simple as getting all the important information on the precautions, which are vital to minimising risk, and countries to be visited helps to choose the right ensuring that problems can easily be dealt with should level of insurance cover. For example, someone they arise.” He said gap year travellers should look heading to New Zealand may want to do something to take out specialist travel insurance to allow for an adventurous, but activities such as bungee jumping and enjoyable and worry-free experience.

International Travel Insurance Journal COMPANYBRIEF 7

NEWSWIRE WPA selects CEGA WPA Worldwide Assistance, the global medical The Europ Assistance Group has launched assistance service, is now being operated by third-party Docticare, a new information-based web portal that supplier CEGA Group Services Ltd. Adrian Humphreys, offers tailored services to clients in the areas of health managing director of WPA Corporate Group, said of protection and the provision of health information. the move: “Throughout the tender process CEGA evidenced their knowledge and expertise, flexibility of Tesco Bank has entered into an agreement service and high-quality approach, whilst demonstrating with Fortis UK, who will provide the underwriting, their ability to meet our needs and provide the best claims management and sales and service support cultural fit with ourselves. There are no changes to the to Tesco Bank’s travel insurance customers. Fortis will features and benefits of WPA Worldwide Assistance start to underwrite the policies at the end of the year. and we will continue to offer our customers the same service.” Rob Upton of CEGA added: “We are very UK-based company Saga, which focuses on proud to have been selected by WPA to provide such serving the needs of those aged 50 and over, an important service to their customers.” has announced its intention to introduce a new comprehensive travel insurance policy to the market, offering customers upgraded cover that IndiGo partners with ONE Group launches specialist brand includes insurance against strike action and airport closure. TATA AIG ONE Group has officially launched its new play in Europe on 1 October. specialist brand, goodtogoinsurance. Focused on Developed by Iain Sykes, managing director CheapTravelInsurance.com has announced Indian budget airline IndiGo has partnered with travel insurance for medically impaired travellers, of the new brand, goodtogoinsurance aims to that it is changing its underwriter to Mondial insurer TATA AIG to offer an insurance package, with no age limits, the insurance policy has been challenge the status quo in which many travellers Assistance. The deal aims to give customers a more Domestic TravInsure, to its passengers. Under designed with the aim of tackling a number of find themselves. He said: “People with medical comprehensive service. the deal, airline passengers booking through the misconceptions about travel insurance for those conditions want to be able to enjoy their holidays company’s website can access the insurance from with medical conditions, as well as the over-65s, by secure in the knowledge that their pre-existing Amadeus and Travel Guard have been as little as Rs129 (£1.80). The package has been providing ‘the right cover at a reasonable price’. In medical conditions are covered. With the core selected to supply real-time travel insurance content, designed to provide complete emergency accidental particular, the insurer is aiming to provide affordable provisions of the Equality Act, we believe a number product availability and booking functionality through medical reimbursement to passengers in the case of cover for certain conditions that other insurers shy of mainstream insures will be looking for a good the direct booking channels of Etihad Airways, Hong any unforeseen incident and also includes baggage away from, including mental health conditions and partner to be able to provide insurance products for Kong Airlines and Kenya Airways. and flight delay cover. Furthermore, it includes travel people who are HIV positive. It also aims to give those with medical conditions, and the over 65s. by all modes of transport within a validity period of mainstream insurers a clear solution to ensure they The proposition can be white labelled and covers a UK building society Nationwide has 30 days from the date of travel. comply with the new Equality Act, which came into wide range of conditions.” replaced its offer of using its cards for free in foreign cash machines with the offer of free travel insurance. The company says the cover is worth around £80 per year. CEOs covered

Nigerian firm SA Insurance plc has created Healthcare Concierge Services of Miami, Florida, a new web portal, SA Travel Portal, where travellers has announced that the Chief Executive Officers can view options on different travel policies for travel Club (CEO Club) will begin offering StandbyMD’s to Schengen and African nations. programme to their CEOS while travelling throughout the US and selected international Towergate Chapman Stevens has confirmed destinations. The StandbyMD programme that it has renewed in excess of £1 million of travel offers business and leisure travellers access insurance scheme gross written premiums through to personalised physician-directed healthcare renewing the policies for Haven Holidays, Butlins services 24/7. Alex Sanchez, managing director Resorts and The Coach Holiday. of Healthcare Concierge Services, commented: “We are thrilled that the CEO Club has chosen to Europ Assistance has launched a free iPhone offer our programme to their travelling CEOs. The application for automated breakdown assistance, need for personalised medical services for travelling which is currently being tested in Brazil and will executives and their significant others has never shortly be deployed to all 35 countries in which the been greater.” Under the programme, individuals group is present. are provided with easy access to a doctor, who will assess the medical condition of the traveller and Chubb Insurance has extended its provide treatment options. partnership with claims management and emergency medical assistance company CEGA Group Services. EasyJet offers onboard travel cover Wi-Fi Bonus offers The US Travel Insurance Association has easyJet airline company is now offering travel insurance emergencies, baggage, personal accident, personal travel protection developed a new web resource, TRIP, which has to UK passengers onboard its planes. Advertisements liability and passport loss. The policies are available been designed to provide helpful information for on the back of seats offer five-day or 14-day single-trip to UK residents on UK outbound flights only and do Airline cost reduction and ancillary revenue anyone planning a trip abroad. cover for Europe, covering policyholders for medical not cover pre-existing conditions. The insurance is development firm Airsavings, based in France, has provided by Mondial Assistance. launched a new Wi-Fi Bonus service that combines Barclays Private Equity has sold FirstAssist In further news, easyJet has switched its financial travel insurance with complimentary Wi-Fi Internet Services Holding to UK outsourcing company Capita security obligations provider from the Travel Trust connection for passengers. Explaining the purpose Group plc for £12.5 million. Association to International Passenger Protection of the product, the company said: “The Wi-Fi Bonus Ltd (IPP). All passengers booking a package (a flight concept was developed to counter the perception A group of 15 travel agencies in Shanghai and another holiday component) online with easyJet that travel insurance is often surplus to requirements, have come to an agreement with the People’s will continue to benefit from financial protection allowing airlines to offer customers something Insurance Company of China to offer travel insurance in the event of its insolvency. The airline tangible and useable to encourage the purchase of insurance to their customers. is the first low-cost carrier to protect its passengers travel insurance. For travellers, the ease of Wi-Fi through insurance arranged with IPP. access combined with travel insurance [protection] Insurance from Malaysia Airlines is now Raul Phillips, group treasurer of easyJet, said: “We ensures that they will perceive the programme as an available to UK passengers. MHinsure has been pride ourselves at being one of the leading and added benefit and a relevant service. Wi-Fi Bonus is launched by Mondial Assistance and can be booked most innovative airlines in the UK and, despite our deducted by the second, allowing a traveller to use when purchasing tickets on the airline’s website. strong financial standing, we recognise that we have their 30 minutes of access at whatever intervals and important legal obligations to adhere to under the in whichever location they wish.” Wi-Fi Bonus has Orbitz Worldwide Inc. has been selected by UK Package Travel Regulations. We acknowledge our been developed in conjunction with AXA Assistance, LAN Airlines to provide dynamic packaging booking continued duty to give passengers financial peace of and works in over 470 airports and in 140,000 capabilities on its US website. mind when buying travel packages online from us.” hotspots worldwide.

www.itij.co.uk 8 NEWS

Tourists injured in US protection rises

Thai crash With concerns rising over terrorism, overseas street crime, kidnappings and the safety of computer and Twenty tourists from Russia and one from the proprietary information, 50 per cent of security and Ukraine were injured after their tour bus turned risk managers said they were more apprehensive over around 15 km from the popular tourist resort about their employees’ overall safety when of Pattaya in Thailand. No-one died in the accident, travelling internationally compared to five years ago, but one Russian tourist was hospitalised, along with according to a recent survey conducted by Travel the Ukrainian citizen; both are now reported to be Guard North America. Travel Guard offers Premier in a stable condition. Other tourists on the bus were Assist, a medical, security and personal assistance treated for minor injuries at a nearby hospital – some programme for international business travellers, of the injuries were sustained after the occupants of expatriates and students travelling overseas. the bus had to break windows in order to escape the The security and risk managers polled were overturned vehicle. attending the annual American Society of Industrial Sergei Shpilko, president of the Russian Association of Security International conference, which was Travel Agents, said that all the tourists were covered held in Dallas, Texas, US, recently. In further by their travel insurance policies. demonstration of the nerves of international corporations when it comes to sending employees overseas, some 49 per cent conducted travel training or awareness seminars, 39 per cent of those surveyed said they conducted international threat briefings for the overseas traveller, 36 per cent subscribed to overseas intelligence newsletters and 23 per cent instituted executive protection and purchased a business travel insurance plan. In light of some recent security breaches, 44 per cent of those surveyed said they were concerned about their travellers’ safety onboard commercial aircraft when travelling overseas, and they were also very concerned about the safety of employees staying in hotels outside the US. John Rose, president of Travel Guard North America’s Business Travel Services, commented on the findings of the survey: “While it’s encouraging to see business travel on a seasonal upswing, security and risk managers have a greater challenge than ever when it comes to monitoring the welfare of employees whose work takes them far afield. There’s a growing duty-of-care obligation and an ever-increasing need for employers to proactively provide for the safety, security and wellbeing of their employees.

Tourists told to take care

Tourists have been advised to make sure they are taking appropriate care of their belongings while on holiday. Scott Gorman, travel insurance manager for Sainsbury’s Finance, has advised holidaymakers to exercise care and caution particularly when they are in popular or crowded tourist areas and consider investing in a money belt for added security. “When holidaying, people take their most valuable possessions with them, such as their camera, passport, going-out jewellery, mobile phone, iPod and of course their spending money,” he said. “It’s easy to be engrossed in your surroundings when in a different country and when you’re feeling relaxed, you can be easily distracted.”

International Travel Insurance Journal NEWS 9

Cruise cover in focus

A recent article published in the US has given company goes out of business, or its employees travellers some good advice about the whys and go on strike.” Consumers were also urged to use wherefores of specialist cruise travel insurance, the power of the Internet to compare and contrast including why a separate product is necessary different policies, using aggregator sites that break to ordinary travel cover. The article was keen to down the benefits and limitations of the policies. A emphasise the importance of reading the fine print, pre-existing condition warning informed travellers that saying ‘not all policies are the same’. Giving details they must check the fine print of insurance policies to of why cruise insurance is necessary, the article see if their existing medical problems are included in states: “Depending on the specific policy, travel the cover. Finally, travel insurance consumers were insurance from a reputable company usually covers told to check their home insurance policy, as in many trip cancellation caused by such occurrences as a cases, it could provide cover for such things as lost death in the family or your house burning down; or stolen luggage. The issue of the cost of insurance medical emergencies, which [domestic] health was also raised, with the article stating: “You will insurance usually won’t cover in foreign countries; trip invest a lot of money and time into taking a cruise. interruption due to illness or an accident; lost, stolen Insurance should definitely be considered, especially if or damaged luggage and other personal items; and you will be far from home and travelling to distant or medical evacuation to a local hospital or back to the unfamiliar ports around the world.” US.” The article continues: “Some cruise insurance policies will compensate you if a cruise is cancelled or cut short because of severe weather or if the cruise

Chubb enjoys increase

US-based Chubb Insurance has seen a dramatic increase in the number of policies sold, which has been credited to increased fears of terrorism overseas. Dominick Zenzola, vice-president of Chubb’s accident and health unit, said: “We have seen a 20-per-cent increase in the amount of travel accident insurance we sell with out-of-country medical benefits. We also have seen an uptick in the number of claims and variety of claims. We have had claims in more traditional travel locations like Western Europe, as well as emerging markets such as Russia, and in the Middle East and elsewhere.” He believes that international companies have been carrying out more comprehensive research about the travel itineraries of their employees in recent months, mostly due to warnings from the US State Department about possible terrorist plots against Western Europe. According to Chubb, companies looking for a group protection policy should make sure it provides cover for emergency air ambulance evacuation on medical grounds or from a country experiencing political upheaval. “In the case of the recent political unrest in Bangkok, companies may have needed to evacuate employees should this situation have worsened,” added Zenzola. Business travellers also need a policy that allows the insurer to pay fees upfront to foreign hospitals, according to Zenzola: “Some hospitals require up to $5,000 before they will admit you.”

www.itij.co.uk 10 INSURANCEMATTERS

Munich Re opens in Japan NEWSWIRE The world’s largest reinsurance company, Munich Re, Wenning seemed unconcerned about the possible is boosting its presence in Japan with the opening of a shrinkage of the general insurance sector in Japan, life reinsurance branch, despite statistics showing the telling Dow Jones: “Reinsurance demand doesn’t Hong Kong’s insurance industry collected country’s slowing economy and ageing population. automatically depend on the growth or decline of the total gross premiums of HK$16.6 billion (US$2.13 The new unit will enable Munich Re to meet the primary insurance volumes.” billion) for the first half of this year, representing Insurers unfazed by rising demand for consultative services, say executives Daniel Cossette, chief executive of the Asian life growth of 14.5 per cent, says the Office of the at the company. business, commented: “We expect considerable Commissioner of Insurance. NZ earthquake Dr Joachim Wenning, a member of Munich growth in Japan and Asia over the coming years, as Insurance Australia Group (IAG) and Suncorp-Medway, Re’s management board and responsible for life reinsurance is increasingly being accepted as a capital Life insurance policies being sold directly who are among Australia’s largest insurers with reinsurance for the firm, said that the new branch management tool and a key source of expertise. With to consumers are gaining favour with individuals operations in New Zealand (NZ), have said that it is forms just part of the group’s overall strategy of the Japanese branch, our clients gain access to Munich across Australia, according to financial service too early to estimate the extent of their exposure to expanding its life and health reinsurance sectors. Re’s global network and established best practices, ratings firm Canstar Cannex. Sales for the sector September’s earthquake in Christchurch, although they The development of these sectors had led to them specifically adapted to the Japanese environment.” increased by 27 per cent over the past 12 months. added that their exposure to the disaster would be contributing more and more to Munich’s Re’s final Munich Re expects its revenue from Asia to continue mitigated by reinsurance cover. In a statement made group figures – life and health reinsurance premiums its double-digit growth over the next five years. China Pacific Insurance has posted net to the Australian Securities Exchange, IAG said that accounted for 24 per cent of the group’s premiums In 2009, more than 10 per cent of the firm’s total profits of ¥4.02 billion (US$592 million) for the first costs would be completely covered by its reinsurance in 1999, compared to 39 per cent in 2009. Dr reinsurance income came from its Asian businesses. half of this year, representing a 67-per-cent increase arrangements, adding that ‘subject to the damage over the same period a year earlier. caused by the Christchurch earthquake’, the loss from a subsequent major event this calendar year would Reinsurers are keeping an eye on the be capped at a maximum of AU$175 million. Michael AIG considers options global economy with low interest rates, inflation Wilkins, chief executive of IAG, said the group’s NZ and falling asset prices continuing to influence the businesses – State and NZI – had mobilised their American International Group Inc. (AIG) will likely list for AIA to escape the restrictions placed upon uncertain outlook over the sector, according to resources well to cope with the aftermath of the quake: its Asian life insurance unit, AIA Group Ltd, in Hong AIG by the US government as part of the bailout Bruce Hodkinson, head of Middle East and Africa “As with all such events, our priority is our customers Kong at the end of October, in order to dispose of agreement, which include curbs on excessive for Swiss Re. and so far we’ve responded to more than 2,000 calls.” assets to repay US taxpayers who committed $182.3 remuneration. When Mark Tucker, the latest head Suncorp, meanwhile, said that due to New Zealand’s billion to prop up the insurer during the financial of AIA, took over in July, he asked the parent firm Gross insurance premiums in Jordan Earthquake Commission and the group’s reinsurance crisis. Thanks to a special clause, AIG could sell more for assurances that his new company could pursue Lockton MENA Ltd, a subsidiary of Lockton, has arrangements, its financial exposure to quake than 50 per cent of AIA, as the company can increase independence before he accepted the role. Tucker received a licence from the Dubai Financial Services losses will be limited. The Earthquake Commission the size of the sale during the course of the marketing has made his presence known in the company Authority to operate in the Dubai International provides earthquake protection of NZ$100,000 plus and bookbuilding period before the sale. The rare already, with six new executive appointments in Financial Centre. The new regional HQ in the DIFC Goods and Services Tax (GST) per dwelling, and ‘upsize’ option, which is on top of a traditional over- the past two months. Independent directors of AIA will serve as the company’s gateway to its targeted NZ$20,000 plus GST for contents, to the insured. allotment option to sell more shares that is built into now include Sir Chung-Kong Chow, chief executive market in the region. All claims that exceed this amount will include a cap the AIA initial public offering, means that AIG could of MTR, the Hong Kong Metro, and former chief of NZ$60 million on Suncorp’s Vero New Zealand ultimately raise more than $20 billion and sell more executive of Brambles Industries. The other The Generali Group has been admitted and AA Insurance businesses. than two-thirds of AIA. new appointments are Rafael Si-Yan Hui, former insurance sector, with higher ratings for Losses from the earthquake are estimated to be Breaching the 50-per-cent threshold and therefore government official in Hong Kong, and Qin Xiao, environment, human resources and business around NZ$1.9 billion. gaining independence from parent AIG is vital former chairman of China Merchants Bank. conduct.

International Travel Insurance Journal INSURANCEMATTERS 11

Bancassurance regulator plan opposed

Plans by the Hong Kong government to implement Bancassurance currently accounts for 30 per cent an independent insurance regulatory authority that of insurance sales in Hong Kong, employing 50,000 would not have any authority over insurance business insurance agents and 18,000 bank staff. conducted by banks has hit a wall in the form of the Eleanor Wan, chief executive of the Institute of rest of the insurance industry. Insurers have asked Financial Planners of Hong Kong, commented, “All the government to extend the public consultation customers who buy insurance policies should receive deadline, which ended in October, to further the same protection, regardless of whether they explore the ramifications of such a regulator. The buy from banks or from insurance companies. To proposal from the government is that bancassurance allow two regulators, the HKMA and the insurance activities are supervised by the Hong Kong Monetary authority, separately regulate the two sectors to sell Authority, instead of by the new regulatory body. insurance is to go in the wrong direction.”

ULIP system kicks off Healthy take up in Malaysia

On 1 September, comply with the new regulations so that they can It has been reported that rising medical costs in stricken with a major illness. Some are even buying the new regulations also gain access to the popular market. Malaysia have prompted a surge in the number of more than one policy to ensure that have ‘sufficient governing unit-linked However, while on one hand the Indian insurance people buying medical insurance policies, with many cover all the way’. Insurers are therefore adapting insurance plans industry is developing and maturing positively, more extending the cover they already hold up to their policies to reflect the demands of the market, (ULIPs) in India came there are concerns that some agents will leave the the age of 100. Several major insurance firms have offering coverage for longer periods. Heng said: into effect, and the industry as a result of new rules that will bring lower reported good demand from the working population “The average life expectancy of a Malaysian male plans launched with fees and commissions payable by customers to who wish to extend their medical cover. and female was only 55.8 years and 58.2 years a bang, with over their insurance agents. Life insurers are therefore Industry experts have credited the increase in respectively in 1957. Today, it is 71.9 years for men 50 such plans being making attempts to retain their agents, particularly demand to the steeply rising cost of healthcare in the and 76.9 years for women. By 2050, the average approved by the as ULIP guidelines mean that the impact of the nation, which, standing at between 13 per cent and lifespan is expected to increase to 77 years for men Mr J Hari Narayan, chairman, IRDA Insurance Regulatory lower charges can only be met through increased 15 per cent a year, puts private healthcare out of the and 82 years for women. This upward trend presents and Development business volumes. Attempts by insurers to keep reach of many who don’t have cover. The longer life a need for insurance companies to provide medical Authority (IRDA). According to chairman of the hold of their successful agents include drawing up expectancy in the country and a desire to avoid long plans that would cover the policyholders beyond the IRDA, J. Hari Narayan, the number of policies plans to compensate their employees in various waiting times at public hospitals have also contributed current life expectancy.” represents 75 per cent of the 28 products that were ways to make up for the shortfall in commission to the growing demand. filed for approval by the 23 life insurers in India that payments, including giving them regular bonuses. Prudential Assurance Malaysia chief product and comply with the new regulations. The figure works The chief executive of one leading player in the life marketing officer Heng Zee Wang said that as most out to be a minimum of two products per insurer. insurance industry who did not wish to be named employers do not provide post-retirement medical Narayan added that in addition to the 51 ULIPs it told a local newspaper: “We are thinking of bearing coverage, more working people aged between had approved, IRDA also gave the green light to the entire loss on the company’s book and not pass 25 and 50 are taking up private medical insurance two pension products to enter the market. Insurers, on the deductions to agents in terms of lowered policies to avoid exhausting their savings if they are he said, are busy trying to design new ULIPs that commissions as of now.”

www.itij.co.uk 12 INSURANCEMATTERS

Indian P&C Malay measures Asian industry forecast positive boost life sector honours

According to a forecast by the Associated Chambers of The Life Insurance Association of Malaysia (LIAM) The 14th Asian Insurance Industry Awards were Commerce and Industry of India (Assocham) and the has predicted that the industry will grow by more held recently, organised jointly by Singapore-based international consulting firm McKinsey, the property than 20 per cent this year, and show even stronger Asia Insurance Review and London-based The and casualty (P&C) industry will exceed Rs500 billion performance in 2011. A statement from LIAM shows Review – Worldwide Reinsurance magazine. This in total premiums by 2013, which is a significant that its prediction for next year is based on a number year’s awards presentation was held on the eve of increase from the Rs370 billion recorded for the of initiatives introduced by the government that are the 25th East Asian Insurance Congress and was most recent financial year, which ended on 31 March aimed at boosting the income of the entire nation. attended by more than 400 senior executives and this year. A joint study by the two organisations has LIAM noted in a recent report that the life insurance officials from the industry at The Westlin Resort forecast, however, that profitability will remain low, industry performed very well in the first half of the Nusa Dua in Bali. with rates of return stagnating at seven per cent, due year as new business sales grew by 24 per cent on In an industry first, a Chinese company – China to increased competition in the domestic marketplace. a weighted premium basis, on the back of strong Pacific Life – took one of the most prestigious titles Dr Swati Piramal, president of Assocham, single premium sales that grew by 51 per cent, and, in the awards, winning Life Insurance Company commented: “Given the macroeconomic situation, to a large extent, by regular premium sales that grew of the Year. In addition, Lonpac Insurance became the underlying demand for property and casualty by 22 per cent – all figures are compared to the the first Malaysian winner of the General Insurance insurance will continue to grow as players will same period in 2009. A spokesperson for LIAM said: Company of the Year Award, in recognition of its Australia embraces “Meanwhile, the outlook for the second half continues responsiveness to customer needs and solid financial to be promising. In fact, historically, the second half performance. The Personality of the Year Award web applications of the year normally contributes on average 55 to was given to Leslie Mouat, chairman of Chartis Asia 60 per cent of the full-year business.” The industry’s Pacific, for holding the team and the fort together A report by Financial Standard, an investment penetration rate, though, remains low at 41 per cent, in the wake of the global financial crisis and the AIG research and publishing firm focused on the financial showing significant scope for further growth. trauma. Sompo Japan Insurance won the inaugural planning and investment management fields, LIAM has praised the government of Malaysia for its Green Company of the Year Award, given to the has found that straight through processing (STP) efforts to make the purchase of life insurance easier company that allocated long-term commitment and technology is helping to quicken the processing for the average citizen. In particular, president of resources to a sustainable green programme, and has of insurance applications. The report showed LIAM Adnan Zain singled out the personal tax relief ensured its successful implementation. that CommInsure, the insurance arm of the of MYR6,000 (US$1,943) that is granted on life India emerged as the market that won the highest Commonwealth Bank of Australia, which recently insurance, medical, education and annuity products number of awards, winning in three of the 14 won the Life Insurance Company of the Year award as a factor that would spur growth for insurers. categories available, taking home Technology at the 2010 Australia and New Zealand Insurance Another boost for life insurers is government support Initiative, Educational Service Provider and Corporate Industry Awards, now processes 40 per cent of its for private pension schemes. Social Responsibility. total business through WriteAway, its STP platform for risk insurance. New applications for insurance with compete aggressively for market share, resulting the company are now turned around in 24 hours, in low pricing levels across both personal and and outstanding requirements within 48 hours. commercial segments.” The report continued, “Zurich Financial Services The report went on to suggest that both on an launched LifeExpress, its quotation and electronic absolute and relative basis, the penetration level of application software in April 2009. It receives around insurance remains extremely low in the country, 40 per cent of its business electronically, with the remaining at 0.6 per cent for the 2004 to 2005 majority of decisions made within 24 hours.” A financial year and 2008 to 2009 financial year. The spokesperson for the insurer said that the company report states that the low penetration rate is the result was very pleased with the take-up of LifeExpress, of a combination of low asset ownership levels, low which has resulted in faster processing and a usage of insurance and extremely low pricing levels. vast reduction in error rates. Elsewhere, Tower However, the Assocham-McKinsey paper adds Insurance’s online STP – Accelerated Protection that there is some scope for improvement in Platform – processes over 50 per cent of its business the business models adopted by insurers in already, and the company aims to raise that to 85 per India who wish to operate in the property and cent of applications fully underwritten within three casualty market. It notes that the pace of product working days, according to a spokesperson. innovation, distribution channels and operations lag behind those of foreign insurance markets – the product range is too limited and could be widened; and the share of alternative channels is low, with the Megi damage balance of power resting in traditional channels. The increased spread of the Internet would help this estimated development. “Furthermore,” continued the report, US-headquartered catastrophe modelling firm AIR “there are weaknesses in underwriting practices that Worldwide has estimated that insured losses to need to be addressed. Operational inefficiencies onshore properties in the Philippines from Super are also low, with claims ratios in the industry being Typhoon Megi, which lashed the archipelago in one of the highest in the world, and expense ratios October, are likely to be less than PHP6.5 billion. remaining high due to low productivity and a lack AIR said: “The loss estimates reflect insured damage of scale.” to property (residential, commercial, industrial) and Meanwhile, the Indian Life Insurance Council contents.” The risk modelling firm added: “While the (LIC), which is a statutory body for the industry, Kuala Lumpur storm was one of the strongest to hit the Philippines in is preparing a roadmap that covers the next 10 years, the typhoon steered away from Metro Manila, years, which is to be submitted to the Insurance where the highest concentration of insured properties Regulatory and Development Authority (IRDA) RSA acquires GCAN Insurance is located. Overall, the penetration of insurance in the in November. In order to prepare the roadmap, Philippines is estimated at only 15 per cent.” the LIC has set up a committee headed by P. RSA Insurance Group plc has announced the further technical expertise, geographic diversification Dr Peter Sousounis, principal scientist of AIR, explained Nandagopal, managing director and chief executive acquisition of GCAN Insurance Company. GCAN and product breadth. The transaction will also drive further: “Commercial properties in the Philippines are officer of IndiaFirst Life Insurance. A panel of is a leading Canadian mid-market, large risks and significant additional reinsurance and capital benefits and generally constructed of reinforced concrete and are experts, lead by Nandagopal, will hold talks with all speciality commercial insurer, offering of range of other synergies. On completion of the deal, RSA will expected to sustain some wind-borne debris damage the companies involved in the Indian life insurance products including property, liability and motor. The pay Ca$420 million in cash from internal resources. to glazing and outer cladding at these wind speeds. industry, regulators and international experts, company has a strong track record of profitability Andy Haste, group chief executive officer, Although residential properties in the coastal regions of focusing on issues such as profitability, growth, with a combined operating ratio of 81 per cent and commented: “At RSA, we have great businesses with central Luzon are commonly constructed of masonry penetration, product development and innovation. gross written premiums of Ca$255 million in 2009. strong market positions delivering excellent results. or reinforced concrete, poor construction practices A senior IRDA official told theFinancial Chronicle: With the transaction, RSA will become the fourth- Over the last five years, RSA Canada has grown and low-quality materials may lead to more significant “The recommendations of the committee will largest general insurer in Canada, with pro-forma gross its premiums by around 60 per cent and doubled damage, involving loss of the roof covering and be implemented, as the LIC is not a trade body, written premiums for 2009 of around Ca$2.2 billion its underwriting results. The acquisition of GCAN damage to non-structural elements, such as cladding but a statutory body. The companies will have to for the combined entity. The acquisition of GCAN will accelerates this momentum and take us to number and glazing. However, a high proportion of residential implement [the recommendations].” strengthen RSA’s commercial proposition by adding four in the market.” losses are not expected to be insured.”

International Travel Insurance Journal

14 INSURANCEMATTERS

Thai regulator cracks down NEWSWIRE The Office of the Insurance Commission in Thailand curb any possible impact on consumers that would is said to be tightening its supervisory regulations, follow as a result of a collapse. with plans afoot to ban insurers that do not meet Meanwhile, in a show of how strong the insurance capital requirements for two consecutive months industry in Thailand is becoming, 14-per-cent growth Fortis Insurance UK has changed its name from writing new policies. The Bangkok Post has was recorded in total premium income in the first to Ageas in the UK. The change follows the approval reported that the new penalty scheme would also half of this year, amounting to a total income of earlier in the year to adopt the new name, reflecting apply to those insurers that fail to adhere to another THB196 billion (US$6.3 billion). Of the total figure, the company’s status as a standalone global insurer new regulation, which requires the companies to life insurance companies contributed THB137 billion, after the disposal of its banking assets in 2009. submit their financial reports to the Office of the a rise of 15.3 per cent, with general insurance making Insurance Commission each month. Failure to deliver up THB59.4 billion, an 11.4-per-cent increase. Singapore has been named as the only the reports for two consequent months would result Secretary general of the Office of the Insurance city in the Asia Pacific region to be ranked among in a ban from new business. Commission Chantra Purnariksha said the strong the top 10 cities in the world with the lowest risk in Amnart Wongpinitwarodom, a senior director of the results of the first half of the year showed that the recruiting, employment and relocation of employees, Office of the Insurance Commission’s planning and political turmoil experienced by the country in the according to a study by Aon Consulting. development department, said that the new penalty first few months of 2010 has ‘hardly affected’ the acts to reinforce the existing early warning system industry negatively – instead, it has heightened Chinese insurers should not rush into setting about a company’s financial well-being, while also awareness of the importance of having insurance to up or buying private equity companies, although ensuring the financial stability of insurers to try and cover such events. a recent regulation allows them to do so, said vice-chairman of the Chinese Insurance Regulatory Commission (CIRC) Yang Mingsheng.

ICICI Lombard General Insurance has won the bid to offer insurance cover of around US$9 billion to Air India, run by the National Aviation Co of India, for 12 months. Chartis Insurance UK is the reinsurer for the deal.

South Korea’s Fair Trade Commission is said to have started an investigation into possible collusion on motor insurance premium increases as auto insurers in the country raised motor insurance premiums for the second month in a row in October.

India’s Insurance Regulatory & Development Authority has said that health and motor insurance policyholders who are not satisfied with the services rendered by their insurers will soon be able to switch providers at the same premium, according to media reports.

Japan’s Financial Services Agency will increase oversight on non-life insurers to limit risks associated with their overseas expansion, said Bloomberg. The Agency will require insurers that have grown abroad through acquisitions or by opening regional offices to provide estimates for the maximum losses those operations might incur.

Fitch Ratings has revised the outlook for the Japanese life insurance sector to stable from negative, following a review of the nine major traditional Japanese life insurers it rates.

Insurers in Malaysia are all for a government initiative to promote private pension funds in the country, but say it is essential that the plans utilise skilled insurers and fund managers that hold long-term views for private pension schemes to be effective.

Prudential Financial and MetLife are battling it out for business in Japan as American International Group sells two Japanese life insurance units to Prudential Financial, while it completes a deal with MetLife for American Life Insurance (Alico).

The worst first half-year for catastrophes since 1994 saw profits at Lloyd’s of London tumble by more than half to £628 million, the lowest level since the historic insurance market began reporting an interim figure five years ago.

Swiss Re has agreed a deal to acquire UBF Seguros, a Brazilian insurer, as part of the reinsurer’s efforts to ramp up its activities in the country. The Swiss firm is to invest $40 million alongside the International Finance Corporation in UBF.

International Travel Insurance Journal HEALTHMATTERS 15

Cairns infection Dengue rates underreported number rises Dengue season is well and truly underway in Asia, prevent the spread of the potentially deadly virus, the with thousands of cases being reported across the government has started fumigation across the city of Health authorities in Cairns, northern Australia, continent. There are high rates in India in particular, Karachi. The Health Ministry has said that six towns have said that 13 people have now been diagnosed and local newspapers have reported that there is have already been sprayed with a solution that is said with dengue fever. Twelve people from the inner a gross discrepancy between statistics released by to be effective against both dengue and malaria. city suburb of Parramatta Park were diagnosed with government hospitals and those from private medical Meanwhile, the number of cases of malaria in having the illness, along with another case at nearby facilities. Dengue is treated by administering bags India has reportedly doubled compared to figures Cairns North. Teams from Queensland Health, of megaplatelets – one per patient, per day; and from last year. The total number of slides collected together with council workers, have inspected and according to Tahir Shamsi of the National Institute in one month was 155,945 – 9,193 of which hosting the Commonwealth Games. The cases were sprayed hundreds of properties in the area. Medical of Blood Diseases, a total of 200 bags have been were confirmed malaria cases. According to the reported from the Palam area in outer Delhi, prompting entomologist Joe Davis said all the residents from transfused this year in Karachi, compared to 100 International Society for Infectious Diseases, more the Municipal Corporation of Delhi to deploy a number Parramatta Park have Type-two dengue fever, but the bags last year. However, the Indian government than 600 cases of malaria have been reported from of specialists to the area to try and find the source of the North Cairns resident has a different strain – Type is claiming that only seven megaplatelet bags have Bhatu Kalan, Ratia and Tohanna, where stagnant disease: “We have deputed a team of entomologists one. He said: “The good news is that we don’t have been used – four in government hospitals and three water is being blamed for the outbreak. Furthermore, and epidemiologists to find the source of the infection. any more suspect or pending cases and no new onset in private hospitals. The discrepancy could be due in the state of Haryana, 237 cases of dengue, 348 They will take appropriate action to check the breeding of illness since the treatment has been in effect.” to a lack of information sharing between public and cases of Japanese encephalitis and 127 cases of swine of mosquitoes and eliminate adult mosquitoes in the private institutions. Shamsi has predicted the number flu have been reported. area.” According to health department officials, the of platelet bags required will either remain steady To add to the country’s woes, chikungunya has made vector that carries dengue fever is also responsible for or rise in the course of the next few months. To a reappearance in the capital city of Delhi, just as it was spreading chikungunya.

Cairns China health concerns The Centre for Health Protection (CHP) of the Chinese monitor the disease levels more closely. He Jianfeng, Rabies reminder Department of Health has received notification from director of the research institute at the Guangdong health authorities in the Guandong Province of local provincial disease prevention and control centre, said: Public health officials in the US have issued a warning cases of chikungunya fever in Dongguan, Guangdong “As the Asian Games approach, we should prevent to travellers heading to Asia after a 42-year-old Province, and has urged members of the public and the disease from spreading and provide a safe, American psychiatrist died following exposure to a visitors to guard against the mosquito-borne disease. A healthy environment throughout the Games.” rabid dog while he was out jogging in India last year. spokesman from the CHP said: “The chikungunya virus is considered to be endemic and subsequently suffer In related news, two Chinese women died after they His case was one of seven rabies infections that were is transmitted by infected Aedes mosquitos to humans. from any of the symptoms, they should seek medical were bitten by chigger mites in Foshan, which triggered acquired abroad by American travellers between The disease is characterised by fever, headache, and attention immediately. more concerns for public health authorities. One of the 2000 and 2009, according to officials from the US joint pain of the wrist, knee, ankle and small joints. Some Meanwhile, the Guandong Province is also suffering victims, a 66-year-old woman, had a recurrent fever Centres for Disease Control and Prevention (CDC). patients may develop a rash affecting the trunk and from a possible outbreak of dengue fever, after since the end of August and died in September. Doctors Other cases were contracted by travellers visiting the limbs.” There is no vaccine for chikungunya. Preventive authorities in Guangzhou reported 11 cases of later discovered that she had been bitten by chigger Philippines, Mexico, Ghana, El Salvador, Haiti and measures include avoiding visits to mosquito-infested the disease in one week. Local health officials in mites and attributed the cause of her death to scrub Mexico. Jesse Blanton, an epidemiologist from the areas, wearing long-sleeved tops and trousers, and using Guangzhou, along with other cities that are due typhus, an acute infectious disease that is transmitted by CDC, said: “[When you] walk up to a cute dog on the insect repellent and mosquito nets. Travellers have been to host the upcoming Asian Games – including mites, predominantly in Asia. The disease is not usually street in a place like India, you are taking a big risk.” told that if they have been to an area where the disease Dongguan, Foshan and Shanwei – were asked to fatal if medical help is obtained quickly.

www.itij.co.uk 16 TRAVELMATTERS

Tui enjoys summer Thai tourism rises surge The Ministry of Tourism and Sports in Thailand has it now hopes to welcome over 14 million tourists to released figures that show tourism to the country is the country this year. The number of international Tui Travel, the owner of UK travel operator up 13.79 per cent for the first seven months of the tourists arriving in Thailand has been boosted mainly Thomson, has reported a turnaround in late summer year compared to the same period in 2009. So far this through an increasing number of travellers from trading, in huge contrast to the profit warning the year, Thailand has received 8,766,706 international other Asian nations. Malaysian tourists led the pack company issued in August. At the same time, rival tourists, compared to 7,703,971 in 2009. with over one million arrivals, followed by China firm Thomas Cook warned that its own operating Experts have expressed their surprise at the figures, with over 561,634; in third place was Japan, with profits would be hit by a further £10 million and that as the rise has come despite significant political 546,947. South Korea contributed 445,809 tourists job losses at the firm would be inevitable. turmoil in Bangkok and other cities in the country, and Australia 438,241. The most significant growth Peter Long, Tui Travel chief executive, said: “Since along with travel advisories from several countries in arrivals was from India – the number of Indian our last update, we have performed well in the ‘lates’ warning their citizens against travelling to Thailand. tourists heading to Thailand increased by nearly 20 market for summer 2010 and the majority of our Since the release of the figures, the Ministry has said per cent on last year. programmes are now almost fully sold. The failure of a number of smaller tour operators and airlines has emphasised the security that travelling with a leading Agent appreciation tour operator brings. We have benefited from this CLIA report released flight to quality, as well as the return to more normal Despite the wealth of online travel resources, travel weather conditions across northern Europe after the agents remain an important and valued resource for Details of the North American cruise industry’s continuing nationwide loss of jobs and consequent earlier period of good weather.” travel planning, according to the results of a recent overall economic impact in the US in 2009 have rising unemployment. Not surprisingly, real inflation- survey from Mondial Assistance USA. The survey been released by the Cruise Lines International adjusted consumer expenditures fell by 0.6 per cent found that 70 per cent of those quizzed would Association (CLIA). “Despite a protracted global in 2009, with discretionary spending on such items New travel warnings consider using a travel agent to plan important trips recession, the North American cruise industry as transportation services falling by 3.7 per cent. In and special vacations. Moreover, 45 per cent said they continued to make an impact on the US economy short, last year represented an economic environment for Europe would consider using a travel agent for an unfamiliar in 2009,” said Terry Dale, CLIA’s president and chief in which consumers were steadily reducing their or exotic location, while 40 per cent would consider executive. “Last year was tough for everyone. We spending, particularly for discretionary services.” Both the US State Department and the British using an agent for a longer or more complicated are encouraged that the current economic climate is Cruise lines continue to report positive statistics, Foreign and Commonwealth Office (FCO) have itinerary. Others said they would consider using a showing signs of improvement and cruise lines have though, for 2010 and beyond, despite the challenges heightened their terrorism level warnings for travel travel agent for finding a great deal or best price (38 been reporting strong activity thus far in 2010.” facing the industry. Many companies have reported to certain European nations, following reports from per cent), for tours (33 per cent), in order to save The report from Business Research and Economic improved revenue yields for the first time since intelligence services about possible terror attacks time by not having to plan their own trip (29 per cent), Advisors, undertaken on behalf of CLIA, found that 2008, strong booking volumes for the second half of in Germany, the UK and France. On 3 October, or for some other reason (seven per cent). Just three North American cruise lines, their employees and this year and effective cost control measures. With the US State Department issued an official alert in 10 people surveyed said they would not consider passengers generated US$35.1 billion in gross output demonstrated consumer interest in new ships, some for Americans planning to travel to Europe in the using a travel agent under any circumstances. in the US last year, including 313,998 jobs that paid lines have seen increased capacity as an opportunity near future, urging citizens to be aware of the Daniel Durazo, director of communications for a total of $14.23 billion in wages and salaries; and to drive revenue, rather than a challenge to fill the chance that attacks could be carried out on ‘public Mondial Assistance, said: “This survey shows what direct cruise industry spending totalled $17.5 billion. expensive state rooms. transportation and other tourist infrastructure’. The we have long believed – Americans find great The cruise industry’s US economic contribution Howard Frank, vice-chairman of the board and alert continued: “Current information suggests that value in using travel agents. From booking trips to was felt in every state to varying degrees, continues chief operating officer for Carnival Corporation al-Qaida and affiliated organisations continue to plan exotic locales to making complicated itineraries the report. Of the 13.44 million passengers sailing and chairman of CLIA’s executive committee, said terrorist attacks. European governments have taken easier, travellers are turning to travel agents for their with CLIA member cruise lines in 2009, US ports the industry should be optimistic about the future: action to guard against a terrorist attack and some knowledge and expertise.” embarked 8.9 million passengers, accounting for “Demand is solid, advanced bookings are encouraging, have spoken publicly about the heightened threat While just six per cent of respondents said that they 66 per cent of the worldwide total. Florida port there are significant growth opportunities around conditions.” Theresa May, UK home secretary, called get most of their trip planning information from travel embarkations alone grew by nearly three per cent on the world, and we’re seeing opportunities for better on British nationals to report any suspicious activities agents, that proportion is slightly higher than those the year before, for a total of 59 per cent of the US pricing strategies that, in the end, mean better results to authorities. The FCO had previously advised of a who get that information through other means, total, thanks to gains in Port Everglades, Tampa and for the cruise lines and greater contributions to the ‘general threat’ of terrorism in European nations, but including TV and radio, newspapers and magazines, Jacksonville. Dale commented: “We are encouraged, economies where we operate.” in the latest update this was moved to a ‘high threat’. or direct mail and brochures. Seventeen per cent said not only by signs that a turnaround is in progress, but The UK’s threat level, as set by the Home Office, that using a travel agent for planning travel is more also by the industry’s history of outperforming other remains severe. A spokeswoman for the FCO said: important than in the past, and a further eight per tourism sectors and even the national economy.” “Like other large European countries, [France and cent said their importance has remained the same. Industry expenditures typically correlate with the Germany] have a high threat of terrorism, which is Interestingly, retired individuals are more likely to say volume of cruise passengers, with the top 15 US reflected in our updated travel advice. We therefore that travel agents are more important than ever, as are cruise ports accounting for 92 per cent of 2009’s US attach great importance to providing information lower-income households. According to the results embarkations, continued the report. Direct increases about personal safety and security overseas to enable of the survey, for everyday and ordinary travel, online in Massachusetts, Maine, Louisiana, Maryland and people to make informed decisions about travel.” seems to be the preferred way of researching a trip. Alabama reflected increased cruise activity, while Americans present in London when the warning was Thirty-four per cent of respondents use online travel Nevada and Arizona benefited from increased issued, though, seem to have taken it in their stride. agencies such as Orbitz, while 20 per cent use online numbers of residents taking cruises and increased Bergen Swanson told The Guardian newspaper: “My search engines such as Google. Others use review direct cruise line spending. Declines in Hawaii and initial reaction was to be a bit concerned, but, in New sites such as TripAdvisor (10 per cent). Alaska were due to the redeployment of cruise ships, York, terror alerts happen regularly, so we’re used to it.” which resulted in reduced capacity. Another tourist said the warning had been vague, simply The report from CLIA continued: “The 2009 advising tourists to ‘stay away from public places’, as well economic environment for the travel industry was as not singling out any particular European nations. Travel turns to social daunting. Most of the negative impact of the global recession, which experts have determined to have media occurred between December 2007 and the fourth quarter of 2008, were felt during 2009 due to Germans flying high A report in USA Today has shown that many sectors of the travel industry are embracing the power of In September 2010, airberlin, Germany’s second- social media in order to better connect with their largest airline, welcomed 3,652,087 passengers customers. “Airlines are maintaining a presence on Corporate buyers see recovery onboard – an increase of 8.7 per cent on September YouTube and offering deals through social mapping last year. At 82.7 per cent, fleet capacity utilisation networks. Hotels are promoting their properties The US National Business Travel Association projected an average year-on-year increase of 4.45 was slightly higher than in the previous year. For through bloggers, and they’re using social networking (NBTA) has published the results of its most recent per cent. the period January to September 2010, a total of sites to gather feedback, monitor trends and provide survey, which found that corporate travel buyers According to the research from the NBTA 25,307,956 passengers travelled on airberlin’s flight concierge services,” states the report. sense an improving economy and a healthier travel Foundation, international travel spending is a primary route network, which includes the NIKI and Tuifly Jill Fletcher, social media and communications manager industry, leading to higher air fares, hotel rates and contributor to overall spending growth, with an routes, an increase of 2.9 per cent on 2009. Fleet for Virgin America, said: “I definitely think that social car rental prices. The survey said: “Stemming from average annual increase among the survey base of 13 capacity utilisation for the first nine months of the media is about to change the way we do things entirely. a combination of larger travel volumes and rising per cent in 2010 and 11.4 per cent in 2011. “That year decreased by 1.5 percentage points, while We’re able to admit over social media if we’ve made a fares and rates, survey respondents – all from North compares to average domestic spending increases accumulated capacity for the January to September mistake or if there’s a weather delay. So we’re able to America, representing a cross-industry sample – of 2.5 per cent this year and 1.5 per cent next year. 2010 period increased by 4.9 per cent. communicate much faster and more effectively.” anticipated that total 2010 travel spending at their As a share of total spending, international travel on organisations would be up from last year by an average is expected to increase from 28 per cent in average of 5.5 per cent.” For 2011, buyers have 2009 to 32 per cent in 2011,” continued the report. International Travel Insurance Journal

18 IPMI NEWS

InterGlobal appoints Sykes in UAE IPMI providers support brokers

International private medical insurer InterGlobal Paul Weigall, head of sales and marketing with At a recent meeting in London, UK, the Association During the meeting, members of AIMIP said has continued the expansion of its presence in the InterGlobal, said of the appointment: “The of International Medical Insurance Providers (AIMIP) that while a competitive market is of paramount Middle East with the appointment of Aaron Sykes as Middle East is an important and growing market outlined its commitment to supporting the interests importance, there are certain areas that could be business development executive in the United Arab for InterGlobal. Despite the difficult economic of intermediaries and their clients both in the UK improved upon, such as the portability of IPMI Emirates (UAE). Sykes joins InterGlobal from Aetna conditions, there are still many expatriate and abroad. AIMIP joint vice-chairman Andrew Apps between providers. Jon Carpenter, joint vice- Global Benefits, where he was a senior accounts employees in the region who require medical was keen to highlight the opportunities international chairman, said that it was only ‘bloody mindedness’ service representative in the International Accounts insurance, and we’re also seeing domestic private medical insurance (IPMI) sales offers brokers, that would prevent the industry from resolving this Management team, responsible for managing a employers increasingly use our plans to provide and moved to dispel some of the concerns among issue for members, adding: “If there’s one thing portfolio of international health insurance clients. high-value international private medical insurance the broking community that IPMI is too complex that as an association we should do it is ensure that Previously he worked for Standard Life as an account to their senior staff. I’m delighted to welcome a product to offer. He told attendees: “Forget the people returning to their home country still have manager, dealing with new business acquisition and Aaron Sykes to our team to help meet this growing physics, forget the difficulties, have a go. Because access to cover.” intermediary relationships. demand in the region.” if you don’t, someone else will.” Apps went on to Brokers attending the meeting raised several issues say that brokers who feel they need guidance in the that they would like to see addressed by AIMIP, world of IPMI sales could set up a dialogue with a including the problem of claims sharing on smaller broad panel of provider partners who would be able group schemes, and increased clarity on insurance Expat healthcare Dubai lifts sponsor to offer advice and support. premium tax. centre opens in Seoul restrictions

A new healthcare clinic has been opened in South More expatriate health insurance policyholders Korea’s capital to deal specifically with expatriate could be in the market for policies that include medical insurance policyholders. The centre, located their families, after authorities in Dubai lifted certain in Seoul’s National University Hospital, aims to restrictions placed upon the country’s sponsorship provide treatment to more than 1,200 patients every system. For a deposit of 5,000 dirhams per person, year and is designed to carry out major surgeries international medical insurance customers can and minor operations, according to the Korea sponsor family members’ residence visas if they work Times. Hospital president Jung Hee-won told the in one of the 57 professions that were previously newspaper that the clinic has three regular doctors, barred from the practice. Major General Nasser two nurses and several assistants on its staff. He Al Awadi Al Menhali, assistant undersecretary for added: “It provides medical care in six languages naturalisation, residency and ports affairs at the and assists patients in arranging appointments for Ministry of the Interior, told Gulf News that the examination, diagnosis, surgery and aftercare at one changes have been made to the system because convenient place. The clinic has shown more than some professionals had not been allowed to sponsor 19-per-cent growth annually.” The hospital itself is their families, regardless of how much they earned. regarded as one of the country’s leading healthcare The news about Dubai comes at the same time facilities, and was originally established due to that Kuwait has announced the scrapping of its own concerns about access to geriatric care for Korea’s sponsorship system for expatriate medical insurance growing elderly population. policyholders looking for work in the country.

International Travel Insurance Journal IPMI NEWS 19

CIGNA names changes Employers struggle to curb costs

David Cordani, president and chief executive According to Mercer’s International Assignments Survey assignments overall have increased by four per cent officer of CIGNA Corporation, has announced the 2010, with the number of expatriate employees over the last two years. appointment of Philip Edmond to the position of increasing, companies have been forced to cut costs The survey found that 50 per cent of companies executive vice-president and chief information officer on international assignments. The company collected have reported a rise in short-term assignments, of CIGNA’s US operations. Edmond, currently data from over 220 multinational firms across all which are more popular due to their quicker senior vice-president of CIGNA Information industries, finding that organisations around the approval process. As a result, two-thirds of the Technology, will succeed Michael Woeller, who will world have more structured international assignment firms have developed special policies for short-term retire after serving as executive vice-president and programmes that place the emphasis on shortened assignments. Over half (56 per cent) of companies chief information officer of CIGNA’s US operations assignments, hiring locally and eliminating non-essential are also compromising on costs by sending married since October 2007. Cordani commented: “For benefits in an effort to more effectively manage their employees overseas without their families on long- the past three years, Mike has ably led CIGNA’s costs. However, despite the economic downturn, term assignments – the majority of companies taking Information Technology Division. During that Mercer’s research showed that international this approach are European. time, the technology organisation has evolved significantly to better meet the changing needs of today’s market, the team has been strengthened, Clements Europe acquires IVRM and succession has been proactively planned – part of which included adding Phil to the team in 2008.” Clements Europe, a member of the Clements of our London office and an important part of our He added: “From the start, Phil has demonstrated a International Group of companies, has acquired growth plans. We will continue to organically grow deep understanding of technology innovation to the the International Vehicle Risk Management (IVRM) our current European business, as well as actively healthcare industry and has shown strong leadership Thomas McCarthy business from Lockton. Clements International is a pursue further acquisitions.” qualities, passion for our customers and a focus on and leadership capabilities that will serve him well as leading provider of insurance solutions for expatriates The IVRM business consists of overseas diplomats consistently delivering results.” acting chief financial officer.” and international organisations. and international fleet business. IVRM’s policyholders’ Elsewhere in the business, Cordani announced Meanwhile, CIGNA has taken home a bronze award Dan Francis, director of Clements Europe, said: “This existing coverage will not be affected and will the appointment of Thomas McCarthy, currently for its Engagement in Intensive Care Management acquisition represents a landmark in the development continue to be offered through Clements Europe. the company’s vice-president and treasurer, to programme at URAC’s 2010 Quality Summit and the position of acting chief financial officer. In that Awards Programme. CIGNA’s programme targets role, McCarthy is replacing Annmarie Hagan, who high-risk individuals who are coping with multiple Aetna expands African options left the firm at the beginning of September. Since mental health issues, such as depression, anxiety and 2003, McCarthy has been responsible for CIGNA’s substance abuse, and helps them to take action that Aetna has announced the launch of a new health EHP Lifestyle plan – all of which have different levels of strategy and corporate development function, which can prevent their condition from worsening, improve benefits plan option for regionally mobile groups and cover and benefits. includes mergers and acquisitions and corporate productivity, decrease missed work days and reduce individuals in Africa. The organisation has expanded Stuart Leatherby, AGB managing director in the Middle risk management. McCarthy began his career with disability. Neal Cohen, vice-president of operations its Aetna Global Benefits (AGB) Executive Healthcare East and Africa, said of the launch: “We are extremely CIGNA in 1980. Cordani said of the appointment: for the company’s behavioural health business, Plan (EHP) to provide additional flexibility and choice in pleased to offer an additional medical plan for customers “We are assigning a proven veteran performer to commented on the award: “Engagement is what private healthcare cover for individuals living across the in the region that provides increased benefits and this key position while we complete our search makes this a winning programme. Through better continent. EHP is offered in partnership with Executive benefit levels. This demonstrates our continued for a permanent chief financial officer. Tom has a engagement we’re able to involve individuals more Healthcare Solutions, a medical insurance provider commitment to providing employers and individuals wide range of technical and operational finance actively in managing their condition – and that leads based in Kenya. Three EHP plans are now available with a wide range of products and services to address experiences, including strong business partnering to better outcomes.” – EHP Major Medical, EHP Foundation and the new their specific benefit or economic requirements.”

www.itij.co.uk 20 CROSS BORDER CARE

Dubai focuses on Government funds RNCOS predicts growth medical tourism academic study According to the latest report by RNCOS, entitled The report has elaborated [the] current market Asian Medical Tourism Analysis 2008-2012, health scenario and key developments in these countries. The Dubai Health Authority, diamond sponsor of An academic study led by the University of York in the tourism in Asian countries has been growing at a Moreover, the emerging market of spa and wellness the third Annual World Medical Tourism and Global UK will put medical tourism under the microscope, fast pace over the last few years. Countries such as industries in each Asian country has been covered, Health Congress, has signed a memorandum of with the aim of assessing its potential advantages Thailand, Singapore and India are being considered depicting a new avenue for growth in the industry.” understanding (MoU) with the US-based Medical and disadvantages to the UK health system. Entitled as some of the most suitable places for medical The report also contains a section that details the Tourism Association. The agreement will see the two Inward and Outward implications for the National treatments globally, in terms of cost and the number cost of various surgical and medical procedures organisations working together towards the continued Health Service (NHS) of medical tourism, the study of services covered. Other countries, such as Malaysia, in Asian nations, with comparisons to costs in development of the medical tourism sector in Dubai is to be funded by the National Institute for Health the Philippines and South Korea, are also strengthening other countries around the world. That section – measures could include collaborating on the Health Research (NIHR) and will examine the reasons why provides an analysis of treatments, which have Authority’s efforts to improve healthcare infrastructure, people wish to travel for medical care. Dr Neil Lunt cost differentials between developed and emerging regulations and policies. will head the study with a team of researchers behind marketplaces. Other sections of the report such as Dubai’s progress in the sector is notable, with the him that includes health economists, social scientists ‘market drivers’ and ‘market trends’ defi ne those development of the Dubai Healthcare City, which and clinicians. They will spend the next 18 months factors and avenues that have been boosting the now has two hospitals, and more than 90 diagnostic examining the economic impact, consumerism and market and providing further momentum. laboratories and outpatient medical centres. In patient decision making, quality, safety and risk, as well According to RNCOS, the report is ‘an outcome further support of the desire to increase medical as overall industry development. of in-depth research and prudent analysis of Asian tourism revenues in the Emirate, Dubai will also be The researchers have been tasked with exploring medical tourism sector with the emphasis on effective hosting the regional Medical Tourism Congress in how patients make their decisions regarding their domestic healthcare infrastructure and wellness forecasting techniques and methods used to project February next year, which will be the fi rst time the treatments and destinations, based on the source of sector in order to attract foreigners for medical future outlook’. RNCOS stated: “The forecasting meeting has been held in a Middle Eastern country. the information they use – whether it is the Internet, tourism. RNCOS predicts that health tourism in Asian section presents a futuristic view of the industry in Laila Al Jassmi, chief executive of the Health Policy for example – and consider how informed patients countries is expected to remain robust in the coming key areas and demonstrates those factors that would and Strategy Sector of the Dubai Health Authority are before they make their decision. Lunt said: “We years, growing at a combined annual growth rate of 17 be responsible for growth. Moreover, descriptions (DHA), said: “The medical tourism industry generates will advance the knowledge of patient treatment per cent in the next two years. of key market players have been added and recent over US$30 billion worth of revenue annually. It is a experience and how consumers think about choice, RNCOS states: “Our report covered various developments have been shown. Overall, the Asian huge industry globally and Dubai already has many and how risk and safety are managed at the consumer aspects of the Asian medical tourism industry, medical tourism report is expected to facilitate factors that work to its benefi t. At the DHA, we are and organisational levels. Our work will contribute focusing on key countries like Thailand, Singapore, the decision-making process of individuals and strengthening our policies, regulations and further towards understanding quality, administrative and India, Malaysia, the Philippines and South Korea. organisations who want to invest in this market.” developing our healthcare capabilities to strengthen legal dimensions of medical tourism, as well as the the medical tourism sector.” She added: “In terms of unintended consequences.” He added: “The study the Gulf Co-operation Council region, we are already will be of interest to those working within and making witnessing an increase in the number of patients and decisions about the NHS, policymakers, regulators, IPMI PROVIDER IWHTA releases now we are keen to provide the international patient providers, clinicians and consumer organisations, with lucrative healthcare opportunities in Dubai. At as well as patients. My main research interests are fi rst fi ndings the DHA, we consider the private sector to be a key around the organisation, management and delivery of Naresh Jadeja of the US-based International stakeholder and thus both the public and private health health and social services, the role of research within Wellness and Healthcare Travel Association sectors in Dubai will be part of the medical tourism policy and practice, welfare policy, migration and (IWHTA) was interviewed by the International conference, which takes place in 2011.” welfare, and medical tourism.” Medical Travel Journal about the initial fi ndings of a Interglobal survey and report that it conducted in conjunction with various Indian healthcare facilities. The IWHTA

CONTACT: Peter Rousseau - Group Business Devlpmt. Director is a collaboration of hospitals, doctors, healthcare Woolmead Hs East, The Woolmead, Farnham, service providers and volunteers. The organisation Surrey, GU9 7TT UNITED KINGDOM provides information, education collaboration and tel: +44 (0)1252 745 900 consultation to patients and members. fax: +44 (0)1252 745 920 The survey data was gathered by visiting hospitals and email: [email protected] clinics in India – so far, 180 have been toured by IWHTA web: www.interglobalpmi.com offi cials, with plans to visit 400 in total. Only hospitals that serve international patients were included in the survey, in order for the IWHTA to compile accurate and relevant data, including where the international patients being treated in these hospitals came from. It was Turkish Airlines discovered that the largest proportion of patients (22 per cent) were non-resident Indians, followed by 18 supports industry per cent from Africa, 16 per cent from the Middle East, Turkey’s national airline has initiated a new support 17 per cent from Bangladesh, Nepal or Sri Lanka, eight package for hospitals and clinics that promote per cent from Iraq, nine per cent from Afghanistan, four medical tourism in the country, which offers special per cent from the US and six per cent from Europe. discounts and incentives for people heading to The survey also found that there are two major regions Turkey for medical treatment. Under the terms that overseas patients travel to, depending on where of the deal, patients from the US will receive a they come from. In Delhi, most patients come from 25-per-cent discount on air fares, while travellers to Iraq, Afghanistan, Bangladesh and Nepal. In Chennai, Turkey from other nations will receive a discount of most patients come from Sri Lanka or other South East 20 per cent on fi rst and business class fares, and a Asian nations. 10-per-cent discount on economy class bookings. However, there are stumbling blocks that must be There is also no rebooking penalty if rebooking overcome before the fi nal results of the survey can is required as a result of medical complications, be published, said Jadeja, for example: “There is no and as an extra bonus, the discounts are also documented proof on foreign patient numbers and applied to members of the patient’s family that most hospitals won’t answer questions about this. In choose to travel with them. In order to qualify for the beginning, we tried to ask for evidence of patient the discounts, passengers travelling for medical numbers, but we quickly realised that we were being treatment are required to present an acceptance given unrealistic numbers, so we are not asking about letter from the hospital or clinic in Turkey that is part numbers anymore.” of the agreement with the airline. CROSS BORDER CARE 21 22 AIRAMBULANCENEWS

NEWSWIRE The ABC of pressure ulcers – part 2 The European Aviation Safety Agency has warned that a recent inspection of a Scottish Following on from part one in ITIJ 116, Gerry cabin pressure on the latter two categories in the Air Ambulance Service EC135 revealed part of the Bolger, former chair of the In-Flight Nurses’ aircraft. Furthermore, many mattresses and devices transmission to the main rotor of the helicopter is Association, looks at what considerations have a washable surface that allows for disinfection, not up to standard. The helicopters are operated by assistance companies and repatriation teams and such surfaces are un-breathable so can cause Bond Air Services, which said remedial work would need to make in the assessment and prevention a build-up of moisture in higher risk parts of the be carried out immediately. of pressure ulcers body – in the sacral area for example – which can lead to breakdown of the skin’s surface even in as Private equity firm Bain Capital LLC has Even though it is the largest organ of the body, little as an hour, and result in a pressure ulcer. As reached a deal to buy Air Medical Group Holdings, many take the skin for granted, only realising how such, it is essential that regular inspection, pressure the largest independent provider of emergency air vulnerable it is when it is subject to damage. And alleviation and/or repositioning be maintained. medical services in the US, for around $1 billion. no-one is immune to pressure damage – babies While this may be appropriate for most patients, and old people are all susceptible. For the majority there will be some patients with whom this is not Michael McConnell has joined aircraft of people who will need the help of a medical possible; for example, patients with spinal injuries. improvement firm Raisbeck Engineering as its assistance company, however, skin damage from As such, careful pre-planning and extra equipment president. McConnell has spent the last seven years pressure ulcers is unlikely. Still, some patients may be required to reduce the likelihood of skin working for Eclipse Aviation, where he held multiple are more susceptible to developing pressure problems. This means that repatriation teams executive leadership positions. damage than others, and these patients need to be should consider having a wide range of pressure- considered carefully. relieving equipment to support patients. Gary Andrews, chairman of the There are a variety of factors that cause pressure A final set of factors that will cause problems International Air Ambulance Alliance (IAAA), will ulcers ­– such as an underlying medical condition, with skin is moisture and incontinence. Patients present the IAAA’s business plan and launch its present skin conditions, associated factors such as who are or may be at risk of incontinence, or intentions at the International Travel Insurance incontinence, as well as the surface a patient is lying whose skin gets hot and is under pressure, Conference in Istanbul, Turkey, in November. on ­(both in terms of the linen and the pressure are at risk of skin breakdown. Incontinence is Andrews is president of Red Consulting. relieving support they are getting). However, it is always a problem in repatriation, especially as possible that some patients, prior to repatriation, the patient will often drink inadequate amounts are well on their way to developing a pressure ulcer to prevent such risks. Repatriation nurses and – commonly known as incipient pressure ulcers – Repatriation nurses doctors should encourage adequate nutrition and Angel MedFlight because deep tissue damage is occurring but not hydration – which supports skin integrity – to obvious until the outer skin surface has broken. and doctors should support the wellbeing of the patient. rewarded Because of the numerous factors that affect the In summary, considering the three phases of risk of pressure ulcers, assistance companies encourage adequate repatriation, the key considerations are: Arizona, US-based Angel MedFlight Worldwide will need to think of identifying those patients Air Ambulance has announced that the company has at risk of pressure ulcers from an early stage in nutrition and hydration Pre-repatriation received two Arizona Corporate Excellence (ACE) the repatriation process. There are a number of – which supports skin • Identify risk factors using a validated pressure awards. The firm was named the third-fastest growing validated risk assessment tools, and while these will ulcer risk assessment tool. privately held company in the state and was also often get used at the point of repatriation, it is good integrity – to support the • Document the skin’s condition prior to presented with the ACE Innovation award. practice to identify at-risk patients using a risk tool repatriation Kelly LoCascio, chief executive, accepted the honours as early as possible. wellbeing of the patient • Plan for the risk. on behalf of the air ambulance company during the It is also essential that there is documented evidence • Appropriately equip the repatriation personnel. 16th annual ACE ceremony in Phoenix. LoCascio on the risk and state of the patient’s skin before said of the award: “The entire Angel MedFlight team repatriation occurs, as well as when the patient is Repatriation stage is proud to receive both the ACE awards and we assessed/collected, and continually throughout the • Assess and document the skin’s condition. sincerely thank all of the judges and sponsors of repatriation, right up until the end of the patient’s Prevention is key • Manage any existing skin lesions as necessary. the programme. Innovation is the hallmark of our journey. This will protect the practitioner, the Once a patient is identified as potentially being at • Use appropriate pressure relieving devices and company. We continue to strive to advance the air assistance company, and the underwriter. risk of developing pressure ulcers, the next step is document why they were used. medical transportation industry through sophisticated As well as the aforementioned factors influencing to actively do something to prevent this happening. • Reposition and relieve the patient within the training and advanced technology.” the formation of pressure ulcers, body weight, Nurses are usually well equipped to manage confines of the travel environment. Company president and founder Jeremy Freer added: secondary conditions, and medications can all pressure ulcer prevention. Pressure-relieving • Maintain fluid and hydration. “Receiving the ACE Innovation Award is especially influence the potential for pressure ulcer formation. devices fall broadly into three categories: standard • Manage moisture risk. meaningful to me because it highlights many of the Furthermore, other factors such as adequate pressure distribution products (example: foam and • Document skin status and actions taken. reasons I started Angel MedFlight. When I was working nutrition and hydration have equal importance synthetic materials), constant low-pressure devices, as a flight paramedic during college I was frustrated with when considering skin integrity. Therefore, a good and alternating pressure. However, assistance Post repatriation the inefficiency of the air medical transport process and assessment of the nutrition and hydration intake of companies and their air ambulance partners are • Decontaminate devices in line with I saw many opportunities for improvement. I designed patient is essential. limited in what they can use due to the effect of manufacturer’s guidance. the Angel MedFlight business model to better serve our patients, their families and case managers.”

International Travel Insurance Journal AIRAMBULANCENEWS 23

Stand-alone EFBs FAA challenge to Air Trek denied for AirMed UK On 20 September the National Transportation that the Administrator did not have sufficient fees to the amount of $2,553, bringing the total Safety Board (NTSB) denied the Federal Aviation evidence to establish his case’. At that time, the award to $124,527 – the largest in the history of Administration’s (FAA) third challenge to an Order NTSB granted additional attorney fees incurred in the FAA. Pursuant to the NTSB rules of practice, the requiring reimbursement of attorney fees payable response to the FAA’s appeal. The total award was FAA cannot challenge the award any further. to Air Trek, Inc., a Florida-based fixed-wing air increased to $121,991.34 Air Trek was represented by Gregory Winton of ambulance operator, pursuant to the Equal Access The NTSB has denied the FAA’s Petition for The Aviation Law Firm and Aviation Law Experts, to Justice Act (EAJA) 49 CFR 826. Reconsideration, stating that the agency’s LLC. Winton commented on the outcome The FAA had petitioned the NTSB to reconsider argument was ‘meritless’ and its reliance upon of the case: “Even though it has taken more its Opinion and Order dated 4 March 2010, case law was ‘misleading’. The NTSB further than a year to obtain a final ruling on the EAJA which held that the Administrator ‘should not stated: “We reject the Administrator’s argument award, the FAA has ignored all of my formal have proceeded to a hearing on allegations of that we erred in issuing a partial award of fees and requests to receive payment. This entire case wrongdoing that he was not prepared to prove’, expenses in this case.” has resulted from an abuse of prosecutorial and that the agency refused to withdraw elements In light of the denial of the FAA’s petition, the NTSB discretion and is a tremendous waste of valuable of its complaint until it ‘became painfully clear granted Air Trek’s request for additional attorney government resources.”

Chief pilot Capt. Phil Hebdon with some of the old paper AirMed manuals, which required extensive updating

Oxford, UK-based air ambulance specialist AirMed has led the way in the UK with approval for the use of stand-alone electronic flight bags (EFBs). Captain Mike Roberson, director of flying, commented: “This is a huge step in our continual strive for greater efficiency within our flight operations. Whilst we are always looking at new and innovative ways to improve our operations, we’re most interested in ways to improve safety. The use of the EFBs in our Learjet 35As has enhanced safety by reducing pilot workload, ensuring the integrity of revisions, and consolidating the world’s approach plates into one two-pound electronic notebook.” AirMed has chosen the Jeppesen Jeppview electronic navigation software to install on their DT312 EFB units. The provider said that throughout the entire approval process, Jeppesen has given invaluable support and will continue to work closely with AirMed to progress the evaluation process for approval on their single-crew aircraft. Steven Morgan, AirMed’s Jeppesen account manager, said: “This has been a new and exciting project for Jeppesen to be involved in. We have always seen the potential benefits of the electronic software and it is fantastic to see it being integrated into commercial [Aircraft Operator Certificate] operations, especially in an operation as specialised as AirMed.” After many hours of flight-testing the potential EFB units, AirMed decided that the DT312 unit was the most user-friendly as well as the most durable. Camtech Systems Ltd, based in Cambridge, UK has provided all the hardware and is also providing the ongoing technical support required for what is now an essential part of the operations of AirMed.

New iPhone app by Air Ambulance Card Medical evacuation membership programme Air Ambulance Card has launched a free application for iPhone mobile phones that aims to help travellers find medical assistance away from home. The app, called Find-ER by Air Ambulance Card, has a one-touch hospital finder that locates the nearest medical centres, maps routes to them and provides contact information for the facilities. The app contains a distress call function that allows travellers to call their designated emergency contact with the touch of a button. Find-ER also stores medical information and doctor and pharmacy contact information that allows doctors and paramedics to access potentially vital information that could be used to help treat the patient. Managing director of Air Ambulance Card Sam Jackson said of the launch: “We offer our members peace of mind that they can come home for treatment when serious injury or illness strikes on the road. With Find-ER, we can extend some of that peace of mind to all travellers from the moment a problem arises.”

www.itij.co.uk 24 AIRAMBULANCENEWS

CareJet expanding its reach US helicopter safety

CareJet, a fi xed-wing air ambulance service Phnom Penh in 2.3 hours, rules proposed provider based on the Pacifi c island of Guam, will Bangkok in 2.8 hours and base its second Westwind air ambulance in Manila, Kuala Lumpur in 3.3 hours. The US Department of Transportation’s Federal Philippines, in November. The service’s Guam- The service added that Aviation Administration (FAA) has proposed broad based plane will continue to cater to patients from some of these locations new rules for helicopter operators, including air Guam, the Commonwealth of the Northern have never had access to air ambulances, which, if accepted, would require stricter Mariana Islands, Micronesia and the Pacifi c Islands, ambulance services before. rules and procedures, improved communications and while the Manila-based aircraft will serve the Additionally, CareJet Guam training, and additional onboard safety equipment. CareJet’s new Westwind plane CareJet Philippines and surrounding Asian countries. With has formed an alliance Transportation secretary Ray LaHood said: “This is the two Westwinds strategically located in Manila with St Lukes Medical Center (SLMC), Manila, to Accreditation of Healthcare Organizations, said a signifi cant proposal that will improve the safety of and Guam, CareJet is expanding its global reach, establish what was described as a ‘fi rst in its kind’ CareJet. Preselected medical staff from SLMC have many helicopter fl ights in the US. The FAA’s initiatives providing clients with a shorter dispatch time, air ambulance operation in the Philippines with received training from CareJet Guam instructors have helped the helicopter industry make progress on reduced and competitive pricing due to positioning an affi liated aeromedical certifi cation programme. to prepare them for participating in CareJet many safety issues, but it’s time to take steps towards hours, said the company. From its base in Manila, St Luke’s is the fi rst healthcare facility in the Philippines aeromedical transports throughout mandating these major safety improvements.” CareJet said it will be able to reach Taipei in 1.8 Philippines and the second in Asia to be accredited Asia. The St Luke’s affi liation will enable CareJet to Under the proposed rules, operators would use the hours, Hong Kong in 1.7 hours, Shanghai in 2.9 by Joint Commission International, which is the utilise the hospital’s specialised doctors, neonatal latest onboard technology and equipment to avoid hours, Hanoi in 2.7 hours, Vientiane in 2.7 hours, international arm of the Joint Commission on team and intensive care nurses. terrain and obstacles. The proposal also contains provisions which, if fi nalised, would require operators

The estimated cost of the proposals in present value for the air ambulance industry is $136 million

to use enhanced procedures for fl ying in challenging weather, at night, and when landing in remote locations. FAA administrator Randy Babbit commented: “We can prevent accidents by preparing pilots and equipping helicopters for all of the unique fl ying conditions they encounter. These new rules are designed to protect passengers, patients, medical personnel and pilots.” The rules would require air ambulance helicopter operators to: • equip aircraft with helicopter terrain awareness and warning systems (HTAWS); • conduct operations under the Part 135 rules, including fl ight crew time limitation and rest requirements, when medical personnel are onboard; • establish operations control centres if they are certifi cate holders with 10 or more helicopter air ambulances; • institute pre-fl ight risk analysis programmes; • conduct safety briefi ngs for medical personnel; • amend their operations requirements to include visual fl ight rules (VFR) weather minima, instrument fl ight rules operations at airports/ heliports without weather reporting, procedures to VFR approaches, and VFR fl ight planning; • ensure their pilots in command hold an instrument rating. The proposals would also require operators of Part 135 aircraft to: • prepare a load manifest; • transmit a copy of load manifest documentation to their base of operations, in lieu of preparing a duplicate copy; • specify requirements for retaining a copy of the load manifest in the event that the documentation is destroyed in an aircraft accident. The estimated cost of the proposals in present value for the air ambulance industry is $136 million, with a total benefi t of $160 million over 10 years. Following the FAA proposal, the Association of Air Medical Services (AAMS) commended the organisation for its efforts to improve air medical transport safety. AAMS has co-operated extensively with both the FAA and the National Transportation Safety Board (NTSB) on the proposed regulatory initiatives, but the Association said it is keen to reiterate that regulation alone is not suffi cient: “A multi-layered approach is necessary. That is why we have not waited to take action; instead, we have worked with our air medical programme members to do what we can now, on a voluntary basis, to make air medical transport as safe as possible.” As part of its safety efforts, AAMS has been tackling human factors, which it says remain largely unexplored.

International Travel Insurance Journal CONFERENCE AGENDA 2010

MEETING ROOM 1 MEETING ROOM 2

Monday, 8th Nov 12:00 - 14:00 Registration and lunch 13:45 - 14:45 Air ambulance interiors 13.00 - 18.00 Sightseeing Tour sponsored by Rowland Brothers Int. 15:00 - 16:30 Permit requirements, inc. 5th and 7th freedom fl ight

Tuesday, 9th Nov

10:00 - 11:15 Cost containment in Turkey 09:30 - 10:00 In-fl ight medical ventilation 11:45 - 13:00 Mobile technology and its impact on 10:00 - 11:15 Assistance in disaster and confl ict the travel industry zones

11:45 - 13:00 Fitness to fl y; patient categorisation 14:15 - 15:45 Assistance world markets: Jordan, Japan and Turkey 14:15 - 15:45 Major disasters – are we prepared? 16:00 - 17:00 Ten suggestions for clinicians and doctors to live happily ever after 16:00 - 17:00 International Air Ambulance Alliance update

Wednesday, 10th Nov

10:00 - 11:15 UAE provider fraud from a Western 09:30 - 10:15 Assistance medicine; Case Study - perspective. Polytrauma in Djibouti, the synergy between assistance & air ambulance 11:30 - 12:00 Cashless outpatients companies. 12:00 - 13:15 Product differentiators – are they an 10:15 - 11:15 Centres of excellence, where are aid to cost containment and insurers these new centres and why are the member service? considered to be leaders? 11:30 - 13:00 Assistance medicine - Changes in 14:15 - 15:30 Medical Directors’ Forum repatriation with the change of client, focusing on the elderly and obese passenger. 14:15 - 15:30 From large land mass to tiny atoll – issues and challenges of providing

assistance 2

Thursday, 11th Nov 0 10:00 - 11:30 Correct policy wording for US 10:00 - 11:00 EURAMI board meeting

hospital healthcare 1 (closed session) 11:45 - 13:00 Cost containment and medical bills 11:00 - 13:00 EURAMI public meeting in Spain 0

18:30 - 20:00 ITIJ Awards and fi nale dinner 8th-11th November Ritz-Carlton Istanbul For full details & registration please visit www.itic.org.uk/istanbul

PROUD SPONSORS Sponsored by Sponsored by

Sponsored by

Air Ambulance provider of Assistance/Claims handler Intermediary the year of the year of the year CEGA Air Ambulance Mapfre Assistance Columbus Direct Netcare 911 Mondial Assistance Healix Insurance Services Skyservice Air Ambulance SOS International Preferential Travel Insurance

At MAPFRE Columbus Direct ASSISTANCE we has been a anticipate and adapt leading light for to the needs of the travel insurance market and of our since 1988. We more than 1,000 set out as the clients. We are present in 40 countries through fi rst independent our own subsidiaries in Europe, America, provider to sell Asia and Africa and provide our clients with directly to the With over 30 years in the business, CEGA Air thirty-fi ve 24-hour contact centres with over public. Now, we sell high quality cover in 50 Ambulance Limited leads the way in patient 2,000 multilingual operators. This is why 1,330 countries worldwide — we are a truly global fl ight care. Based out of new airside hangers corporate clients, 74 million people and 161 insurance intermediary. At home in the UK, at Bournemouth International Airport, we million benefi ciaries place their faith in us, the we’ve been expanding our marketing activity believe our fl eet of medically dedicated King MAPFRE Group’s Assistance and Specialty in 2009 and have seen signifi cant growth in Air 200s are the safest and most suitable Risks Company. Involved with our clients to direct sales – even through the challenging aircraft for effi cient patient transfer and we the utmost, their total satisfaction is MAPFRE economic climate we’ve all faced. Leading only ever use the very latest aeromedical ASSISTANCE’s effort, a goal we achieve based independent research organisation Consumer equipment available. The reach of our aircraft on our three basic principles: outstanding Intelligence has shown that nine out of 10 extends throughout Europe, Scandinavia and quality in our services and actions, continuous customers would save with Columbus. North Africa, as well as the Canary Islands innovation, creativity and fl exibility in our and the Mediterranean. products, and the creation of our own cutting- edge technological applications. Healix Insurance Services is a wholesale i n s u r a n c e i n t e r m e d i a r y regulated by the As one of the largest private emergency UK Financial Services Authority. Established medical service providers in the world, in 2005 to realise the natural synergy between Netcare 911 prides itself on offering quality the Healix Group’s core activities as a medical As an international leader in assistance, travel care and best-in-class solutions. Apart provider and the broader insurance market, insurance and customer relationship services, from our air ambulances, we provide local we are perfectly placed to advise customers a strategy of strengthening customer loyalty emergency services, remote site clinic within the accident, health and general for our clients, whilst boosting their revenue solutions and medical assistance services. personal lines insurance space. Adopting a opportunities is our success. Our pioneering Netcare 911 air ambulance services are high-level consultative approach, we ensure web-based travel insurance solutions have accredited by Eurami – Special Care. Our two that we fully understand our clients’ needs carved us a niche in the low-cost airline permanently confi gured jet aircraft are fully before constructing a comprehensive product industry, but have become a spring board equipped intensive care units to the highest placement plan. We are uniquely placed for conquering new markets for our travel international standards. We have short and to provide corporate clients with bespoke portfolio, such as telecommunications. long-range fl ight capability and operate solutions for their non-standard risks and Underpinning our e-commerce offering is internationally, mainly throughout Africa and can draw upon the IT and medical intellect of a worldwide network of customer services surrounding islands. Our doctor-led, highly the Healix Group to provide added value to experts, dedicated to delivering policy sales, experienced emergency and ICU medical customer propositions. claims management and international medical staff ensure quality patient care. assistance and repatriation.

Preferential was Based in the Nordic and established in Baltic countries, SOS 1996 and from its International delivers a inception, unlike broad range of assistance many others, Skyservice Air Ambulance, established in products on a B2B basis has specialised 1989, has a long rich history in the provision for the leading Nordic solely in travel of high quality, accident-free air ambulance insurance companies, insurance; transportation on a global basis. From our international emergency providing innovative, tailored solutions to each bases in Montreal, Quebec and Toronto, centres, hospitals and of its customer’s requirements. The group Ontario, Canada we have become known as public companies in the is uniquely structured and consists of three the world’s most experienced air ambulance Nordic countries. We render acute personal separate divisions: Preferential Insurance service. Our fl eet of fi ve medically dedicated assistance all over the world. SOS’ special Services – the business to business division; Learjet 35A air ambulances have completed expertise is to put the right competencies into Optimum – the underwriting division; and over 16,000 fi xed wing air ambulance play in any situation – promptly and in all parts Preferential Direct – the consumer division; repatriations. Our critical care fl ight teams of the globe. The core of SOS is knowledge, Marketing a comprehensive portfolio of have been developed in association with the experience and competent employees within Preferential branded travel insurance products McGill University Health Centre’s Montreal travel assistance, crisis management planning direct to specifi c consumer groups fulfi lled via General and Children’s Hospitals. and satellite monitoring and tracking. either the web or their UK based call centre.

International Travel Insurance Journal Sponsored by

Sponsored by Sponsored by Sponsored by

Marketing Campaign of the Hospital/Medical Provider Cost Containment company Insurer/Underwriter of the year year (judged independently) Baptist Health South Florida of the year of the year ADAC International Services Charge Care International Mapfre Assistance Global Excel Management BUPA Cromwell Hospital Marm Assistance PTI United Health International Xanit Olympus RBS Insurance

In a highly competitive marketplace, the three For the last 15 years, MAPFRE companies in the running for this prestigious ChargeCare International ASSISTANCE award have demonstrated their innovation has, through its extensive is the youngest and originality through their advertising. medical providers entity within networks, consistently MAPFRE S.A., the A D A C - A m b u l a n c e reduced and controlled the largest insurance, Service’s foundation in costs of medical expenses r e i n s u r a n c e , 1973 put ADAC’s air rescue Baptist Health South Florida International for insurers. CCI’s record fi nancial, and system on an international Division is one of the largest hospital-based in terms of enforceability and sustainability of services activity company in Spain and basis. ADAC-Ambulance international programmes in the US. Our its cost reduction is exemplary. The local and Latin America and top 10 in Europe. Service organises and specially trained multilingual staff personally international knowledge of CCI professionals MAPFRE ASSISTANCE is a multinational carries out patient assist our international guests with their based in the UK, Greece and Spain focus on insurance, reinsurance and services transport worldwide on ground and by air. medical and travel needs, offering the quality fi nding effective solutions to clients’ specifi c company operating in four continents – Highly qualifi ed medical staff specialised in they deserve as recognized by the US needs. Clients and medical providers, where Europe, America, Asia and Africa with emergency medical assistance, intensive government study, scoring Baptist Health ever they are, can confi dently and quickly direct presence in 40 countries, and more care and fl ight medicine accompany these above most of the hospitals on the US News access their claims via CCI web-based systems, than 3,700 employees. transfers. ADAC-AmbulanceService attends and World reports honour roll list. We’re also keeping them in close touch with the process. MAPFRE ASSISTANCE´s integration of to approximately 40,000 patients per year committed to developing relationships with CCI is a dynamic and innovative company, keen underwriting, assistance activities and claims and carries out some 15,000 transports - international physicians, medical associations to share its ideas and expertise to develop new handling in one single provider offers a on ground and by air. Depending on the and hospitals to become the institution products with visionary partners. centralized, integral and effi cient solution to patient’s diagnosis, air-bound transport may an international physician looks to when a our clients and their fi nal customers. also involve additional transport options like patient requires medical care. stretcher, sleeper and PTC.

Established in Marm Assistance was founded in 1986 with 1996, Global Excel the aim of providing assistance services to international assistance and insurance Management Inc. is Bupa Cromwell Hospital was established Professional Travel Insurance Company companies as an extended arm in Turkey highly specialised in 1981 and acquired by Bupa, the leading Limited (PTI) is an established name as and neighbouring countries. Our service line, in services related healthcare company, in March 2008. It is specialists who implement and manage to name a few, incorporates medical and to the Canadian, renowned for being the fi rst hospital to invest insurance programmes for niche groups and technical assistance, organization services, American, Mexican in some of the UK’s leading edge equipment markets. Formed in 1989, our fi rst undertaking treatment abroad and cost containment. We and Caribbean healthcare systems.Offering and cancer services. Based in West London, it was to create a global travel and personal have developed a unique cost containment a ‘complete solution’ to all our customers, has over 400 consultants, mainly drawn from accident programme for the International programme to provide the best possible Global Excel is a market leader in the London’s teaching hospitals, covering over Airline Passengers Association (IAPA) on cost containment services with reasonable provision of assistance, cost containment, 70 specialities including cancer care, cardiac behalf of its members. The Collinson Group pricing. We are a pro-active organisation case management and claims adjudication services, paediatrics, surgery, neurosciences Limited acquired PTI in 1997 and provided playing a key role in maintaining a quality services for over 110 clients located in more and diagnostics. Outpatient services include the resources to support the expansion of PTI standard in the cost containment market. than 26 countries around the world. We offer private GPs, health screening and a walk- into new products and markets. The company Our cost containment efforts not only focus our clients telephone assistance 24 hours a in family medicine centre. The hospital has was then able to expand its reach, garnering a on the incurred costing, but also aim to get day, 365 days a year and by not outsourcing 128 beds and boasts a large and loyal UK reputation with IAPA, Columbus Direct, Club the best quality standard of treatment at the this important aspect of our offering – and international clientele, admitting self- Direct, Trinity, Mediquote and Insure For All. the service – we are able to maintain an pay, embassy sponsored patients and those right medical facility for a reasonable price. exceptional level of customer service. funded by medical insurance.

Olympus began UnitedHealth Xanit International operations in 1994, Inter national Hospital, a reference and was a pioneer is focused on among private medical in developing providing global centres on the Costa network health network access, insurance solutions del Sol, is fi tted with management and administrative services to individuals and the most advanced solutions for international healthcare payors. groups. CBS provides exclusive access to the healthcare technology. From that base, Olympus has evolved into a UnitedHealth Network of preferred providers, Its 450 multidisciplinary, professional staff leading independent provider of healthcare RBS Insurance is the second-largest travel delivering the most extensive and lowest-cost work together to offer the best care. claims administration and cost management insurer in the UK, with nearly four million in-force network in the US. CBS facilitates products The hospital offers a wide range of healthcare services, utilising both traditional services policies. RBS Insurance provides underwriting and services for travellers, expatriates, services including all medical and surgery and unique solutions. services and direct insurance policies through its indigenous populations, and medical tourists. specialties, with three special units: the As an accredited ISO 9001:2008 company, own brands, such as Direct Line and Churchill, These services are supported by UnitedHealth Heart Unit; the Oncology Unit; and the Olympus is committed to ensuring the highest as well as through partner brands including Group companies and our strategic partners Neurosciences Unit. quality service standards for its products and many respected household names. These worldwide. UnitedHealth Group is a Fortune Xanit International Hospital, which also has services. Our clients receive precise client partnerships offer travel insurance through a 100 company identifi ed as the fi rst or second a Medical Centre in Fuengirola, has a fl eet of management, around-the-clock access to our wide variety of fi nancial and consumer brands, most admired company in the healthcare fi ve ambulances and our International Services call center; on-staff medical professionals, including Santander, RBS, Coutts, Natwest, industry by rankings, as published in Fortune Department provides quality, multilingual, provider networks and EDI enabled Ulster Bank, Nationwide, Prudential, BMW, Mini magazine since 1995. professional care to all our patients. technological capacity. and the AA. www.itij.co.uk 28 FEATURE

Do general practitioners or family physicians know enough about travel insurance? Doctors! Milan Korcok examines the reasons why it’s Please do no harm! vital they know more

“I’m trying to be honest, but my doctor doesn’t tell exhaustion, and loss of appetite. Radiological his doctor’s medical clearance or if he had known off the box that asked if he had been treated or me everything.” As a travel insurance ombudsman examination revealed multiple nodules and masses what the x-rays revealed. investigated for ‘urinary or kidney disorders’ within for over 10 years, I have heard this complaint from throughout the lungs; additional examination revealed the past 12 months. When several weeks later many embittered travellers whose claims for medical cancer in the lungs, liver and other organs. Suspecting Appropriate disclosure he presented to a US hospital with lower right and hospital expenses have been denied by their a pre-existing condition, the insurer requisitioned the Contrast this with a family physician who tells her abdominal pain and a clearly defined ureteral stone, it insurers because their medical histories didn’t match patient’s medical records from Canada and found that patient that though she does not believe the finding didn’t take much investigation to justify a claim denial their applications for coverage. Perhaps they didn’t within 180 days of his trip, the patient made several of a kidney stone may be the proximate cause of a on grounds both of pre-existing condition and non- check off the box asking if they had been treated visits to his family doctor for treatment of persistent persistent lower right abdominal pain – that it might disclosure. for cardiovascular abnormalities, or gastrointestinal cough, lack of appetite, and constant wheezing, just be an incidental finding – he should check with Insurance applicants, especially elderly snowbirds disorders, or urinary or kidney complaints, or lung and chest x-rays showed ill-defined areas of his travel insurer if this might affect his coverage on in less than perfect health, are acutely aware that conditions, or any number of other conditions within increased density in the left lobe of the lung ‘perhaps a pending snowbird trip to Florida. In this case, the the more ‘Yes’ boxes they tick off on their medical the past one, two, or five years; or they failed to representing partially calcified granulomas’. client did not follow his doctor’s advice, mentally applications, the higher their premium tends to report their last visit with their family physician; or The insurer denied the claim on grounds that the locked on instead to his doctor’s opinion that the go. So there is a subliminal pressure to seek out they didn’t understand what their doctor said when policy didn’t cover any pre-existing conditions that stone was irrelevant or ‘incidental’, and when reassurance that they are OK. And when their family he talked about their dyslipidemia; or, perhaps, they manifest symptoms, were unstable, or were treated completing his medical application failed to check physician says, or even hints, that he or she sees no just brushed all other advice aside once he blessed or investigated within 180 days of the effective date reason why they should not take their annual five or them with a ‘clean bill of health’. And then came the of coverage. six-month vacation in the sun, that seems a lot more denial of their claim. In challenging the denial, the patient’s family persuasive than a mass of fine print in a long contract Were they liars, cheats, frauds? Did they deserve to contended that prior to his departure, their father defining abstract terms like ‘pre-existing condition’, be caught out? Or were they just unwitting victims had not been specifically diagnosed with any or ‘stable and controlled’, or ‘treatment and referral’. of a dynamic in which doctors, trying to clear their medical condition, and his doctor had given him Doctors, on the other It’s easier. It’s what patients want to hear. And who waiting rooms, didn’t take the time to explain all their a health clearance to travel. In their appeal, they doesn’t trust their family doctor? test results, or didn’t consider the results clinically appended a letter from the family doctor, which Doctors, on the other hand, have a panoply of significant, or just didn’t want to bother their patients stated that he and his associates had examined hand, have a panoply of reasons for wanting to give a clean bill of health. needlessly? Perhaps the doctor just felt they were the patient and saw ‘nothing on his examination The first is that it makes their patients happy. better served by a good vacation in the sun than by to indicate a health concern’. He was advised to reasons for wanting to Another is that they have neither the time nor the learning an inconvenient truth. see them again when he returned. He died shortly inclination to read their patient’s travel insurance after his return. policies. Who does, when some of these run to Case illustration Certainly, the claim denial came as a cruel blow give a clean bill of health more than 30 pages? An elderly gentleman from Canada flew to Australia to the family as well as a potentially catastrophic But in Canada, where universal, comprehensive where, just days after arriving, he was admitted to financial loss. As a member of the family later noted provincial health plans cover only a small share of hospital for shortness of breath, coughing spasms, to me, his father would not have travelled without out-of-country emergency medical services, private,

International Travel Insurance Journal FEATURE 29

supplemental travellers’ insurance is a fact of life. More than 80 per cent of snowbirds buy it, and each year Canadian seniors make close to one million out-of-country trips of at least 30 days. There are few Canadian family physicians who don’t have some snowbirds on their patient rolls. And though there are literally hundreds of different plan options available, the basic concepts of each of these plans are quite similar, as are the definitions and rules about disclosing medical conditions, or treatments, referrals or changes of medication, or guidelines for covering pre-existing conditions; or reporting any health status changes after a policy is purchased and before it is activated (many snowbirds buy months in advance to take advantage of cheaper prices). The wording differs slightly, depending upon how many lawyers can dance on the head of a pin, and the exclusionary periods for pre-existing conditions vary (i.e. 30 days, 90, 180); so do the eligibility requirements. But the constant in all policies is that travel insurance is for unexpected emergencies, not conditions or symptoms that already existed or had been treated or were being investigated without the insurer’s knowledge.

Doctors onboard No-one expects busy doctors to spend their evenings reading insurance policies, but if they recognise that policies define limits of coverage, and those limits don’t necessarily coincide with how The history prompted claims assessors to review the physicians assess and disclose their patients’ status, client’s medical background, and besides the deep they might moderate their tendency to hand out vein thrombosis they found hiatus hernia, chronic clean bills of health, or decide on their own what phlebitis, pericarditis, and bradycardia. Yet the only is or is not clinically significant enough to tell the Most doctors now are condition or medical intervention disclosed by the in adjudicating a claim, patient. Dr Robert MacMillan, a former president client on his application was high blood pressure. of the Ontario Medical Association, and medical Assessors denied the claim on the grounds that had director of Medipac International, one of Canada’s responsible in sharing all the underwriters known of all of the conditions, they most insurers will require leading vendors of snowbird insurance, says: “It is would not have covered the applicant as they did. no longer the physician’s prerogative to conceal In support of his patient, the family doctor told abnormal results from the patient, even if deemed facts and diagnoses with the assessors that his patient’s chronic phlebitis copies of the physician’s trivial, not just because of insurance applications but was not new, and though he was investigated for because we live in a time of ‘the right to know.’” He their patients pericarditis, it was never confirmed. Neither were notes to confirm benefits adds: “Most doctors now are responsible in sharing the bradycaria or hiatus hernia considered ‘clinically all facts and diagnoses with their patients as required significant’ and so the patient was never told about by their professional colleges, but there are certainly them; therefore, said the doctor, ‘he could not still some of the old school where such information report what he wasn’t told’. is not shared.” cardiac complications, which may prompt a rigid It’s clearly much safer for some applicants to ask their travel insurer to reject a future claim if not revealed Right to know doctor for help in completing an application, even Case illustration on an application.” When I speak to claimants about what they ‘didn’t if they have to pay a fee for the service. Says Dr When a Canadian woman was admitted to a Canadian medical applications vary in their specificity, know’, many say they feel caught in a vice – wanting MacMillan: “Perhaps fewer claim denials would occur California emergency room with what her EKG clarity, and length. Often they will start with some to be open and truthful, but unable to be so. Some if insurers attached a short note to the attention of showed was ‘marked sinus bradycardia (slow heart general health questions to determine eligibility: like, have said that had they known what their doctors the doctor when such assistance is needed.” rate), a right bundle branch block and … subsequent do you take four or more medications, or have you knew, they would not have travelled because – unlike But insurers, too, have to ask themselves how much third degree AV block with a heart rate of 40 beats ever had or been diagnosed with cardiovascular their doctors – they know about travel insurance they can expect of purchasers who just want to ‘get per minute’, case managers went back into her disease, cancer, chronic obstructive pulmonary exclusions and limitations. They have been around insurance, get it cheap, and get the hell out of the Canadian doctor’s medical records and found a disease, HIV/AIDS, and so forth. If the applicant the block. snow’. They realise that medical applications and recent history of ‘recurrent episodes of weakness, clears these hurdles, he or she may qualify for some Do they have any recourse if they feel victimised by underwriting tools need to be clearer, simpler, more faintness, significant shortness of breath … transient level of coverage and be required to answer more a claim denial that was not their fault? Dr MacMillan manageable by applicants as well as precise and second degree AV block, resolved spontaneously specific health questions. Though the questions can notes that in adjudicating a claim, most insurers will probative enough to reflect an honest and accurate … incomplete right bundle branch, left posterior sometimes be tortuously phrased, their intention is to require copies of the physician’s notes to confirm picture of their risk factor. As most will admit, they fascicular block, first degree block’. The client, in elicit answers of fact, not opinion, and they don’t ask benefits and these are required by their professional need to do a better job of getting the medical arguing her denial of claim, said none of these findings the respondent to list only those conditions they think colleges to be legible. Furthermore, he says: “The information they need to assess risk without requiring were considered by her doctors to be abnormal, and relevant. Neither is the applicant’s physician asked if physician could be liable … (for) any information of their applicants, many of them elderly, to jump when she left for California she said her doctors told their patient is ‘medically fit to travel’. significance not revealed to the patient (that) may through increasingly high hoops. her she had ‘no health issues to be concerned of’. The questions are designed to be objective, not have resulted in a faulty application and denied claim.” Busy doctors are not going to set aside time they That may have been her doctors’ fair clinical subjective: have you been treated by a physician, He adds: “It is important for physicians to be aware could be treating patients to pick up a syllabus on assessment, had she not been travelling abroad, referred for tests or other investigation; has your of this potential when abnormalities are found during travel insurance. But perhaps it’s not unreasonable for and had she remained under the umbrella of her medication been changed in type or dosage; have examination or investigation.” generalists and family practitioners to brush up on the comprehensive healthcare system where pre- you been hospitalised – i.e. Do you have a cardiac As insurers expand their options for people in basic concepts of what travel insurance is designed existing conditions don’t impede one’s access to condition with an ejection fraction of less than 40 per less than perfect health, medical underwriting and to do, how it is structured, and to understand that its continuing healthcare. But as soon as she crossed cent or a ventricular function grade of three or four? the applications and requirements that are part purpose is to supplement out-of-country coverage her own boundaries to another country, the rules Says Dr MacMillan: “Objective medical facts are the of that process place more burden on potential and not to be a substitute for domestic medicare. changed. Her hospitalisation in California had its only criteria that should determine both application insurance purchasers. Ultimately, it is they who It may also be reasonable for physicians to admit to pre-existing origins in Canada, even though, as acceptance as well as claims adjudication.” But are responsible for the accuracy of the medical their patients that they can’t qualify them for travel she continued to assert, she was never told by her objective medical facts can be hard to report if the applications they declare and sign. They can’t insurance, or tell them if they should or should not physicians of any significant heart abnormalities or patient doesn’t know about them. blame a misleading, or untruthful, or incomplete travel. It may hurt some doctors’ egos to deny such that she ‘had a disease of the electrical conduction application on someone else. powers of benediction, but they are not the ones who system of the heart’. Case illustration Most insurers now advise applicants who are unsure pay the bills if their patients end up in a foreign hospital. Says Dr MacMillan: “A first degree heart block A Canadian snowbird was admitted to a sunbelt of their medical status, or what the questions mean, But their actions, when dealing with travelling found on a routine electrocardiogram has usually hospital complaining of right-sided weakness and or the terminology used, or what lurks in the depths patients, do have potentially serious consequences been considered of little importance and would be slurred speech. Investigation revealed left cerebral of their medical records to ask their doctors to look of which they may not be aware. Patients need to something some physicians would ‘not bother’ their stroke/ischaemia (TIA) and blockage of the left carotid over their responses. Some insurers also require remind them of one of the most basic principles of patient about. Recent research has, however, shown artery. His history reported chronic kidney disease, applicants in the highest risk groups to have their their art: First, Do No Harm. n that such individuals are at slightly increased risk for hypertension, and chronic deep vein thrombosis. doctors complete their medical questionnaires.

www.itij.co.uk 30 FEATURE

In the line of fire

Conflict zones provide a unique challenge for those providing emergency medical services and repatriation to people working or living in such areas. Paul J. Brinkworth, RMSI operations co-ordinator, spoke to ITIJ about the everyday issues he faces when working in warzones or areas of political instability g

International Travel Insurance Journal

32 FEATURE

he term ‘conflict zone’ refers to challenges, including: logistics for plant, equipment or they have incomplete surfacing and unfinished an area where war or political and consumables, security against insurgent attacks, construction, which has resulted in quicker-than- instability is causing disruption to ensuring the security of all patients receiving normal deterioration, making it uncomfortable for the essential infrastructure and treatment and care, suitable accommodation, clinics Some military hospitals patients and significantly more difficult to transfer spinal tservices required by the community, and essential services including electricity, water, food and other acute cases. Roads in remote locations are (such as government, social services, transportation, and communication. on occasions only mainly unsealed, damaged by erosion and generally communication, sanitation, electricity, water, housing Aside from overcoming the obvious communication unable to be navigated by vehicles. Travelling out and healthcare); thereby requiring assistance from difficulties experienced with patients in remote admit a patient of a city or on remote road networks represents a international organisations and people from outside locations due to unreliable or nonexistent continual threat of attack and ambush by insurgents or of the affected community. The more remote the telecommunications infrastructure, incompatibilities for emergency criminal elements, and risks injury to clinicians, patients community or the area, or the more diminished between the military and civilian communication and patient escorts from IED detonations. the infrastructure, the more essential these outside networks, continual dampening of mobile phone stabilisation, for services become. coverage areas to prevent bomb detonations, Air care Within the normal emergency medical system verbal language barriers with both physicians from periods of up to 12 or a Travel via air is not without its inherent challenges and framework, continuity and definitive care is commenced international military forces and local hospital dangers either. Airstrips located outside international immediately at the incident scene and continued facilities must be overcome. The majority of maximum of 24 hours airports and large military bases are unprotected through hospital emergency departments, intensive local hospitals do not have access to Internet or against attack, and the majority are constructed care units, specialty departments and rehabilitation, email services and produce medical reports and from dirt, inconsistent in length and width, difficult

Within these environments, destabilised governments, changes in interim authorities regional commanders, and sudden changes in policies and procedures may have substantial impact on service delivery

thus allowing patients to successfully re-enter the documentation using the local dialect, resulting in community. In contrast, conflict zones present the health delays with updating assistance companies while service provider with many challenges in maintaining waiting for translations to be completed. the provision and optimum standard of emergency Communication and updates to international stabilisation and onward medical evacuation services assistance companies may also be disrupted for short for expatriate personnel operating within these periods, due to the limitations of or interruptions environments, all within unique conditions and within to communications infrastructure. On occasion, the limitations of the available resources. world time zones can cause delays with receiving ‘authorities to proceed’ on cases, resulting in Precious resources missed opportunities to retrieve and or commence To enable the provision of emergency health services evacuations of patients out of theatre within initial and rapid response medical evacuation capabilities timeframes. within a conflict zone, a company must have the Within major cities, road networks are inadequately resources and the clinicians operating on the ground maintained or severely damaged through detonations within that environment. This itself provides many of improvised explosive devices (IED), overusage,

International Travel Insurance Journal FEATURE 33

to maintain and sparsely located. Uncontrolled extreme weather conditions, provide further support from aid organisations and non-government airspace with no ground aviation radar coverage, challenges with movement by air. Air strips within organisations, to assist with the supply of medications no instrument landing systems (ILS) to assist air desert regions at times suddenly close due to large and equipment. Building disrepair and breakdowns ambulances on approach and landings, and no landing dust storms lasting for days. Mountainous regions in essential services, including electricity and water, strip lighting exist within these locations. Therefore, Some religions and during winter months experience the worst weather greatly impact on the quality of deliverable patient flights into these areas are only achievable within imaginable – from snow dumps to blizzards, which care. Family and relatives attend to nursing duties daylight hours, which are greatly reduced during the indigenous belief temporally ground aircraft, thereby only providing of admitted patients, and presently no system exists winter months. Operators have to be aware that narrow windows of opportunity to retrieve patients. for ongoing education or implementation of current military fly-around zones, sudden closures of military systems prevent Unforeseen, rapid closing in of weather fronts can at best medical practice with local doctors in these airspace without warning and onset of military versus times prevent aircraft from returning, stranding clinical environments. Within some regions, and particularly insurgent conflicts within the area, can all delay an medical treatment of crews within harsh and dangerous areas, managing within the conflict areas of the Middle East, there are aircraft from reaching the patient. Widespread laying the patient until conditions clear. no hospital facilities for patients suffering from burns and distribution of landmines, combined with areas local female patients by trauma or psychological conditions. littered with unexploded ordinance from previous Healthcare Increasingly, greater numbers of individual civilian and current conflicts, increases the risk of safely male clinicians Apart from the odd individual exception, local expatriates presenting to international military hospitals landing rotary aircraft in areas inaccessible by fixed- hospitals are poorly funded, overcrowded and are being denied treatment and admission, as their wing airframes and ground ambulances. under-resourced, with little modern specialised primary role is for the provision of healthcare to military Geography and harsh terrain, combined with diagnostic technology. They tend to be reliant upon service personnel. Some military hospitals on occasions

www.itij.co.uk 34 FEATURE

only admit a patient for emergency stabilisation, for warning or publication with procedural changes, periods of up to 12 or a maximum of 24 hours. as they are disseminated to the local authorities Within these environments, destabilised via word of mouth and, in some cases, interpreted governments, changes in interim authorities, incorrectly or adjusted to an individual’s benefit, regional commanders and sudden changes in prior to implementation. These constant changes policies and procedures may have a substantial and misinterpretations open up the opportunity impact on service delivery. There is usually no for widespread corruption among individuals in

Working with assistance companies

The challenges faced in conflict zones and is promptly and accurately passed to the transfer the very nature of such situations – their team in order to ensure the decision to proceed is being extremely fluid and open to change at a still valid and accurate. moment’s notice – is certainly something that As an example, a recent situation I was faced with all entities, including the assistance company involved the transfer of a patient from an airfield involved, need to take into account. Richard that came under attack after the air ambulance Knight, emergency logistics and special projects had launched from its base and was en route to manager for Europ Assistance USA, focuses on the patient. I was in contact with the fixed-base the assistance company’s role when performing operator, who was providing live information evacuation operations in conflict zones and on the status of the attack and over a 30-minute hostile environments timeframe the airstrip was open and closed five times. This information was promptly passed to When an assistance company is notified of a the air ambulance team, who were unable to patient situation in a conflict zone, they are faced make direct contact with the fixed-base operator, with unique and challenging decisions prior to and the decision was made to keep going to the

if you’re going to send a team into a high-risk situation, make sure it’s for the right reasons

launching the medevac team into a hostile area. airfield in the hope that the attack had ceased by Just some of the challenges faced include the the time they arrived. Luckily, approximately 20 ethical decision of the assistance company to give minutes prior to the arrival of the aircraft, the local the green light on a hostile environment transfer, security forces had repelled the attack and secured with the decision to proceed needing to be carried the airfield. This, however, raises an interesting and out for the right reasons. Specifically, does the rather worrying concern: if due diligence had not patient fall into a category where their life is at risk been followed by the assistance company and the if they are not moved immediately? If, for example, air ambulance was not able to make contact with the patient is not in a critical condition, there the airstrip, there is the possibility that the transfer needs to be careful consideration on the decision team would have had to fly in blind and potentially challenges when operating within conflict zones and to proceed as, after all, the assistance company is land while the attack was still happening, thus the remote isolated areas of these nations. Challenges responsible for sending in medical and air crews risking all their lives. The more remote the never remain stagnant within these environments as to these environments, which inevitably puts the This is just one example of how situations can dynamics are continually shifting, changing and evolving transfer unit into harm’s way due to the high-risk change at a moment’s notice in conflict zones, community or the area, as the levels of conflict either increase and or decrease. factors that are present in conflict zones. Or, to and probably the best advice I can offer is this: If Over time, once hostilities cease, governments put it another way, if you’re going to send a team it can go wrong, it will go wrong, so be prepared the more diminished stabilise and the essential infrastructure and services into a high-risk situation, make sure it’s for the right for any eventuality. EA USA has conducted are rebuilt, other challenges will replace the ones that reasons. over 100 major incident operations in hostile the infrastructure and currently exist. n It is certainly a decision process that I have faced environments so far this year, demonstrating that previously, and it is certainly not an easy one, such missions are achievable, as long as you have essential services as essentially the wrong decision could, in turn, the infrastructure behind you. mean that in the event of a hostile act towards the become Paul Brinkworth transfer team, the question would always be asked has gained his ‘Did they have to be there?’ Richard Knight knowledge Of course, there are many other situations where is emergency positions of power and within local authorities and depth of an assistance company comes into play with regard logistics and and departments. Instead of working towards experience to performing a successful conflict-zone extraction, special projects a greater good and benefit for all, the current through many and in most scenarios these types of situations manager for Europ cultural trend is to live for the now, personal gain years of working normally become joint operations between the Assistance USA. and wanting power, and this, in combination with as both a transfer team – the transfer teams are primarily He has worked poor structure and reporting capabilities within paramedic and specialist units with a ex-military backgrounds who extensively local authorities, allows individuals to instantly flight paramedic are well trained in hostile environments, that being in the field of change procedures and cause extensive delays in within the said other teams are also used but they are not international an attempt to extract bribes. emergency pre- normally the primary choice due to being outside emergency response and assistance for the last Some religions and indigenous belief systems prevent hospital environment. Through a culmination the immediate area of operation and thus having 10 years and has been involved in over 25,000 medical treatment of local female patients by male of 11 years with the Queensland Ambulance a delayed deployment time – and the assistance operational situations. He has developed clinicians, unless permission is obtained from a Service in Australia, and another four years with team. The reason for this is because it can be various specialties ranging from emergency senior family member or husband. Particularly within RMSI, he has broadened his scope through down to the assistance team to remain in contact logistics in hostile environments, remote area remote areas, religious leaders are the main source the delivery of emergency pre-hospital care with the persons on the ground (the employer for emergency response and major incident of guidance and education to members of the local within the remote and hostile environment of example) when initially notified of a patient needing extraction operations. Currently, he is in charge community, and therefore, have substantial influence Afghanistan, through the provision of clinical and evacuation, and make sure that all information of emergency logistical and major incident regarding the local acceptance of humanitarian operational ground ambulance, rotary and fixed- relating to locations, current security threats, air management, primarily in high-risk areas. medical assistance from international organisations wing air ambulances services. field status, and changes in the patient’s condition operating within their locations. In reality, medical service providers face many

International Travel Insurance Journal FEATURE 35 International Travel Insurance Conference PACIFIC

Hong-Kong 21-23 June 2011

www.itij.co.uk

ITIJ Awards 2010 broc.indd 6 20/10/10 13:36:54 36 ASSISTANCE&HEALTHCAREWORLDMARKETS Belgium: the crossroads of Europe

Belgium may be a relatively small country, but it packs a punch when it comes to healthcare delivery. Tatum Anderson details the standards and access to medical care for those needing treatment while in the country

Belgium may not attract vast numbers of tourists just over 30,000 square kilometres in size, making in relation to many of its European neighbours, it the second most densely populated country in but at the crossroads of Europe, it is administrative Europe. It is divided along ethnic lines between home to the European Union (EU) and boasts a Dutch-speaking Flemings and French-speaking vast international community. Luckily for visitors Walloons. In addition, there are eastern German and the significant population of expats, Belgium cantons, and the bilingual (Dutch and French) capital, spends 10.2 per cent of its GDP on health, and has Brussels. But for a country that is deeply divided a high standard of care, and corresponding good along linguistic, economic and political lines, there is health indicators. Here, we investigate how that actually little inequity between healthcare provided healthcare is delivered – both to foreign residents in the different regions, although approaches might as well as those more temporary visitors – and we differ slightly (the federal government manages most look at standards and access to emergency care, curative healthcare but a few elements of the health including a run down of some of the top hospitals system are devolved to the communities). recommended by assistance companies operating in Overall, there are plenty of decent hospitals in the country. Belgium. As Dr Jan Christiaen of Falck, an assistance company that operates in several European countries, In safe hands including Belgium, told ITIJ: “The standard of the Belgium is home to over 10.6 million people, yet is hospitals [in Belgium] are among the best in Europe.

Access is excellent, almost no waiting lists, facilities are issue raised has been over guarantee of payment clean and they have well organised structures.” Of (GOP). As Ivo Bonte, network co-ordinator for course, many of the most renowned medical facilities Belgian assistance company VAB, told ITIJ: “In general, are located in Brussels and are frequented by expats. hospitals accept GOPs from Belgian assistance Erasmus hospital, a university hospital (where the companies without any problems. However, I’ve crown princess gave birth to her children), Brussels seen an evolution over the last 10 years – in Belgium Saint-Luc University Hospital and Edith Cavell as well as many other countries around the world – Interregional Hospital Group (CHIREC), a group where there’s less trust. This started even before the of private hospitals, all have excellent reputations. financial crisis. If a hospital doesn’t have a GOP from University hospitals are particularly renowned. They someone they ‘know and trust’, immediate payment operate in Belgium’s major cities including Antwerp, is being more frequently demanded by the hospital.” Ghent, Leuven, Charleroi and Liège. There are also good Catholic organisations, such as Onze-Lieve- All for one Vrouw Hospital (OLV) in Aalst. Furthermore, Truus Unlike tax-based healthcare systems, the Belgian Andries, project and network manager of Touring health system is based on social insurance, a system Club, which provides medical assistance for foreign dependent on employment infrastructure and tourists visiting Belgium, reckons leading Belgian separate from health facilities, such as hospitals and institutions include Antwerp’s Middelheim Ziekenhuis clinics. In exchange for social security payments, and Algemeen Ziekenhuis St Lucas, which has sites in which are directly deducted from wages, Belgian both Ghent and Bruges. citizens are insured against the risks of illness, accident Indeed, facilities are so good in many Belgian or hospitalisation. Mutual insurance organisations, hospitals that neighbouring countries, including the or sickness funds, provide this insurance to citizens. Netherlands, have agreements with Belgian hospitals They are financed not only by earnings – generally, for prompt access to medical care to help reduce every employed person pays 13.07 per cent of his national waiting lists. And Belgians do not generally gross remuneration to the federal state for social go abroad for healthcare apart from cheaper plastic security – but other sources, including employers’ surgery. A shortage of nurses has led Belgium to contributions. import EU-trained staff, but assistance companies say It is compulsory for all employees to join a sickness these shortages are yet to affect services provided. fund. In 2008, 99 per cent of the Belgian population Generally, international assistance companies have belonged to one of these funds. Over 9.4 million very good relationships with local hospitals. The only people were insured under a so-called general

If a hospital doesn’t have a GOP from someone they ‘know and trust’, immediate payment is being more frequently demanded by the hospital

International Travel Insurance Journal ASSISTANCE&HEALTHCAREWORLDMARKETS 37

For Belgians venturing abroad, personal travel medical assistance is usually provided through the additional insurance taken out by the majority of the population with their mutual insurer or sickness fund

scheme and over one million under the scheme for the self-employed. There are six private non-profit-making sickness funds. The National Alliance of Christian Mutualities is the largest and manages around 45 per cent of the population. There is one public sickness fund. Essentially, they are politically oriented, each having a Flemish, Walloon or German community identity. The funds have a long history, starting in the late 19th Century, when workers organised societies to protect members against the risk of disease, unemployment and incapacity for work. Today, they are highly politicised and powerful, says Filip Declercq, business manager at Expat & Co, a start- up health insurer. Essentially, sickness funds exist to reimburse citizens for health services they may use. The main insured members are entitled to health insurance based on their current or previous profession. Their dependants, defined as a member of the family of the entitled person living in the same main place of residence, are covered under their contribution too. However, the rate of reimbursement and method by which reimbursement takes place differs depending on the intervention. That means Belgian citizens are expected to co-pay to some extent for their health services. Most Belgians purchase additional coverage from their mutual insurer on top of the compulsory insurance, however, which ensures most out-of- pocket healthcare expenditure is kept to a minimum. The level of reimbursement is independent of the job the patient does, unless their disorder is the result of an occupational accident. In that case, all medical costs are covered. Generally, the rule of thumb is that for Belgian citizens, about 80 to 90 per cent of the cost of healthcare is covered by the sickness funds. The rest is paid by the patient through official co-payments, supplements (such as private rooms in hospitals) and other non-reimbursable services, drugs and devices. Essentially, rates of reimbursement for treatment are set out in a rather complex document called the nomenclature. The difference between the actual charge and the reimbursement is the user fee or co- payment rate. A visit to a GP will elicit one rate, and a visit to a cardiologist will elicit another. Co-payment rates are about 25 per cent for GP consultations, 35 per cent for GP home visits, and 40 per cent for specialist consultations, physiotherapy or speech therapy. (Rates of reimbursement are the same for everyone except those with special reimbursement status). However, doctors and hospitals are at liberty to increase prices, which means reimbursement amounts can be lower. Specialist fees can vary by a factor of four, says Filip Declercq. Most inpatient services require co-payments of no more than 20 per cent of the cost. A hip replacement will cost about c1,000 to the patient, as an example. Dr Jan Christiaen says: “Indeed, the rule is mostly that if you are seriously ill, and need hospitalisation, most costs will be covered. If you are

www.itij.co.uk 38 ASSISTANCE&HEALTHCAREWORLDMARKETS

‘ambulatory ill’, the non-refundable part gets higher.” for physicians and freedom of choice for patients. So, Inpatient services are charged on the basis of set unlike some countries in Europe, citizens are able to flat-rate user fees. Furthermore, patients do not have approach specialists directly rather than go through to pay the entire cost of services upfront and wait for a GP gatekeeper system. “It is very easy to find a reimbursement. The sickness funds have agreements specialist if you go to the website of any hospital with hospitals for the direct payment of hospitalisation on the Internet, and you can make an appointment costs, but ambulant medical treatment is paid for directly,” says Andries. The advantage of such a by the patient and then reimbursed. The set rates system, say experts, is that citizens can seek a second can comprise a flat rate per day for hospitalisation; a opinion if they do not trust the first. The disadvantage room supplement when the patient has requested is that health spending is higher (especially as some a single or double room; a flat rate charge for doctors can sometimes raise their prices). pharmaceuticals (around c0.62/day); an inpatient That said, some sickness funds prefer clients to first stay for biological tests (c7.44/stay); and for radiology consult a GP before seeing a specialist. “Sometimes, (c€6.20/stay). Room supplements are usually taken the GP can solve the problem and the patient doesn't up by private patients who have top-up health have to go to the specialist and in that way it costs insurance in addition to basic sickness fund coverage. less for the sickness fund,” adds Andries. In recent “All costs are invoiced. On the invoice you can see years, the government has introduced a series of what has been charged to the health insurance and measures to try and strengthen the role of GPs what is not covered or how much the personal and prevent so many patients relying on hospital cost is,” says Dr Jan Christiaen. Different drugs are emergency services for less urgent problems. For reimbursed at different rates too. Drugs issued instance, it has raised the reimbursement rate for the at normal pharmacies for non-life-threatening first visit to a specialist if referred by a GP. In addition, diseases such as antibiotics, anti-asthmatic and anti- hypertensive medicines, incur a co-payment rate of 25 per cent, to a maximum of c10.80. Tourists with a European Health Insurance Card are subject to the same co-payment system as Belgian citizens. Citizens of some countries, including the Three regional air UK, are able to seek reimbursement for some co-payments – such as for seeing a doctor – once ambulance services they return home, but only if the doctor is registered with the national health service (conventionné/ provide emergency geconventioneerd). Doctors offering private healthcare are not usually reimbursed under this primary, and in some system. Expats living and working in Belgium are able to join cases secondary, sickness funds. Some are able to get reimbursements for co-payments. If that is the case, the sickness transfers to hospital fund does the work of settling bills with the home

country institute to ensure co-payments are covered. For those without medical insurance or who do not belong to a sickness fund, health services are hospitals must now charge ambulatory patients a generally expensive. Drugs are also expensive fixed amount for using a hospital A&E unit for non- compared to other countries. urgent visits. The fees have varied over the years but are now about c9.50, according to a review of the Insuring a healthy future Belgian health system published by the World Health Because the public hospital system is generally Organization this year. quite good, private profit-making health insurance GP services are undergoing a revamp too. GP companies account for only a small part of the non- federations, or circles, have been created so that compulsory health insurance market, say experts. local GPs work together to provide out-of-hours According to Truus Andries, some patients use the shifts, improve emergency care and arrange locums private system to provide top-up payments over and for colleagues who are ill or on holiday. In addition, above those paid out by sickness funds to cover costs primary care outposts, providing permanent the funds do not reimburse. Expats without any form on-call GP services with facilities to treat minor of social security tend to use private insurance as their urgencies are being piloted too. Patients with minor primary health insurance. emergency needs can therefore call the GP out-of- The social insurance infrastructure is just one of a hours service and either receive a GP visit or call distinct set of principles to which the Belgian health in at the practice. The GP can make a diagnosis, system abides. Others include therapeutic freedom decide to treat the patient or refer them to the

International Travel Insurance Journal

40 ASSISTANCE&HEALTHCAREWORLDMARKETS

Already covered For Belgians venturing abroad, personal travel medical assistance is usually provided through the additional insurance taken out by the majority of the population with their mutual insurer or sickness fund. This extra coverage provides insurance for travel abroad for recreational purposes only – not business

The sickness funds have agreements with hospitals for the direct payment of hospitalisation costs, but ambulant medical treatment is paid for nearest A&E department at a hospital. Filip Declercq says some measures are having the by the patient and then desired effect amongst Belgians. “There was a time when patients went directly to the hospital with all reimbursed their complaints,” he says. “Then the government introduced an extra cost for non-emergency treatments that could be done by a GP. Now we see local people more often going to the GP.” travel or expatriate travel. In general, it covers the But while Belgians have started to use GPs more, insured while abroad for up to six months, with foreigners, particularly expats, tend to head for the covered amounts for travel within Europe generally prestigious Brussels hospitals, and students to the being more comprehensive than for those venturing university hospitals. The longer they stay in the out of Europe. The cover is strictly limited to medical country, however, the more likely they are to call on costs and does not include car-related assistance. GPs. In addition, there are a few doctors practices Considering that the sickness funds offer travel that specialise in treating expats, providing services in assistance to members who pay for additional cover, different languages. and that the majority of Belgian people opt for the

additional coverage, it is perhaps not surprising that specialise in providing emergency services at that stand-alone travel insurers ‘have a challenge the scene. selling their products’, as Ivo Bonte explained to Three regional air ambulance services provide ITIJ. Naturally, the cover provided by independent emergency primary, and in some cases secondary, insurers is much more comprehensive – providing transfers to hospital for those needing such a mode reimbursement for baggage, natural disasters, liability, of transport, explains Dr Laurent Taymans, an and so on. In fact, the one major selling point of emergency physician with iMedevac. Between them, independent travel insurance is that it covers for car- they cover the whole country, but are run very related assistance (breakdown and recovery) – a very independently of each other, with separate funding, important element for Belgians. Furthermore, the membership schemes, and operating policies. Belgian tax regime is favourable towards company For the repatriation of patients out of Belgium, cars, so the long-term leasing market in the country there are a handful of other local air ambulance is huge. As these leasing companies want to care for providers such as Skylifeguard and ASL, but nearby their customers when they have a breakdown or foreign companies are also used. Furthermore, accident in Belgium or abroad, they want to trust the the Dutch airline KLM and group partner Air assistance to a reliable provider. France both have good reputations for repatriating On the flip side, for those visiting Belgium and international patients, especially to Amsterdam and requiring immediate emergency assistance, the Paris (respectively), but their stretcher pricing policy number to call is 112, or 100 for an ambulance. is considered by some to be relatively expensive. Emergency medical care is provided by 17 ‘aid In addition, SN Brussels Airlines also has a good centres’, which inform the nearest ambulance reputation for providing swift medical clearance, and service and make sure the patient is transported is lauded for its clear pricing policies. It reportedly to the most suitable hospital (or, in some cases, fl ies to many of the destinations favoured by Belgian a GP). Aid centres can also call on one of 79 tourists, including a number in Africa, so is also used ‘mobile urgency groups’, 24-hour crack teams frequently by local assistance companies. n

International Travel Insurance Journal

42 PROFILE

in its approach to Internet sales channels weather’, different approaches to refunds, re-booking over the last decade? and re-screening. In the direct market, the Internet and the advent Whilst many are sceptical about how long the Commercial of search engines such as Google has changed the customer will remember the volcano impact, I approach to customer acquisition. With cost being do believe that we need to react better to such key to a desirable bottom line, many providers saw events. The Association of British Insurers and the the web as a low-cost distribution channel but, Association of Travel Insurance Intermediaries are conundrum in recent years, the customer acquisition cost has both working with the Foreign and Commonwealth ITIJ spoke to Greg Lawson, commercial director of Citybond escalated as more providers and aggregators fight Office to improve our crisis management and I hope for the online customer. Meanwhile, the ads in that the industry will be better prepared next time. Suretravel, about the changing nature of travel insurance print media have died off as the marketing spend is Citybond continues to work with our insurers to diverted to online and brand promotion, from PPC develop a travel disruption product that is suitably distribution, as well as why he loves Men Behaving Badly to SEO (to OMG when the bills come in!). priced and that the customer believes adds value and The Financial Services Authority regulation, combined will pay for such. with the need to concentrate on the core business, has led to a severe drop in travel trade sales and the Moving onto some more personal high-street brokers have struggled to compete with information, what is the worst job you have the online direct brands. However, as the customer ever had, and how long did you last at it? starts to become more web-savvy, I predict that the Well, having only had two real jobs and still being need for customer service and added value will start employed in one of them, I guess it would have been to influence the online purchase decision, helped by as a paperboy. The early mornings never suited me Google’s drive for ‘relevance’. The travel trade and but the tips meant that I was still delivering in my the brokers can then quickly catch up if they provide holidays after five years at the age of 18. an online service rather than just an online price. If you could do any other job in the What is Citybond doing to use the selling world, other than the one you have right power of technology? now, what would it be? In recent years, Citybond has concentrated on I would love Gary Lineker’s job – not the Walkers developing better functionality for its agents and one, but the one that involves going to watch all the the policy issuing system remains one of the most football, golf and any other sporting event around the functional tools to sell travel insurance, including world. Assuming that it will not be vacant in the near adjustable gross pricing, multiple upsell opportunities, future, my other dream job would be working as a integrated medical screening with one payment game ranger running safaris in South Africa or similar. basket, and a stable of products. We will shortly be adding SMS text messaging as an option for What is your favourite movie/TV series, agents, but it’s their customer not ours, so customer and why? communication needs to always be developed with Gladiator – love the opening battle scene, great lines, that in mind. great music, great good guys and bad guys, and no We have used our technology to make the selling Hollywood ending. process simple but, in recent months, we have Men Behaving Badly – I was living with a mate in a launched our Portable Quote Engine (PQE), and now flat that echoed so many of the moments and it just we can make travel insurance sexy as well (now that’s always made me laugh! a claim?!). The PQE allows any brand or company to sell travel insurance on their website within 48 hours, Please complete the following sentences: with a proven sales process including integrated -My favourite journey is … our honeymoon to South medical screening. For those who do not want or Africa. We flew to Cape Town for three days, a week have a sales team to handle enquiries, we also offer driving the Garden Route, staying in a log cabin in the branded customer support via the telephone on hills and then whale-watching in Plettenberg, ending behalf of our larger agents. This technology gives up with a three-day safari at Mala Mala tracking lions agents that want to sell travel insurance a solution that and leopards. The new Mrs Lawson loved it so Where were you born, where were you scheme in three months. Fortunately, we found one, does not involve negotiating IT resources. much, she cried as we left – or maybe she realised educated and where do you live now? then decided to set up our own medical screening what she’d let herself in for! I was born on 31 January 1971 in Redhill General service, launched it all to a very tight schedule and the Are there any sports that Citybond -My favourite holiday destination is … Pembrokeshire, Hospital, currently a very nice housing estate about rest, as they say, is history. considers too dangerous to cover? Wales – some of the best coastal scenery and 500 yards from where I live now. I also went to Now commercial director, my work experience at In the late 1990s, I worked with Citybond and their beaches but, admittedly, the weather can be a bit Reigate Grammar School – in fact, the only time I Citybond has expanded from wholesale broking to Lloyd’s underwriters at the time to create one of suspect. We go regularly with my in-laws and, despite really got away was when I went to Loughborough include direct sales, digital marketing, product pricing, the first inclusive hazardous sport listings. Citybond that, we all love it! University and studied economics and politics, as well call centre operations and corporate governance. I believed that ‘impulse’ sports should be rated within as playing hockey and working in the bar to support cannot recommend enough the virtues of working in the policy as it was impossible to expect customers to If you could implement one new law my social life. Now in a mid-life crisis, I still try to play a fast-moving, independent company led by a spirit remember the need to get ‘permission’ before they across the whole world, what would it be? hockey regularly, enjoy a few rounds of golf, but mostly of innovation and passion hard to match. Equally, I went snorkelling or sailing. In some cases, there were It should be illegal to wear headphones while walking spend time with the family, including our two girls, cannot recommend it at all if you have a weak heart various limits to personal accident and liability cover, in the street. It’s bad enough anywhere else but do Beth, nine, and Naomi, seven, and the family dog. and like the quiet life! but the concept has been used in various formats we all need to shut ourselves off to that extent? I’m ever since across the industry. clearly getting too old and grumpy… How did you become involved in the There have been several changes to We agree that there needs to be better science behind travel insurance industry in the first place, Citybond’s travel insurance offerings the underwriting of these risks and this has to start If you could be a stand in for any actor for and move to the current role you have? recently, such as the introduction of no with the collation of claims data. We need to know the any movie, who would you play and why? In 1993, my mum got me work experience with upper age limits, and an 18-50 option. value of all claims associated with these sports to justify Tom Cruise – Top Gun. As for why, how about getting a Lloyd’s insurance broker, Butcher, Robinson & What prompted these changes? the higher cost in both administration and rate that is to ride motorbikes, fly fighter planes, wear Ray-Bans Staples. David McGregor and Roger Ludlow gave me Citybond has a history of working closely with the allocated to numerous sports and activities. and Kelly McGillis? I accept that I may need a second the perfect grounding for the future ensuring that, travel trade and the insurance broker market, still stand in for the naked torso volleyball scene though! as well as the sales presentations, medical letters, servicing nearly 1,000 agents across the country. What would you change about how the account management, claims investigations and However, we need to keep moving with the market travel insurance industry dealt with the What was the first album/single you ever underwriter visits, they gave me access to a variety of and, more importantly, harness the latest technology volcanic ash problem if you could go back bought? decent lunch venues in the City! In the 10 years I was to improve our market share. On our launch with in time to when it first started? Red Box – Living in a Box there, I learnt how to balance being a broker and a AXA this year, we offered a greater product range to As some readers may remember from the ITIC salesman and it was a great foundation. our agents but, as well as providing cover for those Brighton conference this year, I was disappointed What is the best souvenir you have I joined Citybond Holdings plc in 2004, having over 85, we also needed to give better prices for the that our industry could not communicate with speed brought home from your travels? worked with Mansukh Ganatra as his broker for younger age groups who are courted so much by the and clarity to our consumers. It took too long for Porcupine quills taken from the scene of a lion hunt. Citybond for a few years. It was always going to be a direct insurers. Maintaining a balance of products is insurers to communicate their interpretation on all The night before, we’d witnessed eight lionesses challenge, moving jobs from the City to Beckenham, the key to ratings for both agent and insurer. the key areas. Worst of all, when the customer finally trying to corner a porcupine – very chaotic and not commuting by car instead of train, but the greatest had the information, there was a disjointed approach helped by one of the jeeps breaking down in the challenge was to source an underwriter for the travel How have you seen the industry change with different interpretations of the words ‘adverse middle of it all! International Travel Insurance Journal CATEGORY KEY CLAIMS MANAGEMENT INSURERS AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES 44 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

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

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

Air Ambulance Network CareFlight International AUSTRALASIA

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

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

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

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

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

Netcare 911 International Hope Medflight Asia Pte Ltd Jacques Pienaar – Fixed Wing Operations Manager Dr Charles Johnson – Medical Director Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA 2 Loyang Lane 03-01, Singapore 508913, SINGAPORE

tel: +27 10 209 8392 email: [email protected] 24hr tel: +65 6100 1911 email: [email protected] fax: +27 10 209 8405 website: www.netcare911.co.za fax: +65 6400 5254 website: www.hope-flight.com

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

West African Rescue Association Skyservice Air Ambulance Florian Zagel – Managing Director David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, Klotey Cresent 6, North Labone, Accra, GHANA CANADA 24hr tel: +233 243 666 111 email: [email protected] tel: +1 514 497 7000 email: [email protected] tel: +233 302 781 258 website: www.westafrican-rescue.com fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance ) AeroMed Asia Inc. South Pacific Air Ambulance Cindy Wong / Lorraine Paul – International Account Management Scotty Watson – Managing Director SINGAPORE BANGKOK THAILAND NEW NEW ZEALAND AUSTRALIA SINGAPORE

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

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

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

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

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

CATEGORY KEY CLAIMS MANAGEMENT INSURERS Air Medical Ltd AIR AMBULANCE CLAIMS SUBROGATION MEDICAL ESCORT ON COMM. AIRLINE AIR AMBULANCE INTERIOR COMMERCIAL REPAT SPECIALISTS MEDICAL PROVIDER Glenn Salt – Flight Operations Manager AIRCRAFT PERFORMANCE SOLUTIONS CRITICAL CARE PATIENT TRANSPORT MEDICAL SCREENING Oxford Airport, Kidlington, Oxfordshire OX5 1QX, UK ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE CATASTROPHIC CLAIMS SPECIALIST HEALTHCARE CLINICS TRAVEL AGENTS tel: +44 1865 842 887 email: [email protected] COST CONTAINMENT HOSPITALS WEB & DESIGN SERVICES tel: +44 1865 370 642 website: www.airmed.co.uk call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 45 ) AirMed International LLC ) Medic’Air International Jeffrey T Tolbert – President Dr Herve Raffin – General Manager 1000 Urban Center Drive, Suite 470, Birmingham, AL 35242, USA 35 rue Jules Ferry, 93170 Bagnolet, Paris, FRANCE

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

Augsburg Air Ambulance Medilink International Air Ambulance Roland Schoberth – Director Martin Farrugia – Business Development Manager AIR AMBULANCE AIR AMBULANCE Roseggerstr 17, D-86368, Gersthofen, GERMANY 99 Mill Street, Qormi, QRM 3100, MALTA

tel: +49 821 299 1020 email: [email protected] tel: +356 2278 5400 email: [email protected] tel: +49 821 299 2030 website: www.ambulanzflugdienst.de fax: +356 2278 5700 website: www.mi-aa.com

Capital Air Charter North Flying a/s Lisa Humphries – Sales Director Jesper Kragelund – Sales Manager Exeter International Airport, EX5 2BD, UK North Flying Terminal, Aalborg Airport, DK-9400, Nørresundby, DENMARK

tel: +44 845 055 2828 email: [email protected] tel: +45 9632 2900 email: [email protected] fax: +44 1392 350 039 website: www.capitalaircharter.co.uk fax: +45 9632 2909 website: www.northflying.com

European Air Ambulance Redstar Aviation Patrick Schomaker – Director Sales & Marketing Mustafa Atac – CEO 175A, rue de Cessange, L-1321, LUXEMBOURG Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

24hr tel: +49 711 7007 7007 email: [email protected] tel: +90 216 588 0216 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +90 216 588 0225 website: www.redstar-aviation.com

Euro Link Air Ambulance Skyservice Air Ambulance Dr. Friedrich Renner – Medical Director David Ewing – VP International Market Development YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), H9P 1A2, Putzbrunner Str. 114, 81739, München, GERMANY CANADA 24hr tel: +49 89 613 72103 email: [email protected] tel: +1 514 497 7000 email: [email protected] fax: +49 89 613 72106 website: www.FlyEuroLink.de fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance

FAI – rent-a-jet AG Swiss Air Ambulance / Rega Volker Lemke – Director Sales & Marketing Peter Meierhans – Director of Sales Flughafenstrasse 100, D-90268 Nuremberg, GERMANY PO Box 1414, Zurich Airport, CH-8058, SWITZERLAND

tel: +49 911 36009 31 email: [email protected] tel: +41 333 333 333 email: [email protected] fax: +49 911 36009 59 website: www.rent-a-jet.de fax: +41 44 654 3590 website: www.rega.ch

German Red Cross Air Ambulance Service Tyrol Air Ambulance Andreas Speich – Managing Director Jakob Ringler – Managing Director Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY PO Box 81, A-6026, Innsbruck Airport, AUSTRIA

tel: +49 228 2300 23 email: [email protected] tel: +43 512 224 220 email: [email protected] fax: +49 228 2300 27 website: www.grcairambulance.de fax: +43 512 288 888 website: www.taa.at

Greek Flying Doctors Aero Jet International Dimitris Kanellis – Manager Stuart Hayman – President (NORTH AMERICA) 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE 4631 NW 31st Avenue, #220 Ft Lauderdale, FL 33309, USA

tel: +30 210 674 0600 email: [email protected] tel: +1 954 730 9300 email: [email protected] fax: +30 210 674 0634 website: www.greekflyingdoctors.gr fax: +1 954 485 6564 website: www.aero-jet.com

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

tel: +44 870 042 1465 email: [email protected] tel: +1 832 934 2390 email: [email protected] fax: +44 870 042 1480 website: www.iasmedical.com fax: +1 832 934 2395 website: www.airambulanceinternational.com

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

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

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

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

tel: +34 952 048 609 email: [email protected] tel: +1 720 875 9182 email: [email protected] fax: +34 924 048 612 website: www.mayoralaviation.com fax: +1 720 875 9183 website: www.airaasi.com 46 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

AirMed International LLC West African Rescue Association Jeffrey T Tolbert – President Florian Zagel – Managing Director 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 (AMERICAS) European Air Ambulance On Call International Patrick Schomaker – Director Sales & Marketing Michael J. Kelly – President & CEO AIR AMBULANCE

(NORTH AMERICA) 175A, rue de Cessange, L-1321, LUXEMBOURG One Delaware Drive, Salem, NH 03079, USA

24hr tel: +49 711 7007 7007 email: [email protected] tel: + 888 289 0567 email: [email protected] fax: +49 711 7007 7009 website: www.air-ambulance.com fax: +1 603 328 1770 website: www.oncallinternational.com ASSISTANCE COMPANIES ASSISTANCE Global Jetcare, Inc. SelectCare Worldwide Bart Gray – President Magdi Riad – President 16479 Runway Drive, Brooksville, FL 34604, USA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA

tel: +1 352 799 7771 email: [email protected] tel: +1 416 340 7265 email: [email protected] fax: +1 352 799 7776 website: www.globaljetcare.com toll free: +1 866 261 6718 website: www.selectcareworldwide.com

JET ICU Asia Assistance Partners Mike Honeycutt – President Siriporn Wongurai – International Operations Director 184/235 Forum Tower, 36 Flr Ratchadapisek Rd Huaykwang, Bangkok 10320, 2561 Rescue Way, Brooksville, FL 34604, USA THAILAND tel: +1 352 796 2540 email: [email protected] tel: +662 645 3733-5 email: [email protected] fax: +1 352 796 2549 website: www.jeticu.com fax: +662 645 3732 website: www.aapartners.net

LIFESUPPORT Patient Transport Assistance Online (AUSTRALASIA) Graham Williamson – CEO Bertrand Guichoux – CEO #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA Zendai Cube Edifice 6/F, 58, Changliu Road, Pudong, 200135 Shanghai, CHINA

tel: +1 866 554 3817 email: [email protected] tel: +86 21 6104 9500 email: [email protected] fax: +1 877 288 2908 website: www.LifeSupportTransport.com fax: +86 21 6104 9484 website: www.assistanceonline-china.com

Skyservice Air Ambulance Customer Care Pty Ltd David Ewing – VP International Market Development Louise Heywood – Business Development & Marketing Manager YUL/Trudeau Int Airport, 9785 Avenue Ryan, Montreal (Quebec), Level 3, 60 Miller Street, North Sydney 2060, NSW, AUSTRALIA H9P 1A2, CANADA tel: +1 514 497 7000 email: [email protected] tel: +612 9202 8222 email: [email protected] fax: +1 514 636 0096 website: www.skyservicebas.com/airambulance fax: +612 9202 8220 website: www.customercare.com.au

AIMS To have your company listed in our service directory Bernadette Breton – Managing Director Private Bag X5, Benmore Gardens 2010, Johannesburg, SOUTH AFRICA contact the sales department now:

(AFRICA) tel: +00 27 11 783 0135 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +00 27 11 783 2950 website: www.aims.org.za

AMREF Flying Doctor Service Dynamiq Dr Bettina Vadera – Medical Director Janine Benson – Director of Emergency Assistance NEW Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA Level 5/33 York St, Sydney 2000, NSW, AUSTRALIA

tel: +254 20 6000 090 email: [email protected] tel: +61 (0) 2 9978 6600 email: [email protected] fax: +254 20 344 170 website: www.amref.org fax: +61 (0) 2 9888 3609 website: www.dynamiq.com.au/assist ASSISTANCE COMPANIES ASSISTANCE

Interhealth Technologies First Assistance Kevin Thomas – Director - International Mary-Jo McDonald – General Manager P O Box 3058, Bedfordview 2008, SOUTH AFRICA PO Box 17-310, Greenlane, Auckland, NEW ZEALAND

tel: +27 11 622 8010 email: [email protected] tel: +64 9 356 1650 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +64 9 525 1278 website: www.firstassistance.co.nz

Netcare 911 International Global Assistance & Healthcare Louis Mabele – International Assistance Operations Manager Mario Babin – Chief Executive Officer Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, Riverview Park, Janadel Avenue, Midrand, SOUTH AFRICA Jakarta 12560, INDONESIA tel: +27 (0)10 209 8387 24hr email: [email protected] tel: +62 21 299 78 999 email: [email protected] fax: +27 (0)10 209 8405 website: www.netcare911.co.za fax: +62 21 299 78 9555/66 website: www.global-assistance.net

South Pacific Air Ambulance CATEGORY KEY CLAIMS MANAGEMENT INSURERS Scotty Watson – Managing Director MEDICAL ESCORT ON AIR AMBULANCE CLAIMS SUBROGATION COMMERCIAL AIRLINE NEW ZEALAND AUSTRALIA SINGAPORE AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER tel: +64 9256 9000 email: [email protected] INTERIOR SPECIALISTS fax: +64 9256 9111 website: www.spaa.co.nz AIRCRAFT PERFORMANCE CRITICAL CARE MEDICAL SCREENING SOLUTION PATIENT TRANSPORT ADAC-Ambulance Service ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE Robert Glueck – Marketing & Sales Director CATASTROPHIC CLAIMS Am Westpark 8, 81373 Munich, GERMANY SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS tel: +49 89 76 76 52 85 email: [email protected] (EUROPE) WEB & DESIGN 24h Alarm: +49 89 76 76 50 05 website: www.adac.de/ambulance COST CONTAINMENT HOSPITALS SERVICES call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 47

Altas Assistance Savitar Arvydas Bebravi˘cius – Managing Director Lydia Semchenkova – Business Development Manager Lentvario Str. 7, Lt-02300 Vilnius, LITHUANIA 25/1, 7th Floor, Trubnaya Str., Moscow, 127051, RUSSIA

tel: +370 5 264 4020 email: [email protected] tel: +7 495 987 1775 email: [email protected] (EUROPE) (EUROPE) fax: +370 5 264 4021 website: www.altas-assistance.lt fax: +7 495 987 1776 website: www.savitar-gr.com

AP Companies SOS International Natalya Butakova – Business Development Manager Helle Drager Sandahl – Communications & Marketing Manager str. 9, dom 5/7, ul. Nizhnyaya Syromyatnicheskaya, Moscow 105120, RUSSIA Nitivej 6, DK-2000 Frederiksberg, Copenhagen, DENMARK

tel: +7 495 989 1120 email: [email protected] tel: +45 7010 5055 email: [email protected] fax: +7 495 989 1130 website: www.ap-companies.ru fax: +45 7010 5056 website: www.sos.eu ASSISTANCE COMPANIES ASSISTANCE ASSISTANCE COMPANIES ASSISTANCE ARC Europe SA TBS Team 24 d.o.o Hans Biekmann – Network Director Edvard Hojnik – General Manger Avenue des Olympiades 2, 1140 Brussels, BELGIUM Ljubljanska Ulica 42, 2000 Maribor, SLOVENIA

tel: +32 2 706 6660 email: [email protected] tel: +386 2618 2301 email: [email protected] fax: +32 2 706 6601 website: www.arceurope.com fax: +386 2618 5800 website: www. tbs-team24.com

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

tel: +33 438 49 83 49 email: [email protected] tel: +97 14 257 82 84 email: [email protected]

fax: +33 438 49 83 40 website: www.cnas-assistance.com EAST) (MID. fax: +97 14 257 82 85 website: www.connexassistance.com

DRK Assistance IES Medical Andreas Speich – Managing Director Eitan Kariv – CEO NEW Aufm Hennekamp 71, 40225 Düsseldorf, GERMANY 2 Yagea Kapaim Street, Tel Aviv, ISRAEL

tel: +49 211 2711 2020 email: [email protected] tel: +972 3 639 9990 email: [email protected] fax: +49 211 3018 0527 website: www.drkassistance.com fax: +972 3 687 2950 website: www.iesmedical.co.il

Global Assistance a.s. Dr Colin Plotkin & Sons Consulting INC. Petr Bold – General Manager Dr Colin Plotkin – Managing Director Dopraváku˚ 749/3,184 00 Prague 8, CZECH REPUBLIC 27-3088 Francis Road, Richmond, British Columbia V7C 5V9, CANADA

tel: +420 266 799 770 email: [email protected] tel: +1 604 241 9677 email: [email protected] fax: +420 266 799 797 website: www.1220.cz fax: +1 604 241 0733 website: www.plotkinconsulting.com

Global Voyager Assistance - Russia To have your company listed in our service directory Costas Danilenko – CEO CATASTROPHIC PO Box II, 125124 Moscow, RUSSIA contact the sales department now:

tel: +7 495 775 0999 email: [email protected] CLAIMS SPECIALISTS [email protected] or telephone: +44 (0)117 922 66 00 fax: +7 495 775 0998 website: www.gvassistance.com

Global Voyager Assistance - Black Sea AIMS Olga Turubarova – General Manager Bernadette Breton – Managing Director 77-79 Nezhinskaya Str., 65023, Odessa, UKRAINE Private Bag X5, Benmore Gardens, 2010 Johannesburg, SOUTH AFRICA

tel: +38 048 7373 441 email: [email protected] tel: +00 27 11 783 0135 email: [email protected] (AFRICA) fax: +38 048 7373 442 website: www.gvassistance.com fax: +00 27 11 783 2950 website: www.aims.org.za

Greek Flying Doctors Interhealth Technologies Dimitris Kanellis – Manager Kevin Thomas – Director - International 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE P O Box 3058, Bedfordview 2008, SOUTH AFRICA COST CONTAINMENT tel: +30 210 674 0600 email: [email protected] tel: +27 11 622 8010 email: [email protected] fax: +30 210 674 0634 website: www.greekflyingdoctors.gr fax: +27 11 622 8264 website: www.interhealth.net

Marm Assistance ChargeCare International Jill Atac – CEO Christiane Burniston – Managing Director Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY Monument Business Park, 1D Park Offices, Warpsgrove Lane, Chalgrove, Oxford, UK

tel: +90 216 588 0588 email: [email protected] (EUROPE) tel: +44 1865 400 007 email: [email protected] fax: +90 216 588 0602 website: www.marmassistance.com fax: +44 845 003 9923 website: www.chargecareinternational.co.uk

med con team GmbH Marm Assistance Michael Weinlich – Managing Director Jill Atac – CEO Gerhard-Kindler-Str.8, 72770 Reutlingen, GERMANY Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +49 7121 433 660 email: [email protected] tel: +90 216 588 0588 email: [email protected] fax: +49 7121 433 619 website: www.medconteam.com fax: +90 216 588 0602 website: www.marmassistance.com

Save Assistance France Medical Claims International Spain Franck Molinier – Director of Business Development Fatima Guillen Grande – Managing Director 19 rue de Provence, 78310 Maurepas, FRANCE C/Ciudad de Aguilas No.2, Local 2A, Madrid 28030, SPAIN

tel: +33 13062 6752 email: [email protected] tel: 00 34 913 016 145 email: [email protected] 24 tel: +33 13062 1122 website: www.saveassistance.com fax: 00 34 913 016 160 website: www.mcimanager.com 48 SERVICEDIRECTORY To have your company listed in the Service Directory email: [email protected]

Global Excel Management SelectCare Worldwide Michael Drew – Vice-President Sales Magdi Riad – President 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA #1201, 438 University Avenue, Toronto M5G 2K8, CANADA 17548 Deer Isle Circle, Winter Gdn, FL 34787 USA tel: +1 866 566 1130 email: [email protected] tel: +1 416 340 7265 email: [email protected] fax: +1 819 566 8335 website: www.globalexcel.ca toll free: +1 866 261 6718 website: www.selectcareworldwide.com

Global Medical Management Star Healthcare Raija Itzchaki – COO Gigi Galen – President

(NORTH AMERICA) 7901 SW 36th Street, Suite 100, Davie, FL 33328, USA 850 7th Avenue, Suite 803, New York, 10019, USA

tel: +1 954 370 6404 email: [email protected] tel: + 1 212 581 8228 email: [email protected] COST CONTAINMENT

fax: +1 954 370 8613 website: www.gmmusa.com CLAIMS MANAGEMENT fax: + 1 212 581 8272 website: www.starhealthcarenet.com

Olympus Managed Healthcare To have your company listed in our service directory Steven Jacobson – CEO 777 Brickell Avenue, Suite PH70, Miami, Florida 33131, USA contact the sales department now: tel: +1 305 530 8600 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +1 305 530 0766 website: www.omhc.com

OneWorld Assist LIFESUPPORT Patient Transport Taka Katsube – Director Assistance & Cost Managment Graham Williamson – CEO 10th Floor, 6081 No.3 Road, Richmond, BC V6Y 2B2, CANADA #9-1009 Allsbrook Road, Parksville, British Columbia, V9P 2A9, CANADA

tel: +1 604 303 2113 email: [email protected] tel: +1 866 554 3817 email: [email protected] fax: +1 604 276 4593 website: www.oneworldassist.com fax: +1 877 288 2908 website: www.LifeSupportTransport.com SPECIALISTS SelectCare Worldwide Voyageur Aeromedical Travel Magdi Riad – President Marc Lucas – General Manager #1201, 438 University Avenue, Toronto M5G 2K8, CANADA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

tel: +1 416 340 7265 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected]

toll free: +1 866 261 6718 website: www.selectcareworldwide.com COMM. REPATRIATION fax: +44 (0)117 925 5940 website: www.voyageur24.com

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

tel: + 1 212 581 8228 email: [email protected] tel: +49 89 7676 2912 email: [email protected] fax: + 1 212 581 8272 website: www.starhealthcarenet.com 24hr Alm: +49 89 7676 5005 website: www.adac.de/ambulance TRANSPORT UnitedHealth International Lufthansa Medical Services Philip Brun – Vice President of Sales & Service Doris Ehring – Manager Sales & Marketing Lufthansa German Airlines, Lufthansa Base, FRA SX/M, D-60546, 3100 SW 145 Avenue, Miramar, FL 33027, USA Frankfurt/Main, GERMANY tel: +1 954 378 0694 email: [email protected] tel: +49 (0)69690-20904 email: [email protected] fax: +49 (0)69690-58147 website: www.dlh.de

fax: +1 954 378 0771 website: www.uhgi.com PATIENT CARE CRITICAL

Global Assistance & Healthcare Albin Repatriation Ltd Mario Babin – Chief Executive Officer Emerson De Luca – General Manager Cilandak Commercial Estate - # 111 GC, Jl. Raya Cilandak KKO, 83 Westbourne Grove, Bayswater, London W2 4UL, UK Jakarta 12560, INDONESIA tel: +62 21 299 78 999 email: [email protected] tel: +44 20 7313 6920 email: [email protected] fax: +62 21 299 78 9555/66 website: www.global-assistance.net fax: +44 20 7313 6999 website: www.albininternational.com

Global Excel Management ANUBIS International Repatriation Michael Drew – Vice President of Sales Fabrice Kana – Development & Quality Manager 73 Queen St, Sherbrooke, QC J1M 0C9, CANADA Tour Pleyel, 93200 Paris, Saint Denise, FRANCE 17548 Deer Isle Circle, Winter Gdn, FL 34787, USA

tel: +1 866 566 1130 email: [email protected] FUNERAL DIRECTORS tel: +33 149 195 960 email: [email protected] fax: +33 149 471 901 website: www.anubisgroup.org CLAIMS MANAGEMENT fax: +1 819 566 8335 website: www.globalexcel.ca

Interhealth Technologies DELA Kevin Thomas – Director - International Greta Plas – Repatriations Manager NEW P O Box 3058, Bedfordview 2008, SOUTH AFRICA Ringlaan 49, 1930 Zaventem, BELGIUM

tel: +27 11 622 8010 email: [email protected] tel: +32 2 720 80 00 email: [email protected] fax: +27 11 622 8264 website: www.interhealth.net fax: +32 2 720 88 22 website: www.repatriations.com

Funeral Home AURIGA Ltd. CATEGORY KEY CLAIMS MANAGEMENT INSURERS Helen Pradova – Chief of International Department MEDICAL ESCORT ON AIR AMBULANCE CLAIMS SUBROGATION COMMERCIAL AIRLINE B. Nmcové Street 1052/1, 412 01 Litomerice, CZECH REPUBLIC AIR AMBULANCE COMMERCIAL REPAT MEDICAL PROVIDER tel: +420 724 257 899 email: [email protected] INTERIOR SPECIALISTS fax: +420 416 735 800 website: www.funeral-assistance.cz AIRCRAFT PERFORMANCE CRITICAL CARE MEDICAL SCREENING SOLUTION PATIENT TRANSPORT Funeralcare International ASSISTANCE COMPANIES FUNERAL DIRECTORS RE-INSURANCE Louisa Killen – Repatriation Specialist CATASTROPHIC CLAIMS Murray House, 50 Whitta Road, Manor Park, London, Essex E12 5DA, UK SPECIALISTS HEALTHCARE CLINICS TRAVEL AGENTS WEB & DESIGN tel: +44 20 8788 5303 email: [email protected] COST CONTAINMENT HOSPITALS SERVICES fax: +44 20 8788 2525 website: www.co-operativefuneralcare.co.uk call +44 (0) 117 925 5151 To make an alteration to a listing email: [email protected] SERVICEDIRECTORY 49

John Allison Monkhouse Co., Ltd (Thailand) Medic’Air International 每递安国际 Apple Kaewprasert – General Manager Dr Huaqun Gao – Medical Director President Park View Tower, 99/243 (30B) Pine Tower, Sukhumvit soi 24, Klongton 885 Renmin Road, Huaihai China Building, Room 808, 200010 Shanghai, CHINA Klongtoey, Bangkok, THAILAND (ASIA) tel: +66 2382 5345-7 email: [email protected] tel: +86 2163 558289 email: [email protected] fax: +66 81 584 5942 website: www.monkhouse.com.au fax: +86 2163 558285 website: www.medic-air.com

Lutece International AMREF Flying Doctor Service Zouhaier Hertelli – Repatriation Specialist Dr Bettina Vadera – Medical Director 56 rue Olivier de Serres, 75015 Paris, FRANCE Wilson Airport, Langata Road, PO Box 18617, Nairobi, KENYA

tel: +33 1 56 08 00 23 email: [email protected] (AFRICA) tel: +254 20 6000 090 email: [email protected] FUNERAL DIRECTORS fax: +33 1 56 08 00 43 website: www.pflutece.com fax: +254 20 344 170 website: www.amref.org

Rowland Brothers International To have your company listed in our service directory Melanie Walkling – Partner 299-305 Whitehorse Road, West Croydon, Surrey CR0 2HR, UK contact the sales department now: tel: +44 20 8684 2324 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +44 20 8684 8000 website: www.rowlandbrothersinternational.co.uk

Servilusa Greek Flying Doctors Vanda Castro – Manager International Department Dimitris Kanellis – Manager Agencias Funerarias SA, International Dept. Rua do NEW

MEDICAL ESCORT ON COMMERCIAL AIRLINES COMMERCIAL ON ESCORT MEDICAL 3 Doukisis Plakentias Str, 152 34 Halandri, Athens, GREECE Entreposto Industrial, 8-2 Esq, 2610-135 Amadora, PORTUGAL tel: +35 121 470 6300 email: [email protected] tel: +30 210 674 0600 email: [email protected] (EUROPE) fax: +35 121 470 6499 website: www.servilusa.pt fax: +30 210 674 0634 website: www.greekflyingdoctors.gr

BUPA Cromwell Hospital Redstar Aviation Shams Maladwala – Commercial Director Mustafa Atac – CEO Cromwell Road, London SW5 0TU, UK Sabiha Gokcen International Airport, J Blok Kurtkoy, 34912 Istanbul, TURKEY

tel: +20 7460 2000 email: [email protected] tel: +90 216 588 0216 email: [email protected]

(EUROPE) fax: +20 7835 2444 website: www.cromwellhospital.com fax: +90 216 588 0225 website: www.redstar-aviation.com HOSPITALS HOSPITALS Baptist Health Int. Center of Miami Voyageur Aeromedical Travel Yohandra Fuentes – Finance Manager Marc Lucas – General Manager 8940 North Kendall Drive, Suite 601-E, Miami, Fl 33176, USA Voyageur Buildings, 43 Colston Street, 43 Colston Street, Bristol BS1 5AX, UK

tel: +1 786 596 2373 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected] fax: +1 786 596 5979 website: www.baptisthealth.net/international fax: +44 (0)117 925 5940 website: www.voyageur24.com

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

tel: + 1 305 222 6750 email: [email protected] 24hr tel: + 1 727 934 3999 email: [email protected]

(AMERICA) tel: + 1 305 222 6751 website: www.hcaeastflorida.com fax: + 1 727 937 0276 website: www.airambulancenetwork.com (N AMERICA)

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

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

CareFlight Group Voyageur Aeromedical Travel Medical and Tasking Centre Marc Lucas – General Manager PO Box 5078, Robina Town Centre, Queensland, 4230, AUSTRALIA Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK

24hr tel: +61 7 5553 5955 email: [email protected] tel: +44 (0)117 927 3554 email: [email protected] fax: +61 7 5553 5914 website: www.cmsairambulance.com fax: +44 (0)117 925 5940 website: www.voyageur24.com

CareFlight International To have your company listed in our service directory

Sue Robshaw – Co-ordinator AGENTS TRAVEL Westmead Hospital Campus, PO Box 159, Westmead, NSW 2145, contact the sales department now: AUSTRALIA MEDICAL ESCORT ON ON ESCORT MEDICAL tel: +61 1300 655 855 email: [email protected] [email protected] or telephone: +44 (0)117 922 66 00 fax: +61 2 9689 2744 website: www.careflight.org COMMERCIAL AIRLINES COMMERCIAL

Medical Wings V Creative Design Dr Sommart Somsiri – Medical Director Steve Annette – New Media Director 222 Room 3259, Bangkok Int Airport, Viphavadee-Rangsit Rd, Sikan, Don Muang, Voyageur Buildings, 43 Colston Street, Bristol BS1 5AX, UK Bangkok 10210, THAILAND tel: +662 247 3392 email: [email protected] tel: +44 (0)117 929 4636 email: [email protected] fax: +662 535 4355 website: www.medicalwings.com fax: +44 (0)117 925 2040 website: www.vcreativedesign.co.uk WEB & MEDIA MEDIA & WEB ADVERTISING 50 REGULARS GRAPEVINE • GRA PEVINE VINE G RAPEVINE GRAP EVINE

GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • Grapevine Ferrari in flames over to a friend so he could take a break. Seeming the insurer detected the scam and Carey ended up to misunderstand the kind of warm feeling Carey in court for fraud. His ultimate prize was a sentence Travel woes When Chris Carey, a car dealer from the UK, took was looking for, the uninsured driver promptly of 200 hours of unpaid work. his supercar to a Ferrari fun day, he was probably smashed the F360 Spider into a tree and it burst Travel Guard’s online competition to find the hoping to get a warm feeling from having done into flames. So, a good day had turned into a bad world’s unluckiest traveller continues, and his part to raise money for the local air ambulance day, but at least he could get the money back from with it come some excellent examples of helicopter charity, the Thames Valley and Chiltern his insurers, as long as he said that he’d been the why having comprehensive travel insurance Air Ambulance. In July 2009, Carey was charging one behind the wheel when the £50,000 Ferrari is vital, as you can never predict what holiday people £15 a go for a ride around the Newbury crashed. But there was one more kind of warm woes will befall you. For one man, his dream Show Ground. After a while, he handed the keys feeling in store – the flush of embarrassment when trip to Hawaii to admire the waves with his family soon turned into a nightmare: “Eleven

• GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE • GRAPEVINE GRAPEVINE • GRA PEVINE VINE G RAPEVINE • hours after arriving,” said the man, “the first morning on the beautiful sandy beach, I was hit by a monster wave that broke my leg in three places. After being rescued by my kids, I was rushed to the trauma centre for a five-hour reconstructive bone surgery. I was well insured, thank God, otherwise I would be bankrupt.” Another story that is popular with voters on the website is the tale of woe of a couple’s honeymoon in Jamaica – surely not the only couple who have looked forward to the holiday of a lifetime, and have been sorely (in this case, very sorely) disappointed. A romantic trip to a beautiful waterfall ended in both parties getting a severe ear infection – pretty uncomfortable – but just before the end of the honeymoon, the newlywed groom decided to try waterskiing – after all, how hard could it be? Very. “About 10 feet offshore, one ski went forward, and the other did not. He ended up pulling and ripping every tendon and muscle [in one of his legs] – as close to breaking his leg as possible.” Another harsh lesson in the importance of travel insurers being able to send their clients to the right hospital is the story of one

American who had booked an 11-week trip through Southeast Asia. “But as soon as we arrived at our steamy, monsoon-weathered guesthouse, my ankles began to swell and I started having severe joint pain. Our plan was to visit Angkor Wat, a Hindu temple complex built in the 12th century. We bought a three-day pass. Unreasonably determined, I proceeded to temple-trudge my body into a swollen mess. Symptoms worsened and at that point I began my tour of the Cambodian healthcare system.” (At this point, travel insurance could have saved her all sorts of trouble!) “I met a variety of local clinicians and international MDs. One clinic even came fully equipped with mangy dogs with swinging teats. Between doctors’ visits and while staying at the dampest, buggiest guesthouse with no bathroom door, I managed to pick up a stubborn parasite/ stomach bacteria. After four painful weeks and with an accumulation of confounded doctor friends, I finally threw up my hands in defeat to my mystery disease and decided to go home. In the few days I had left in the gritty capital of Phnom Penh, I got a brick thrown at me and was scammed by professionals while walking to the hospital. They got $500.”

• GRAPEVINE • GRAPEVINE • GRAPEVINE • International Travel Insurance Journal ONTHEMOVE 51

Aon appoints Preston Catlin Europe hires BUPA appoints Aviva chooses HR

Aon Risk Solutions, a global risk and insurance Offenhau McCoy director firm, has appointed Craig Preston, currently chief commercial officer of Aon’s Crisis Management Catlin Europe, the Continental European operations BUPA’s UK Health Aviva has appointed Rupert McNeil to the new role (ACM) business, as area director responsible for Aon wing of Catlin Group Ltd, has announced that Detlef and Wellbeing of UK human resources (HR) director, responsible for Corporate’s Reading and Southampton offices in the Offenhau has joined the company as senior liability service has developing and leading the company’s people strategy UK. John Harris, currently executive director with underwriter for Europe. Offenhau, who will be appointed Craig for its 21,000-strong UK workforce across its life and regional responsibilities for ACM UK and Ireland, will based in Cologne, Germany, will be responsible for McCoy as its new general insurance businesses. McNeil will report to be taking over as global chief commercial officer of all of the company’s liability insurance activities in the human resources Aviva UK chief executive Mark Hodges and become Crisis Management. region. He has more than 20 years of experience in director. Craig a member of the UK executive team. He joins Aviva Jim Herbert, managing director of Aon Corporate, liability underwriting and was most recently senior joins BUPA from Barclays Group, where he has held a number commented: “I am delighted that Craig is joining commercial manager at AXA Corporate Solutions. with over 20 of positions, including executive management director us, and that we have been able to fill this key In this position, he was responsible for all lines of years of human within HR and, more recently, HR director of the position from within Aon’s existing talent. Craig’s business for strategic key accounts and brokers. resources (HR) global retail and commercial banking division. Before diverse experience in developing and leading high- Ralf Tillenburg, chief executive officer of Catlin Europe, experience across that, he was a partner at Deloitte & Touche. McNeil performing teams will be invaluable as we focus said: “I am very pleased that Detlef has joined Catlin a wide variety brings with him a wealth of international experience, on continuing to delight our clients and grow the Europe to further develop our liability portfolio. Catlin of industries. covering all aspects of HR, including leadership and business.” already has a good reputation in Europe as a source of He has worked development, reward and governance, recruitment, Craig McCoy Paul Basset, global chief executive of Aon’s Crisis liability insurance, and Detlef’s expertise, as well as his for a number and talent management. Management division, added: “Having worked right extensive market contacts, will further strengthen our of blue-chip companies in the media, technology, Mark Hodges said McNeil’s extensive in-house and across Aon over a long period of time, and with the position in the Continental European insurance market.” telecommunications and professional services consultancy experience would prove invaluable crisis management team since July 2009, John brings sectors. to Aviva as the company continues to shape its a wealth of experience and understanding of the way Announcing the appointment, Dr Natalie Jane UK strategy and bring its life and general insurance our clients like to work, and the market we operate Macdonald, managing director of BUPA Health and businesses closer together. He added: “We want in. It is this experience I know he will utilise to Gambach joins Wellbeing UK, said: “Craig brings to BUPA a wealth to attract and retain the best so that we can deliver develop even stronger relationships across our firm, of experience in human resources. His experience great service to our 19 million UK customers. driving growth in sales, adding to the success of Aon’s GMMI in people development and talent management will Rupert’s role will be to ensure that we build and Crisis Management team.” be an invaluable asset as BUPA Health and Wellbeing develop the right talent for Aviva into the future and Fernando Gambach has joined US-based cost continues to drive forward its people strategy.” create an environment in which we support and containment firm GMMI, Inc., as the company’s McCoy added: “I am delighted to be joining BUPA reward individuals for their skills and contributions to new business development manager. Fernando Health and Wellbeing at such an exciting time. It is the business.” earned his bachelor’s degree in economics and a very strong business, as a market leader in health Sullivan joins Willis business administration from the Open University insurance, with clear aspirations to be a recognised in Israel and a master’s degree in international leader in healthcare. I look forward to further Willis Group Holdings (WGH) has hospitality management from developing BUPA’s talent to support its growth announced the appointment of Bournemouth University in the ambitions.” Martin Sullivan as deputy chairman UK. He is trilingual in English, McCoy’s appointment follows the appointment of of WGH and chairman and chief Spanish and Hebrew. Originally Denise Collis as BUPA’s group HR director. executive of a new business unit, from Argentina, Fernando lived Willis Global Solutions, which in Israel for 18 years and has will oversee brokerage and risk served in the Israeli Army as a management advisory services for combat engineer commander. WTTC appoints Willis’s multinational and global A statement from the company accounts. Martin will be based in read: “Before joining GMMI, Scowsill as president New York City, US. Fernando worked for a financial In his role as deputy chairman institution as an international The World Travel and Tourism Council (WTTC) of WGH, Martin will report to marketing director for eight has announced the appointment of David Scowsill Joe Plumeri, chairman and chief years. His considerable as its new president and chief executive officer. executive officer of WGH, and experience in the international Formally starting the role on 15 November, assist in managing and shaping the business scene and multilingual Scowsill will continue the organisation’s work to long-term growth strategy for the Fernando Gambach background makes him a strong raise awareness of the importance of travel and company. He will also work with presence in GMMI, where he tourism and its US$5.8-trillion value to the global Plumeri and other senior leaders as a member of will be extremely valuable for the continued growth economy. As president, Scowsill will represent the the company’s executive committee. As chairman and development of the company.” interests of travel and tourism’s foremost private and CEO of Willis Global Solutions, Martin will work GMMI has also welcomed Carmen Poehlmann- sector enterprises to governments worldwide. He with Grahame Millwater, president of Willis Group, Wolfe back to the company, after a career break to will lead the organisation in addressing the political, to develop and manage a differentiated service raise her family. In addition to her role as account environmental, social and technological factors facing proposition in the large account sector. The new manager, Carmen’s prime responsibilities are focused the industry, and encouraging the public and private unit, it is hoped, will distinguish the company as a on the business development of new clients within sector partnerships necessary to build strategies and significant player in the global marketplace. the German-speaking insurance industry. policies for future growth and prosperity. Rupert McNeil

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